Mustafa Gönüllü

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

PurposeTo compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects.MethodsAfter Ethics Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L3–4 interspace in 90 ASA physical status I–II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 μg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded.ResultsDuration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001), Pain score, respiration rate, and SpO2 values were similar in all study groups.ConclusionWe conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration.RésuméObjectifComparer ie tramadol à la combinaison de tramadol-clonidine ou de tramadol-dropéridol en regard de leurs effets analgésiques et indésirables.MéthodeAyant obtenu l’approbation du Comité d’éthique et le consentement éciairé des patients, nous avons réalisé l’insertion préopératoire d’un cathéter péridural dans l’espace intercostal L3–4 chez 90 patients adultes d’état physique ASA I–II devant subir une intervention abdominale basse. Lanesthésie a été normalisée. Les patients ont été répartis en trois groupes de façon aléatoire. Ceux du groupe I (T) ont reçu 75 mg de tramadol, ceux du groupe II (TD), 75 mg de tramadol et 2,5 mg de dropéridol et du groupe III (TC), 75 mg de tramadoi plus 150 μg de clonidine dans un volume total de 10 mL administré à la salle de réveil en une seule injection péridurale. Le délai d’installation et la durée de l’analgésie, la douleur selon l’échelle visuelle analogique, la sédation, les nausées, les signes vitaux et les effets secondaires ont été notés.RésultatsLa durée de l’analgésie a été comparable entre les groupes TD et TC et signifcativement plus longue que dans le groupe T (P < 0,001). Les patients du groupe TC, comparés à ceux des autres groupes, ont connu une hausse signifcative des scores de sédation et une baisse de la tension artérielle et de la fréquence cardiaque (P < 0,001). Aucun effet indésirable n’a été observé dans le groupe TD tandis que les scores de nausées ont été plus élevés dans les groupes T et TC (P < 0,001). Les scores de douleur, la fréquence respiratoire et la SpO2 ont présenté des valeurs similaires dans tous les groupes de l’étude.ConclusionNous pouvons conclure que l’administration péridurale de tramadol, combinée au dropéridoi ou à la clonidine, prolonge la durée de l’analgésie; cependant, le dropéridoi semble un meilleur choix quand on considère les effets indésirables et les propriétés antiémétiques.

Factors Affecting Anxiety and Depression Symptoms in Relatives of Intensive Care Unit Patients

Aim: To determine the incidences of anxiety and depression in relatives of patients admitted to an intensive care unit (ICU) and to investigate the relationships between psychological symptoms and demographic features of the patients and their relatives. Methodology: Relatives of 78 ICU patients were enrolled in the study. Sociodemographic features of patients and their relatives were recorded. The Turkish version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Results: Twenty-eight (35.9%) cases with anxiety and 56 (71.8%) cases with depression were identified. The mean anxiety and depression scores were 9.49 ± 4.183 and 9.40 ± 4.286, respectively. Anxiety (P = .028) and concomitant anxiety with depression (P = .035) were more frequent among family members of young patients. The relationship to the patient, especially being a spouse, was significantly associated with symptoms (anxiety, P = .009; depression, P = .019; and both, P = .005). Conclusion: Spouses and family members of relatively young patients had higher rates of anxiety and depression. In contrast to the literature, depression was more common than anxiety among the relatives of ICU patients. Further research is needed on the impact of cultural and regional differences on anxiety and depression rates in family members of ICU patients.

Comparison Between Ultrasonography-Guided Popliteal Sciatic Nerve Block and Spinal Anesthesia for Hallux Valgus Repair

Background: We aimed to compare the efficacy, postoperative pain scores, adverse effects, additional analgesic requirements, and patient satisfaction scores of ultrasonography-guided sciatic nerve block by popliteal approach with spinal anesthesia for hallux valgus correction surgery. Methods: Sixty patients scheduled for hallux valgus correction surgery were enrolled in this prospective randomized study. Unilateral spinal block was performed on patients in the spinal anesthesia group. Popliteal block group patients received popliteal sciatic nerve block with guidance by both nerve stimulator and ultrasonography. Durations of anesthetic and operative interventions and time until the initiation of surgery were recorded for both groups. Pain magnitude of the patients at the 2nd, 4th, 6th, 12th, and 24th hours following anesthetic interventions were assessed with a visual analog scale (VAS). Adverse effects such as postoperative urinary retention and postdural puncture headache were recorded. Also, patient satisfaction was recorded. Patients were interviewed by phone for anesthetic and operative complications at 72 hours postoperatively. Results: Spinal anesthesia group patients exhibited hypotension, bradycardia, postdural puncture headache, and urinary retention rates of 6.6%, 3.3%, 10%, and 3.3%, respectively. Popliteal block group patients showed none of these adverse effects. Moreover, VAS scores of the patients at the 2nd, 4th, 6th, and 12th hours were significantly lower (P < .001, P = .003, P < .001, P <.001, respectively), postoperative first analgesic requirement times were significantly longer (P < .001), and pain satisfaction scores were significantly higher (P < .001) in the popliteal block group. Conclusion: Given the complications related to spinal anesthesia and its insufficiency to maintain analgesia postoperatively, we believe the preferred anesthetic method should be peripheral nerve blocks for hallux valgus correction surgeries. Level of Evidence: Level I, randomized prospective study.

Comparison of halothane/thiopental and propofol anesthesia for strabismus surgery.

Day case surgery has become a widely accepted practice for many ophthalmological procedures including strabismus surgery. Prompt recovery from anesthesia and minimal postoperative morbidity are especially requested to the anesthesiologists to deal with the high day case surgery burden. The purpose of this study was to compare two anesthesia techniques, halothane/thiopental anesthesia and propofol anesthesia, for patients undergoing monocular strabismus surgery. We studied the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity in 43 patients, ranging from 7 to 41 years of age. A scoring system was used to assess these parameters in the first postoperative 48 h. Although there was not a significant difference in the level of ocular pain, the propofol group had less morbidity in terms of having a better level of consciousness and appetite, less nausea and vomiting and enhanced activity than the halothane/thiopental group. We conclude that propofol anesthesia has significant advantages over halothane/thiopental anesthesia on an outpatient basis for strabismus surgery.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery

BACKGROUND The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. METHODS Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldretes Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. RESULTS A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. CONCLUSION Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Acute Back Pain Following Surgery under Spinal Anesthesia

The purpose of this study was to determine the factors having a role in the occurrence of acute back pain following spinal anesthesia.

Efeito de informações por meio de vídeo sobre a ansiedade e satisfação de pacientes submetidos à anestesia espinhal

BACKGROUND Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia. METHODS A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period. RESULTS No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5±10.0 in Group 1 and 39.6±8.6 in Group 2 (p=0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5±0.6 in Group 1 and 3.5±1.2 in Group 2 (p<0.001). CONCLUSIONS Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.