Mediha Türktan

The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy

BACKGROUND:Dexamethasone has been shown to cause inhibition of sugammadex reversal in functionally innervated human muscle cells. In this prospective, double-blind, randomized, controlled study, we evaluated the effect of dexamethasone on the reversal time of sugammadex in children undergoing tonsillectomy and/or adenoidectomy. METHODS:We recruited 60 patients with ASA physical status I to II, between the ages of 3 and 8 years, scheduled for elective tonsillectomy and/or adenoidectomy. After the induction of anesthesia, patients in group D received IV dexamethasone at a dose of 0.5 mg/kg within a total volume of 5 mL saline, whereas patients in group S received only 5 mL IV saline as the control group. At the end of surgery, all patients were given a single bolus dose (2 mg/kg) of sugammadex at reappearance of T2. Demographic data, hemodynamic variables, time to recovery (a train-of-four ratio of 0.9), time to tracheal extubation, and adverse effects were recorded. RESULTS:There was no statistical significance between 2 groups in time to recovery and time to extubation. Time to recovery was 97.7 ± 23.9 seconds in group D and 91.1 ± 39.5 seconds in group S (P = 0.436; 95% confidence interval, −10.3 to 23.5). Time to extubation was 127.9 ± 23.2 seconds and 123.8 ± 38.7 seconds in group D and in group S, respectively (P = 0.612; 95% confidence interval, −11.9 to 20.05). CONCLUSIONS:IV dexamethasone, given after induction of anesthesia, at a dose of 0.5 mg/kg, does not substantively affect the reversal time of sugammadex in pediatric patients undergoing adenoidectomy and/or tonsillectomy.

Coadministration of Intravenous Remifentanil and Morphine for Post-thoracotomy Pain: Comparison With Intravenous Morphine Alone

OBJECTIVES In this double-blind, randomized study, the authors compared the effects of a patient-controlled remifentanil and morphine combination with morphine alone on post-thoracotomy pain, analgesic consumption, and side effects. DESIGN A prospective, randomized, double-blind clinical study. SETTING University hospital. PARTICIPANTS Volunteer patients at a university hospital undergoing elective thoracotomy surgery. INTERVENTIONS Patients were allocated randomly into 2 groups to receive patient-controlled analgesia: the morphine (M) group or the morphine plus remifentanil (MR) group. Pain, discomfort, sedation scores, cumulative patient-controlled morphine consumption, rescue analgesic (meperidine) requirement and side effects were recorded for 24 hours. MEASUREMENTS AND MAIN RESULTS Sixty patients were allocated randomly to receive intravenous patient-controlled analgesia with morphine alone (M) or morphine plus remifentanil (MR) in a double-blind manner. Patients were allowed to use bolus doses of morphine (0.02 mg/kg) or the same dose of a morphine plus remifentanil (0.2 µg/kg) mixture every 10 minutes without a background infusion. VAS scores were lower in the MR group than in the M group at 30 minutes (p = 0.04), 1 hour (p = 0.03), and 2 hours (p = 0.04). Mean cumulative doses of morphine were not significantly different at 27.8±15 mg for the M group and 21.9±10.5 mg for the MR group. Significantly more patients needed meperidine in the M group (p = 0.039); these also experienced more nausea (p = 0.01). CONCLUSIONS Coadministration of PCA remifentanil with morphine for the treatment of post-thoracotomy pain did not reduce morphine consumption but provided superior analgesia, less use of rescue analgesics, and fewer side effects compared to morphine alone.

The anesthesia of trachea and bronchus surgery.

The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade. In this review, anesthesia management of the trachea and bronchus surgery is evaluated in the light of new knowledge.

Comparison of Dexmedetomidine, Remifentanil, and Esmolol for the Control of Hypertension During Tracheal Extubation and Emergence From Anesthesia After a Craniotomy

Hypertension has been reported during emergence from anesthesia to be >90% in neurosurgical patients. We examined the effects of dexmedetomidine, remifentanil, and esmolol infusion on recovery profiles and cardiovascular responses of patients during the emergency period after a craniotomy. ASA I to III physical status patients, who were undergoing intracranial surgery for either vascular or space-occupying lesions, were eligible if aged between 17 and 65 years. Anesthesia was induced using propofol and dexmedetomidine and maintained using sevoflurane and dexmedetomidine infusion. Patients were randomly allocated in 3 groups. Dexmedetomidine infusion was continued until the initiation of skin closure in group D. Dexmedetomidine infusion was discontinued in other groups after placing the bone graft. Thereafter, remifentanil infusion (0.25 µg/kg/min) or esmolol infusion (0.25 mg/kg/min) were started in the other groups (group R or E) until the initiation of skin closure. Extubation time, recovery time, incidence of coughing during extubation, and hemodynamic variables during the emergence phase were recorded. During the emergence phase, the systolic and mean arterial blood pressures and heart rates were similar compared with baseline values in all study groups. The median extubation time was similar in the dexmedetomidine (4.9 min), remifentanil (3.9 min), and esmolol groups (2.7 min). The incidence of cough was similar in the dexmedetomidine group compared with the remifentanil or esmolol groups. Time to eye opening, time to orientation, and response to verbal command were longer in the dexmedetomidine group compared with the remifentanil group. We concluded that remifentanil, dexmedetomidine, and esmolol infusion can be used to control blood pressure during emergence from anesthesia after a craniotomy.

Upper Acute Respiratory Failure in Neck Cancer

Respiratory complications are a significant cause of mortality and morbidity in patients with primary or metastatic head and neck cancers [1]. The seriousness of the symptoms differs according to the location of the cancer. For example, a small lesion in the larynx may cause a severe respiratory distress, while a massive lesion in the pharyngeal fossa may cause only minimal respiratory problem. The secondary tumor or metastatic cancer that is found in the upper neck region, pressure of the lesion on the tissue, or sometimes hemorrhage of fragile mass or even little aspiration that adds to the pressure of already existing lesion may also cause respiratory failure. Consequently, the common concern for these cancer types is a respiratory failure [2].

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery

Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods: Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4).Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion: The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanil-sevoflurane in CABG surgery.

Çocuklarda ultrasonografi eşliğinde yapılan rektus kılıf bloğunda lokal anestezik volümünün anestezik ve analjezik ajan tüketimi üzerine etkisi

Amac: Bu calismada, cocuklarda yapilacak major abdominal cerrahilerde, ultrasonografi esliginde iki farkli volumle uygulanan rektus kilif blogunun peroperatif sevofluran ve postoperatif morfin tuketimi uzerine etkilerinin arastirilmasi amaclanmistir. Gerec ve Yontem: Amerikan Anestezistler Dernegi (ASA) I-II grubu, 1-16 yas arasi, major batin cerrahisi yapilacak 40 olgu calismaya dahil edildi. Genel anestezi uygulandiktan sonra rastgele iki gruba ayrilan olgulardan Grup I’e (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volum 0.1 ml/kg olacak sekilde serum fizyolojik ile seyreltilerek) ile Grup II’ye (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volum 0.4 ml/kg olacak sekilde serum fizyolojik ile seyreltilerek) ile ultrasonografi esliginde rektus kilif blogu uygulandi. Operasyon boyunca hemodinamik veriler ve sevofluran tuketimi, operasyon sonunda agri duzeyleri, ek analjezik ihtiyaci ve sedasyon duzeyleri kaydedildi. Bulgular: Intraoperatif donemde inspire edilen ve tuketilen sevofluran miktarlari her iki grupta da benzer olup, toplam sevofluran tuketimi Grup I’de 106.85±28.6 ml, Grup II’de 91.50±36.6 ml olarak bulundu (p>0.05). Olgularin postoperatif agri ve sedasyon skorlari ve ek analjezik ihtiyaclari arasinda fark saptanmadi. Sonuc: Major abdominal cerrahi uygulanacak cocuklarda ultrasonografi esliginde yapilan rektus kilif blogunun etkin ve guvenilir bir analjezi sagladigi, uygulanan lokal anestezik volumunu arttirmanin intraoperatif sevofluran tuketimini ve postoperatif ek analjezik ihtiyacini azaltmadigi kanisina varildi.

Comparing the Laryngeal Mask Airway, Cobra Perilaryngeal Airway and Face Mask in Children Airway Management

OBJECTIVE We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery. METHODS In this study, 90 cases of 1-14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%-50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively. RESULTS There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p<0.05). CONCLUSION We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA.

Cusum analysis for learning curve of videothoracoscopic lobectomy

Abstract Background Video assisted thoracoscopic (VATS) lobectomy has a demanding learning curve due to its technical complexity and risk of uncontrollable bleeding. We investigated the case number required for gaining technical proficiency by applying cumulative sum analysis on initial VATS lobectomy operations of a single surgeon. Methods CALGB definition was used for the definition of VATS lobectomy. The data of the initial cases evaluated and cumulative sum (CUSUM) analysis was applied to duration of the operations and length of hospital stay. Results Fifty-eight patients underwent VATS lobectomy. Of those 51 were malignant and 7 were benign. Fifty-five of the procedures were lobectomy, 2 were inferior bi-lobectomy and 1 was left upper lobectomy with chest wall resection. CUSUM analysis reached to proficiency at 27 cases for duration of the operations. Conclusions The length of learning curve depends on previous experience of the surgeon on open lobectomy and simpler VATS operations, potential number of VATS lobectomy cases and VATS capability of the surgeon. Depending on these factors, it is possible to obtain technical proficiency with an inferior number of procedures compared with existing literature (50-200).

The Effect of Intravenous Magnesium Sulphate Treatment on the Spinal Anaesthesia Produced by Bupivacaine in Pre-eclamptic Patients

OBJECTIVE In our study, the effect of intravenous magnesium sulphate in normal and pre-eclamptic patients on spinal anaesthesia produced by bupivacaine was investigated. METHODS Sixty-four pregnant (32 normal and 32 pre-eclamptic) were accepted in this study. Pregnants were divided into four groups as patients given intravenous magnesium sulphate and as control. Spinal anaesthesia was induced with 12.5 mg 0.5% hyperbaric bupivacaine. Intraoperative and postoperative haemodynamic variables, sensorial block periods, onset times of sensorial and motor block, maximum sensorial block levels, the time to reach maximum block level, Bromage scores, consumptions of intraoperative analgesic and ephedrine, the quality of anaesthesia, the duration of spinal anaesthesia and magnesium levels in blood and cerebrospinal fluid were measured and recorded. RESULTS The level of magnesium in blood and cerebrospinal fluid was significantly higher in the group given magnesium in pre-eclamptic patients (p<0.01). Onset of sensory block times were significantly longer in intravenous magnesium group than in groups 1, 2 and 3 (p<0.05). Onset of motor block times were significantly longer and the duration of anaesthesia was shorter in groups given magnesium (p<0.05). Although the quality of anaesthesia was similar, supplemental analgesic consumption was significantly higher in pre-eclamptic pregnants given magnesium sulphate than in pre-eclamptic pregnants who were not given magnesium sulphate (p<0.05). CONCLUSION Intravenous magnesium sulphate treatment during the spinal anaesthesia produced by bupivacaine extended the onset of sensory and motor block times, shortened the duration of spinal anaesthesia and therefore led to early analgesic requirement.