Mehmet Emin Orhan

Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial

AIM This paper is a report of a study conducted to compare the effects of two different oxygen delivery methods on both patient peripheral oxygen saturation and patient satisfaction. BACKGROUND One of the most serious problems encountered in the early postoperative period is hypoxemia. Giving oxygen to patients in the perioperative period reduces the incidence of hypoxemia. Oxygen is generally delivered to patients through oxygen masks or nasal cannulae. Previous studies have shown that face masks and nasal cannulae are effective in the early postoperative period. METHOD A randomized trial was conducted between 2007 and 2008 with patients undergoing thyroidectomy. In the early postoperative period, 5 L/minute of oxygen was given to patients via an oxygen mask (n = 53) or nasal cannulae (n = 53). Peripheral oxygen saturation were measured by pulse oxymeter every 5 minutes for a 30-minute period. The Postoperative Nausea Vomiting Scale was used and patient satisfaction was evaluated using a 10-point scale. RESULTS Average peripheral oxygen saturation for the nasal cannulae group was statistically significant higher than that in the mask group. This difference arose from more frequent removal of the oxygen mask than the nasal cannulae by patients and healthcare professionals. Average satisfaction scores for patients in the nasal cannulae group were statistically significantly higher than those in the mask group. CONCLUSION During the early postoperative period, using nasal cannulae for patients undergoing thyroidectomy increases oxygenation.

Is there a difference between the STOP-BANG and the Berlin Obstructive Sleep Apnoea Syndrome questionnaires for determining respiratory complications during the perioperative period?

AIMS AND OBJECTIVES This study aimed to compare the efficiency of the STOP-BANG and Berlin Obstructive Sleep Apnoea Syndrome questionnaires for evaluating potential respiratory complications during the perioperative period. BACKGROUND Questionnaires that are used to determine obstructive sleep apnoea risk are not widely used for surgical patients. Among the questionnaires that are commonly used for obstructive sleep apnoea screening, it remains unclear whether the STOP-BANG or Berlin Obstructive Sleep Apnoea Syndrome questionnaire is more effective in terms of ease of use, usage period and diagnosis of surgical patients with obstructive sleep apnoea risk. DESIGN This study was designed as a descriptive and prospective study. METHODS The study included 126 patients over 18 years of age who were American Society of Anesthesiologists classification class I-II and underwent laparoscopic cholecystectomy. To determine the potential obstructive sleep apnoea syndrome risk, the STOP-BANG and Berlin questionnaires were administered. Respiratory complications were then observed during the perioperative period. RESULTS During intubation and extubation, we observed statistically significant differences in difficult intubation, difficult facemask ventilation and desaturation frequency between the high- and low-risk groups for obstructive sleep apnoea syndrome, as determined by the STOP-BANG questionnaire. During extubation, statistically significant differences in coughing, breath-holding and desaturation frequency were observed between the high-risk and low-risk groups, according to the Berlin questionnaire. In the post-anaesthesia care unit, both questionnaires found statistically significant differences between the low- and high-risk groups. CONCLUSION Obstructive sleep apnoea syndrome screening questionnaires administered during the preoperative period are useful for predicting perioperative respiratory complications. It may be most useful to administer the STOP-BANG questionnaire as the initial evaluation. RELEVANCE TO CLINICAL PRACTICE Questionnaires may be used to determine the risk of obstructive sleep apnoea syndrome, which could impact the anaesthetisation of surgical patients. Questionnaires for determining the risk of obstructive sleep apnoea syndrome should be used regularly for surgical patients, and these questionnaires should be used to improve clinical protocols for anaesthesia and postanaesthesia care.

Efficacy of different concentrations of sevoflurane administered through a face mask for magnetic resonance imaging in children

Background:  The main aim of this study was to use a non‐invasive method such as a face mask to maintain anesthesia in children during magnetic resonance imaging (MRI). The secondary aim was to ascertain hemodynamic‐respiration parameters, recovery time and complications of anesthesia with the administration of different concentrations of sevoflurane.

Assessment of the effectiveness of lumbar transforaminal epidural steroid injection for low back pain

OBJECTIVES Transforaminal epidural steroid injection (TFESI) is a minimally invasive technique used for low back pain. We aimed to assess the efficiency of TFESI in patients with low back pain who did not respond to conservative or surgical methods. METHODS This study was a retrospective analysis of the records of 37 patients (range: 24-80 years) who presented to our clinic with low back pain and were treated by TFESI. Outcomes were assessed by Visual Analog Scale (VAS) measured at the 3rd week and 6th month. RESULTS Median age of the patients was 50 years, and mean duration of symptoms was 48 months. Diagnosis was lumbar disc herniation (LDH) in 51%, failed back surgery syndrome (FBSS) in 38%, and spinal stenosis (SS) in 11% of the patients. Baseline VAS scores were similar between the three groups. The 3rd week and 6th month VAS scores of LDH and FBSS cases were significantly decreased compared to baseline scores (p<0.001, p=0.001), and no significant change was observed between the VAS scores at the 3rd week and 6th month (p>0.05). If success is defined as 50% or more decrease in VAS scores, the success rate of TFESI was 84% at the 3rd week and 78% at the 6th month. CONCLUSION TFESI significantly reduced the intensity of low back pain in most of the patients with LDH, FBSS or SS; thus, it may be considered as an effective method in the treatment of low back pain.

Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy.

Lingual tonsillar hyperplasia is rare, and it may cause difficulty with tracheal intubation during induction of general anesthesia. A different orotracheal intubation technique was performed using a double-lumen endotracheal tube, flexible fiberoptic bronchoscope, and a stylet, in an unexpected difficult endobronchial intubation case due to massive lingual tonsillar hyperplasia.

Respiratory and Cranial Complications during Anaesthesia in PfeifferSyndrome

Pfeiffer syndrome (PS) is rarely encountered, even at major craniofacial centers. Published reports indicate high mortality rates (25-85%) for severely affected subtypes. PS is characterized by bilateral coronal craniosynostosis, midface hypoplasia, beaked nasal tip, broad and medially deviated thumbs and great toes. We present a case of a 12-monthsold male infant with PS type 2 who underwent a craniosynostosis and advancing a supraorbital bar operations during general anesthesia. For simple procedures, a safe anesthetic plan can be formulated if the anatomic factors affecting the airway are carefully considered. More extensive and prolonged patient diagnosed to have PS require more monitoring and include all the problems associated with difficult intubation, hazardous airway management, massive blood loss and fluid shift, shunt-dependent hydrocephalus, and long anesthetic times. This case is presented since anaesthesiologists should be aware of the high incidence of respiratory and cranial complications in PS.