The comparison of ultrasound-guided ilioinguinal/iliohypogastric nerve block and pre-incision wound infiltration for pediatric inguinal hernia repair: A prospective randomized clinical study.

OBJECTIVES: Inguinal hernia repair is one of the most common daily surgeries performed in pediatrics. This prospective randomized clinical trial aims to compare ultrasound (USG)-guided ilioinguinal/iliohypogastric (IL/IH) nerve block and pre-incisional wound infiltration (PWI) in terms of post-operative analgesia on pediatric unilateral inguinal hernia repair. METHODS: After receiving ethics committee approval, 65 children aged 1-6 years who had unilateral inguinal hernia repair were allocated to USG-guided IL/IH nerve block (group IL/IH, n=32) and (group PWI, n=33). In both groups, 0.5 mg/kg 0.25% bupivacaine+2% prilocaine mixture was used by calculating the volume as 0.5 mL/kg for the block and infiltration. The primary outcome was to compare both groups' post-operative Face, Legs, Activity, Cry and Consolability (FLACC) scores. The secondary outcomes included the time to first analgesic request and the total acetaminophen consumption. RESULTS: The FLACC pain scores at the 1st, 3rd, 6th, and 12th h were statistically significantly lower in group IL/IH than in group PWI (p=0.013, p<0.001, p<0.001, and p=0.037, respectively) (p<0.001). There was no difference between the groups at the 10th and 30th min and at 24 h (p=0.472, p=0.586, and p=0.419, respectively) (p>0.05). CONCLUSION: USG-guided IL/IH nerve block in pediatric patients with inguinal hernia repair was found to be superior to PWI in terms of lower pain scores, less additional analgesia requirement, and longer first analgesia requirement.

Evaluation of distal skin temperature and tissue oxygen saturation determined by near-infrared spectroscopy for predicting ultrasound-guided lateral infraclavicular block success.

BACKGROUND: Changes in tissue oxygen saturation determined by near-infrared spectroscopy (NIRS) may help predict and determine the success of a lateral infraclavicular (LIC) block.We investigated whether evaluation of tissue oxygen saturation determined by NIRS couldbe an indicator of LIC block success. METHODS: Forty patients scheduled for hand or forearm surgery under LIC block were studied. NIRS sensors were placed on the ventral aspect of both mid-forearms, and the contralateral hand was used as the control group. NIRS values were recorded before the block andat regular intervals during the following 30 min. RESULTS: NIRS values were significantly higher in the successfully blocked patients whencompared to the complete failure, partial failure, and contralateral hand groups at the 10thmin. In the successfully blocked patients, NIRS values (mean ± SD [change in %]) increasedby 11.09 ± 4.86 (16.03%), 15.00 ± 4.53 (21.76%), 16.35 ± 5.14 (23.77%), 16.38 ± 4.88(23.85%), 16.67 ± 5.04 (24.29%), and 16.96 ± 5.71 (24.78%), respectively, from baselineto 5, 10, 15, 20, 25, and 30 min. ΔTs values were significantly higher in the successfullyblocked patients than in the complete failure patients and contralateral hand at the 30thmin. However, there was no statistically significant difference when comparing ΔTs values ofsuccessful block and partial failure block patients at the 30th min. CONCLUSIONS: We conclude that measurement of tissue oxygen saturation by NIRS withinthe scope of evaluation of the lateral infraclavicular block is a rapid, effective, and applicabletechnique.

Use of ultrasonography in confirming the malposition of the i-gel in pediatric patients: a prospective observational study.

BACKGROUND: This study was designed to observe and compare the performance of fiberoptic laryngeal (FOL) view, leakage test (LT) and ultrasonography (USG) usage in detecting i-gel position in pediatric patients. METHODS: One hundred ten consecutive children were included in this single-armed prospective observational study. After anesthetic induction, i-gel placement confirmed using FOL and LT was evaluated using USG in three planes. According to our scoring system, acceptable and unacceptable grades (FOL, LT and USG) were determined to describe placement. Sensitivity and specificity were determined by comparing USG performance with the other two tests. RESULTS: Ultrasonography was found a sensitivity of 20% positive predictive value (PPV) for unacceptable i-gel placement according to FOL grade and a sensitivity of 37.04% with a 100% PPV according to LT grade. USG was found a specificity of 91.84% negative predictive value (NPV) of 91.84% for acceptable i-gel placement according to FOL grade and the NPV specificity of 100% with a 82.65% NPV according to LT grade. DISCUSSION: Ultrasonography demonstrated a very good diagnostic performance in the detection of optimal i-gel placement according to both FOL and LT. However, both FOL and LT showed poor diagnostic performance compared to USG in demonstrating i-gel malposition.

The effect of bispectral index monitoring on cognitive performance following sedation for outpatient colonoscopy: a randomized controlled trial.

BACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients' baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients' post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance. CLINICAL TRIAL REGISTRATION: This trial was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12617000134325).

The effect of bispectral index monitoring on cognitive performance following sedation for outpatient colonoscopy: a randomized controlled trial

ABSTRACT BACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients' baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients' post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance. CLINICAL TRIAL REGISTRATION: This trial was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12617000134325).

Transient Facial Nerve Palsy After the Scalp Block for Burr Hole Evacuation of Subdural Hematoma.

Scalp block has become a frequently used technique with an increasing number of indications today. Despite the many advantages of the scalp block, certain rare complications have been identified. It should be remembered that although it is a relatively safe procedure, it may lead to the development of facial nerve palsy. In this article, we present a case of transient facial nerve palsy developed after the scalp block that was used to drain the subdural hematoma with a burr hole.

Hyoscine N-Butylbromide for Preventing Propofol Injection Pain: A Randomized, Placebo-Controlled and Double-Blind Study.

OBJECTIVE: In this study, the aim was to investigate the effect of hyoscine N-butylbromide (HnBB) pretreatment on pain during propofol injection. SUBJECTS AND METHODS: In this prospective, randomized, placebo-controlled and double-blind trial, 60 patients scheduled to undergo routine outpatient surgery under general anesthesia were randomly allocated to 2 groups, the HnBB (n = 30) and sodium chloride (n = 30) groups. Twenty seconds after the injection of 20 mg HnBB or 0.9 % sodium chloride, a 50-mg dose of propofol was injected in 2-3 s. Ten seconds later, the pain intensity was assessed using a 4-point scale: no pain (0), mild (1), moderate (2), and severe (3) pain. The Student t test was used for the analysis of parametric data and the Pearson χ2 test for categorical data. RESULTS: The occurrence of pain in the HnBB group (43.3%) was significantly lower than the control group (73.3%) (p < 0.018). Of the 30 patients in each group, 10 in the control group and 3 in the HnBB group experienced severe pain (p = 0.001). CONCLUSIONS: Pretreatment with 20 mg HnBB significantly reduced propofol injection pain compared to placebo.

Comparison of the Effects of Different Positive End-Expiratory Pressure Levels on Cerebral Oxygen Saturation With Near Infrared Spectroscopy During Laparoscopic Cholecystectomy.

PURPOSE: Although positive end-expiratory pressure (PEEP) is commonly used to improve respiratory mechanics and oxygenation during pneumoperitoneum (PP), the effect of PEEP on cerebral homeostasis during carbon dioxide PP remains uncertain. This study investigated the changes in regional cerebral oxygen saturation (rSO2) associated with 0, 5, and 10 cm H2O PEEP during PP while undergoing laparoscopic cholecystectomy under sevoflurane anesthesia. MATERIALS AND METHODS: In total, 105 patients between the ages of 18 to 60 years, scheduled to undergo laparoscopic cholecystectomy under general anesthesia, were studied. The patients were randomized, into 3 groups: group I (n=35) with no external PEEP, group II (n=35) with external PEEP of 5 cm H2O, group III (n=35) with external PEEP of 10 cm H2O. Heart rate, mean blood pressure, oxygen saturation, and rSO2 values were continuously recorded from awake status to tracheal extubation. RESULTS: The measurements of hemodynamic parameters were statistically similar between 3 groups (P>0.05). rSO2 values were statistically similar between 3 groups (P>0.05). CONCLUSIONS: We consider that both 5 and 10 cm H2O PEEP levels can be safely used during PP applied during laparoscopic surgery, without affecting hemodynamics, and without causing a decline in rSO2.

Comparison of McGrath(®) Series 5 video laryngoscope with Macintosh laryngoscope: A prospective, randomised trial in patients with normal airways.

OBJECTIVE: The McGrath Video laryngoscope is a newly developed video laryngoscope that significantly improves laryngeal view and facilitates endotracheal intubation in difficult airways. However in patients with normal airway that is not mentioned before. The aim of this study was to compare the McGrath video laryngoscope with the Macintosh laryngoscope in patients with normal airways. METHODS: A total of 100 patients requiring orotracheal intubation, were randomized to either having intubation with the McGrath video laryngoscope or the Macintosh laryngoscope. The primary outcome was the laryngoscopy view using percentage of glottic opening (POGO) score. Secondary outcomes included Cormack and Lehane grading system, time to intubation, number of failed intubations, number of attempts before successful intubation and hemodynamic parameters during intubation. RESULTS: POGO scores were significantly higher in the McGrath group compared with the Macintosh group (p<0.001) despite time to successful intubation was similar in both groups. The McGrath video laryngoscope provided more Grade-I laryngoscopic views than the Macintosh laryngoscope (p<0.001). Number of more than one attempts in order to achieve success was significantly higher in the Macintosh group (p=0.001). The number of minor complications were significantly higher in the Macintosh group (p=0.004). There were no significant changes in hemodynamic responses between the two groups (p>0.05). CONCLUSION: McGrath video laryngoscope allows patients with normal airways to achieve higher POGO scores and significantly more Grade-I laryngoscopic views when compared with the Macintosh laryngoscope.

Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy.

BACKGROUND: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. AIM: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. METHODS: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. RESULTS: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). CONCLUSIONS: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.

The effects of bispectral index monitoring on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery.

BACKGROUND: General anesthesia is often preferred for dental surgery or rehabilitation in developmentally delayed pediatric patients. Bispectral index monitoring is used to monitor the depth of anesthesia and to ensure early recovery. However, studies on the topic in developmentally delayed pediatric patients are limited. AIM: To evaluate the effects of Bispectral Index Scale (BIS) on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery. METHODS: Forty children between the ages of 6-16 years were studied in this prospective and randomized study. The children were randomized into two groups. In Group 1 (n = 20), general anesthesia was maintained with 1-2 minimum alveolar concentration (MAC) of sevoflurane in oxygen by standard practice. In Group 2 (n = 20), the depth of anesthesia was monitored by BIS. BIS values were continuously recorded from awake status to tracheal extubation. The duration of the surgical procedure, anesthesia, postanesthesia care unit (PACU) stay was noted. To evaluate recovery profile, time to spontaneous ventilation, extubation, open eyes, and PACU discharge were also noted. RESULTS: There were significant differences between recovery times and Non-communicating Children's Pain Checklist - Postoperative Version (NCCPC-PV) scores of two groups. Time to spontaneous ventilation [Difference in means (95% CI); 3.17 (1.79-4.54) P < 0.001], extubation [Difference in means (95% CI); 3.13 (1.66-4.60) P < 0.001], open eyes [Difference in means (95% CI); 3.97 (2.34-5.59) P < 0.001], and PACU stay time [Difference in means (95% CI); 23.55 (18.08-29.01) P < 0.001] were significantly shorter in Group 2. CONCLUSION: In conclusion, results suggest that routine BIS monitoring may be beneficial due to its favorable effects on the recovery profile in developmentally delayed pediatric patients.

Effects of incrementally increasing tidal volume on the right internal jugular vein in pediatric patients.

PURPOSE: The aim of the present study was to evaluate the effects of incremental increases of tidal volume (TV) on the cross-sectional area (CSA) and size of the right internal jugular vein (RIJV), and the relationship between RIJV and the carotid artery (CA). METHODS: This prospective study included 23 pediatric patients aged between 7 and 12 years who were anesthetized. Using a standard anesthesia protocol, the TV was increased from 6 to 10 mL/kg in 1 mL/kg increments. For each TV, images of the RIJV and CA at the level of the cricoid cartilage were recorded at the end of the inspiration. From these results, the CSA and size of the RIJV and the percentage of CA overlap were calculated. RESULTS: The median (interquartile range) RIJV CSA was 0.82 (0.52-1.07) cm2 at a TV of 6 mL/kg and significantly increased to 0.86 (0.58-1.05), 0.88 (0.55-1.08), 0.95 (0.62-1.17) and 1.02 (0.70-1.20) cm2 at TVs of 7, 8, 9 and 10 mL/kg, respectively. There were no significant differences in the percentage overlap of the CA between all TVs. The median (interquartile range) transverse diameter was 1.16 (0.99-1.36) cm at a TV of 6 mL/kg and significantly increased to 1.20 (1.10-1.41), 1.26 (1.05-1.45), 1.28 (1.10-1.49) and 1.35 (1.12-1.52) cm at TVs of 7, 8, 9 and 10 mL/kg, respectively. The median (interquartile range) anteroposterior diameter was 0.77 (0.72-0.90) cm at a TV of 6 mL/kg and significantly increased to 0.81 (0.72-0.94), 0.85 (0.74-0.99), 0.88 (0.75-1.02) and 0.89 (0.79-1.06) cm at TVs of 7, 8, 9 and 10 mL/kg, respectively. CONCLUSIONS: This study reveals that a TV of 10 mL/kg in anesthetized children achieved the greatest size in the RIJV, and caused no difference in the CA overlap. These results suggest that a TV of 10 mL/kg is the optimal choice when facilitating catheterization and in the avoidance of complications in anesthetized children connected to mechanical ventilator that are required to undergo RIJV catheterization.

[Comparison the effects of prilocaine and the addition of dexketoprofen and dexamethasone to prilocaine for intravenous regional anesthesia]. / Intravenöz rejyonel anestezi tekniginde prilokain, prilokaine eklenen deksketoprofen ve deksametazonun etkinliklerinin karsilastirilmasi

OBJECTIVES: The aim of this study was to compare the anesthetic and analgesic effects of prilocaine alone, prilocaine added dexketoprofen and dexamethasone during intravenous regional anesthesia (IVRA). METHODS: Forty five patients undergoing forearm or hand surgery were randomly assigned to one of three groups to receive (Group P) 3 mg/kg 0.5% prilocaine; (Group PDK) 3 mg/kg 0.5% prilocaine plus 50 mg dexketoprofen; (Group PDM) 3 mg/kg 0.5% prilocaine plus 8 mg dexamethasone in total 40 ml volume for IVRA. The onset and duration of sensory and motor blocks, hemodynamic datas, duration of analgesia and tourniquet, time to first analgesic requirement, visual analog scale (VAS), total analgesic consumption in 24 hours and patient satisfaction score were assessed and recorded. RESULTS: Time to onset of sensory block was found to be longer in Group P (p<0.05), though no significance was found according to sensory block recovery times amoung groups. Time to onset of motor block was found to be longer and recovery time of motor block was found to be shorter in Group P (p<0.05). Time to first analgesic requirement was found to be longer in Group PDK,and was found to be high in Group PDM than Group PDK(p<0.05). The VAS scores was found to be high and patient satisfaction scale was found to be low in Group P (p<0.05). CONCLUSION: The addition of dexketoprofen and dexamethasone to prilocaine during IVRA improves the quality of both anesthesia and analgesia moreover dexketoprofen provides beter postoperative analgesia during the first 24 hour after surgery.