Tümay Umuroğlu

Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol.

Background : Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children.

Histopathologic effects of lipid content of enteral solutions after pulmonary aspiration in rats

OBJECTIVE We compared the pulmonary histopathologic effects of different enteral formulas with various lipid contents during the subacute period of aspiration in rats. METHODS Fifty Wistar albino rats, weighing 180 to 300 g, were randomly assigned to one of five groups (n = 10). Anesthesia was induced with an intraperitoneal injection of 100 mg/kg of ketamine hydrochloride, rats were intubated endotracheally with a 16-gauge angiocatheter, and 0.9% saline (group 1, control), Impact (group 2), Jevity (group 3), Biosorb Energy Plus (group 4), or Pulmocare (group 5) with a lipid content of 0, 28, 39.3, 58, or 93.3 g/L, respectively, was injected into the lungs in a volume of 3 mL/kg. Seven days later, rats were killed, and lungs with trachea were removed en bloc for histopathologic examination. For histopathologic assessment, slides were examined for the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. The degree of severity was assessed by using a 4-point scale. One-way analysis of variance and Student-Newman-Keuls test were used for statistical analysis. RESULTS Peribronchial inflammatory cell infiltration was present in all groups but was significantly more severe in group 2 than in groups 1, 4, and 5 (P < 0.05). Alveolar edema was statistically higher in group 2 than in group 1 (P < 0.05). Alveolar septal infiltration was statistically higher in group 4 than in group 1. Alveolar histiocytes were statistically higher in groups 2 and 3 (P < 0.01) and groups 4 and 5 (P < 0.05) than in group 1. Alveolar exudate, interstitial fibrosis, granuloma, and necrosis formation were absent in all groups. CONCLUSION The pulmonary histopathologic effects of aspiration of Impact were severe peribronchial inflammatory cell infiltration (greater than aspiration of Biosorb and Pulmocare), abundant alveolar histiocytes, and alveolar edema in comparison with aspiration of saline, even though Impact had the lowest lipid content of all studied formulas. We concluded that the tissue damage occurring after pulmonary aspiration of Impact is more severe than after aspiration of Pulmocare.

Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation

It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video‐assisted laryngoscope devices for the management of difficult pediatric airway.

The effect of propofol and alfentanil on the increase in intraocular pressure due to succinylcholine and intubation.

Purpose The aim of this study was to evaluate the effects of propofol and alfentanil on the increase in intraocular pressure (IOP) due to succinylcholine and intubation, in comparison with thiopental sodium and vecuronium bromide. Methods Forty patients aged 20–50 years, scheduled for elective surgery requiring endotracheal intubation, were assigned to four groups of ten. General anesthesia was induced with 2.5 mg/kg propofol in Group I, 2.5 mg/kg propofol and 10 μg/kg alfentanil in Group II and 5 mg/kg thiopental in Groups III and IV; muscle relaxation was obtained with either 1.5 mg/kg succinylcholine (Group I, II and III) or 0.1 mg/kg vecuronium bromide (Group IV). In all patients mean arterial pressure, heart rate, oxygen saturation and IOP were recorded before (baseline) and after induction, after the muscle relaxant and after endotracheal intubation. Results Compared with their baseline values in Group I IOP decreased significantly after propofol (p<0.01) and increased significantly after intubation (p<0.01). In Group II IOP decreased significantly after propofol and alfentanyl (p<0.001), remained low after succinylcholine (p<0.01) and did not change after intubation. In Group III IOP decreased significantly after thiopental (p<0.001) and increased significantly after intubation (p<0.001). In Group IV it decreased significantly after thiopental (p<0.001), remained low after vecuronium (p<0.001) and increased significantly after intubation (p<0.05). Conclusions In all Groups, IOP did not increase significantly after succinylcholine, but only anesthesia induced with propofol and alfentanil prevented the increase in IOP due to intubation.

Perioperative Anesthetic and Surgical Complications of the Nuss Procedure

OBJECTIVE The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN A retrospective analysis. SETTING An academic hospital. PARTICIPANTS Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.

The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy.

For the treatment of postoperative pain, multimodal analgesia can reduce the side effects and required dose of opioids by combining drugs and methods with different modes of action. This study evaluated the efficacy of preoperative oral pregabalin and perioperative intravenous lidocaine in patients undergoing laparotomy.

The Preventive Effect of Dopamine Infusion in Rats with Abdominal Compartment Syndrome

ABSTRACT Background: The most significant perfusion disorder of the intra-abdominal viscera occurs in the abdominal compartment syndrome (ACS). Free oxygen radicals diffuse into the body during the reperfusion phase of ACS. Our aim was to determine the effects of dopamine infusion (3 μg/kg/min) on renal perfusion, cytokine levels, free oxygen radicals, and renal histopathological changes in the presence of ACS in a prospective randomized manner. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6). Group 1 was used as control. In group 2, air was inflated until the intra-abdominal pressure (IAP) reached 20 mmHg. In group 3, dopamine was infused for 60 min meanwhile IAP was kept at 20 mmHg. In group 4, dopamine was infused for 60 min before IAP rise. After this phase, renal artery (RA) perfusion was measured continuously. Myeloperoxidase activity (MPO), glutathione (GSH), and lipid peroxidation (MDA) levels were measured in tissue samples and histopathological scoring was performed. Results: Dopamine treatment before and during ACS significantly decreased MPO and MDA levels and also increased renal blood flow and GSH levels. However, histopathological damage was improved simultaneously. Conclusion: Dopamine infusion before and during ACS, increases renal perfusion and decreases free oxygen radicals. According to our findings, dopamine infusion may be proposed for the treatment of ACS and perfusion disorders in critically ill patients.

An Alternative Lung Isolation Technique in Paediatric Pulmonary Alveolar Proteinosis

Lung isolation during the lung lavage of children with pulmonary alveolar proteinosis (PAP) poses challenges to anaesthesiologists. There is no established technique in the management of lung lavage in children; each described technique has its own advantages and disadvantages. We described a patient (2.5-year-old) with PAP, who has undergone left lung lavage. While his lung was isolated by a Fogarty catheter, lavage was performed via a feeding tube, and the right lung was ventilated with a rigid bronchoscope. We suggested that the technique we used was safe and effective because it enabled direct visualisation of both bronchi entrances, allowing early recognition of any possible catheter dislocations at the bronchus of the lavaged lung, completely eliminating the risk of contralateral lung contamination. This case reports an alternative unilateral lung isolation and lavage technique that may be applicable to other paediatric patients with PAP.

Low Tidal Volume-Positive End-expiratory Pressure versus High Tidal Volume-Zero Positive End-expiratory Pressure and Postoperative Pulmonary Functions in Robot-assisted Laparoscopic Radical Prostatectomy

Objective: The aim was to compare the effects of low tidal volume (V_T) and moderate positive end-expiratory pressure (PEEP) with high V_T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V_T-PEEP and high V_T-ZEEP groups. The patients were ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP in the low V_T-PEEP group and a V_T of 10 mL/kg and 0 cm H₂O PEEP in the high V_T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V_T-PEEP group than in the high V_T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V_T-PEEP group than in the high V_T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V_T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V_T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP than in patients ventilated with a V_T of 10 mL/kg and ZEEP.

The Assessment of Intravascular Volume with Inferior Vena Cava and Internal Jugular Vein Distensibility Indexes in Children Undergoing Urologic Surgery

ABSTRACT Purpose: The purpose of this work is to assess the predictive value, for fluid responsiveness (FR), of the inferior vena cava distensibility index (IVC-DI) and internal jugular vein distensibility index (IJV-DI) in pediatric surgical patients. Material and Methods: Prior to being placed under general anesthesia, 24 surgical patients were enrolled. Baseline parameters were recorded with the patient in the semirecumbent position (Stage 1). Next, the passive leg raising (PLR) maneuver was carried out and a second measurement was recorded (Stage 2). Patients with an increase in the cardiac index (CI) of >10%, induced by PLR, were considered to be responders (R), otherwise they were classified as nonresponders (NR). At both stages, CI and DI of the IVC and IJV were measured. Results: Responders had higher IVC-DI and IVJ-DI than NR in stage 1 (both p <.001). In stage 2, IVC-DI and IJV-DI were not different in R and NR groups (p =.164, p =.201). Utilizing cut-off values of > 22.7% for IVC-DI and > 25% for IJV-DI, these parameters had positive correlation coefficients, both in R and NR of, respectively, 0.626 and 0.929. Conclusions: The IVC-DI predicts FR in anesthetized pediatric patients and correlates well with the IJV-DI; both may be used as prediction markers of FR in children.