Ruveyda Irem Demircioglu

Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients.

The aim of this study was to investigate the usefulness of sonography for verifying tracheal tube placement within 3 seconds in adult surgical patients.

Dexmedetomidine for the prevention of shivering during spinal anesthesia

PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection. RESULTS: Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207). CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study

STUDY OBJECTIVE To determine whether magnesium sulfate (MgSO(4)) infusion during surgery reduces shivering during spinal anesthesia. DESIGN Double-blinded placebo-controlled, randomized trial. SETTING Operation room of a university hospital. PATIENTS 60 patients, aged 40 to 70 years, scheduled for elective transurethral resection of the prostate (TURP) during spinal anesthesia. INTERVENTIONS Subarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5% was injected using a 25-G Quincke spinal needle. Patients received either saline (Group C, n = 30) or MgSO(4) (Group Mg, n = 30). Group Mg received an intravenous (IV) bolus of MgSO(4) 80 mg/kg via syringe pump over a 30-minute period, followed by a two g/hr infusion during the intraoperative period. Group C received an equal volume of saline. MEASUREMENTS Motor blockade was evaluated by Bromage motor scale. Sensory block level was assessed by pinprick test. Shivering was assessed after the completion of subarachnoid drug injection. Side effects were recorded. MAIN RESULTS Hypothermia was observed in all patients (100%) in Group Mg and in 24 patients (80%) in Group C (P = 0.024). The decrease in core temperature in Group Mg was significantly greater (P < 0.005). Shivering was observed in two patients (6.7%) in Group Mg and 20 patients (66.7%) in Group C (P = 0.0001). CONCLUSIONS MgSO(4) infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia. MgSO(4) infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia.

Patient-controlled analgesia and sedation with alfentanyl versus fentanyl for colonoscopy: a randomized double blind study.

Study Objective The aim of this study was to evaluate whether sedo-analgesia with alfentanyl/fentanyl, using a patient-controlled analgesia (PCA) pump, may have positive outcomes in terms of safety, postprocedural workload, and expectations of the colonoscopist, nurse, and patients in elective colonoscopy. Patients One hundred American Society of Anesthesiology physical status I and II adult patients. Interventions Patients were randomized in a double-blind trial to receive either alfentanyl (n=50) or fentanyl (n=50) by PCA, and incremental doses of midazolam. Measurements Patient expectations were assessed using hemodynamic variables, willingness to have a repeat colonoscopy in the same way, adverse events, discomfort scores, and patient/operator/nurse satisfaction associated with sedo-analgesia. Result All patients in both groups had adequate sedo-analgesia with high satisfaction and willingness scores. There were no serious adverse effects and except for a few events, no required medication. The total sedation times were shorter in the alfentanyl group compared with the fentanyl group. Conclusions PCA and sedation with alfentanyl and fentanyl for colonoscopy are safe, feasible, and acceptable to most patients. However, shorter sedation times make alfentanyl more attractive for postprocedural workload.

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

Background: Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double‐blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.

Remifentanil-propofol in vertebral disk operations : Hemodynamics and recovery versus desflurane-N2O inhalation anesthesia

The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N2O/O2. A constant infusion of remifentanil was provided at 0.125 μg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/ 50% N2O/O2, with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O2 saturation, and end-tidal CO2 data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33–3.53 min), extubation (3.13–3.88 min), eye opening (4.06–6.23 min), and being able to give name and date of birth (5.4–7.9 min) compared with times in the desflurane group (P<.05). In theTIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In theTIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.

The comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain.

Purpose: Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain. Methods: Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic. Results: In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs. Conclusions: Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.

Cervical epidural steroid injections for symptomatic disc herniations

OBJECTIVES Cervical radiculopathy is widespread in society, and the methods used in the treatment cover a wide range from conservative treatment to surgical treatment. There is not yet a full consensus on the use of invasive approaches for the optimal treatment of radicular pain. However, cervical epidural steroid injection (CESI) has been used in patients with symptoms of cervical discopathy. METHODS Results of the six-month period of treatment of 58 patients, diagnosed as symptomatic cervical radiculopathy with application of CESI within a one-year period, were evaluated retrospectively. With the patients in a sitting position and with the head flexed, the epidural space was accessed from the C7-T1 aperture using the median approach and the hanging drop technique, and a pre- prepared 6 ml solution consisting of 80 mg triamcinolone with 10 mg levobupivacaine was injected following standard sterilization. RESULTS The post-CESI treatment VAS values of the patients were significantly lower than pretreatment VAS values. The treatment success rates for CESI application were 93% in the 1st month, 86% in the 3rd month, and 72% in the 6th month, respectively. CONCLUSION The CESI application is an effective method in the treatment of cervical radiculopathy and reduces the rate of patients needing surgery.

A Comparison of Articaine and Fentanyl-Supplemented Articaine for Hemodialysis Fistula Creation under Ultrasound-Guided Axillary Block

The aim of this prospective randomized, double-blinded study was to evaluate the effect of fentanyl addition to articaine on the duration of sensory as well as motor blocks, and the duration of analgesia during hemodialysis fistula creation under ultrasound-guided axillary block. Fifty patients were randomly allocated to two groups, an articaine group (A), receiving 40 mL of articaine HCI (20 mg/mL) with 2 mL of isotonic sodium chloride solution, and an articaine-fentanyl group (AF), receiving 40 mL of articaine HCI (20 mg/mL) with 2 mL (100 µg) of fentanyl. The onset as well as the duration of sensory and motor blocks, the time necessary for first analgesic administration, the hemodynamic parameters, and the side effects were recorded. Three patients in Group A and two patients in Group AF due to incomplete block were excluded from the study. The duration of sensory and motor blocks was significantly longer in the AF group than in the A group. The first time for analgesic need was also significantly longer in group AF (363 ± 134 min) than in group A (244 ± 84 min) (p = 0.001). The addition of fentanyl did not improve the onset of sensory and motor block times. Hemodynamic parameters were similar in the two groups. In conclusion, the addition of fentanyl to articaine in axillary block prolongs the duration of sensory and motor blocks, as well as the time of first analgesic requirement.

Evaluation of Recovery and Anesthetic Gas Consumption Using Remifentanil Combined with Low-Flow Sevoflurane Anesthesia in Tympanoplasty

Background: The aim of this study was to compare the effects of low-flow sevoflurane and low-flow sevoflurane supplemented with remifentanil anesthesia on the recovery time, consumption amount of the anesthetic drugs and hemodynamic differences. Materials and Methods: A prospective, randomized and double-blinded study with 50 patients was designed. Following intubation, group S received sevoflurane 1.8 vol%, oxygen, nitrous oxide at 4 l · min–1 and normal saline continuous infusion; group SR received sevoflurane 1.2 vol%, oxygen, nitrous oxide at 4 l · min–1 and 0.25 µg · kg–1 · min–1 remifentanil continuous infusions. Ten minutes after intubation the flow rates decreased to 1 l · min–1. Consumption of each drug, postoperative recovery characteristics and visual analog scale (VAS) scores for pain were recorded. Result: There were no significant differences in hemodynamic parameters, tramadol consumption and VAS scores for pain. The patients in group SR showed faster early recovery as compared to group S. The mean consumption of sevoflurane was 18 ml in group SR, while it was 25 ml in group S. Conclusions: Low-flow sevoflurane anesthesia combined with remifentanil regimen in patients undergoing tympanoplasty surgery resulted in a faster early recovery and decreased sevoflurane consumption.