Mukadder Sanlı

Performance of Size 1 I-Gel Compared with Size 1 ProSeal Laryngeal Mask in Anesthetized Infants and Neonates

Purpose. The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA. Methods. Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications. Results. There were no significant differences in terms of airway leak pressure between the I-gel (27.44 ± 5.67) and ProSeal LMA (23.52 ± 8.15) (P = 0.054). The insertion time for the I-gel was shorter (12.6 ± 2.19 s) than for the ProSeal LMA (24.2 ± 6.059 s) (P = 0.0001). Insertion success and conditions were similar in groups. We encountered few complications. Conclusion. Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.gov NCT01704118.

Anesthesia Management in a Child with Osteogenesis Imperfecta and Epidural Hemorrhage

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems.

Conduta anestésica em criança com osteogênese imperfeita e hemorragia epidural

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems.La osteogenesis imperfecta (OI) es el resultado de una mutacion genetica que causa la formacion defectuosa o insufi ciente de colageno. La OI puede causar varias complicaciones anestesicas a causa del manejo dificil de las vias aereas, de la presencia de deformidad de la columna vertebral, de enfermedades respiratorias, anomalias cardiacas, trastorno de la funcion plaquetaria, riesgo de hipertermia, invaginacion bacilar, deformidades oseas y trastornos metabolicos. El abordaje anestesico de pacientes con OI debe ser hecho con cautela, ya que existe un riesgo de ciertas complicaciones respiratorias. Esos riesgos son causados por deformidad del torax, fracturas oseas durante el movimiento o el cambio de posicion, fracturas mandibulares y cervicales relacionadas con la intubacion, intubacion dificil e hipertermia maligna. Las tecnicas anestesicas con el uso de anestesia venosa total (AVT) y mascarilla laringea, son adecuadas para el manejo de paciente pediatrico con OI. Sin embargo, esas tecnicas todavia no han sido mencionadas como utiles en relatos de casos neuroquirurgicos. En este estudio, presentamos el uso de AVT y mascarilla laringea ProSeal (MLP) en un nino con OI y hemorragia epidural. Concluimos que la MLP y la AVT pueden ser usadas con seguridad en el manejo anestesico de pacientes con OI y problemas anestesicos graves.

Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial

STUDY OBJECTIVE Multimodal analgesic strategies are recommended to decrease opioid requirements and opioid-induced respiratory complications in patients undergoing laparoscopic bariatric surgery. Recent studies have demonstrated that intravenous ibuprofen decreases opioid consumption compared with placebo. The primary aim of this study was to compare the effect of intravenous ibuprofen and intravenous acetaminophen on opioid consumption. We also aimed to compare postoperative pain levels and side effects of the drugs. DESIGN Randomized, double-blinded study. SETTING University hospital. PATIENTS Eighty patients, aged 18-65 years, (ASA physical status II-III) undergoing laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass surgery were included in this study. INTERVENTIONS Patients were randomized to receive 800 mg ibuprofen or 1 g acetaminophen intravenously every 6 h for the first 24 h following surgery; in addition, patient-controlled analgesia with morphine was administered. MEASUREMENTS Postoperative morphine consumption in the first 24 h, visual analog scale (VAS) pain scores at rest and with movement, and opioid related side effects were assessed. In addition, time to passage of flatus, surgical complications, lengths of intensive care unit and hospital stay, and laboratory parameters were recorded. MAIN RESULTS The mean morphine consumption was 23.94 ± 13.89 mg in iv ibuprofen group and 30.23 ± 13.76 mg in the acetaminophen group [mean difference: -6.28 (95% CI, -12.70, 0.12); P = 0.055]. The use of intravenous ibuprofen was associated with reduction in pain at rest (AUC, 1- to 24-h, P < 0.001 and 12- to 24-h, P = 0.021) and pain with movement (AUC, 1-24, 6-24, and 12-24 h, P < 0.001). Intravenous ibuprofen was well tolerated with no serious side effects except dizziness. CONCLUSIONS Intravenous ibuprofen did not significantly reduce opioid consumption compared to intravenous acetaminophen; however, it reduced the severity of pain. Intravenous ibuprofen may be a good alternative to intravenous acetaminophen as part of a multimodal postoperative analgesia in patients undergoing bariatric surgery.

Anesthetic management of Guillain Barre Syndrome in a pregnant woman /Guillain Barre Sendromlu gebede anestezi yonetimi

Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy with symmetrical weakness characterized by loss of sensation and reflexes. During pregnancy the morbidity and mortality of GBS is high. GBS patients are prone to acute respiratory failure due to weaknes of respiratory muscles, hypotension associated with autonomic dysfunction, hemodynamic instability such as the development of hypertension and arrhythmia. Patients may need intensive care. The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient. Therefore, we aimed to present the anesthetic management of cesarean planned in a GBS case.

Middle turbinate angiofibroma: an unusual location for juvenile angiofibroma.

Angiofibromas are the most frequently encountered histologically benign but potentially locally destructive vascular tumors that generally originate from the posterior lateral wall of the nasopharynx. These neoplasms are typically found in adolescent males and rarely seen after 25 years of age. Angiofibromas located in extranasopharyngeal sites are uncommon, and sporadically reported in the literature. In this article, we present a very rare case, the fourth case in the literature, of an angiofibroma arising from the middle turbinate in a 13 year-old male who presented with recurrent epistaxis and nasal blockage. The clinical presentation, endoscopic examination, radiological findings, histopathologic evaluation and management of this pathology are discussed.

The Effect of Dexamethasone in Tramadol Induced Nausea and Vomiting

We aimed to investigate the efficacy of a single dose bolus of dexamethasone on tramadol induced nausea and vomiting in our study. After approval was taken from ethics committee and patients, a total of 60 ASA I-II patients who were planned to undergo total abdominal hysterectomy (TAH) under general anesthesia were included in this study. A patient-controlled analgesia device was explained for the patients with preoperative visit. After the non-premedicated patients were taken in the operation room, the routine monitorization was performed. Induction was provided with 1μg/kg of fentanyl, 2 mg/kg propofol and 0.1 mg/kg vecuronium. 6-8% concentration of desflurane in a mixture of 50% air and 50% O2 was used for maintenance of anesthesia. When the incision was started to be closed, the patients were randomized into two groups by envelope method. 8 mg iv dexamethasone (2 mL) was given for Group D (n=30), iv Saline solution (2 mL) was given for Group K (n=30). After the incision was closed, a loading dose of intravenous tramadol 1 mg/kg was administered in both groups. The patients were taken in the postanesthesia care unit by extubating following the antagonism of muscle relaxant at the end of surgery. The patient-controlled analgesia device was scheduled to be as infusion: no, bolus: 12 mg, lock-out time: 10 min, 24 hour dosing limit: 400 mg. The pain and nausea and vomiting scores, additional analgesic and antiemetic requirements, the total amount of tramadol consumption were recorded at post-operative recovery and postoperative 2, 4, 6, 12 and 24 hours. Although the incidence of nausea and vomiting, and pain scores at 2 and 4 hours were not statistically significant, they were lower in Gorup D compared to Group K (p>0.05). 14 patients in Group K required additional antiemetics and 12 patients in Group D required additional antiemetics (p>0.05). Six patients in Group K required additional analgesics and 4 patients in Group D required additional analgesics. Although the total amount of tramadol consumption was not statistically significant, it was lower in Group D compared to Group K. It was concluded that a single bolus dose of dexamethasone 8 mg has not reduced tramadol induced nausea and vomiting in patients who were planned to undergo TAH.

Successful Management of Ultrasound-Guided Combined Spinal-EpiduralAnesthesia for Cesarean Section in a Patient with Achondroplasia

Anesthetic management of the pregnant achondroplastic patient for cesarean section poses significant challenges for anesthetists when coupled with anesthetic risks encountered during the third trimester of pregnancy. We report the case of a 25-year-old, 107 cm in height, and 37-week woman with achondroplasia who underwent neuraxial anesthesia for an elective cesarean section. Due to lumbar hyperlordosis and tissue edema, spinous processes could not be palpated and ultrasound probe was used to identify the vertebral interspace and also, the distance to the ligamentum flavum was measured. Accompanied by combined spinal-epidural (CSE) set, epidural space was located and a spinal needle was placed to the subarachnoid space. After 5 mg 0.5% hyperbaric bupivacaine with 10 μg fentanyl (total volume 1.2 mL) was injected to the subarachnoid space, the epidural catheter was advanced. A bilateral T5 sensory block level to pinprick was obtained after 5 min and the operation was allowed. A baby girl weighing 2460 gr was delivered 7 min after skin incision. The patient felt pain and discomfort during the elevation of the uterus and 3 mL 2% lidocaine was injected twice at 5 min intervals via the epidural catheter. The patient had no complications related to her delivery or anesthetic and was discharged home on the second postoperative day. CSE anesthesia with low spinal dose and ability to increase the level of the block via epidural route when needed, in combination with ultrasound guidance, provided successful and safe anesthesia.

Anesthetic Approach in the Arnold Chiari Malformation Accompanied with Syringomyelia: Case Report [Siringomiyelinin Eslik Ettiği Arnold Chiari Malformasyonunda Anestezik Yaklaşım: Olgu Sunumu]

Arnold Chiari is a congenitally developed malformation. Syringomyelia is accompanied in some of the cases. Four types of malformation have been identified and type I is frequent in adults. Cerebellar tonsils are displaced downward from the foramen magnum in this type. In order to prevent tonsillar herniation, anesthesist should avoid central blocks and increasing intracranial pressure in the management of anesthesia. We aimed to rewiew the management of anesthesia in a patient with decompressioned Arnold Chiari type I malformation accompanied with siringomiyelia undergone to ureteral dilatation.

INFORMAÇÃO CLÍNICAConduta Anestésica em Criança com Osteogênese Imperfeita e Hemorragia Epidural

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems.La osteogenesis imperfecta (OI) es el resultado de una mutacion genetica que causa la formacion defectuosa o insufi ciente de colageno. La OI puede causar varias complicaciones anestesicas a causa del manejo dificil de las vias aereas, de la presencia de deformidad de la columna vertebral, de enfermedades respiratorias, anomalias cardiacas, trastorno de la funcion plaquetaria, riesgo de hipertermia, invaginacion bacilar, deformidades oseas y trastornos metabolicos. El abordaje anestesico de pacientes con OI debe ser hecho con cautela, ya que existe un riesgo de ciertas complicaciones respiratorias. Esos riesgos son causados por deformidad del torax, fracturas oseas durante el movimiento o el cambio de posicion, fracturas mandibulares y cervicales relacionadas con la intubacion, intubacion dificil e hipertermia maligna. Las tecnicas anestesicas con el uso de anestesia venosa total (AVT) y mascarilla laringea, son adecuadas para el manejo de paciente pediatrico con OI. Sin embargo, esas tecnicas todavia no han sido mencionadas como utiles en relatos de casos neuroquirurgicos. En este estudio, presentamos el uso de AVT y mascarilla laringea ProSeal (MLP) en un nino con OI y hemorragia epidural. Concluimos que la MLP y la AVT pueden ser usadas con seguridad en el manejo anestesico de pacientes con OI y problemas anestesicos graves.