The effects of maternal presence during anesthesia induction on salivary cortisol levels in children undergoing tonsillectomy and/or adenoidectomy.

OBJECTIVE: Although parental presence during anesthesia induction is suggested to diminish operative stress level in children, there have been conflicting results about this strategy. The aim of this study was to evaluate the effects of maternal presence during induction on operative stress level in children who had tonsillectomy and/or adenoidectomy by determining the salivary cortisol levels. DESIGN: Non-randomized clinical study. SETTING: Preoperative and postoperative recovery rooms, operating room. PATIENTS: The study included 48 children between the ages of 5-12years who underwent tonsillectomy and/or adenoidectomy. INTERVENTIONS: The patients were divided into 2 groups. The children in group 1 were separated from their mothers at the preparation room. The children in group 2 stayed together with their mothers till the anesthesia induction. MEASUREMENTS: State Trait Anxiety Inventory (STAI) was performed to the mothers and children preoperatively. Salivary cortisol levels were evaluated in 4 different time frames: 1) in preparation room, 2) after anesthesia induction, 3) at the 30th minute of operation, and 4) in postoperative recovery room. MAIN RESULTS: There were no statistically significant differences between groups regarding demographic features, and operation or anesthesia times. The child's or mothers' preoperative anxiety scores were not different between the groups. Salivary cortisol levels in group 1 were significantly increased after induction and in recovery room compared to those in group 2 (p: 0.001, and p: 0.02, respectively). CONCLUSIONS: We have determined decreased salivary cortisol levels during anesthesia induction and recovery in the maternal presence revealing diminished stress in these periods. Further studies are warranted to determine the effects of parental presence during anesthesia induction especially on surgical outcomes.

The effects of sevoflurane and desflurane on the hemodynamics and respiratory functions in laparoscopic sleeve gastrectomy.

STUDY OBJECTIVES: Sleeve gastrectomy has been one of the most commonly performed bariatric surgery methods. The study aimed to compare the effects of 2 most commonly used inhalation anesthetics, sevoflurane and desflurane, on the peroperative hemodynamic alterations and postoperative respiratory functions in morbidly obese patients undergoing sleeve gastrectomy. DESIGN: Nonrandomized cohort. SETTINGS: Operating room, postoperative period. PATIENTS: Eighty-four morbidly obese patients with a body mass index greater than 40 kg/m2 who had scheduled to undergo sleeve gastrectomy operation were prospectively included in the study. INTERVENTIONS: Patients were divided into 2 groups. The maintenance of inhalation anesthesia was performed by sevoflurane in 1 group (sevoflurane group) and desflurane (desflurane group) in the other group. MEASUREMENTS: Demographic features, peroperative hemodynamic alterations, and the results of preoperative and postoperative 24th hour respiratory function tests were recorded. RESULTS: There was not any statistically significant difference between groups regarding age, sex, body mass index, anesthesia time, peroperative mean arterial pressure, arterial oxygen saturation, end-tidal carbon dioxide, and preoperative or postoperative forced expiratory volume 1/forced vital capacity ratios. CONCLUSION: We determined that both desflurane and sevoflurane provide similar intraoperative hemodynamic and early postoperative respiratory functions in morbidly obese patients in laparoscopic sleeve gastrectomy. Both agents can be regarded as alternatives for inhalation anesthetics in maintenance of anesthesia.

The Syrian civil war: The experience of the Surgical Intensive Care Units.

OBJECTIVE: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. METHODS: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. RESULTS: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. CONCLUSION: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.