Ruhiye Reisli

Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation : perioperative haemodynamics and anaesthetic requirements.

AbstractBackground: Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 μ/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation, need for anaesthetic agent and perioperative haemodynamic stability. Methods: Fifty patients scheduled for elective minor surgery were randomised into two groups (dexmedetomidine group and placebo group, n = 25 in each group). During and after drug administration, the Ramsey sedation scale was applied every 5 minutes. Fentanyl 1 μ/kg was administered to all patients and thiopental was given until lash reflex disappeared. Anaesthesia continuation was maintained with 50% : 50%, oxygen : nitrous oxide. Sevoflurane concentration was adjusted to maintain systolic blood pressure within 20% of preoperative values. After extubation, the Steward awakening score was applied at 5 and 10 minutes. Haemodynamic parameters and adverse effects were recorded every 10 minutes for 1 hour after surgery. Results: During intubation the need for thiopental and sevoflurane concentration were decreased by 39% and 92%, respectively, in the dexmedetomidine group compared with the placebo group. In all groups, blood pressure and heart rate increased after tracheal intubation; both were significantly lower in the dexmedetomidine group than in the placebo group (p < 0.05). Fentanyl requirement during the operation was 74.20 ± 10.53μg in the dexmedetomidine group and 84.00 ± 27.04μg in the placebo group (p < 0.05). At 5 minutes, the Steward scores were >6 in 56% of the dexmedetomidine group and in 4% of the placebo group (p < 0.05). At 10 minutes, sedation scores were ≥4 in all patients in the dexmedetomidine group (p < 0.05). Arterial blood pressure and heart rate in the postoperative period were significantly lower in the dexmedetomidine group compared with the placebo group (p < 0.05). Conclusion: Preoperative administration of a single dose of dexmedetomidine resulted in progressive increases in sedation, blunted the haemodynamic responses during laryngoscopy, and reduced opioid and anaesthetic requirements. Furthermore, dexmedetomidine decreased blood pressure and heart rate as well as the recovery time after the operation.

Prevention of postoperative nausea and vomiting after thyroidectomy : Combined antiemetic treatment with dexamethasone and ginger versus dexamethasone alone

AbstractBackground: The aim of this study was to compare the prophylactic effects of dexamethasone plus ginger and dexamethasone alone on postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Methods: One hundred and twenty patients undergoing general anaesthesia for thyroidectomy were enrolled in this randomised, double-blind study. Patients received oral diazepam 10mg with either oral placebo (group I) or 0.5g of ginger (group II) as premedication 1 hour prior to surgery. Standard general anaesthetic techniques and postoperative analgesia were employed. Both group I and group II received intravenous dexamethasone 150 μg/kg immediately before the induction of anaesthesia. Data were recorded over a 24-hour observation period after surgery. Results: In the dexamethasone-treated group, 14 patients experienced nausea, two patients retched, three patients vomited once, two patients vomited repeatedly, and 14 patients required a rescue antiemetic. In the dexamethasone-plus-gingertreated group, 12 patients experienced nausea, one patient retched, four patients vomited once, no patients vomited repeatedly, and 13 patients required a rescue antiemetic. Dexamethasone plus ginger did not significantly reduce nausea and vomiting compared with dexamethasone alone during the observation period. Conclusion: In conclusion, the prophylactic combination of antiemetic treatment with dexamethasone and ginger was not clinically or statistically superior to dexamethasone alone in preventing PONV in patients undergoing thyroidectomy.

A Comparison of Ketamine and Paracetamol for Preventing Remifentanil Induced Hyperalgesia in Patients Undergoing Total Abdominal Hysterectomy

Background: The aim of this prospective, randomized, placebo-controlled study was to compare the effects of ketamine and paracetamol on preventing remifentanil induced hyperalgesia. Methods: Ninety patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups to receive (I) either saline infusion; (II) 0.5 mg/kg ketamine iv bolus or (III) 1000 mg iv paracetamol infusion before induction of anesthesia. Until the skin closure, anesthesia was maintained with 0.4 µg/kg/min remifentanil infusion in all groups, additionally Group II received 5 µg/kg/min ketamine infusion. Pressure pain thresholds were measured the day before surgery during the preoperative visit for baseline measurements and repeated postoperatively at 24 and 48 hours (hrs). Pressure pain thresholds were established by digital algometer on three different peri- incisional regions for calculating mean pressure pain threshold values. The visual analogue scale (VAS), sedation scores, total morphine consumption and side effects were assessed postoperatively. Results: Demographic characteristics, duration of surgery and anesthesia were similar in the three groups. Pain thresholds at the incision region were significantly lower at 24 and 48 hrs postoperatively in Group I than the other Groups (p< 0.05). In Group І, pain thresholds were lower compared with preoperative baseline values. Thresholds in Group ІІ and Group ІІІ were higher compared with preoperative baseline values (p< 0.05) The VAS scores at all evaluation times were significantly higher in Group І when compared to Group ІІ and at 2, 4, 6 ,12 hrs were higher in Group I than Group ІІІ (p< 0.05). The morphine consumption was higher in Group ІІІ at 24 and 48 hrs postoperatively (p< 0.05). Conclusion: It was shown that ketamine and paracetamol were both effective in preventing remifentanil induced hyperalgesia.

Effect of gabapentin on postoperative pain: A randomized, placebo-controlled clinical study

Background: Both clinical and experimental studies suggest that gabapentin (GBP) has analgesic effects in neuropathic pain. The aim of the study was to investigate the effect of gabapentin on postoperative pain. Methods: This study was performed on 45 (ASA I-II) patients planned for major orthopaedic surgery. 45 patients were randomized into three equal groups. Patients received 1200 mg GBP (Group I), 800 mg GBP (Group II) or placebo (Group III) 1 h before surgery. Anaesthesia was standardized for all patients. Morphine by intravenous patient-controlled analgesia was applied as 1 mg bolus dose and 7 min lockout time for postoperative analgesia. The pain was evaluated at the first 2 and 4 h after operation. The amount of morphine used was recorded at the same hours. Results: In all groups, there were no significant differences in the demographic characteristics, duration of surgery and anaesthesia, or dose of fentanyl received in the operating room. Pain scores and side effects were similar in all groups. Morphine consumption was lower in the Groups I and II than in the Group III at 2 h and 4 h postoperatively ( p< 0.05). Morphine consumption was lower in the Group I than in the Group II at 2 h and 4 h ( p< 0.05). Conclusion: Our results demonstrate that a single dose of 1200 or 800 mg oral gabapentin reduces morphine consumption in the early postoperative period. However, gabapentin 1200 mg is more effective than gabapentin 800 mg for pre-emptive analgesic effect. summary

Auditory function after spinal anaesthesia : the effect of differently designed spinal needles

Background and objective Recurrent, bilateral or unilateral, persistent or transient, mild or profound hearing loss has been reported after spinal anaesthesia. We studied the effects of the needle type (Quincke, ballpen, pencil-point spinal needles) on hearing loss after spinal anaesthesia with the use of pure-tone audiometry. Methods Forty-five ASA physical status I patients scheduled for elective inguinal herniorraphy with spinal anaesthesia were enrolled in the study. The patients were randomly divided into three groups. Group Q (n = 15) patients received spinal anaesthesia through a 25-gauge (G) Quincke spinal needle, group B (n = 15) patients received the same through a 25-G ballpen spinal needle and those in group P (n = 15) received the same through a 25-G pencil-point spinal needle. Patients were interviewed about postoperative complaints such as postdural puncture headache, vertigo, nausea–vomiting, transient neurological symptoms and major neurological deficits. Pure-tone audiometry was performed by an audiologist at specific time intervals. Results The number of patients who had greater than 10 dB hearing loss in group Q was significantly more than that found in group B and group P at 250, 500, 4000 and 6000 Hz on postoperative day 1. When group B and group P were compared for change in hearing, no statistically significant difference was detected at any frequency tested. Conclusion Because the use of ballpen and pencil-point needles reduces hearing loss after spinal anaesthesia, these needles are preferred.

The effect of environmental tobacco smoke on the dose requirements of rocuronium in children

Background:  Smoking affects the pharmacodynamic and pharmacokinetic behaviour of several drugs. The aim of this study was to evaluate the effects of environmental tobacco smoke on onset and recovery time after single dose rocuronium in children.

Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil.

STUDY OBJECTIVES To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 microg kg(-1). DESIGN Prospective, randomized study. SETTING University teaching hospital. PATIENTS 40 ASA physical status I pediatric patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. INTERVENTIONS Patients were divided into two groups to receive either a single caudal injection of one mL kg(-1) levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 microg kg(-1) (Group LS). MEASUREMENTS Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. MAIN RESULTS The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for pain scores at two, three, 4, 5, 6, 9, 12, and 24 hours. Degree of motor block was comparable between the two groups. CONCLUSION The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children.

Effects of desflurane, sevoflurane and propofol on phagocytosis and respiratory burst activity of human polymorphonuclear leucocytes in bronchoalveolar lavage

Background and objective In polymorphonuclear leucocytes, phagocytosis and respiratory burst activity are mainly responsible for bacterial killing. We aimed to investigate the effects of anaesthesia with desflurane, sevoflurane and propofol on these functional activities of polymorphonuclear leucocytes in bronchoalveolar lavage fluid. Methods Sixty patients scheduled to have tympanoplasty surgery were studied. The patients were divided into three groups (group D, desflurane; group S, sevoflurane; group P, propofol). Anaesthesia was induced with propofol, fentanyl and rocuronium in all groups. Anaesthesia was maintained with inhalation agent or propofol. Bronchoalveolar lavage was performed immediately after induction of anaesthesia and after surgical procedure by a fibreoptic bronchoscope. Leucocyte respiratory burst and phagocytic activity in bronchoalveolar lavage fluid were determined by flow cytometric analysis of gated leucocyte populations within 2 h after each bronchoalveolar lavage sample. Changes in leucocyte functions with time were expressed as mean fluorescence intensity. Results There were no significant differences in phagocytic activity of polymorphonuclear leucocytes within and between the groups. The respiratory burst function of polymorphonuclear leucocytes showed a significant increase after surgery in group P (P < 0.05). When we compared the differences between the three groups, we found the difference in mean fluorescence intensity as statistically significant between group P and group S. Conclusion This study showed that propofol anaesthesia increased the respiratory burst function of polymorphonuclear leucocytes in bronchoalveolar lavage fluid.

Anaesthetic and haemodynamic effects of continuous spinal versus continuous epidural anaesthesia with prilocaine

Background and objective: To compare, using prilocaine, the effects of continuous spinal anaesthesia (CSA) and continuous epidural anaesthesia (CEA) on haemodynamic stability as well as the quality of anaesthesia and recovery in patients undergoing transurethral resection of the prostate gland. Methods: Thirty patients (>60 yr) were randomized into two groups. Prilocaine, 2% 40 mg, was given to patients in the CSA group, and prilocaine 1% 150 mg was given to patients in the CEA group. Incremental doses were given if the level of sensory block was lower than T10 or if needed during surgery. Results: There was a significant decrease in mean arterial pressure in Group CEA compared with Group CSA (P < 0.01). The decrease in heart rate in Group CSA occurred 10 min after the first local anaesthetic administration and continued through the operation (P < 0.05). The level of sensory anaesthesia was similar in both groups. The times to reach the level of T10 and the upper level of sensory blockade (Tmax) were 18.0 ± 4.7 and 25.3 ± 7.0 min in Groups CSA and CEA, respectively, and were significantly longer in Group CEA. The duration of anaesthesia was 76.8 ± 4 min and was shorter in Group CSA (P < 0.01). Conclusions: Spinal or epidural anaesthesia administered continuously was reliable in elderly patients undergoing transurethral resection of the prostate. Continuous spinal anaesthesia had a more rapid onset of action, produced more effective sensory and motor blockade and had a shorter recovery period. Prilocaine appeared to be a safe local anaesthetic for use with either continuous spinal anaesthesia or continuous epidural anaesthesia.

Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children.

Background: The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children.