Tayfun Apuhan

Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy.

The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients.

The Developmental Relation between Adenoid Tissue and Paranasal Sinus Volumes in 3-Dimensional Computed Tomography Assessment

Objective. The aim of this study was to evaluate the developmental relationship between the volumes of paranasal sinuses and adenoid tissue by using a 3-dimensional (3D) reconstruction technique. Study Design. Cross-sectional study. Setting. Tertiary referral center. Subjects and Methods. Multislice computed tomography (MSCT) images were obtained using 3D reconstructions and a volume-rendering technique (VRT) in 69 boys and 35 girls aged 3 to 16 years, and bilateral maxillary, frontal, and sphenoid sinus volumes, as well as adenoid tissue volume marked in axial-coronal-sagittal planes, were calculated. The patients were grouped in 3 categories according to adenoid tissue volumes, and comparisons were made. Results. There was no significant difference between the right maxillary volume and left maxillary volume (P = .93). No significant difference was noted between the groups in terms of age and gender. There was no significant correlation between frontal, sphenoid, right and left maxillary, or total maxillary sinus volumes in all 3 groups of patients. Conclusion. When classified according to adenoid tissue size, it was observed that increasing adenoid tissue volumes did not significantly affect the development of paranasal sinuses. Developmentally, there are no statistically significant correlations between the volumes of paranasal sinuses and adenoid tissues.

Comparison of lidocaine and levobupivacaine in transnasal fiberoptic laryngoscopy.

Background The anatomy of the nasal passages, pharynx, and larynx and evaluation of mucous membranes and laryngeal function is well observed by transnasal fiberoptic laryngoscopy (TFL). In this procedure, to provide good local infiltrative analgesia, medication such as anesthetics is important for the otolaryngologist. The aim of this study was to evaluate the efficacy of lidocaine (L) spray, compared with levobupivacaine solution, used for local anesthetic in patients undergoing TFL for complete examination. Methods Sixty-two subjects (39 men and 23 women; mean age, 36 ± 7 years) were enrolled in the study. Patients were randomly classified into two groups as levobupivacaine hydroclorur (LB) and L groups. A standard flexible transnasal fiberoptic 4.2-mm-diameter laryngoscope was passed through the nasal cavity and into the aerodigestive tract. Patients were asked to evaluate the intensity of the pain they experienced during the TFL, using a visual analog scale (VAS) and Ramsay sedation scale. Results Demographic data were similar in both groups. There was no difference in VAS and Ramsay res between bith groups (p > 0.05). Conclusion Our findings indicated that topical levobupivacaine seems to be an effective medication for anesthesia of the nasal mucosa and may be used to allow complete examinations involving TFL.

Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty.

Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P ≤ 0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P < 0.001 and P < 0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (P = 0.002 and P < 0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients.

Celiac disease and sensorineural hearing loss in children

Abstract Conclusion: Sensorineural hearing loss (SNHL) is a neurological situation and celiac disease (CD) may be seen coincidentally. Children with clinical signs of hearing deficiency of unknown etiology should be assessed for CD. Objective: CD is a chronic inflammatory gluten-dependent intestinal disease and has extraintestinal findings. The aim of this study was to determine the incidence of CD and SNHL in our pediatric patients. Methods: A total of 25 pediatric patients (50 ears) with biopsy-proven CD were diagnosed in the pediatric gastroenterology department; 25 healthy control subjects (50 ears) were also included in the study. All subjects underwent pure tone audiometry at frequencies of 250–8000 Hz and tympanometry. Results: In the patients and controls, normal peak compliance, gradient, peak pressure, ear canal volume, and acoustic reflexes were obtained by tympanometry. There was no air–bone gap in any of the participants. There was a statistically significant difference between the audiometric results in the CD and control groups (right ear and left ear) (p < 0.05).

The Effect of Prilocaine or Levobupivacaine Infiltration on Pain during Nasal Packing Removal

Objective. The aim of this study was to evaluate the efficacy of rehydration of Merocel nasal packs with prilocaine or levobupivacaine on reducing pain and discomfort of nasal packing removal in patients who had undergone septoplasties or endoscopic sinus surgery. Study Design. Prospective clinical study. Setting. Tertiary referral center. Methods. This prospective study was conducted on 72 patients, aged 18 to 55 years, who had undergone septoplasty, bilateral functional endoscopic sinus surgery, or both. The patients were divided into 2 groups: prilocaine group (group P, n = 36), who received 2.5 mL of 2% prilocaine, and levobupivacaine group (group L, n = 36), who received 2.5 mL of levobupivacaine hydrochloride dilution. These solutions were diluted with 2.5 mL saline to a final volume of 5 mL, which was then injected into the Merocel packing 15 minutes before removal of the pack. In both groups, 5 mL of saline was injected into the packing in the contralateral nostril as a control 15 minutes before removal of the pack. Visual analog score (VAS) and the Ramsay sedation score were recorded. Results. Statistically significant differences were found in VAS and Ramsay sedation scale scores of levobupivacaine and prilocaine groups compared to controls. No significant difference was noted between the groups in terms of levobupivacaine and prilocaine. Conclusions. Levobupivacaine or prilocaine infiltration before removal of nasal packs in patients who undergo septoplasties or endoscopic sinus surgery can decrease discomfort and improve patient tolerability.

Otosclerosis and vitamin D receptor gene polymorphism

OBJECTIVE The possible genetic relationship between otosclerosis and Vitamin D Receptor (VDR) gene polymorphism is uncertain. The aim of this study is to assess association between otosclerosis and VDR gene polymorphisms. STUDY DESIGN Case-control Studies. SETTING Tertiary referral center. SUBJECTS AND METHODS Clinical diagnosis of stapes fixation was based on otoscopic, audiometric, tympanometric and surgical findings. We identified 25 eligible patient and 60 controls to investigate the association of the VDR gene polymorphisms FokI, BsmI, ApaI, and Taq I with otosclerosis. The patient and control DNA was genotyped for; VDR Bsm I (rs1544410), VDR Apa I (rs7975232), VDR Taq I (rs731236) and VDR Fok I (rs2228570) gene. Primer, simple probe sequences was genotyped by RT-PCR restriction fragment length polymorphism. RESULTS There was a statistically significant association between VDR gene and otosclerosis in polymorphism Taq I, Apa I and Bsm I. There was no significant association between VDR gene and otosclerosis in polymorphism Foq I. CONCLUSION Three polymorphisms (Taq I, Apa I and Bsm I) in the VDR gene appear to be associated to susceptibility to otosclerosis disorder with otosclerosis patients.

A case of anesthesia mumps after general anesthesia

To the Editor: We report a 57-year-old female patient who underwent a correction of surgical scar and sagging of the abdominal skin by plastic surgeons. She was 155 cm and 95 kg, with body mass index 37.5 kg/m. She had a history of arterial hypertension for 5 years. General anesthesia was induced by propofol 3 mg/kg and fentanyl 1 lg/kg. Endotracheal intubation was performed with muscle relaxation using rocuronium bromide 0.6 mg/kg after assisted ventilation and induction. Maintenance of anaesthesia was achieved with sevoflurane (2–3 vol%) in 50% O2 and 50% air. The patient was extubated without any problems at the end of the surgery. In the recovery room, a painless swelling on the left pre-auricular and post-auricular areas extending up to the angle of the mandible was detected (Fig. 1). In addition, there was crepitation on palpation. There was no evidence of inflammation. The left parotid gland swelling was decreased in the next 24 h and resolved completely in 2 days. Pneumoparotitis is a postoperative complication of general anesthesia characterized by acute transient swelling of the parotid gland that is defined as ‘‘anesthesia mumps.’’ Anesthesia mumps is a rare and interesting clinical entity. However, the phenomenon is a clinical condition well known to experienced anesthesiologists. This clinical entity results from air refluxing into the parotid ductal system via an incompetent Stensen duct orifice [1]. These swellings usually resolve spontaneously over a period of a few hours to a few days without any known sequelae [2]. The exact mechanism of the development of pneumoparotitis in not fully understood. Stensen’s duct leaves the lateral surface of the parotid gland, passes lateral to the masseter muscle, and enters the oral cavity through the buccal tissues adjacent to the maxillary first and second molars [3]. Possible explanations include positive pressure ventilation during general anesthesia and increased pressure in the oral cavity. Pneumoparotitis has been reported in the following situations or maneuvers in the literature: wind instrumentalists, balloon and glass blowers, bicycle tire inflation by mouth, dental procedures using air-powered equipment, cough in chronic obstructive pulmonary disease and cystic fibrosis, nose blowing, whistling, valsalva maneuver to clear ears, and spirometry [4]. We thought that the clinical picture in the present case may have resulted from intra-oral pressure increase via mask ventilation during general anesthesia. Medical history and physical examination are important in the differential diagnosis of the disease. Obstructive, inflammatory, metabolic, and neoplastic causes of parotid gland enlargement should be ruled out. Crepitation on palpation is diagnostic for pneumoparotitis, but it can be mistaken in up to 50% of the patients [4]. Gland swelling, erythema, and tenderness on palpation may be detected in pneumoparotitis as a consequence of inflammation and infection [5]. In our case; the clinical examination showed swelling of the gland and crepitation on palpation, but erythema and pain were not observed. In conclusion, parotid gland enlargement with air after general anesthesia is a rare condition. Medical history, physical examination, and radiologic studies may play an important role in the differential diagnosis and management of the condition. U. Y. Tekelioglu (&) A. Akkaya A. Demirhan H. Bayır H. Kocoglu Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey e-mail: drtekelioglu@yahoo.com

The effects of desflurane and sevoflurane on the peri- and postoperative bleeding of adenotonsillectomy patients

OBJECTIVE To compare the effects of, volatile anesthetics, desflurane and sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. MATERIAL AND METHOD Totally 40 children (14 girl and 26 boys) aged between 2 and 16years were included in this prospective randomized double-blind clinical trial. The patients underwent conventional cold tonsillectomy and curettage adenoidectomy under general anesthesia. For the maintenance of anesthesia, the patients were randomized into two groups; desflurane group and sevoflurane group, each including 20 subjects. Desflurane concentration was set between 4% and 6% (0.7-0.9 MAC), whereas sevoflurane concentration was set between 2% and 2.5% (0.7-0.9 MAC). The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient. RESULTS Desflurane caused significantly lower amount of perioperative bleeding compared to sevoflurane (p=0.03). No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively (p=0.20, p=0.49, p=0.07). CONCLUSION Desflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding than sevoflurane during tonsillectomy and adenoidectomy operations.

Is there any developmental relationship between mastoid pneumatization and adenoid tissue volume

OBJECTIVE The aim of this study was to investigate the developmental relationship between adenoid tissue volume and mastoid air cell volume, using a 3D reconstruction technique. STUDY DESIGN Cross-sectional retrospective study. SUBJECTS AND METHODS Multislice computed tomography (MSCT) images were obtained using three-dimensional (3D) reconstruction and volume-rendering techniques (VRT). The subjects were 63 boys and 37 girls, 3-16 years of age. The volumes of bilateral mastoid air cells and adenoids marked in axial-coronal-sagittal planes were calculated. The patients were grouped into three categories according to adenoid tissue volume, total mastoid volume (TMV), and age. RESULTS No significant difference was noted between the right mastoid volume (RMV) and the left mastoid volume (LMV) or between age and sex (p=0.368; p=0.549; p=0.454). The incremental increase in adenoid tissue volume did not correlate with TMV (r=-0.161, r=-0.279, r=0.015). The incremental increase in TMV did not correlate with the volume of adenoid tissue (r=0.024, r=0.148, r=0.017). CONCLUSIONS No significant correlation was obtained between the incremental increase in adenoid tissue volume and TMV or the incremental increase in TMV and adenoid tissue volume. There does not seem to be a developmental relationship between adenoid tissue volume and TMV.