Murat Bilgi

Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty.

Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P ≤ 0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P < 0.001 and P < 0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (P = 0.002 and P < 0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients.

Ultrasound-guided femoral and sciatic nerve blocks combined with sedoanalgesia versus spinal anesthesia in total knee arthroplasty.

Background Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. Methods We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. Results A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). Conclusions Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.

Association Between Hemogram Parameters and Survival of Critically Ill Patients

Aim: Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution. Methods: We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups—dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients. Results: Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients (P = .001). Conclusion: We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

BACKGROUND AND OBJECTIVES Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. METHOD 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50mgkg(-1) over 10min and maintained at 15mgkg(-1)h(-1); in Group D, dexmedetomidine was given at 1mcgkg(-1) 10min before induction and maintained at 0.6mcgkg(-1)h(-1). Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. RESULTS Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. CONCLUSIONS Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

Evaluation of olfactory memory after coronary artery bypass grafting.

Introduction This study determined whether coronary artery bypass grafting (CABG) surgery has any effect on olfactory function, employing the Brief Smell Identification Test (B-SIT). Material and methods All the participants were informed preoperatively about the B-SIT test and the mode of its application. The test was performed by each patient preoperatively (d0) as well as 1 (d1) and 3 (d3) days following the surgery. C-reactive protein (CRP) levels were recorded at the same time as the smell test. Results This prospective study included 45 patients. The mean age was 67 ± 7.55, and the group was 29% male. The mean durations of cross clamping and cardiopulmonary bypass were 54 ± 32 min and 62.5 ± 37.0 min, respectively. Eleven different odors were tested. Significant differences were observed for several odors: leather between d0 and d3, pine between d0 and d3, onion between d0 and d1, onion between d0 and d3, and soap between d0 and d1. The postoperative CRP levels were significantly higher than the preoperative levels. The correlation analysis determined that the postoperative CRP levels were negatively correlated with the B-SIT score (r = –0.48, p = 0.001). Conclusions Our findings suggest that patients after CABG are prone to develop olfactory dysfunction in the early postoperative period and that olfactory dysfunction is associated with postoperative CRP levels.

Novel Mortality Markers for Critically Ill Patients

Aim: Inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), derived from a complete blood count have recently attracted attention as potential markers of morbidity and mortality in various diseases. The aim of the present study was to assess the usefulness of the NLR and PLR as markers of hospital stay and mortality of patients in intensive care units (ICUs). Methods: Patients treated in the ICU of our institution between October 2016 and August 2017 were enrolled in the study. After obtaining approval from the institutional committee, patient data were sourced from the institution’s computerized database and retrospectively analyzed. The patients were assigned to 2 groups according to the outcomes: survivors and deceased. Results: The NLR of survivors and deceased patients was 2.06 (1.18-21.68) and 10.42 (2.85-48.2), respectively. The NLR was significantly elevated in deceased patients as compared with that of survivors (P < .001). Similarly, the median PLR of patients in the deceased group (268.9 [150-3000]) was significantly higher than that of patients in the survivor group (55.7 [11.8-152.5]). The difference in the PLR between groups was significant (P < .001). Conclusion: Both the NLR and PLR, as well as C-reactive protein, predicted mortality in this critically ill population. The PLR and NLR are easy-to-measure, inexpensive markers. Physicians should be aware of elevations in PLR and NLR in patient care in ICUs.

Colostomy with Transversus Abdominis Plane Block.

Transversus abdominis plane (TAP) block is one of the abdominal field block. The TAP block is used for both anaesthetic management and post-operative pain therapy in lower abdominal surgery. TAP block is a procedure in which local anaesthetic agents are applied to the anatomic neurofacial space between the internal oblique and the transversus abdominis muscle. TAP block is a good method for post-operative pain control as well as allows for short operations involving the abdominal area. In this article, a case of colostomy under TAP block is presented.

Experience of Laparoscopic Cholecystectomy Under Thoracic Epidural Anaesthesia: Retrospective Analysis of 96 Patients

OBJECTIVE Although the traditional anaesthesia method for laparoscopic cholecystectomy has been general anaesthesia, regional anaesthesia techniques are also successfully used today. In this paper, we aimed to report our experiences with thoracic epidural anaesthesia, including complications, postoperative analgesia, technical difficulties and side effects. METHODS Between December 2009 and November 2012, 90 patients undergoing laparoscopic cholecystectomy were retrospectively analysed. Demographic data, American Society of Anesthesiologists (ASA) scores, comorbidities, duration of operations, medications and doses used for sedation were reviewed. RESULTS The gender distribution of patients were recorded as 15 males (15%) and 81 females (85%). The patients had an average age of 46.74±13.28, an average height of 162.50±5.57 cm and a mean weight of 73.57±12.48 kg. ASA classifications were distributed as follows: ASA I: 63 (65%) patients, ASA II 28 (29%) patients and ASA III: 5 patients. We recorded 3 patients with chronic obstructive pulmonary disease (COPD), 14 patients with diabetes mellitus (DM) and 22 patients with hypertension who got their diagnosis in the perioperative visit. During the operation, three patients had bradycardia (heart rate 50 min(-1)), and atropine was applied. Ephedrine and fluid resuscitation had been applied to 3 patients for the treatment of intraoperative hypotension. Midazolam, ketamine hydrochloride and propofol were administered to patients for sedation during the operations. Thoracic epidural anaesthesia was performed at the level of T7 -9 intervertebral space with the patients in the sitting position. Patients were given oxygen by a face mask at a rate of 3-4 L min(-1). The pneumoperitoneum was created by giving carbon dioxide at the standard pressure of 12 mmHg into the abdominal cavity in all patients. If needed, postoperative analgesia was provided by epidural local anaesthetic administration. CONCLUSION Thoracic epidural anaesthesia can be applied as an alternative to general anaesthesia for laparoscopic cholecystectomy.

Technology and Information Tool Preferences of Academics in the Field of Anaesthesiology

OBJECTIVE Researchers use a large number of information technology tools from the beginning until the publication of a scientific study. The aim of the study is to investigate the technology and data processing tool usage preferences of academics who produce scientific publications in the field of anaesthesiology. METHODS A multiple-choice survey, including 18 questions regarding the use of technology to assess the preferences of academicians, was performed. RESULTS PubMed has been the most preferred article search portal, and the second is Google Academic. Medscape has become the most preferred medical innovation tracking website. Only 12% of academicians obtain a clinical trial registration number for their randomized clinical research. In total, 28% of respondents used the Consolidated Standards of Reporting Trials checklist in their clinical trials. Of all participants, 21% was using Dropbox and 9% was using Google-Drive for sharing files. Google Chrome was the most preferred internet browser (32.25%) for academic purposes. English language editing service was obtained from the Scribendi (21%) and Textcheck (12%) websites. Half of the academics were getting help from their specialist with a personal relationship, 27% was doing it themselves, and 24% was obtaining professional assistance for statistical requirements. Sixty percent of the participants were not using a reference editing program, and 21% was using EndNote. Nine percent of the academics were spending money for article writing, and the mean cost was 1287 Turkish Liras/year. CONCLUSION Academics in the field of anaesthesiology significantly benefit from technology and informatics tools to produce scientific publications.

İlginç Bir İnhaler Cihaz Kazasi; Çivi Aspirasyonu Olgusu

Sonucta bu olgu bildirimi, KOAH tanisiyla bron- kodilatator ilac kullanimi sirasinda inhaler cihaz icinde biraktigi civiyi aspire etmis olan yasli bir hastada oldugu gibi, ender olarak olusabilecek as- pirasyonlari onleyebilme adina, riskli hasta grup- larinda tibbi cihaz ve ilaclarin kullanimi hakkin- da daha iyi bilgilendirmenin onemini vurgulamak amaciyla sunulmustur