İsmail Aytaç

Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists

BACKGROUND AND OBJECTIVES residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution. METHODS This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation <90% and 90-93% despite receiving 3 L/min nasal O2, respiratory rate > 20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study. RESULTS The incidence of PORC was 43% (n = 179) for TOFR < 0.9, and 15% (n = 61) for TOFR < 0.7. The incidence of TOFR < 0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR < 0.9 was found in 46% (n = 126) of the patients receiving neostigmine. CONCLUSIONS When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

Acute unilateral parotid gland swelling after lateral decubitus position under general anesthesia.

Acute swelling of the parotid gland after general anesthesia (commonly known as anesthesia mumps or acute postoperative sialadenitis) is a rare but declared complication of anesthesia. The etiology is not clear, but some possible causes such as obstruction of glandular excretory ducts caused by patient position and increase in the viscosity of the saliva because of acute dehydratation and/or medications like atropin have been proposed. We report a swelling in the left preauricular and postauricular region extending to the angle of the mandibule in a 35-year-old patient after left lateral decubitus position for laparoscopic nephrectomy.

Sevoflurane versus propofol for electroconvulsive therapy: effects on seizure parameters, anesthesia recovery, and the bispectral index.

BACKGROUND/AIM In this prospective randomized cross-over study we compare the effects of sevoflurane versus propofol for electroconvulsive therapy (ECT) anesthesia. MATERIALS AND METHODS Twenty four patients (ASA I-III, 18-65 years old) receiving ECT three times per week were included. Anesthesia was induced with either propofol (0.75 mg/kg iv) or 5% sevoflurane in 100% oxygen. Consecutive ECT sessions followed a 2 × 2 crossover design and a 2-day washout period until the 10th ECT. Intravenous succinylcholine (1 mg/kg) was administered while bispectral index (BIS) values were ≤60%. RESULTS Electromyogram and electroencephalogram seizure duration, postictal suppression index, BIS values, mean arterial blood pressure (MAP), heart rate, times to start of spontaneous respiration, eye opening, understanding verbal commands, and side effects were compared. No differences were found between the regimens for seizure activity and recovery. At the end of ECT, MAP was higher with sevoflurane. Although BIS values were higher after sevoflurane, no differences between the regimens were found in terms of the need of muscle relaxants and in hypnosis levels. CONCLUSION Sevoflurane (5%) may be an effective alternative to propofol for induction of anesthesia for ECT.

The Management of Anaesthesia in Administration of Hyperthermic Intraperitoneal Chemotherapy Combined with Cytoreductive Surgery

The evolvings of alternative treatment choices as cytoreductive surgery combined with hyperthermic chemotherapy for peritoneal surface malignancies creates new responsibilities for anesthesiologists to manage the procedure with sufficient information. To adequately care for these patients, anesthesiologists should control complex malfunctions of physiologic mechanisms, such as hypo-hyperthermia, blood loss, electrolyte abnormalities, coagulopathies, increased cardiac index, oxygen consumption, decreased systemic vascular resistance and toxic effects of chemotherapy agents related with both longer duration of radical surgery and the effects of hyperthermic chemotheraphy.Peritoneal yuzey maligniteleri icin sitoreduktif cerrahi ve kombine hipertermik intraperitoneal kemoterapi ile alternatif tedavi seceneklerindeki gelismeler anestezistler icin prosedurun yeterli bilgi ile yonetimi icin yeni sorumluluklar olusturmaktadir. Bu hastalari yeterli bakimi icin anestezistler hipo-hipertermi, kan kaybi, elektrolit bozukluklari, koagulopatiler, artmis kardiyak indeks, oksijen tuketimi, azalmis sistemik vaskuler rezistans ve kemoterapi ajanlarinin toksik etkileri gibi hem uzun sureli radikal cerrahi hem de hipertermik kemoterapinin etkilerini iceren kompleks fizyolojik bozukluklari kontrol etmelidir.