Seref Otelcioglu

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.

Oral magnesium lozenge reduces postoperative sore throat: a randomized, prospective, placebo-controlled study.

Background: Postoperative sore throat (POST) is an undesirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The present study aimed to investigate the effect of preoperative administration of oral magnesium lozenge on POST. Methods: Seventy patients undergoing orthopedic surgery were randomly allocated into two groups, to either receive placebo (control) or magnesium lozenges (magnesium) to be dissolved by sucking 30 min preoperatively. Patients were assessed for incidence and severity (four-point scale, 0–3) of POST at 0, 2, 4, and 24 h postoperatively. The primary outcome was sore throat at 4 h after surgery. The secondary outcome was the severity of POST at four evaluation time-points postoperatively. Results: The incidence of POST at 4 h was higher in control group than in magnesium group (95% CI: 26%, 14–42%; P = 0.032). The highest incidence of POST occurred at the second hour after surgery, with the rate of 23% in the magnesium group and 57% in the control group (95% CI: 34%, 20–51%; P = 0.007). The severity of POST was significantly lower in the magnesium group at 0 (P = 0.007) and 2 h (P = 0.002). The incidences of POST at 0 and 24 h and severity scores at 4 and 24 h were not significantly different between the groups. Conclusions: The administration of magnesium lozenge 30 min preoperatively is effective to reduce both incidence and severity of POST in the immediate postoperative period.

Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol.

Background and objective The aim of this study was to compare the efficacy of pretreatment with paracetamol 0.5 mg kg−1, 1 mg kg−1, 2 mg kg−1 and lidocaine 0.5 mg kg−1 for prevention of propofol induced pain. Methods In this double-blind, placebo-controlled study, 250 adult patients ASA I or II, scheduled to undergo elective surgery, were randomly assigned into five groups of 50 each. Group P0.5, group P1 and group P2 received 0.5, 1 and 2 mg kg−1 paracetamol respectively; group L received 0.5 mg kg−1 lidocaine; and the control group, group C, received isotonic saline pretreatment in the dorsum of the hand, followed by propofol 1 min later. A blinded researcher assessed the patients pain level via a four-point scale. Results There were no significant differences in patient characteristics among the groups. The incidence of propofol injection pain in all treatment groups was significantly lower than in the control group (P < 0.001). When the paracetamol 0.5 mg kg−1 group was compared with both the paracetamol 1 mg kg−1 group (P < 0.01) and the paracetamol 2 mg kg−1 group (P < 0.001), significant differences were observed. In the lidocaine 0.5 mg kg−1 group propofol injection pain was significantly reduced compared with the paracetamol 0.5 mg kg−1 group (P < 0.01). However, in the paracetamol 2 mg kg−1 group pain was more significantly reduced than in the lidocaine 0.5 mg kg−1 group (P < 0.001). In the paracetamol 2 mg kg−1 group the incidence of pain was significantly less than in paracetamol 1 mg kg−1 group (P < 0.001). Conclusion When given as venous retention pretreatments 1 min before propofol, paracetamol 1 mg kg−1 and lidocaine 0.5 mg kg−1 were equally effective in attenuating pain during intravenous (i.v.) injection of propofol whereas pretreatment with paracetamol 2 mg kg−1 was shown to be the most effective treatment.

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

Effectiveness of the C-MAC video laryngoscope in the management of unexpected failed intubations

BACKGROUND AND OBJECTIVES The purpose of this study was to review the experiences of an anesthesiology department regarding the use of a C-MAC videolaryngoscope in unexpected failed intubation attempts. METHODS Data were analyzed from 42 patients whose intubation attempts using Macintosh direct laryngoscopes had failed, and on whom a C-MAC videolaryngoscope was utilized as the primary rescue device. The success rate of C-MAC in intubation was assessed, and laryngeal views from both devices were compared. RESULTS The Cormack and Lehane score was III in 41 patients, and IV in one patient, with the Macintosh laryngoscope, while Cormack and Lehane score was I in 27 patients, II in 14 and III in one with CMAC. Tracheal intubation with CMAC was successful on the first attempt in 36 patients (86%), and on the second attempt in 6 patients (14%). No complications were observed other than minor damage (blood on blade) in 8 patients (19%). CONCLUSION These data provide evidence for the clinical effectiveness of C-MAC videolaryngoscope in managing the unexpected failed intubations in routine anesthesia care. The C-MAC videolaryngoscope is efficient and safe as a primary rescue device in unexpected failed intubations.

Prevention of propofol injection pain in children: a comparison of pretreatment with tramadol and propofol-lidocaine mixture.

Background: The pain on propofol injection is considered to be a common and difficult to eliminate problem in children. In this study, we aimed to compare the efficacy of pretreatment with tramadol 1 mg.kg-1and propofol-lidocaine 20 mg mixture for prevention of propofol induced pain in children. Methods: One hundred and twenty ASA I-II patients undergoing orthopedic and otolaryngological surgery were included in this study and were divided into three groups with random table numbers. Group C (n=39) received normal saline placebo and Group T (n=40) received 1 mg.kg-1 tramadol 60 sec before propofol (180 mg 1% propofol with 2 ml normal saline) whereas Group L (n=40) received normal saline placebo before propofol-lidocaine mixture (180 mg 1% propofol with 2 ml %1 lidocaine). One patient in Group C was dropped out from the study because of difficulty in inserting an iv cannula. Thus, one hundred and nineteen patients were analyzed for the study. After given the calculated dose of propofol, a blinded observer assessed the pain with a four-point behavioral scale. Results: There were no significant differences in patient characteristics and intraoperative variables (p>0.05) except intraoperative fentanyl consumption and analgesic requirement one hr after surgery among the groups (p<0.05). Both tramadol 1 mg.kg-1 and lidocaine 20 mg mixture significantly reduced propofol pain when compared with control group. Moderate and severe pain were found higher in control group (p<0.05). The incidence of overall pain was 79.4% in the control group, 35% in tramadol group, 25% in lidocaine group respectively (p<0.001). Conclusions: Pretreatment with tramadol 60 sec before propofol injection and propofol-lidocaine mixture were significantly reduced propofol injection pain when compared to placebo in children.

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.

Differences in tip visibility and nerve block parameters between two echogenic needles during a simulation study with inexperienced anesthesia trainees

Needle tip visualization during ultrasound-guided regional anesthesia (UGRA) is necessary for safety and efficacy. However, disruption of the image of the needle tip driven toward the target is a general problem, especially for beginners. The purpose of this study was to compare performance parameters between using the Sonoplex and Stimuplex D-Plus echogenic needles in a simulated ultrasound-guided interventional task by inexperienced anaesthesia residents. After a standardized training session, 28 anesthesiology residents performed simulated nerve blocks in a beef phantom with each needle. All ultrasound images were digitally stored for analysis. The absolute time the needle tip was in view, total procedure time, and angle of needle insertion were subsequently measured objectively by two single investigators. The procedures that used the Sonoplex echogenic needle had significantly better tip visibility and shorter total procedure time at insertion angles between 42° and 64° relative to the phantom surface. We have demonstrated that inexperienced users who used the Sonoplex echogenic needle were able to complete the procedure more quickly. Needles with improved visibility would be a very useful addition to UGRA for inexperienced users.