Sevgi Bilgen

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 40 min before induction and were then randomly assigned to receive 2 mg/kg ketamine, 10 µg/kg alfentanil or 1 ml 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.

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 Effect of Flurbiprofen on Postoperative Sore Throat and Hoarseness After LMA-ProSeal Insertion: A Randomised, Clinical Trial

OBJECTIVE We hypothesized that flurbiprofen lozenges reduce the ProSeal laryngeal mask airway (LMA) related symptoms of Post Operative Sore Throat (POST), hoarseness and dysphagia compared to placebo lozenges. METHODS Eighty American Society of Anesthesiologists (ASA) I-II patients undergoing general anaesthesia with LMA were included in this prospective, randomized, placebo-controlled clinical and single centre (university hospital) study. Group F received an 8.75 mg flurbiprofen lozenge (Strefen(®)) and Group P received a placebo lozenge 45 minutes before the induction of anaesthesia. Postoperative sore throat, hoarseness and dysphagia were evaluated 30 minutes after removal of the LMA in the recovery room and then at 4, 12 and 24 h after surgery using a 4-point scale. Data were analysed using Students t test, and Fishers exact and Mann-Whitney U tests. A p value of <0.05 was considered statistically significant. RESULTS The 8.75 mg flurbiprofen lozenges reduced the severity of early (30 mins) POST and dysphagia. The severity of dysphagia at 4 h and hoarseness at 12 h were also significantly reduced in Group F. There were no significant differences betweeen the groups regarding incidence of sore throat, dysphagia and hoarseness throughout the study period. CONCLUSION Preoperative flurbiprofen lozenges reduce the severity of early postoperative sore throat and dysphagia.

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.

Collision Tumor: Dermoid Cysts and Mucinous Cystadenoma in the Same Ovary and a Review of the Literature

Collision tumor is defined as the coexistence of two adjacent, but histologically distinct tumors without histological admixture in the same tissue or organ. Collision tumors involving ovaries are extremely rare. The coexistence of a mucinous cystadenoma with a dermoid cyst is infrequently reported. However, the most common histological combination of collision tumor in the ovary is the coexistence of teratoma with mucinous tumors. If a dermoid cyst accompanies a multiseptated cyst and if the multiseptalcyst contains fatty foci, these two components may be associated. Recognizing the potential for the coexistence of these two neoplasms in the same ovary is essential to be able to make a correct diagnosis.

Comparing Effects of Intraventricular Hypertonic Saline and Magnesium Sulfate Application on Diffuse Brain Injury in Rats

E-mail : nurcankizilcik@yahoo.com Phone : +90 532 776 54 44 ABSTRACT Objective: Diffuse brain injury is one of the most common issues encountered in, patients with trauma and it leads to morbidity and mortality via increased intracranial pressure. The aim of the study was to compare the effects of magnesium sulfate and hypertonic saline on diffuse brain injury in rats. Materials and Methods: In this study 18 male Sprague-Dawley rats weighing 250-300 g were used. The rats were randomly divided into trauma (control), trauma+magnesium, and trauma+hypertonic saline groups. Traumatic brain injury was induced by modified Feeney head trauma model. A single dose of 10 μL isotonic saline, magnesium sulphate and hypertonic saline were applied intraventricularly to the control, magnesium, and hypertonic saline groups, respectively. Rats were decapitated 24 hours after the head trauma. Their brains were dissected immediately and stored with dry ice at -80 °C for histopathological experiments. Results: The number of damaged neurons were significantly higher in both control and hypertonic saline groups (p=0.001, p=0.008). However, the number of damaged neurons did not show significant difference between hypertonic saline and control groups, it was significantly lower in magnesium group (p<0.05). Conclusion: In this study, intraventricular magnesium application is found effective in reducing the number of the damaged neurons in rat traumatic brain injury model. These results suggest that magnesium usage may be evaluated for the treatment of patients with traumatic brain injury in further prospective studies.

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

BACKGROUND AND OBJECTIVES The 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. METHODS After 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. RESULTS Insertion 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. CONCLUSIONS Choosing 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.

Pyogenic granuloma: a rare case of an infantile intraoral lesion

Pyogenic granuloma (PG) is a non-neoplastic inflammatory hyperplasia that may be encountered in any part of the body including the oral mucosa. The onset of symptoms is mostly observed at adolescence in children. In this presentation, the second youngest case of gingival PG in the literature is reported to provide an insight into early neonatal gingival masses, which may be a stress factor for both the parents and the physician. A 4-month-old male baby was referred to our clinic with the complaint of erythema and swelling at the upper gingival floor, which was first observed 2 months ago by his mother before his admission. At physical examination, a soft, hyperemic mucosal lesion was observed that protruded from the upper gingival floor. After the excision, granulomatous-type PG was diagnosed. The excision site healed and the postoperative period was uneventful. The gingiva is the most common intraoral site of PG as in our case, but this localization is specific for the older age group rather than in infants. Intraoral lesions of neonatal period are unfamiliar to the parents resulting in their anxiety. The PG is a benign lesion that can be healed completely, with good cosmetic results.