Zehra Baykal Tutal

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist

PURPOSE To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. PATIENTS AND METHODS Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. RESULTS SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). CONCLUSION Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Regional Anesthesia For A Patient With Severe Kyphoscoliosis In Percutaneous Nephrolithotomy Surgery

Scoliosis is a deformity of the spine resulting in a lateral curvature of the spine. Patients with scoliosis present unusual challenges for the administration of anesthesia during surgical procedures. The most common problems are airway management and respiratory problems (1). Regional anesthesia might also be difficult in this type of patients. We report a case of successful combined spinal epidural anesthesia in a patient with severe kyphoscoliosis.

Hypothermia Frequency of Patients in the Postoperative Period

In this study, we aimed to investigate the frequency of postoperative hypothermia in our hospital.In Kecioren Training and Research Hospital, 165 ASA I-III patients between the ages of 18 and 81, whose operation times were longer than 30 minutes were included in this study. In addition to recording the demographic data of the patients, the body temperatures were also measured twice in the preoperative preparation room, and in the postoperative care unit in the forehead with infrared thermometers. The operation types, the durations, the anesthesia types, and the patients’ heating status in the perioperative period were recorded. If the body temperature was 35oC or below, it was accepted as hypothermia; and if it was 34oC and below, it was accepted as deep hypothermia. We compared the data of normothermic, hypothermic and deep hypothermic patients. 79 women (47.9%) and 86 men (52.1%), totally 165 patients were included in this study. It was detected that 7 patients (4.2%) were heated preoperatively. It was determined that 16 patients (9.7%) were hypothermic in the postoperative period, and 3 of them were deep hypothermic. There were no statistically meaningful differences between the hypothermic and non-hypothermic patients in terms of age, gender, ASA, type of anesthesia, and operation time (p>0.05). Although postoperative hypothermia has not been found as a common problem in our operating theaters, we observed that most of the postoperative hypothermia cases were in percutaneous urological operations. In order to reduce the frequency of postoperative hypothermia, specific precautions for this type of operations should be taken.

A 5-Year Evaluation of Invasive Device-Associated Infections Rates in Intensive Care Unit of a Training Hospital in Turkey -

Objective: This study aimed to determine invasive instrument-related infections in the general intensive care unit by comparative evaluation of the annual infection control measures. Methods: A surveillance study was made based on the data of 1494 patients treated for 48 hours in the general intensive care unit (GICU) between January 2008 and December 2012. Results: The hospital infection (HI) rates of the GICU for each year of the study period were calculated as 29.15%, 28.85%, 16.62%, 18.05% and 8.30% respectively. For each 1000 patient days, the infection rates for each year were calculated as ventilator-related pneumonia (VRP) 2.31, 4.32, 2.77, 11.49 9.62, central venous catheter-related bloodstream infections (CVCRBI) 1.57, 2.23, 8.58, 0.56, 1.03, and catheter-related urinary system infections (CRUSI) 6.00, 7.09, 4.35, 4.57, 3.17. When the infection agents were isolated and evaluated, the infection rates were determined as 61.92% Gr(-) bacteria infections, 20.89% fungal infections and 17.16% Gr(+) bacteria infections. Conclusions: Although the infection control precautions which were taken improved urinary and central catheter infection rates, no significant fall was obtained in rates of ventilator-related pneumonia. It can be concluded that it is necessary to increase the infection control precautions in this area to reduce infection rates.

Late Local Anaesthetic Toxicity After Infraclavicular Block Procedure

Local anaesthetic (LA) toxicity is the most fatal complication of peripheral nerve block techniques. Accidental intravascular application or use of doses above the safety range are the most common cause of toxicity. Bupivacaine is a long-acting LA frequently used for long procedures or those associated with significant post-procedural pain. Fatal central nervous system and cardiovascular system toxicity are described. In this paper, we reported a young patient who showed LA toxicity symptoms 7 h after an infraclavicular peripheral block.

Preemptive Segmental Epidural Levobupivacaine Administration and Wound Infiltration Following Posterior Fusion Surgery: A Case Serie

ABS TRACT Objective: The current study aimed to provide intraoperative smooth wake-up test and postoperative effective analgesia by segmental epidural analgesia and wound infiltration in patients undergoing posterior fusion surgery. Material and Methods: Fifteen ASA I-II adolescent patients aged 11-16 undergoing posterior fusion and instrumentation were included to the study. After general anesthesia with standard intravenous anesthesia, epidural catheter was inserted to all patients in lateral decubitus position. Following confirmation of the place of the catheter under scopy, initially 3-4 ml of prepared mixture was administered from the catheter and then the catheter was retracted and during retraction, 1-2 mL of the mixture was given to each segment. Neuromonitorization was achieved with motor evoked potential (MEP). Postoperative pain was evaluated with visual analogue scale (VAS). Paracetamol infusion and nonsteroidal antiinflammatory analgesics were given for routine postoperative pain management. Intravenous patient-controlled analgesia with morphine was prepared to be given in case of VAS score higher than 40. Results: In all patients effective analgesia was achieved for postoperative 24 hours. No side effects and hemodynamic impairment were observed. The highest pain scores were obtained at the postoperative 12th hour and during movement. There was no requirement for morphine patient controlled anesthesia (PCA) as VAS values were lower than 40. The sleep quality of patients and the patient satisfaction were very good in all patients. Conclusion: Segmental epidural analgesia with a preoperatively placed epidural catheter and wound infiltration is a simple and reliable method for effective pain control in posterior fusion and instrumentation surgery in patients with adolescent idiopathic scoliosis.

Efeito da infusão de esmolol sobre a necessidade de anestesia no intraoperatório e analgesia, náusea e vômito no pós-operatório em um grupo de pacientes submetidos à colecistectomia laparoscópica

PURPOSE Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. METHODS Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I - Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II - Only propofol and remifentanil was used during maintenance, III - Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV - Only desflurane and remifentanil was used during maintenance. They have been followed up for 24h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. RESULTS VAS scores were significantly lowest in group I (p=0.001-0.028). PNV incidence was significantly lowest in group I (p=0.026). PNV incidence was also lower in group III compared to group IV (p=0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p=0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p=0.001) however blood pressures were similar in all groups (p=0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p=0.024-0.03). CONCLUSION Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.