Murat Haliloglu

Perioperative low-dose ketamine improves postoperative analgesia following Cesarean delivery with general anesthesia

Abstract Objective: In this study, the effect of perioperative uses of low dose ketamine on post-operative wound pain and analgesic consumption in patients undergoing elective Cesarean section was evaluated. Methods: In randomized, double blind clinical trial, 52 women with American Society of Anesthesiologists (ASA) class I-II identification undergoing elective Cesarean section in general anesthesia were enrolled. In the ketamine group (group K), a ketamine bolus of 0.5 mg kg−1 IV was administered at the time of induction of general anesthesia. After induction, a ketamine infusion of 0.25 mg kg−1 h−1 was started and discontinued at the end of surgery. Patients allocated to the control group (group C) were given identical volumes of saline. The cumulative dose of morphine consumption after surgery was measured as the primary outcome of this study. Secondary outcomes were pain control assessed by numeric rating scale (NRS) and need for rescue analgesia and incidence of side effects. Results: The mean 24-h morphine consumption was lower in group K (p = 0,001). At 15 min postoperatively, NRS values were lower in group K than group C (p = 0,001). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (p > 0.05). Conclusions: Perioperative uses of low dose ketamine decreased post-operative opioid requirements, which was observed long after the normal expected duration of ketamine.

Analgesic efficacy of wound infiltration with tramadol after cesarean delivery under general anesthesia: Randomized trial

To examine whether tramadol wound infiltration decreased postoperative pain following cesarean section (CS) under general anesthesia or reduced the need for analgesics in the immediate postoperative period.

The Effects Of Nitrous Oxide On Postoperative Pain, Nausea Vomiting and Intraoperative Haemodynamics in Robotic Gynecologic Surgery

Published Date:15 th Apr 2017 Mehtap Ozdemir, Nurten Bakan, Murat Haliloglu, Yonca Yanli, Nevin, Kurt Celebi, Zeynel Abidin Erbesler, Tulin Yollu 1 Department of Anesthesiology and Reanimation, Umraniye Training and Research Hospital, İstanbul,Turkey 2 Department of Anesthesiology and Reanimation, Marmara University Hospital, Istanbul,Turkey 3 Department of Anesthesiology and Reanimation, Vize State Hospital, Kırklareli,Turkey 4 Department of Anesthesiology and Reanimation, Ahi Evran University Hospital, Kırsehir,Turkey 5 Department of Anesthesiology

Simple method for determining the size of the ProSeal laryngeal mask airway in children: a prospective observational study

BACKGROUND AND OBJECTIVES The size of the ProSeal laryngeal mask airway in children is determined by the patients weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. METHODS After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturers guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. RESULTS Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. CONCLUSIONS Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patients weight is unknown, such as in emergency situations.

Low Tidal Volume-Positive End-expiratory Pressure versus High Tidal Volume-Zero Positive End-expiratory Pressure and Postoperative Pulmonary Functions in Robot-assisted Laparoscopic Radical Prostatectomy

Objective: The aim was to compare the effects of low tidal volume (V_T) and moderate positive end-expiratory pressure (PEEP) with high V_T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V_T-PEEP and high V_T-ZEEP groups. The patients were ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP in the low V_T-PEEP group and a V_T of 10 mL/kg and 0 cm H₂O PEEP in the high V_T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V_T-PEEP group than in the high V_T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V_T-PEEP group than in the high V_T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V_T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V_T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP than in patients ventilated with a V_T of 10 mL/kg and ZEEP.

A Comparison of Pregabalin and Ketamine in Acute Pain Management after Laparoscopic Cholecystectomy

Objective: Pregabalin and ketamine are popular analgesic adjuvants for improving perioperative pain management. We designated this double-blind, placebo controlled study to test and compare the preventive effects of pregabalin and ketamine on postoperative pain management after elective laparoscopic cholecystectomy. Methods: Seventy five patients (18 to 65 years of age) undergoing laparoscopic cholecystectomy were randomly assigned to one of the following 3 groups: control group (group C) received oral placebo capsule 1 h before surgery and bolus plus intravenous (iv) infusion of saline during surgery; ketamine group (group K) received oral placebo capsule 1 h before surgery and 0.3 mg kg-1 iv bolus plus 0.05 mg kg-1 h-1 iv infusion of ketamine during the surgery; pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery and bolus plus iv infusion of saline during surgery. The anesthetic technique was standardized, total tramadol consumption, visual analog scale (VAS), incidence of postoperative nausea and vomiting (PONV), sedation score and complications related to the drugs used in the study were assessed in the postoperative 24 h period. Results: Postoperative total tramadol consumption were significantly lower in the pregabalin and ketamine group compared to the group C (p=0.001). Tramadol requirement was similar between pregabalin and ketamine groups. At 30 min postoperatively, VAS values were lower in the pregabalin and ketamine groups compared with group C (p=0.001). There was no difference between the three groups in the need for supplemental analgesia, incidence of PONV and sedation score >2. Discussion: Pregabalin and ketamine improved postoperative pain control and decreased analgesic consumption after laparoscopic cholecystectomy with a good safety profile without any changes in sedation level or PONV.