Kemal Tolga Saraçoğlu

Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation

It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video‐assisted laryngoscope devices for the management of difficult pediatric airway.

Comparative study of fentanyl and morphine in addition to hyperbaric or isobaric bupivacaine in combined spinal anaesthesia for caesarean section

Introduction The aim of our study was to compare the effects of isobaric and hyperbaric bupivacaine combined with morphine or fentanyl in patients undergoing caesarean section. We assessed quality and spread of analgesia and anaesthesia, postoperative analgesic requirement and side effects. Material and methods Hundred patients with American Society of Anesthesiologists physical status (ASA) I-II, age 18 to 40 years, were randomized to 4 groups. The intrathecal solutions were isobaric bupivacaine + morphine (group A), isobaric bupivacaine + fentanyl (group B), heavy bupivacaine + + morphine (group C) and heavy bupivacaine + fentanyl (group D). Mean arterial pressure, heart rate, oxygen saturation, ephedrine consumption, analgesic requirement time and additional analgesic needs were recorded. Results The 1st min value of mean arterial pressure was the lowest one in all groups. Heart rate decreased significantly in group A at the 10th min but not in the other groups. The decrease of visual analogue scale (VAS) pain scores began in the groups after the 4th postoperative h (p < 0.05) and the VAS value of group B at the 8th h was significantly higher than the other groups. The first analgesic requirement time in the postoperative period was longer in patients who had intrathecal morphine than those who had fentanyl. The duration of analgesia with isobaric bupivacaine and morphine was the longest one. Conclusions We concluded that intrathecal morphine provides a long duration of postoperative analgesia but the duration gets longer when it is combined with plain bupivacaine instead of heavy bupivacaine.

Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery

STUDY OBJECTIVE The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. DESIGN Prospective randomized study. SETTING In the operating room. PATIENTS Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. INTERVENTIONS Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. MEASUREMENTS Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. MAIN RESULTS There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P < .05). Heart rate and systolic blood pressure increased in neostigmine group 3 minutes after the medication and during postoperative measurements (P < .05). Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P < .05). CONCLUSIONS We suggest that sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery.

The Preventive Effect of Dopamine Infusion in Rats with Abdominal Compartment Syndrome

ABSTRACT Background: The most significant perfusion disorder of the intra-abdominal viscera occurs in the abdominal compartment syndrome (ACS). Free oxygen radicals diffuse into the body during the reperfusion phase of ACS. Our aim was to determine the effects of dopamine infusion (3 μg/kg/min) on renal perfusion, cytokine levels, free oxygen radicals, and renal histopathological changes in the presence of ACS in a prospective randomized manner. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6). Group 1 was used as control. In group 2, air was inflated until the intra-abdominal pressure (IAP) reached 20 mmHg. In group 3, dopamine was infused for 60 min meanwhile IAP was kept at 20 mmHg. In group 4, dopamine was infused for 60 min before IAP rise. After this phase, renal artery (RA) perfusion was measured continuously. Myeloperoxidase activity (MPO), glutathione (GSH), and lipid peroxidation (MDA) levels were measured in tissue samples and histopathological scoring was performed. Results: Dopamine treatment before and during ACS significantly decreased MPO and MDA levels and also increased renal blood flow and GSH levels. However, histopathological damage was improved simultaneously. Conclusion: Dopamine infusion before and during ACS, increases renal perfusion and decreases free oxygen radicals. According to our findings, dopamine infusion may be proposed for the treatment of ACS and perfusion disorders in critically ill patients.

Lightning strike: a rare cause of incudostapedial disruption with intact membrane

To the Editors: L ightning strikes can cause different systemic injuries. Generally, lightning strikes are fatal. Cardiopulmonary arrest is the most common cause of death in lightning victims. Although persons struck by lightning show evidence of multisystem derangement, the most dramatic effects involve the cardiovascular and nervous systems. The living victims also have different sequelae such as psychiatric, otologic, and so on. Tympanic membrane rupture can be detected in lightning-injured patients who have audiovestibular sequelae. In the published literature about lightning-induced otologic injury, there is no documented case of ossicular disruption with intact membrane. We present a case of ossicular chain damage with intact tympanic membrane in a lightning-injured patient and discuss the pathophysiology of acoustic injury in similar cases.

Comparative study of intravenous opioid consumption in the postoperative period.

BACKGROUND Intravenous patient-controlled analgesia (IV PCA) using opiods is an accepted method for delivering postoperative analgesia. The aim of this study was to compare fentanyl and tramadol with IV PCA after spinal anesthesia (SA) and general anesthesia (GA) following cesarean section (C/S). METHODS Ninety women were randomly assigned to three groups (n=30). Group 1 was treated with IV fentanyl PCA after SA. Groups 2 and 3 were treated with IV fentanyl PCA and IV tramadol PCA after GA. Outcome measures were recorded for the first 24 h post-anesthesia. RESULTS PCA use was significantly lower after SA (P<0.05). Eighteen patients in the SA Group and 27 patients and 24 patients from the GA groups required additional opioid. Opioid consumption and patient satisfaction were similar for groups after GA (P>0.05). 638.4 ± 179.1 μg fentanyl was consumed by patients of Group 2, 356.3 ± 87.0 μg fentanyl and 559.5 ± 207.0 mg tramadol was consumed by Group 1 and Group 3 respectively. There was no significant difference in the overall severity and incidence of nausea, drowsiness or pruritus. CONCLUSION Our study shows that analgesic consumption and post-operative pain scores after SA in C/S decreased, without increase in adverse reactions.

İdrar kültürlerinde izole edilen bakterilerin antibiyotik duyarlılıkları

Objective: Urinary tract infections (UTI) come upon a common infection disease in hospital. Empiric antibiotic therapy for patients with suspected UTI is commonly used because obtaining antibiogram result is usually time consuming. Aim of the study was to investigate urine culture and antibiogram results of patients who were admitted to our hospital. Methods: Urine cultures were investigated between November 2008 and June 2010 in database of laboratory information system. Samples of isolated microorganism and antibiogram results were evaluated. Results: Microorganisms were isolated in 691 of 1342 urine cultures. Polymicrobial infection was determined in 46 patients. Most common identified microorganism was E. coli (71.3%). If all samples considered, bacteria resistance was detected against to ampicilline, trimethoprim/ sulfamethoxazole (TMP/SMX) ampicilline/sulbactam (AMS) and ciprofloxacin (CIP) (52.1%, 39.5%, 22.7% and 19.6%). Lower bacterial resistance was determined against amicasin, gentamicine, tobramicine and nitrofurantoin (7.9%, 3.3%, 17.5% and 12.6%). As E. coli isolated samples were investigated, bacterial resistance was detected against ampicilline, CIP, levofloxacin and TMP/ SMX (58.1%, 40.8%, 36.1% ve 39.5%). Nitrofurantoin, amicasin, gentamicine and tobramicine were found as sensitive antibiotics (90.3%, 88.9%, 79.4% and 69.9%). Conclusion: High bacterial resistance was determined against to most preferred empiric antibiotics which are TMP/SMX, AMS and also CIP. J Clin Exp Invest 2013; 4 (3): 356-359

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery

OBJECTIVE Single intravenous bolus administration and postoperative or perioperative infusions are the most preferred methods of ketamine. Nevertheless, there is no clear explanation on the ideal ketamine administration method. In this study, we aimed to compare the effects of the most common ketamine administration methods and administration time on postoperative opioid consumption. METHODS Fifty-two patients undergoing colectomy for colon cancer were randomly assigned into four groups. Group 1 was the control group. Group 2 received only a single intravenous bolus dose of 0.5 mg kg(-1) ketamine at induction. Group 3 received 0.5 mg kg(-1) intravenous ketamine bolus at induction and perioperative ketamine infusion at a rate of 0.25 mg kg(-1) h(-1). Group 4 received a bolus of 0.5 mg kg(-1) intravenous ketamine at induction and perioperative and postoperative ketamine infusion at a rate of 0.25 mg kg(-1) h(-1). Postoperatively, visual analogue scale pain scores, side effects, and morphine consumption were recorded. RESULTS There was no statistically significant difference in postoperative pain scores. Total morphine consumption was found to be significantly lower in Group 4 compared to the other groups (p=0.03, p=0.004, p=0.03, respectively). During the 1(st), 2(nd), and 4(th) hours in the postoperative period, patient-controlled analgesia morphine consumption was significantly lower in Group 4 compared to the control group (p<0.01). CONCLUSION Preoperative single-bolus dose or intraoperative low-dose ketamine infusion does not decrease postoperative morphine consumption; however, per- and postoperative 48-hour ketamine infusion has a significant effect in decreasing morphine consumption without decreasing the incidence of side effects in patients undergoing major abdominal surgery.

Abducens Nerve Paralysis Following Spinal Anesthesia

Among the complications of spinal anaesthesia, 6th cranial nerve palsy occurs rarely. There is a possibility of encountering nerve injury during subarachnoid injections due to a long extracranial course. The symptoms appear as a result of ocular muscle paralysis. These symptoms often begin after the 4th day and spontaneous recovery lasts for weeks to months. We present a case in which Nervous Abducens palsy occurred following spinal anaesthesia for double j ureteral catheter placement surgery.

N-Acetylcysteine is ineffective on short-term neuron-specific enolase levels following coronary artery bypass graft surgery

To the Editor: The incidence of neurological complications related to cardiac surgery has remained unchanged, despite increasing age and comorbidity [1]. One of the most important methods for stopping this oxidant-mediated damage is the use of agents containing glutathione. The most investigated among these agents is N-acetylcysteine (NAC), which is a precursor of glutathione. Serum neuron-specific enolase (NSE) level was shown to reach its peak during cardiopulmonary bypass (CPB) at the end of rewarming and started to decrease immediately after the end of operation, down to near-normal levels by the second day after surgery, in neurologically intact patients [2]. We aimed to investigate the indirect neuroprotective effects of NAC on NSE levels in patients undergoing elective CPB surgery. Approved by the hospital ethics committee, 40 patients, of ages 30–70 years between March and October 2010 were enrolled in this study. Patients were randomly divided into two groups: group N, NAC infusion group (n = 20) and group C, saline infusion group (n = 20). In group N, 20 mg/kg/h NAC infusion was initiated intravenously at 100 ml/h. In group C, intravenous infusion of saline at 100 ml/h was started. Blood samples were collected three times from the jugular bulb catheters of the patients at prespecified times: T0, before CPB; T1, at the end of CPB surgery; and T2, in the sixth postoperative hour. Neurological examination results were recorded on the postoperative third day. However, these results revealed no abnormality. Patient demographics were similar (Table 1). There was no significant difference between the NSE concentrations of groups at T0, T1, and T2 (P [ 0.05) (Table 2). A correlation was found between the increase in NSE values at T2 and CPB time in patients in group N (Pearson: r = 0.47, P \ 0.01). NSE seems to be the most useful biochemical marker for the evaluation of cognitive disorders after CPB [3]. For the detection of NSE values, we could not find a study in which the blood samples were taken from the jugular bulb, which is anatomically closest to the cerebral circulation. NSE levels of the NAC group were not significantly decreased when compared to those of the control group after CPB. Therefore, it is thought that NAC does not have a neuroprotective effect in the early period after CPB. According to the results of our study, differences between the blood samples collected from the jugular bulb and peripheral blood should be considered, and comparative studies should be done with the blood samples collected simultaneously from jugular bulb and peripheral blood. In conclusion, it was shown that levels of NSE increased at the end of CPB. According to the results of our study, NAC was not found to be neuroprotective in the early period after CPB surgery. The administration of NAC in E. H. Ugur N. Yapici T. Kudsioglu Z. Aykac Department of Anesthesiology and Reanimation, Siyami Ersek M.D. Cardiovascular and Thoracic Surgery Research Hospital, Istanbul, Turkey