Kemalettin Koltka

Implantable cardioverter-defibrillator placement in patients with mild-to-moderate left ventricular dysfunction: Hemodynamics and recovery profile with two different anesthetics used during deep sedation

OBJECTIVE To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement. DESIGN Prospective clinical investigation. SETTING University hospital. PARTICIPANTS Thirty-four adult patients. INTERVENTIONS After administration of midazolam, 0.025 mg/kg, and fentanyl, 0.5 to 1 mug/kg, surgery was performed under topical infiltration with 1% lidocaine. In group I (GI) (n = 17), patients received thiopental by slow injection and patients in group II (GII) (n = 17) received propofol before induction of ventricular fibrillation (VF). MEASUREMENTS AND MAIN RESULTS Patients received 4.1 +/- 1.4 mg of midazolam, 114 +/- 34 mug of fentanyl, and 280 +/- 78 mg of thiopental in GI; and 4.6 +/- 1.7 mg of midazolam, 119 +/- 62 mug of fentanyl, and 147 +/- 40 mg of propofol in GII (p > 0.05). Hemodynamics did not show significant differences between the groups at any recording time. Average time needed to regain the pretest sedation level was 16.4 +/- 8.8 minutes in GI and 10.9 +/- 5.5 minutes in GII (p = 0.03). Time required to achieve a score of 10 using a modified Aldrete score was 26.4 +/- 9.3 minutes in GI and 17.4 +/- 4.9 in GII (p = 0.001). Seven patients in GII (41%) and 1 patient in GI (6%) became hypotensive after DFT (p = 0.04). CONCLUSIONS Deepening the sedation level by slow injection of thiopental or propofol before DFT provided satisfactory conditions during brief episodes of VF. Delay in recovery of arterial pressure after DFT with propofol and delay in arousal and discharge of patients with thiopental are major disadvantages of the regimens.

Bispectral index-guided desflurane and propofol anesthesia in ambulatory arthroscopy: comparison of recovery and discharge profiles

In this prospective, randomized study we compared the recovery profiles of bispectral index (BIS)-guided anesthesia regimens with desflurane or propofol in ambulatory arthroscopy. Fifty ASA I–II adult patients who underwent knee arthroscopy were randomized to receive desflurane (D) or propofol (P) infusion accompanied by remifentanil and nitrous oxide during maintenance, titrated to maintain a bispectral index value between 50 and 60. Initial awakening, fast-track eligibility, and home readiness as well as intraoperative hemodynamics, were compared. The groups did not differ with respect to demographics, duration of operation, or intraoperative vital signs. Although the times for initial awakening parameters were shorter in group D, the differences between the groups were not significant. The time needed for the White fast-track score to reach 12 was shorter in group P than group D (9 ± 3.5 min vs 12.5 ± 5.3 min). However, home readiness did not differ significantly between the groups. Desflurane is an alternative to propofol for BIS-guided ambulatory anesthesia. Using desflurane in combination with opioid analgesics blunted its rapid emergence characteristics, and the higher frequency of emetic symptoms with desflurane diminished the success of its fast-track eligibility.

Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study.

OBJECTIVE Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery. METHODS After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours. RESULTS The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL. CONCLUSION Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.

Magnesium therapy in pre-eclampsia prolongs analgesia following spinal anaesthesia with fentanyl and bupivacaine: An observational study.

BACKGROUND Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV) magnesium sulphate (MgSO4) therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. AIMS The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. STUDY DESIGN Case-control Study. METHODS Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C) and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg). Following blood and cerebrospinal fluid (CSF) sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 μg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. RESULTS Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015). Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p<0.001; with a mean difference of 108.6 min and 95% CI between 81.6 and 135.7). Side effects were similar in both groups. Group C required significantly more fluids. CONCLUSION Treatment with IV MgSO4 in severe pre-eclamptic parturients significantly prolonged the time to first analgesic request compared to healthy preterm parturients, which might be attributed to the opioid potentiation of magnesium.

Analgesia for Arthroscopic Shoulder Surgery: A Comparison of Interscalene and Subacromial Levobupivacaine with IV Morphine Patient Controlled Analgesia

Backgorund and Aim : Arthroscopic shoulder surgery (ASS) may result in severe postoperative pain. We compared a continuous subacromial infusion of levobupivacaine after single shot interscalene block (ISB), a continuous ISB with levobupivacaine and intravenous morphine PCA with preoperative ISB for patients undergoing arthroscopic shoulder surgery. Methods : After obtaining ethics committee approval and informed consent 120 patients were randomized to three groups, Group 1 (G1) ISB with 0.5% levobupivacaine (l-bupi) (30 mL) followed by a postoperative subacromial infusion: 0.125% l-bupi 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time or; Group 2 (G2) ISB with 0.5% l-bupi (30 mL) followed by a postoperative interscalene infusion: 0.125% l-bupi 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time; or Group 3 (G3) ISB with 0.5% l-bupi (30 mL) followed by a postoperative morphine PCA 0.3 mg/h basal infusion, 1mg bolus dose and a 20 min lockout time. Infusions were maintained for 24 hours. Results : The median VAS scores in the postanesthesia care unit and at 4 h were not different. The median VAS scores at 8, 12, and 24 hours were ≤ 4 in all groups; but they were significantly lower in G2. There were no differences in VAS values of G1 and G3 patients. Additional analgesic requirements were lower in G2 (60% vs 7.5% vs 50% respectively for G1, G2 and G3). Nausea and vomiting were more common in G3. Patients’ satisfaction scores of groups were 8 ± 0.7 in G1, 9 ± 0.8 in G2 and 7.1 ± 0.9 in G3 (G1 vs G3, p< 0,001). Conclusions : Subacromial infusion provided good postoperative analgesia for ASS, but it’s less effective than ISB, but is superior to intravenous PCA because it causes less nausea and vomiting with higher patient satisfactions. Subacromial infusions can be considered as an alternative for postoperative pain treatment after ASS when ISB is contrainticated.

Perioperative Care of Thoracic Trauma Patient

Thoracic trauma may involve several mechanisms of injury, resulting in pneumothorax, hemothorax, pulmonary contusion, and rib fractures. Anesthesiologists dealing with trauma cases should be alert to diagnose and treat these – at times life-threatening – conditions and to offer effective analgesia.

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul This study aimed to investigate cardiopulmonary resuscitations (CPR) performed within the last year at Istanbul Medical Faculty and to determine success rates, to evaluate the factors affecting success rates and to compare outcomes to those previously performed.