Ozge Koner

Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG.

During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 microg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

Effects of Single-Dose Gabapentin on Postoperative Pain and Morphine Consumption After Cardiac Surgery

OBJECTIVEnThe purpose of this study was to evaluate the analgesic effect of single-dose preoperative gabapentin on postoperative pain and morphine consumption after cardiac surgery.nnnDESIGNnA randomized, double-blind, placebo-controlled, clinical study.nnnSETTINGnA single university hospital.nnnPARTICIPANTSnSixty patients undergoing coronary artery bypass graft surgery.nnnINTERVENTIONSnPatients were randomly allocated into 2 groups preoperatively either to receive 600 mg of oral gabapentin (GABA) or placebo (PLA) 2 hours before the operation. After extubation, an anesthesiologist blinded to the groups recorded pain scores both at rest and with cough with a 10-point verbal rating scale and sedation scores at 2, 6, 12, 18, 24, and 48 hours. Cumulative morphine consumption and the incidence of side effects were recorded during the study period.nnnMEASUREMENTS AND MAIN RESULTSnThe total morphine consumption was lower in the GABA group (6.7 ± 2.5 mg) than in the PLA group (15.5 ± 4.6 mg, p < 0.01). Pain scores at rest were significantly lower in the GABA group than in the PLA group throughout the study period (p < 0.05 in all measurement times). Pain scores at 2, 6, and 12 hours during coughing were significantly lower in the GABA group (p < 0.05). The number of oversedated patients was significantly higher in the GABA group at 2, 6, and 12 hours of study compared with PLA (p < 0.001 at 2 and 6 hours and p < 0.02 at 12 hours). The postoperative mechanical ventilation period was significantly prolonged in the GABA group (6.6 ± 1.2 hours) compared with the PLA group (5.5 ± 1 hours, p < 0.01). Nausea incidence was significantly lower in the GABA group (n = 9) than in the PLA group (n = 18, p = 0.02).nnnCONCLUSIONSnOral GABA at a dose of 600 mg given before cardiac surgery significantly reduced postoperative morphine consumption and postoperative pain both at rest and with cough.

Internal jugular vein diameter in pediatric patients: are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound.

Aim:u2002 This study investigates whether the diameters of right internal jugular vein (RIJV) are suitable for the use of ‘big radius curved J‐tip’ Seldinger wires in pediatric patients.

Effect of ketamine versus alfentanil following midazolam in preventing emergence agitation in children after sevoflurane anaesthesia: A prospective randomized clinical trial

Objective To investigate the effect of intranasal ketamine versus alfentanil in addition to oral midazolam for the prevention of emergence agitation in children. Methods Children undergoing urological surgery with sevoflurane anaesthesia received oral midazolam 40u2009min before induction and were then randomly assigned to receive 2u2009mg/kg ketamine, 10u2009µg/kg alfentanil or 1u2009ml isotonic saline intranasally. Parental separation status and mask acceptance were assessed preoperatively. Emergence agitation was evaluated using a paediatric anaesthesia emergence delirium (PAED) score. Results Data from 78 children were evaluated in the study. There were no significant differences between the groups in demographic characteristics, recovery times or parental separation scores. Mask acceptance was significantly better in the ketamine group than in the saline group. The mean PAED score in the ketamine group was significantly better than in the other two groups, but was similar in the saline and alfentanil groups. The incidence of emergence agitation was 3.8%, 36.0% and 40.7% in the ketamine, alfentanil and saline groups, respectively. Conclusions The addition of intranasal ketamine to oral midazolam significantly improved the quality of induction and reduced sevoflurane-induced emergence agitation, in children undergoing urological surgery.

Comparison of Dexamethasone–Dimenhydrinate and Dexamethasone–Ondansetron in Prevention of Nausea and Vomiting in Postoperative Patients

IntroductionPostoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone–dimenhydrinate and dexamethasone–ondansetron combinations in prevention of nausea and vomiting in postoperative patients.MethodSixty 18–65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone–dimenhydrinate group (group DD) and dexamethasone–ondansetron group (group DO). All patients received dexamethasone 8xa0mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air–oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4xa0mg iv and group DD received dimenhydrinate 1xa0mg/kg iv. For postoperative analgesia tramadol (1.5xa0mg/kg) iv, tenoksikam (20xa0mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24xa0h. Total amount of tramadol was recorded. All results were statistically evaluated.ObservationsDemographics and Apfel risk scores of both groups were similar. Surgical operation duration (pxa0=xa00.038) and total preoperative remifentanil consumption were higher in group DD (pxa0=xa00.006). In group DO, nausea at 30 and 60xa0min (pxa0=xa00.001, pxa0=xa00.007), retching at 30 and 60xa0min (pxa0=xa00.002, pxa0=xa00.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30xa0min (pxa0=xa00.001). Postoperative analgesic consumption was similar in both groups.ResultOur study revealed that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron in prevention of nausea and vomiting after rhinoplasty operations.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial

Background Propofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain. Methods The patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 µg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Students t-tests and Fishers exact tests; P < 0.05 was considered to indicate statistical significance. Results The demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001). Conclusions This study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain.

The effects of intra-articular levobupivacain versus levobupivacain plus magnesium sulfate on postoperative analgesia in patients undergoing arthroscopic meniscectomy: A prospective randomized controlled study

Objective The aim of this study was to compared the effectiveness of intraarticular levobupivacain with levobupivacain and magnesium sulfate. Methods In this prospective randomized double blinded study, 96 patients (67 male, 29 female; age range: 18–65 years) with ASA (American Society of Anesthesiologist) score I and II, who had undergone arthroscopic meniscectomy operation, were divided to 3 groups that had postoperative analgesia with intra-articular saline injection (control group), levobupivacain injection (L group) or levobupivacain and magnesium sulfate injection (LM group). Patients were compared with postoperative VAS (Visual Analog Score) score during rest and activity, opioid analgesic need, non-opioid analgesic need and other medication needs. Results Postoperative VAS scores during rest and activation at early postoperative period were significantly lower at LM group when compared with L group and lower than control group at all time periods. Opioid analgesic need, non-opioid analgesic need and other medication needs for non-pain symptoms were lower at LM group when compared with L and control groups at all time periods. Conclusion Intraarticular magnesium sulfate plus Levobupivacain injection is a safe and effective method for post operative pain management after arthroscopic meniscectomy. Keywords: Intra-articular injection, Magnesium sulfate, Levobupivacain, Postoperative analgesia, Chondrocyte apoptosis, Pain management, Arthroscopic menisectomy Level of Evidence Level I, Therapeutic study

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.

Effect of morphine on lower urinary tract discomfort after transurethral resection of prostate under general anesthesia: a randomised clinical study

BackgroundLower urinary tract (LUT) discomfort is a common complaint after transurethral resection of the prostate (TURP), and it may lead to agitation and restlessnes. We have evaluated the efficacy of morphine for preventing TURP-related LUT discomfort symptoms.MethodsThis was a prospective randomised study including 60 patients (American Society of Anesthesiologists class I and II) who were scheduled to undergo TURP. The patients were divided into two equally sized groups (group M: morphine, group C: control). A standartized anesthesia method was used. Group M patients received morphine 0.04xa0mg/kg intravenous (iv) in 100xa0ml of normal saline followed by an infusion of morphine for 24xa0h (0.01xa0mg/kg/h); group C patients received 100xa0ml normal saline 20xa0min before the expected extubation time, followed by a normal saline infusion which looked identical to that of the morphine infusion. The incidences and severity of LUT discomfort, postoperative pain, sedation level, postoperative nausea and vomiting (PONV) and respiratory depression were recorded at 0, 1, 2, 6, 12 and 24xa0h postoperatively.ResultsThe incidence of LUT discomfort was lower in group M patients at all time points during the study (pxa0<xa00.05) except for 2xa0h postoperatively, and the severity of LUT discomfort was also lower this group at 0, 12 and 24xa0h postoperatively (pxa0=xa00.001, pxa0=xa00.04 and pxa0=xa00.02, respectively). Pain (numeric rating scale) scores were lower in group M patients at 0 (pxa0=xa00.003) and 6xa0h (pxa0<xa00.001). The need for rescue analgesic was lower in group M patients (19 patients in group C, 10 patients in group M; pxa0=xa00.04). The incidence of PONV was higher in group M patients (pxa0=xa00.03). The incidence of pruritus, respiratory depression and over-sedation were similar among the groups.ConclusionBased on these results, we conclude that morphine effectively reduces LUT discomfort after TURP at a cost of postoperative nausea and vomiting.

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

BACKGROUND AND OBJECTIVESnThe 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.nnnMETHODSnAfter 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.nnnRESULTSnInsertion 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.nnnCONCLUSIONSnChoosing 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.