Psychometric properties of Iowa Anesthesia Satisfaction Scale Turkish version.

BACKGROUND: The Iowa Satisfaction with Anesthesia Scale (ISAS) is a valid and reliable measurement tool developed to evaluate patient satisfaction with anesthesia care during different surgical interventions. It is adapted to various languages and used in many studies. Considering the satisfaction of the patient with anesthesia applied in surgical procedures, the presence of such a measurement tool is crucial. AIM: From this point of view, the study aimed to evaluate psychometric properties of the ISAS by adapting it to Turkish culture. METHODS: In this study, a descriptive, methodological and cross-sectional design was used. A total of 210 patients who underwent surgery under general or regional anesthesia were in the study. RESULTS: ISAS Turkish version (ISAS-T) shows good reliability which is obvious with a Cronbach's alpha value of 0.80. The correlation levels of the items with the ISAS total score were calculated between .45 and .73. Test-retest reliability was calculated as 0.83. CFA analysis was applied to the one-dimensional 11-item final version of ISAS. The uni-dimensionality of the 11-item scale was confirmed on a Turkish patient sample. The fit indices for the model obtained were calculated as χ2/sd = 2.342, RMSEA = .80, SRMR = .04, CFI = .90, GFI = .92. The fit indices of the model have good and acceptable fit values. CONCLUSION: Based on the psychometric evaluation, ISAS-T is a valid and reliable measurement tool for measuring patient satisfaction with anesthesia applied during different surgical procedures.

Investigation of the nephroprotective effect of dexmedetomidine on colistin-induced nephrotoxicity in rats.

ACKGROUND: There are very few studies in the literature focusing on whether dexmedetomidine exerts a protective effect on colistin nephrotoxicity. Our study aims to investigate the nephroprotective effect of dexmedetomidine in an experimental model of nephrotoxicity in rats. METHODS: The control group was administered saline (SF) intraperitoneally twice a day. The colistin group received an intraperitoneal (ip) injection of 10 mg/kg of colistin twice a day. The DX10 group received 10 mg/kg of colistin 20 minutes after the intraperitoneal injection of 10 mcg/kg of dexmedetomidine. The DX20 group received 10 mg/kg of colistin 20 minutes after the intraperitoneal injection of 20 mcg/kg of dexmedetomidine. Applications were continued for 7 days, twice a day. All rats were sacrificed on the 8th day after blood and kidney tissue samples were taken. BUN, Creatine, KIM-1 and Endothelin-1 were studied in blood samples. RESULTS: There was a significant difference in the median values of Urea, BUN and Creatine between the groups (p<0.001, p<0.001, p<0.001, respectively). There was a significant difference in the median values of KIM-1 and Endothelin-1 between the groups (p=0.009, p=0.001, respectively). A significant difference was observed between the histopathological scores of the groups (p<0.001). CONCLUSION: Dexmedetomidine significantly decreased the elevated levels of BUN, Creatinine, KIM-1, and Endothelin-1 induced by colistin. Dexmedetomidine, at both doses, histopathologically prevented apoptosis and reduced the number of necrotic cells in the kidneys. Dexmedetomidine provides renoprotective effects, therefore it is a valuable sedation agent for clinicians working in intensive care units (Tab. 2, Fig. 4, Ref. 19). Text in PDF www.elis.sk Keywords: rat, colistin, nephrotoxicity, dexmedetomidine.

Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study.

BACKGROUND: Tumor Necrosis Factor-α (TNF-α) and Interleukin-1ß (IL-1ß) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines. METHODS: TAP (study group; n=40) or p-TAP (placebo group; n=40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-α and IL-1ß levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0-hours, 30-minutes, 4-hours, and 24-hours. Analgesic use within the first 24-hours following surgery was monitored. RESULTS: The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24hours), and the differences between groups were statistically significant (p< 0.001 for all comparisons). In the TAP group, the TNF-α and IL-1ß levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p< 0.001 for all comparisons). CONCLUSION: The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflammatory cytokines TNF-α and IL-1ß in the first postoperative 24hours, indicating immunomodulatory effect.

The effect of Fasting during Ramadan on the Kidney functions of Stage III-IV Chronic Kidney Disease Patients.

OBJECTIVES: Examine the effect of fasting during Ramadan on kidney functions in patients with chronic kidney disease. METHODS: The study was conducted on 130 patients with stage III-IV chronic kidney disease (CKD), who were admitted to the Ordu University nephrology polyclinic during the month before Ramadan and one month after Ramadan in 2019. Blood samples were taken in the morning after 12 hours of fasting. RESULTS: There was a statistically significant difference between BUN in the fasting group before and after the month of Ramadan. The median BUN before Ramadan was 26.65 mg/dl, the median after Ramadan was 24.05 mg/dl (p=0.004).There was a statistically significant difference between the nonfasting groups before and after Ramadan with respect to creatinine level. Median creatinine before Ramadan was 1.69 mg/dl,and the median after Ramadan was 1.86 mg/dl (p <0.001).There was a statistically significant difference between the fasting groups before and after Ramadan with respect to creatinine levels. Fasting group ,the median before Ramadan was 1.5 mg/dl, and the median after Ramadan was 1.42 mg/dl (p = 0.038).The impact of independent variable of fasting, using linear regression was found to be statistically significant (ppost-<0.001). The eGFR was 14.826 points higher in those who fasted after Ramadan than in those who did not. CONCLUSION: Fasting during the month of Ramadan does not deteriorate kidney functions and even leads to a moderate improvement in kidney functions. Taking these results into consideration, fasting may be advised for patients with stage III-IV CKD who want to fast and remain in stable condition.

The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block?

Introduction and Objective: TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques. Materials and Methods: Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space. Results: A higher level of patient satisfaction was observed in the EPI group (p=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (p=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group (p < 0.001). Conclusion: The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.

The Effect of Unilateral Spinal Anaesthesia and Psoas Compartment with Sciatic Block on the Postoperative Pain Management in Total Knee Artroplastic Surgery.

Purpose. This study was designed to investigate the effects of peripheral nerve block methods, applied through unilateral spinal anaesthesia on elderly patients to undergo total knee arthroplasty, on perioperative hemodynamic parameters and postoperative analgesia period. Materials and Method. 60 patients were randomly divided into two groups in the study. In group USA spinal anaesthesia was performed. In group PCS it was applied on psoas compartment block and sciatic nerve block. Results. Significantly higher intraoperative 60th and 90th minute mean arterial pressure values were ascertained in the PCS group compared to the USA group. The decrease observed in the 5th, 10th, and 20th minute MAP values in the USA group was statistically significant according to the control MAP value. Concerning within group comparisons, the decrease in 5th, 10th, and 20th minute heart rate values in the USA group was statistically significant compared with the control measurement value. The mean beginning time of sensory and motor blocks in the PCS group was found to be at a significantly advanced level compared with that in the USA group. Conclusions. The PCS block technique using bupivacaine hydrochloride ensured a higher haemodynamic efficiency in the perioperative period in high-risk elderly patients undergoing total knee arthroplasty. This trial is registered with ClinicalTrials.gov Identifier: NCT03021421.

Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or subcutaneous morphine?

OBJECTIVE: To compare 3 different techniques of preventive analgesia before circumcision operations in male children between 6-12 years of age. Our objective was to investigate the duration and quality of postoperative analgesia in patients, who were subject to caudal block technique, dorsal penile nerve block or who were administered subcutaneous morphine. METHODS: The prospective, randomised, single-blind study was conducted at Ordu University Training and Research Hospital, Ordu, Turkey, from January 1 to June 30, 2015, and comprised boys aged 6-12 years, who were scheduled to undergo circumcision operation. All patients were under general anaesthesia by means of laryngeal masks. The patients were randomised into 3 equal groups. The patients in Group C received caudal block with bupivacaine 0.25% in a total volume of 0.50 ml/kg in lateral position. Those in Group M received injections of 100 mcg/kg of subcutaneous morphine into the deltoid muscle. Patients in Group DP were subjected to dorsal penile nerve block with 1 mg/kg of bupivacaine 0.25%. Intraoperative haemodynamic data, pain and sedation scores, according to Children's Hospital of Eastern Ontorio Pain Scale and Ramsay Sedation Scale, were recorded at postoperative 1st, 6th and 24th hours in all cases. RESULTS: The 60 subjects in the study were divided into 3 groups of 20(33.3%) each. The overall mean age was 7.75±8.12 years. At 1 hour after surgery; 8(40%) cases in Group M, 5(25%) cases in Group DP, and all the 20(100%) cases in Group C had a pain score <6 (p<0.05). When the scores were analysed 12 hours post-operatively, 5(25%) cases in Group M and 10(50%) cases in Group DP had a pain score >6, while the pain scores of all the 20(100%) cases in Group C were <6 (p<0.01). Among the groups, there was no statistically significant difference regarding the sedation scores (p>0.05). CONCLUSIONS: Using the three methods, analgesia lasted until 12 hours postoperatively, being more evident in the caudal block group, minimising postoperative stress in children and parents.

Histopathologic comparison of dexmedetomidine's and thiopental's cerebral protective effects on focal cerebral ischemia in rats.

This study was designed to investigate whether dexmedetomidine and thiopental have cerebral protective effects after focal cerebral ischemia in rats. Thirty male Sprague Dawley rats were randomly assigned to three groups: control group (Group C, n=10), dexmedetomidine group (Group D, n=10), thiopental group (Group T, n=10). After all rats were anesthetized, they were intubated, then mechanically ventilated. A catheter was inserted into the right femoral artery for continuous mean arterial pressure, physiological parameters and blood sampling at baseline, 5min after occlusion and 20min after reperfusion. A catheter was inserted into the left femoral vein for intravenous (IV) medication administration. Right common carotid artery of each rat was isolated and clamped for 45min. At the end of the duration common carotid artery were unclamped and the brain reperfusion was achieved for 90min. Dexmedetomidine was administered for Group D IV infusion, and Group T received thiopental IV. According to histopathologic scores cerebral ischemia was documented in all rats in Group C, but no ischemia was found in three rats in Group T and in four rats in Group D. Grade 3 cerebral ischemia was documented in three rats in Group C, and in only one rat in both groups T and D. For histopathologic grades the difference between Group T and Group D was not significant (p>0.05). But the differences between Group C and Group T (p<0.05) and Group C and Group D (p<0.01) were statically significant. In conclusion, we demonstrated that dexmedetomidine and thiopental have experimental histopathologic cerebral protective effects on experimental focal cerebral ischemia in rats.

[Histopathologic comparison of dexmedetomidine's and thiopental's cerebral protective effects on focal cerebral ischemia in rats]. / Comparação histopatológica dos efeitos protetores cerebrais de dexmedetomidina e tiopental sobre isquemia cerebral focal em ratos.

This study was designed to investigate whether dexmedetomidine and thiopental have cerebral protective effects after focal cerebral ischemia in rats. Thirty male Sprague Dawley rats were randomly assigned to three groups: control group (Group C, n=10), dexmedetomidine group (Group D, n=10), thiopental group (Group T, n=10). After all rats were anesthetized, they were intubated, then mechanically ventilated. A catheter was inserted into the right femoral artery for continuous mean arterial pressure, physiological parameters and blood sampling at baseline, 5min after occlusion and 20min after reperfusion. A catheter was inserted into the left femoral vein for intravenous (IV) medication administration. Right common carotid artery of each rat was isolated and clamped for 45min. At the end of the duration common carotid artery were unclamped and the brain reperfusion was achieved for 90min. Dexmedetomidine was administered for Group D IV infusion, and Group T received thiopental IV. According to histopathologic scores cerebral ischemia was documented in all rats in Group C, but no ischemia was found in three rats in Group T and in four rats in Group D. Grade 3 cerebral ischemia was documented in three rats in Group C, and in only one rat in both groups T and D. For histopathologic grades the difference between Group T and Group D was not significant (p>0.05). But the differences between Group C and Group T (p<0.05) and Group C and Group D (p<0.01) were statically significant. In conclusion, we demonstrated that dexmedetomidine and thiopental have experimental histopathologic cerebral protective effects on experimental focal cerebral ischemia in rats.

Intraocular pressure changes associated with tracheal extubation: Comparison of sugammadex with conventional reversal of neuromuscular blockade.

OBJECTIVE: To compare the effects of neostigmine/atropine combination and sugammadex on intraocular pressure during tracheal extubation period. METHODS: The single-blind prospective randomised controlled study was conducted at Ordu University Research and Training Hospital from August to October 2014, and comprised patients who were randomly assigned to 2 groups according to the agent used for reversal of neuromuscular blockade. Group N received 0.05mgkg-1 neostigmine and 0.02 mgkg-1 atropine and the patients in Group S received 2mgkg-1 sugammadex intravenously. Heart rate, mean arterial pressure and intraocular pressure were measured at baseline, before the induction (T1), after the application of reversal agent (T2), and 1 (T3), 3 (T4), 5 (T5) and 10 (T6) minutes after the extubation. SPSS 16 was used for statistical analysis. RESULTS: There were 36 patients in the study; 18(50%) in each group. There was no significant difference between the groups in terms of age, gender and body mass index (p>0.05 each). Intraocular pressure was significantly higher when the baseline level was compared with all measurement intervals in Group N (p<0.05 each). In Group S, it showed no significant difference at T2 (p>0.05) whereas it was significantly higher at all other measurement intervals (p<0.05 each). Intergroup comparisons showed statistically significant difference in heart rate and mean arterial pressure levels at T2 interval which were higher in Group N (p<0.01). Intraocular pressure levels at T2 and T3 intervals were significantly higher in Group N (p<0.01). CONCLUSIONS: Lower end-extubation intraocular pressure levels were obtained when sugammadex was used as a neuromuscular block reversal agent in comparison with neostigmine-atropine combination. Sugammadex may be a better option for the reversal of neuromuscular blockade and intraocular pressure increase should be avoided in patients with glaucoma or penetrating eye injury.

Periodontal disease as a risk factor for pre-eclampsia: a case control study.

OBJECTIVE: To investigate the association between periodontal disease and pre-eclampsia, while controlling known risk factors for pre-eclampsia. METHODS: A matched case-control study was carried out on 41 pre-eclamptic women and 41 normotensive, healthy, pregnant, control women. The pre-eclamptic women and controls were individually matched for age, gravidity, parity, smoking and prenatal care. The number of teeth and the number of restorations and decay on all tooth surfaces, and clinical periodontal parameters, excluding third molars were determined within 48 h before delivery. The relation of independent variables to pre-eclampsia was assessed using conditional multiple logistic regression analysis on subject-based data. RESULTS: There were no statistically significant differences in mean percentages of sites with plaque between groups. The mean probing depth (PD) and mean clinical attachment level (CAL) for pre-eclamptic patients were significantly greater compared to those of normotensive patients (P < 0.01). The percentage of sites exhibiting bleeding on probing (BOP) (P < 0.05), the number of sites with PD >/= 4 mm and with CAL >/= 3 mm was significantly higher among pre-eclamptic patients than those with normotensive patients (P < 0.01). Conditional multiple logistic regression analysis indicated that periodontal disease and triglycerides level were significantly associated with pre-eclampsia. Other independent variables (maternal body weight and serum total cholesterol level) did not appear to be associated with pre-eclampsia. Conditional multiple logistic regression results showed that pre-eclamptic patients were 3.47 (95% CI = 1.07-11.95) times more likely to have periodontal disease than normotensive patients. CONCLUSION: The present study shows that maternal periodontal disease during pregnancy is associated with an increased risk for the development of pre-eclampsia. The higher incidence of periodontal disease parameters in pre-eclamptic group would suggest a possible role for periodontal disease in the development of pre-eclampsia. The nature both of periodontitis and pre-eclampsia is multifactorial, and caution should be exercised when implicating periodontal disease in causation of pre-eclampsia.

Prevalence and handedness correlates of recurrent aphthous stomatitis in the Turkish population.

OBJECTIVES: The present study was designed to determine the relationship between recurrent aphthous stomatitis (RAS) and handedness, and to assess the prevalence of RAS in the Turkish population. METHODS: The present study was conducted among 11,360 persons (5,705 males and 5,655 females) with a mean age of 30.4 years. A questionnaire focusing on handedness was administered to these patients. Handedness was assessed according to the Edinburgh Handedness Inventory. The diagnosis of RAS was made on the basis of clinical appearance, location, and the patient's health history. RAS information of patients was collected by means of a data form specifically designed for this study. Subjects were informed about RAS. We took anamneses and filled out the investigation forms. Apart from patients with registration of current aphthae (average point prevalence, APP), patients who had a past two-year history (self-reported two-year prevalence, SRTP) of the lesion were also included in this study. Data were analyzed using the chi-square and logistic regression tests. RESULTS: The prevalence of RAS (APP) was 2.7 percent and that of a history of RAS (SRTP) 22.8 percent. Thus, the total prevalence (APP+SRTP), including present lesions and a two-year history (SRTP), was 25.5 percent. Adjusted results showed that females, left-handers, 10-30-year-olds, and nonsmokers were 1.53, 1.69, 2.05, and 1.61 times more likely to have RAS (APP+SRTP) than males, right-handers, 31-50-year-olds, and smokers, respectively (P<.0001). CONCLUSION: The present study suggests that left-handedness appears to be a predictor factor for RAS.

Effect of handedness on learning subgingival scaling with curettes: a study on manikins.

The aim of the present study was to evaluate the influence of systematic manikin-head training and the effectiveness of subgingival scaling applied with hand instruments (curettes) by right- and left-handed dental students on dental chairs (traditional) designed for right-handers. A questionnaire focusing on handedness was administered to 69 voluntary dental students in the third class at the School of Dentistry during pre-participation examination. Handedness was assessed using the Turkish version of the Edinburgh Handedness Inventory. Then, 18 dental students were specially selected in 2 equal groups according to hand preference: consistent right-handers with Geschwind Scores of +100 (5 female and 4 male) and consistent left-handers with Geschwind Scores of -100 (5 female and 4 male). These two untrained dental student groups received 10 weeks manikin-head training. Subgingival scaling was performed with hand instruments (Gracey curettes) in manikin-head mounted on right-sided dental chairs. At 6 test days each dental student had to instrument 12 test teeth. Effectiveness of subgingival scaling was evaluated by adoption of a grading system. This system had scores from 0 to 3 and was defined by illustrated and described criteria. Statistical analysis was carried out with SPSS. Two groups were statistically compared on all test days. The yet-untrained left-handed dental students begin with a relatively high the mean score of 2.25, compared to the yet-trained right-handed dental students with 1.93, which was statistically significant (p > .05). The right-handed dental students reached the mean score of 0.53, whereas the left-handed dental students reached the mean score of 0.87 on test day 6. Significant differences in the mean scores were found between the two groups for overall surfaces (p < .05), the distal surfaces (p < .01), lingual surfaces (p < .01), and each group of teeth (p < .05). But there was no statistically significant difference between the 2 groups of students on all test day, except for test day 3 in terms of the mean scores for the facial and mesial surfaces (p > .05). Learning success was observed a high level in both groups through systematical training (p < .0001). The present study has documented that the left-handed dental students were less successful than the right-handed dental students in subgingival scaling, except for mesial and facial surfaces. However although training on right-sided chairs, they were quite similar to their right-handed counterparts in terms of learning success.