Onur Koyuncu

Comparison of the laryngeal mask (LMA ™ ) and laryngeal tube (LT ® ) with the new perilaryngeal airway (CobraPLA ® ) in short surgical procedures

Background and objective: We compared the laryngeal mask airway (LMA™) and the laryngeal tube (LT®) with the newly introduced perilaryngeal airway (CobraPLA®, PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. Methods: After premedication, 90 ASA I–II patients awaiting short surgical procedures were randomized to receive, LMA, LT or PLA. Anaesthesia was induced with intravenous propofol (2.5 mg kg−1) and mivacurium (0.2 mg kg−1). Number of attempts, time of insertion of the device, any other unwanted effect, mean aterial pressure, heart rate, oxygen saturation and end‐tidal carbon dioxide were recorded. At the end of surgery, the cuff of the device was immediately deflated and the airway device was removed. The device was examined and noted for the presence of visible blood. Patients were asked to rate their throat soreness, dysphonia and dysphagia 1 and 24 h postoperatively. Results: There were no differences in haemodynamic variables. Insertion times for the devices were similar (LMA: 20 ± 11 s, LT: 19 ± 14 s and PLA: 21 ± 12 s.) The success rates at first insertion were lower in the (LMA group (57%) when compared with the PLA (97%, P < 0.05). The number and type of airway interventions for achieving an effective airway were similar. When the airways were removed 50% of the PLA devices had positive blood traces, while only 17% of the LMA and LT devices had positive blood traces (P < 0.01). Fifty percent of the patients suffered from a sore throat in the PLA group, which was significantly higher than in the LMA and LT groups (P < 0.05). Conclusion: We conclude that haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with, LMA, LT and PLA, but LT and PLA were easier to insert; LMA and LT caused less mucosal trauma.

Effects of lornoxicam on the physiology of severe sepsis

IntroductionThe purpose of the present study was to evaluate the effects of intravenous lornoxicam on haemodynamic and biochemical parameters, serum cytokine levels and patient outcomes in severe sepsis.MethodsA total of 40 patients with severe sepsis were included, and were randomly assigned (20 per group) to receive either lornoxicam (8 mg administered intravenously every 12 hours for six doses) or placebo. For both groups the following were recorded: haemodynamic parameters (heart rate, mean arterial pressure), nasopharyngeal body temperature, arterial blood gas changes (pH, partial oxygen tension, partial carbon dioxide tension), plasma cytokine levels (IL-1β, IL-2 receptor, IL-6, IL-8, tumour necrosis factor-α), biochemical parameters (lactate, leucocytes, trombocytes, creatinine, total bilirubin, serum glutamate oxalate transaminase), length of stay in the intensive care unit, duration of mechanical ventilation and mortality. All measurements were obtained at baseline (before the start of the study) and at 24, 48 and 72 hours from the start of lornoxicam/placebo administration.ResultsNo significant differences were found between the intravenous lornoxicam and placebo groups in major cytokines, duration of ventilation and length of intensive care unit stay, and inspired fractional oxygen/arterial oxygen tension ratio (P > 0.05).ConclusionIn these patients with severe sepsis, we found intravenous lornoxicam to exert no effect on haemodynamic and biochemical parameters, cytokine levels, or patient outcomes. Because of the small number of patients included in the study and the short period of observation, these findings require confirmation by larger clinical trials of intravenous lornoxicam, administered in a dose titrated manner.

Induction with Propofol Decreases Emergence Agitation in Pediatric Patients

Background and objectives: Emergence agitation (EA) is a common complication seen after inhalational anesthesia especially with sevoflurane, with an incidence of 20-80%. The hypothesis of the study was that induction with propofol reduces the incidence and severity of emergence agitation when compared with sevoflurane in children undergoing inguinal hernia surgery. Methods: 116 Children undergoing inguinal hernia were randomly assigned to two groups: Sevoflurane group received sevoflurane increasing concentrations up to 8% and propofol group received 3 mg kg propofol in induction. Postoperative agitation treatment and analgesia was standardized, and postoperative assessments included Cole Agitation Scale and narcotic consumption for agitation, Wong-Baker Faces Pain Rating Scale for pain, first spontaneous eye opening time, first verbal command follow time, post-anesthesia care unit (PACU) staying time, first analgesic requirement time and parents satisfaction. Results: The incidence of EA at arrival in PACU and the cumulative incidences at the end of the postoperative two hours were significantly lower in the propofol group. EA scores were lower in propofol group in all measurement times during postoperative 30 minutes. Fentanyl consumption at arrival in PACU and the sum of the two hours were significantly lower in propofol group. Pain scores were lower in propofol group in the postoperative 24 hours. First analgesic requirement time and parents satisfaction were higher in propofol group. Conclusion: Propofol in accurate dose is effective in reducing the incidence and intense of EA in children undergoing inguinal hernia and maybe preferred in children with high risk of EA.

Correlation of carboxyhemoglobin levels and secondhand smoking related complications in pediatric tonsillectomy patients: 10AP2-6

with the ratio of 83% and mother smoking 15%, father smoking 39%, caregiver smoking 5%, guest smoking was 30%, windows of the house do not open everyday 13% and no statistical dif ference between all other enviromental factors. Conclusion: This study provides limited insight into the COHb levels of children exposed to enviromental sources and especially there was a correlation between coal use at home and high preoperative COHb levels. Preoperative high COHb levels may be alerts about intraoperative and postoperative anesthesia and surgery complications. Reference(s): Yee B, Ahmed I.M, Brugge D et all. Second-hand smoking and carboxyhemoglobin levels in children: a prospective observational study. Ped Anesth 2010; 20:82-89