Tugba Karaman

The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients

BACKGROUND/AIM Anesthesiologists have encountered various difficulties in securing the airway. Therefore, we compare the intubation times and hemodynamic changes between the McGrath Series 5 video laryngoscope and the Macintosh laryngoscope. MATERIALS AND METHODS A total of 80 obstetric patients were divided into 2 groups, orotracheally intubated with either the McGrath video laryngoscope or the Macintosh laryngoscope. The intubation times, Cormack-Lehane grade, percentage of glottic opening, mean arterial blood pressure, and heart rates were compared among the groups. RESULTS Intubation time in the McGrath video laryngoscope group was significantly longer than in the Macintosh laryngoscope group (P <0.01). The percentage of glottic opening was found to be higher in the McGrath video laryngoscope group (P = 0.002). CONCLUSION The McGrath Series 5 video laryngoscope provides excellent views during orotracheal intubation in obstetric anesthesia with normal airways.

Central nervous system toxicity after acute oral formaldehyde exposure in rabbits: An experimental study

Formaldehyde (FA) is one of the most widely used chemical compounds in industrial field. It is described as toxic, particularly to the nervous system, the urogenital system, and the respiratory tracts. In this study, we determined the effects of acute oral exposure to FA in rabbit brain tissue. A total of 16 rabbits were selected and divided into 2 groups: formaldehyde group (group F) and control group (group C). FA was administered to group F at a rate of 40 mg/kg/day via a nasogastric tube for 5 days. Saline was similarly administered to the eight controls. All the animals were euthanized after 5 days of exposure, and brain tissue samples were collected in 10% neutral formalin and embedded in paraffin. To investigate the effects of FA on the apoptotic process, we examined active caspase-3, Bax, and Bcl-2 immunohistochemical expression and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate –biotin nick-end labeling (TUNEL) reactivity in the rabbit brains. In addition, glial fibrillary acidic protein (GFAP) was biochemically assessed in brain tissue samples for neurotoxicity. We found that FA treatment caused a significant decrease in Bcl-2 expression and an increase in active caspase-3 and Bax expressions as well as an increase in the number of TUNEL-positive apoptotic cells. The GFAP level was found to be significantly higher in group F. In conclusion, acute oral exposure to FA caused DNA damage, apoptosis, and neuronal injury in the rabbit brains.

Retrospective Evaluation of Anesthesia Approaches for Lumbar Disc Surgery

Objective: Lumbar spinal surgeries have been performed with either spinal or general anesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anesthesia on one-level lumbar discectomies. Methods: After approval of Ethics Committee, we retrospectively analysed 328 patients those administered either spinal or general anesthesia for elective one-level lumbar discectomies over a two-year period. Patient records were reviewed to obtain demographic features, type of anesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate and mean arterial pressure, duration in the operating room, amount of intravenous fluids, estimated blood loss, incidence of perioperative complications such as bleeding, nauseavomiting, hypotension and bradycardia, and postoperative analgesic consumption. Results: Patient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea-vomiting (p = 0.002 and p < 0.01, respectively). Analgesic comsumption in general anesthesia group was significantly higher than in spinal anesthesia group (p < 0.01). Conclusion: The present study revealed that spinal anesthesia is an effective alternative to general anesthesia in lumbar spinal discectomy.

Intraocular pressure changes: the McGrath video laryngoscope vs the Macintosh laryngoscope; a randomized trial

STUDY OBJECTIVE To determine the effects of the McGrath Series 5 video laryngoscope on intraocular pressure (IOP) during laryngoscopy. DESIGN Prospective, randomized, double blind. SETTING Operating room. PATIENTS Eighty adult patients of American Society of Anesthesiologist physical status 1 scheduled for nonophthalmic elective surgery under general anesthesia. INTERVENTIONS The endotracheal intubation was provided using McGrath series 5 video laryngoscope in MG group (n=40) or Macintosh laryngoscope in M group (n=40). MEASUREMENTS The IOP of the right and left eyes was measured before and after the laryngoscopic process. MAIN RESULTS The mean arterial blood pressure values just before laryngoscopy and intubation and after intubation were 77.38±6.18 and 97.38±12.77 in the McGrath video laryngoscope group and 75.85±7.88 and 99.12±14.30 in the Macintosh laryngoscope group, respectively. The IOP values of the left eye after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group were found to be significantly higher than those in the McGrath video laryngoscope group (P=.019, P=.019, and P=.007, respectively). In addition, the IOP values of the right eye were found to be higher after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group, compared to the McGrath video laryngoscope group (P=.009, P=.021, and P=.011, respectively). The mean IOP values for the left eye just before laryngoscopy and intubation and after intubation were 10.65±2.52 and 15.57±3.62 in the McGrath video laryngoscope group, and for the right eye, they were 10.60±1.64 and 17.17±2.38 in the Macintosh laryngoscope group, respectively. CONCLUSION The McGrath Series 5 video laryngoscope may provide a lower IOP level compared to the Macintosh laryngoscope in an otherwise healthy, young patient population.

Laparoskopik bariatrik cerrahide anestezi yönetimi: 3 yıllık uygulamada perioperatif komplikasyonlar ve sonuçlar

Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1%) underwent laparoscopic roux-en-Y anastomosis, 44 (42.3%) underwent laparoscopic sleeve gastrectomy, and 11 (10.6%) underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication). Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2): 200-205

Evaluation of the perfusion index according to the visual analog scale in postoperative patients

Objectives: To evaluate the possible value of the perfusion index (PI) as a tool for pain assessment. Methods: This prospective, observational study was performed with 89 patients underwent surgery with general anesthesia. The patients with visual analog scale (VAS)>3 were grouped as M1, and patients with VAS≤3 and performed morphine were grouped as M2. After surgery patients with VAS>3 were given 2mg morphine. Patients with VAS>3 were given increments of intravenous morphine (2 mg) at 20 minute intervals until VAS<3. The correlation and difference between PI and VAS score values were evaluated before and after analgesic administration. Results: Significant changes were found in both PI values and VAS scores between M1 and M2 groups (2.80±0.77, 3.97±0.94, p<0.001; 6.60±1.20, 2.74±0.46, p<0.001) Despite no correlation was found between PI values and VAS scores of M1 and M2 groups, weak negative correlation was detected between differences in PI values and VAS scores among groups (r=-0.255, p=0.016). Conclusion: Perfusion index is a parameter that can be used in the assessment of postoperative pain and responses to analgesics.

Efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total: um estudo randômico e controlado

BACKGROUND AND OBJECTIVES A transversus abdominis plane block is a peripheral block method that has been used successfully for pain relief after total abdominal hysterectomy. However, the effects of the combination of the transversus abdominis plane block and general anesthesia on analgesic and anesthetic requirements remain unclear. This randomized placebo-controlled study is aimed to evaluate the effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy under general anesthesia. METHODS Sixty-six women undergoing total abdominal hysterectomy were randomized into two groups to receive general anesthesia alone (control group) or with transversus abdominis plane block using 20mL of 0.25% bupivacaine (transversus abdominis plane group). Intraoperative remifentanil and sevoflurane consumption were recorded. We also evaluated the postoperative pain, nausea, quality of recovery scores and rescue analgesic requirement during postoperative 24hours. RESULTS The total remifentanil and sevoflurane consumption is significantly lower in transversus abdominis plane group; respectively mean (SD) 0.130 (0.25) vs. 0.094 (0.02) mcg.kg-1.min-1; p<0.01 and 0.295 (0.05) vs. 0.243 (0.06) mL.min-1; p<0.01. In the postoperative period, pain scores were significantly reduced in transversus abdominis plane group soon after surgery; median (range) 6 (2-10) vs. 3 (0-5); p<0.001, at 2h (5 [3-9] vs. 2.5 [0-6]; p<0.001), at 6h (4 [2-7] vs. 3[0-6], p<0.001), at 12h (3.5 [1-6] vs. 2 [1-5]; p=0.003). The patients in the transversus abdominis plane group had significantly higher QoR-40 scores 190.5 (175-197) vs. 176.5 (141-187); p<0.001). CONCLUSION Combining transversus abdominis plane block with general anesthesia can provide reduced opioid and anesthetic consumption and can improve postoperative pain and quality of recovery scores in patients undergoing total abdominal hysterectomy.

Comparison of Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)‐guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery.

Evaluation of Postoperative Analgesic Cafter Emergency and Elective Cesarean Section

OBJECTIVE: This study compares post-operative pain and analgesic consumption among patients who have undergone either an emergent or elective caesarean section. STUDY DESIGN: A total of 115 patients, comprised of 48 emergency caesarean section and 67 elective caesarean section patients, were enrolled in this prospective study. Pain intensity was evaluated with a numeric pain scale in the 1st, 2nd, 6th, 12th and 24th post-operative hours and total post-operative tramadol consumption within 24 hours was recorded for each patient. RESULTS: Total tramadol consumption for emergency caesarean section patients under general anesthesia was 222.91±56.52 mg and for elective caesarean section patients under general anesthesia was 181.71±55.38 mg (p 0.05). CONCLUSION: Analgesic consumption for emergency caesarean section patients under general anesthesia was observed to be high.

The effect of patient positions on perfusion index

BackgroundThe optimal position for surgery is one in which the patient is provided the best possible surgical intervention and put at minimum risk. Different surgical positions may cause changes in tissue perfusion. This study investigates the relationship between surgical patient positions and perfusion index.MethodsA sample of 61 healthy individuals with no peripheral circulatory disorders, chronic diseases, or anemia was included in this study. Participants held six different positions: supine, prone, 45-degree sitting-supine, 45-degree supine with legs lifted, Trendelenburg (45-degrees head down), and reverse Trendelenburg (45-degrees head up). Perfusion index values were then measured and recorded after individuals held their positions for five minutes.ResultsParticipants’ perfusion index values were affected by different body positions (p < 0.05). Perfusion index was lowest in the sitting position (4.5 ± 2.5) and highest in individuals with Trendelenburg position (7.8 ± 3.8).ConclusionDifferent body positions can cause changes in tissue perfusion. This should be considered in patient follow-up along with the perfusion index.