Özgür Yağan

Effect of Sugammadex on Postoperative Bleeding and Coagulation Parameters After Septoplasty: A Randomized Prospective Study.

Backround Sugammadex is a reversal agent with well known advantages but it’s effects on haemostasis and bleeding have been a topic of interest. Septoplasty is a common surgical procedure with postoperative respiratory complications and bleeding. The aim of this study is to investigate the effects of sugammadex on postoperative coagulation parameters and bleeding after septoplasty procedure. Material/Methods In this randomized controlled study, fifty patients were grouped into two groups; neostigmine (Group N) vs. sugammadex (Group S). For the evaluation of PT, aPTT and INR, blood samples were taken for at the postoperative 120th minutes and alteration of these values with respect to preoperative values were documented. Postoperative bleeding was measured by evaluating the amount of blood absorbed on the nasal tip dressing during 3 hours postoperatively. Results Postoperative bleeding amount was significantly higher in the Group S compared to Group N (p=0.013). No significant difference was observed between two groups according to coagulation parameters (PT; p=0.953, aPTT; p=0.734, INR; p=0.612). Conclusions Sugammadex was associated with higher amount of postoperative bleeding than neostigmine in septoplasty patients. In surgical procedures having high risk of bleeding the safety of sugammadex need to be verified.

Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting

BACKGROUND AND OBJECTIVES The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). METHODS Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2mgkg-1 sugammadex (Group S) or 50μgkg-1 neostigmine plus 0.2mgkg-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. RESULTS In the first hour postoperative 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011). CONCLUSIONS At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia

BACKGROUND AND OBJECTIVES The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60mg dextrose was added to 7.5mg of 0.5% levobupivacaine, in Group II, 80mg and in Group III, 100mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10min. RESULTS The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p<0.05, p<0.00). The time to full recovery of the sensorial block was 136min in Group I, 154min in Group II and 170min in Group III. The differences were statistically significant (p<0.05). The mean duration of the motor block was 88min in Group I, 105min in Group II, and 139min in Group III and the differences were statistically significant (p<0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p<0.00). CONCLUSIONS The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30mg mL(-1) concentration of dextrose added to 7.5mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

Comparação dos efeitos de sugamadex e neostigmina em náusea e vômito no pós‐operatório ☆

BACKGROUND AND OBJECTIVES The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). METHODS Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly allocated into two groups given 2mgkg-1 sugammadex (Group S) or 50μgkg-1 neostigmine plus 0.2mgkg-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. RESULTS In the first postoperative hour 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011). CONCLUSIONS At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24hours of monitoring.

Continuous Spinal Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm in High-Risk Patient

Endovascular aneurysm repair (EVAR) is increasingly being used in abdominal aortic aneurysm (AAA) treatment, as it is less invasive than open surgery. A wide range of anaesthetic types, such as general anaesthesia, neuroaxial blocks and local anaesthesia, have been shown to be appropriate for the EVAR procedure. In the continuous spinal anaesthesia (CSA) method, the local anaesthetic may be titrated through a catheter placed in the subarachnoid space, allowing better control of the anaesthetic level and a reduction in potential haemodynamic side effects. Our aim is to present CSA as a successful anaesthetic technique for EVAR in an AAA patient with severe co-existing diseases.

Evaluation of predictive effect of PAF-AH on the prognosis of intensive care unit patients / Yoğun bakım hastalarında PAF-AH’ın prognoz üzerindeki prediktif etkisinin değerlendirilmesi

Abstract Objective: Determination of the factors associated with the intensive care unit (ICU) prognosis and mortality has important role in the clinical follow-up of the patients. Definition of novel biomarkers, beside older biomarkers available for evaluation of the outcome of these patients has been proposed. Platelet-activating factor acetylhydrolase (PAF-AH) is an enzyme that inactivates the platelet-activating factor. A reduction in the level of the PAF-AH has been demonstrated during systemic inflammation and multiple organ failure. This research aims to determine whether measurement of PAF-AH enzyme activity in ICUs can be used as a prognostic indicator like conventional biomarkers. Methods: Eighty five adult patients have been included. Following data have been recorded: preliminary C-reactive protein (CRP), lactate, albumin and PAF-AH values, APACHE II scores and discharge forms from ICU. Patients were divided in two groups with respect to APACHE II values: Group 1 (1-19) and Group 2 (≥20). Results: Observed mortality was 51.2%. In the APACHE II Group 2 patients, the values of CRP (p=0.001) and lactate (p=0.040) were significanty high, and the values of PAF-AH (p=0.008) and albumin (p=0.001) were significantly low. A statistically significant difference was found between PAF-AH values of exitus and alive patients (p=0.001). According to ROC analysis, the sensitivity and specificity of predicting mortality was 70.5% and 70.7% for CRP, 63.6% and 70.7% for lactate, 90.2% and 61.4% for albumin and 63.6% and 70% PAF-AH, respectively. Conclusion: Our study demonstrated that, in predicting the ICU mortality risk, sensitivity of the PAF-AH is similar to the sensitivity of the lactate, and specificity of the PAF-AH is better than that of the albumin. According to our results, PAF-AH can be included in the novel biomarkers. Özet Amaç: Yoğun Bakım unitelerinde mortalite ve prognozu etkileyen faktorlerin belirlenmesi, hastanın klinik durumunun takibi icin faydalıdır. Bu amacla rutin kullanılan diagnostik belirteclerin yanı sıra yeni belirteclerin kullanımı da gundemdedir. Platelet aktive edici faktor asetil hidrolaz (PAF-AH), PAF’ı inaktive eden enzimdir. Sistemik enflamasyonda ve multipl organ yetmezliklerinde dolaşımdaki PAF-AH duzeylerinde azalma gosterilmiştir. Bu araştırmada PAF-AH enzim aktivitesi olcumunun Yoğun Bakım unitelerinde prognoz gostergesi olarak kullanılıp kullanılamayacağını araştırdık. Metod: Seksen beş erişkin hasta calışmaya dahil edildi. Hastaların Yoğun Bakım’a kabuldeki C-reaktif protein (CRP), laktat, albumin ve PAF-AH değerleri ile APACHE II skorları ve yoğun bakımdan cıkış bicimleri kaydedildi. Hastalar APACHE II değerlerine gore iki gruba ayrıldılar; Grup 1 (1-19) ve Grup 2 (≥20). Bulgular: Yoğun Bakım Unitemizde gozlenen mortalite oranı %51.2 idi. APACHE II 2. grupta CRP (p=0.001) ve laktat (p=0.040) seviyeleri anlamlı olarak yuksek iken, PAF-AH (p=0.008) ve albumin (p=0.001) değerleri duşuktu. PAF-AH duzeyleri acısından olen hastalarla yaşayan gruplar arasında anlamlı bir farklılık tespit edildi (P=0.001). Yapılan ROC analizine gore, CRP’nin mortaliteyi gostermedeki duyarlılığı %70.5, ozgulluğu %70.7, laktatın duyarlılığı %63.6, ozgulluğu %70.7, albuminin duyarlılığı %90.2, ozgulluğu %61.4, PAF-AH’ın duyarlılık ve ozgulluğu ise sırasıyla %63.6 ve %70 idi. Sonuç: Calışmamızda PAF-AH’ın Yoğun Bakım mortalite riskini belirlemede laktat ile eşit duyarlılıkta olduğu, ozgulluğunun ise albuminden daha yuksek olduğu tespit edilmiştir. PAF-AH, Yoğun Bakım hastalarında prognozun değerlendirilmesi amacıyla kullanılabilecek yeni bir biyobelirtectir.

Anesthesia in a patient with Stiff Person Syndrome

Stiff Person Syndrome (SPS), typified by rigidity in muscles of the torso and extremities and painful episodic spasms, is a rare autoimmune-based neurological disease. Here we present the successful endotracheal intubation and application of TIVA without muscle relaxants on an SPS patient. A 46 years old male patient was operated with ASA-II physical status because of lumber vertebral compression fracture. After induction of anesthesia using lidocaine, propofol and remifentanil tracheal intubation was completed easily without neuromuscular blockage. Anesthesia was maintained with propofol, remifentanil and O2/air mixture. After a problem-free intraoperative period the patient was extubated and seven days later was discharged walking with aid. Though the mechanism is not clear neuromuscular blockers and volatile anesthetics may cause prolonged hypotonia in patients with SPS. We think the TIVA technique, a general anesthetic practice which does not require neuromuscular blockage, is suitable for these patients.

Uma comparação das diferentes densidades das soluções de levobupivacaína para raquianestesia unilateral

BACKGROUND AND OBJECTIVES The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60mg dextrose was added to 7.5mg of 0.5% levobupivacaine, in Group II, 80mg and in Group III, 100mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10min. RESULTS The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p<0.05, p<0.00). The time to full recovery of the sensorial block was 136min in Group I, 154min in Group II and 170min in Group III. The differences were statistically significant (p<0.05). The mean duration of the motor block was 88min in Group I, 105min in Group II, and 139min in Group III and the differences were statistically significant (p<0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p<0.00). CONCLUSIONS The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30mgmL(-1) concentration of dextrose added to 7.5mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery

OBJECTIVE The aim of this study is to compare the sedative properties and haemodynamic and respiratory effects of dexmedetomidine and a ketamine-propofol combination (ketofol), which are expected to have minimal effects on spontaneous breathing. METHODS Sixty patients were enrolled in this prospective randomised study. Patients were divided into 2 groups according to the administration of dexmedetomidine (Group D) and ketofol (Group K). Target sedation level was determined as a Ramsay Sedation Score of 3. In Group D, 0.5 mcg kg(-1) dexmedetomidine was administered via intravenous route in 10 minutes versus 0.125 mL kg(-1) of a solution containing 200 mg propofol and 100 mg ketamine in Group K. Haemodynamic and respiratory effects, postoperative awakening time, analgesic properties and satisfaction levels of the patients and surgeon were assessed. RESULTS There was a statistically significant decrease in mean arterial pressures following drug administration compared to initial measurements in both groups. However, there was a statistically significant decrease in heart rate only in Group D. There was no significant difference between the two groups regarding respiratory rate and protection of spontaneous respiration. Although the time for Aldrete score to be 9 was 16.1 minutes for Group K, it was 24.9 minutes for Group D, and this difference was statistically significant (p<0.01). There was no significant difference between the two groups regarding adverse effects, pain scores and satisfaction levels of the patients and surgeon. CONCLUSION Compared to dexmedetomidine, at similar sedation levels, sedation provided by ketofol enables satisfactory analgesia. Moreover, ketofol has a more rapid onset of action and a shorter recovery period from anaesthesia without causing significant haemodynamic or respiratory adverse effects.

A Retrospective Analysis of Comparison of General Versus Regional Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm

OBJECTIVE The aim of this study is to compare general anaesthesia (GA) versus regional anaesthesia (RA) for endovascular aneurysm repair (EVAR). METHODS We analysed the files of 89 patients between August 2010-August 2012 who underwent elective EVAR retrospectively. RESULTS We performed RA for 32 patients (36%) and GA for 57 patients (64%). The operations were completed successfully in both groups and did not require conventional surgery. The mean age of the patients was 71.5±7 (range 50-88 years). RA was preferred more than GA in the presence of advanced-stage chronic obstructive pulmonary disease statistically (p=0.032). The usage of vasodilator drug and atropine was found to be higher in the GA group than the RA group in the intraoperative period (p=0.001 and p=0.01, respectively). The intensive care unit (ICU) was necessary for 5 patients in the RA group (16%) and 13 patients for the GA group (23%) postoperatively (p=0.301). The median ICU stay in the RA group was 2 hours and 4.4 hours in the GA group (p=0.114). The median hospital stay was 2.63±1.91 days in the RA group and 2.04±1.16 days in the GA group, with no statistically significant difference between groups (p=0.120). There was no mortality of patients in either group for the peroperative period and the 30-day follow-up period. CONCLUSION Our present study suggests that patient characteristics are more important than the anaesthetic method on the outcomes of EVAR.