The Effects of Hypocapnia and Hypercapnia on Intraoperative Bleeding, Surgical Field Quality, and Surgeon Satisfaction Level in Septorhinoplasty: A Prospective Randomized Clinical Study.

BACKGROUND: Septorhinoplasty (SRP) is one of the most commonly performed procedures in the world for functional and aesthetic purposes. The present study was aimed to compare the effects of hypocapnia and hypercapnia regarding the total amount of intraoperative bleeding, surgical field quality, and surgeon satisfaction level. METHODS: In this randomized prospective clinical study, eighty patients with American Society of Anesthesiologists I-II and were 18-45 years old scheduled for septorhinoplasty were randomly allocated to group hypocapnia [end-tidal carbon dioxide (EtCO2) 30 ± 2 mmHg] and group hypercapnia (EtCO2 40 ± 2 mmHg). We evaluated the total amount of intraoperative bleeding, the surgical field quality, surgeon satisfaction level, hemodynamics and peri- and postoperative adverse events. RESULTS: Group hypocapnia significantly reduced the total amount of intraoperative bleeding (p < 0.001). The surgical field quality and surgeon satisfaction level in group hypocapnia were significantly better than group hypercapnia (p < 0.001). EtCO2 levels of group hypocapnia were significantly lower than group hypercapnia at all time points (p < 0.001 for all time points). There were no significant differences between the groups in terms of heart rate and mean arterial pressure at all time points. There were no significant differences between the groups in terms of adverse events CONCLUSIONS: The results of this double-blind randomized clinical trial showed that reducing the amount of intraoperative bleeding for patients with hypocapnia undergoing SRP through known methods (e.g., reverse Trendelenburg head-up position, positive end-expiratory pressure limiting, controlled hypotension, and use of topical vasoconstrictors, corticosteroids, and tranexamic acid) would improve the quality of the surgical field and raise the surgeon satisfaction level. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Does smoking increase the anesthetic requirement?

Background/aim: To examine the effects of active and passive smoking on perioperative anesthetic and analgesic consumption. Materials and methods: Patients were divided into three groups: group S, smokers; group PS, passive smokers; and group NS, individuals who did not have a history of smoking and were not exposed to smoke. All patients underwent the standard total intravenous anesthesia method. The primary endpoint of this study was determination of the total amount of propofol and remifentanil consumed. Results: The amount of propofol used in induction of anesthesia was significantly higher in group S compared to groups PS and NS. Moreover, the total consumption of propofol was significantly higher in group S compared to groups PS and NS. The total propofol consumption of group PS was significantly higher than that of group NS (P = 0.00). Analysis of total remifentanil consumption showed that remifentanil use was significantly higher in group S compared to group NS (P = 0.00). Conclusion: The amount of the anesthetic required to ensure equal anesthetic depth in similar surgeries was higher in active smokers and passive smokers compared to nonsmokers.

Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery

Background/aim: Despite different regional anesthesia techniques used to provide intraoperative and postoperative analgesia in pediatric patients, the analgesic effectiveness of peripheral nerve blockades with minimal side effect profiles have not yet been fully determined. We aimed to compare the efficacy of ultrasound-guided transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, and caudal epidural block on perioperative analgesia in pediatric patients aged between 6 months and 14 years who underwent elective unilateral lower abdominal wall surgery. Materials and methods: Ninety-four patients classified under the American Society of Anesthesiologists physical status classification system as ASA I or ASA II were randomly divided into 3 equal groups to perform TAP, QL or Caudal epidural block using 0.25% of bupivacaine solution (0.5 ml kg−1). Results: Postoperative analgesic consumption was highest in the TAP block group (P < 0.05). In the QL block group, Pediatric Objective Pain Scale (POAS) scores were statistically significantly lower after 2 and 4 h (P < 0.05). The length of hospital stay was significantly longer in the caudal block group than the QL block group (P < 0.05). Conclusion: We suggest that analgesia with ultrasound-guided QL block should be considered as an option for perioperative analgesia in pediatric patients undergoing lower abdominal surgery if the expertise and equipment are available.

Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study.

Objective: Electrolyte disorder (ED) is frequently encountered critically ill patients during admission or admission to the intensive care unit (ICU). This study aimed to determine the frequency of ED encountered in ICU patients to evaluate the relationship of ED with drugs. Methods: This prospective, multicenter study was conducted in the medical and anesthesiology ICUs of two training and research hospitals and included patients with at least one ED during admission or hospitalization in the ICUs. The relationship between ED and the drug was evaluated by calculating the logistic probabilistic method scale (LPMS) and the expert panel's evaluation. The correlation between EDs and LPMS was determined using Kendal tau. A binary logistic regression model was preferred in the analysis of factors related to ED. Statistical significance was set as p < 0.05. Results: A total of 117 patients were included in the study. A total of 165 EDs were detected, including at least one in 88 (75.2%) patients. According to the expert panel, 61 (21.7%) of EDs were drug-related, whereas according to the LPMS, 111 (39.6%) (p < 0.001). Mortality (50% vs. 13.7%) and mechanical ventilation rates (52.2% vs. 17.2%) were significantly higher in patients with ED (p < 0.001). Patients with ED had 8.352 times higher odds of exhibiting mortality (OR: 8.352, %95 CI: 1.598-43.648, p: 0.012) and need mechanical ventilation with higher odds of 3.229 (OR: 3.229 95% CI: 0.815-12.787 p: 0.045). Patient who required enteral or parenteral feeding were associated with an increased likelihood of exhibiting ED (respectively OR: 30.057, %95 CI: 2.265-398.892, p: 0.01, OR: 5.537, %95 CI: 1.406-21.800, p: 0.014). Conclusion: EDs are very common in the ICU. Dysnatremia was detected more commonly in other EDs. It has also been found that patients with ED are more often under mechanical ventilation, have more prolonged hospitalizations, and have higher mortality rates than patients without ED. The suitability of LPMS for assessing ED-drug relationships in the ICU context is questioned.

Effect of epidural levobupivacaine and levobupivacaine with fentanyl on stress response and postoperative analgesia after total knee replacement.

BACKGROUND: Providing sufficient and convenient analgesia is crucial during the postoperative period after totalknee replacement (TKR) to enhance patient mobility and reduce stress response to surgery. The scope of this study is to compare the effects of levobupivacaine and levobupivacaine plus fentanyl on stress response and analgesic efficiency after TKR. METHOD: In this study, 40 ASA I - II patients scheduled to undergo TKR were subjected to combined spinal epidural anesthesia (CSEA) injecting of 15 mg levobupivacaine and randomly assigned to receive either levobupivacaine 0.125% (Group L) or levobupivacaine 0.125% plus fentanyl 4 µg ml-1 (Group F) during postoperative period via the epidural route. Patient controlled epidural analgesia (PCEA) was offered for 24 hours. Venous blood samples were assayed for adrenocorticotropic hormone (ACTH), cortisol and prolactin levels before surgery and after analgesia administration. Analgesia was assessed using a visual analogue scale (VAS) at rest (VASR) and during movement (VASM). RESULTS: There was no statistically significant difference between the groups in terms of total doses, bolus requests, bolus delivered and side effects (p > 0.05). The ACTH, cortisol and prolactin levels increased following the surgery and decreased during PCA infusion in both groups where the decline in Group F was significant (p < 0.05) at 24 hours after the analgesic treatment and 48 hours after the surgery. CONCLUSION: We have demonstrated that infusion of levobupivacaine (0.125%) in combination with fentanyl (4 µg ml-1) using PCEA suppressed stress response to surgery significantly and provided better pain relief than levobupivacaine (0.125%) alone after TKR.

Utility of the gastro-laryngeal tube during transesophageal echocardiography: A prospective randomized clinical trial.

BACKGROUND: To validate the utility and performance of the gastro-laryngeal tube (GLT) in terms of cardiologist and patient satisfaction levels, incidence of and attempts at successful transesophageal echocardiography (TEE) probe placement, perioperative and postoperative hemodynamics, and adverse events related to the TEE procedure. METHODS: In this randomized prospective clinical study, forty-four patients undergoing TEE and aged 20 to 80 years old scheduled for TEE were randomly allocated to two study groups: Group SA (sedation and analgesia) and Group GLT. Cardiologist and patient satisfaction levels, TEE probe placement performance, hemodynamics, adverse events related to the TEE procedure, demographic characteristics, and TEE procedure data were recorded. RESULTS: The cardiologist satisfaction level was significantly higher in Group GLT (P = .011). The TEE probe was successfully placed at the first attempt in all the patients in Group GLT and at the first attempt in 11 patients, at the second attempt in 8 patients, and at the third attempt in 3 patients in Group SA. The TEE probe placement success was significantly higher in Group GLT (P < .001), and TEE probe placement was significantly easier in Group GLT (P < .001). There were no significant differences in patient satisfaction, heart rate, mean arterial pressure, oxygen saturation, adverse events related to the TEE procedure between the groups. CONCLUSION: The present study revealed that GLT use elicited a higher cardiologist satisfaction level and resulted in more successful and easier TEE probe placement. We thus conclude that the use of the recently developed GLT may ensure airway management safety and a comfortable TEE experience.

The effects of tourniquet on intraocular pressure during knee surgery.

BACKGROUND: In this prospective study we aimed at examining the effects of pneumatic tourniquet on intraocular pressure during elective knee surgery. METHOD: Twenty patients undergoing elective knee surgery under general anesthesia with tracheal intubation were inluded the study. Anesthesia was induced with pentothal, rocuronium and fentanyl, then maintained with sevoflurane and nitrous oxide in oxygen. Intraocular pressure measurements were performed at 7 time points; awake (baseline), following induction, following tracheal intubation, just before tourniquet inflation, after the inflation of tourniquet, before tourniquet deflation, after the deflation of the tourniquet. RESULTS: Baseline IOP was 15 +/- 1 mmHg. Following the induction of anesthesia IOP was reduced significantly (12 +/- 1 mmHg) (p < 0.05), then increased to 16 +/- 1 mmHg after tracheal intubation (p < 0.05). IOP was significantly higher after tourniquet inflation compared with just before (13 +/- 1 mmHg vs 16 +/- 1 mmHg recpectively) (p < 0.05). There was no significant difference between the IOP measurements after the inflation and before the deflation of the tourniquet (p > 0.05). The lowest value was 12 +/- 0 mmHg measured after the tourniquet loosened and it was significant compared with the baseline and the measurement performed before deflation of the tourniquet (16 +/- 0 mmHg) (p < 0.05). CONCLUSION: Pneumatic tourniquet may cause a significant IOP increase in patients performing knee surgery under general anesthesia.

The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis: A Randomized Controlled Study.

STUDY DESIGN: Prospective randomized comparative (controlled) study. OBJECTIVE: Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries. SUMMARY OF BACKGROUND DATA: A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries. METHODS: We randomly divided 56 consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20-mL mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 mL physiological saline was injected. Postoperatively, we ordered 1 g paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS). RESULTS: Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ±â€Š12.3 mg versus 33.75 ±â€Š6.81 mg in the ESPB participants (P < 0.001). Except for postoperative 24th-hour VAS (P = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (P < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (P < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications. CONCLUSION: Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption.Level of Evidence: 1.

Usefulness of oxidative stress marker evaluation at admission to the intensive care unit in patients with COVID-19.

OBJECTIVE: Two critical processes in the coronavirus disease 2019 (COVID-19) pandemic involve assessing patients' intensive care needs and predicting disease progression during patients' intensive care unit (ICU) stay. We aimed to evaluate oxidative stress marker status at ICU admission and ICU discharge status in patients with COVID-19. METHODS: We included patients in a tertiary referral center ICU during June-December 2020. Scores of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and clinical severity, radiologic scores, and healthy discharge status were noted. We collected peripheral blood samples at ICU admission to evaluate total antioxidants, total oxidants, catalase, and myeloperoxidase levels. RESULTS: Thirty-one (24 male, 7 female) patients were included. At ICU admission, patients' mean APACHE II score at ICU admission was 17.61 ± 8.9; the mean SOFA score was 6.29 ± 3.16. There was no significant relationship between clinical severity and oxidative stress (OS) markers nor between radiological imaging and COVID-19 data classification and OS levels. Differences in OS levels between patients with healthy and exitus discharge status were not significant. CONCLUSIONS: We found no significant relationship between oxidative stress marker status in patients with COVID-19 at ICU admission and patients' ICU discharge status.

Comparison of LMA® Gastro™ airway and gastrolaryngeal tube in endoscopic retrograde cholangiopancreatography: a prospective randomized observational trial.

BACKGROUND: New generation airway devices with different designs have been developed as an alternative to endotracheal intubation in order to avoid adverse events associated with sedation in endoscopic procedures and to provide patent airway. We aimed to compare two supraglottic airway devices (SGADs), the LMA® Gastro™ airway and gastrolaryngeal tube (GLT), in terms of airway efficiency, performance during procedure and adverse events in endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A hundred-three ERCP patients without high risk of aspiration were included. Patients were randomly allocated to the LMA Gastro and GLT groups. The primary study outcomes were the comparison of the two SGADs in terms of oropharyngeal leak pressure (OLP). Secondary study outcome was SGADs-related adverse events. RESULTS: Procedures were completed with SGADs in fifty patients in each group. The rate of successful insertion at first attempt was 72% in GLT and 96% in LMA Gastro (P=0.004). The mean OLP of LMA Gastro Group (31.8 cmH2O) was significantly higher than that of the GLT Group (26.5 cmH2O), (P=0.0001). However, endoscopists' satisfaction was higher in GLT (P=0.0001). Mucosal damage and sore throat were lower in LMA Gastro Group. CONCLUSIONS: LMA® Gastro™ had a higher OLP than GLT. However, GLT was better for endoscopist satisfaction, as it provides more satisfying maneuverability. As to secondary outcome advers events were lower in LMA® Gastro™. The lower complication rates associated with the device and providing a more patent airway also highlighted the apparent clinical efficacy of LMA® Gastro™ than GLT, in ERCP.

[Our performance of supraclavicular, intercostobrachial and lateral femoral cutaneous block in a patient with high risk undergoing malign melanoma surgery on the forearm]. / Önkolda malign melanom nedeniyle opere edilen yüksek riskli hastada supraklavikular, interkostobrakiyal ve lateral femoral kutanöz blok uygulamasi.

The practice of anesthesia can include the need to accommodate surgical interventions on multiple extremities in a single procedure. General anesthesia is usually preferred in such cases in order to prevent an overdose of local anesthetics. One of the major benefits of using ultrasonography to provide regional anesthesia is that it facilitates reducing the local anesthetic drug dose required to obtain a successful block. The use of multiple, ultrasound-guided extremity blocks can be a reasonable alternative approach to general anesthesia, especially in high-risk patients. This report describes the case of a patient with malignant melanoma of the left lateral forearm. Surgical resection of the lesion, dissection of the axillary sentinel lymph node, and grafting from the lateral left thigh were planned. As the surgical procedure involved more than one extremity, a combination of anesthetic blocks was applied using ultrasound guidance. The use of supraclavicular, intercostobrachial, and lateral femoral cutaneous blocks is explained in the context of the literature.

Two different doses of caudal neostigmine co-administered with levobupivacaine produces analgesia in children.

SUMMARY BACKGROUND: This study was aimed to evaluate the analgesic efficacy duration of analgesia, and side effects of two different doses of caudal neostigmine used with levobupivacaine in children. METHODS: Sixty boys, between 5 months and 5 years, undergoing genitourinary surgery were allocated randomly to one of three groups (n =20 each). Group I patients received caudal 0.25% levobupivacaine (1 ml.kg(-1)) alone. Groups II and III patients received neostigmine (2 and 4 microg.kg(-1) respectively) together with levobupivacaine used in the same does as Group I. Pain scores were assessed using Children's and Infant's Postoperative Pain Scale (CHIPPS) at 15th (t(1)) min after arrival to postanesthetic care unit, and 1st (t(2)), 2nd (t(3)), 3rd (t(4)), 4th (t(5)), 8th (t(6)), 16th (t(7)), and 24th (t(8)) hour postoperatively. Duration of analgesia, amount of additional analgesic (paracetamol), score of motor blockade and complications were recorded for 24 h postoperatively, and compared between groups. RESULTS: CHIPPS scores were higher during t(2), t(3), t(6), t(7), and t(8) periods, duration of analgesia was shorter, and total analgesic consumption was higher in Group I compare to neostigmine groups (P < 0.05). Duration of postoperative analgesia and total analgesic consumption were similar in Groups II and III (P > 0.05). Adverse effects were not different between three groups. CONCLUSIONS: Caudal neostigmine in doses of 2 and 4 microg.kg(-1) with levobupivacaine extends the duration of analgesia without increasing the incidence of adverse effects, and 2 microg.kg(-1) seems to be the optimal dose, as higher dose has no further advantages.

The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients.

BACKGROUND: The aim of this study was to evaluate whether the addition of magnesium to levobupivacaine will decrease the postoperative analgesic requirement or not, and to investigate the possible preventive effects on laryngospasm. METHODS: Seventy-five children undergoing elective tonsillectomy and/or adenoidectomy surgery. The drug was prepared as only NaCl 0.9% for the first group (Group S, n=25), levobupivacaine 0.25% for the second group (Group L, n=25), and levobupivacaine 0.25% plus magnesium sulphate 2mg/kg for the third group (Group M, n=25). Pain was recorded at 15th minute, 1st, 4th, 8th, 16th, and 24th hour postoperatively. Pain was evaluated using a modified Children's Hospital of Eastern Ontario pain scale (mCHEOPS). Incidence of postoperative nausea and vomiting (PONV) was assessed at various time intervals (0-2, 2-6, 6-24h) by numeric rank score. Patients were followed for laryngospasm for 1h in recovery room after extubation. Other complications appeared within 24h postoperatively were recorded. RESULTS: All postoperative CHEOPS values were lower than control in both groups. Analgesic requirement was decreased significantly in both groups in comparison with control patients, but this requirement was significantly lower in Group M (p<0.05). Although laryngospasm was not observed in Group M, the difference between groups was not statistically significant. PONV was similar in both groups. CONCLUSIONS: Levobupivacaine and Levobupivacaine plus magnesium infiltration decrease the post-tonsillectomy analgesic requirement. Insignificant preventive effect of low doses of magnesium infiltration on laryngospasm observed in this study needs to be clarified by larger series.

Preconditionin effects of dexmedetomidine on myocardial ischemia/reperfusion injury in rats.

BACKGROUND: Preconditioning might protect the myocardium against ischemia/ reperfusion injury by reducing infarct size and preventing arrhythmias. Dexmedetomidine (DEX) is a highly selective α2-agonist used for sedoanalgesia in daily anesthetic practice. The cardioprotective effects of DEX on infarct size and on the incidence of arrhythmias observed after regional ischemia/reperfusion injury in vivo have not been reported. OBJECTIVE: The aim of this study was to determine whether DEX exhibits a preconditioning effect and reduces infarct size and the incidence and duration of arrhythmias in a regional cardiac ischemia/reperfusion model in rats. METHODS: Adult male Sprague-Dawley rats were anesthetized with sodium thiopental and mechanically ventilated (0.9 mL/100 g at 60 strokes/min) through a cannula inserted into the trachea after tracheotomy. Cardiac ischemia was then produced by ligating the left main coronary artery for 30 minutes, followed by a reperfusion period of 120 minutes. Blood pressure (BP) and heart rate (HR) were monitored and echocardiograms (ECGs) were performed. Arrhythmia was scored based on incidence and duration. The animals were randomly divided into 3 groups. The ischemic preconditioning (IPC) group underwent 5 minutes of ischemia followed by 5 minutes of reperfusion before the 30-minute ischemia/120-minute reperfusion period. In the DEX group, intraperitoneal (IP) DEX 1 mL (100 µg/kg) was administered 30 minutes before the ischemia/ reperfusion period. In the control group, IP saline 1 mL was administered 30 minutes before the ischemia/reperfusion period. After reperfusion, the heart was excised, demarcated with saline and ethanol to identify the occluded and nonoccluded myocardium, and cut into slices ~2 mm thick, that were then stained and placed between 2 glass plates. The risk zone and the infarct zone were compared between groups. The investigator assessing the infarcts was blinded to the study group. RESULTS: Twenty-one adult (aged 4-6 months) male Sprague-Dawley rats weighing 280 to 360 g were included in the study; 7 rats were assigned to each group. BP, HR, and ECG readings were not significantly different between groups and did not change during the study. Arrythmias occurred during ischemia and reperfusion in all groups. The duration of the arrhythmias was significantly shorter and the arrhythmia score was significantly lower in the IPC group (all, P<0.05), compared with the control group; however, they were not significantly different in the DEX group. During the ischemic period, duration of ventricular tachycardia (VT) and ventricular premature contractions (VPC) in the DEX group was significantly longer than that observed in the IPC group (all, P<0.05). The duration of VPC was also significantly shorter than that observed in the control group (both, P<0.05). Duration of VT during the reperfusion period in the DEX group was significantly longer than that observed in both IPC and control groups (both, P<0.05). The mean (SD) percentage of damage was significantly lower in the IPC group (44.1% [2.0%]) and the DEX group (26.7% [2.0%]) compared with the control group (69.0% [3.0%]; both, P<0.05). The percentage of damage in the DEX group was also significantly lower compared with the IPC group (P<0.05). CONCLUSIONS: This small, experimental in vivo study found that DEX was associated with reduced infarct size in ischemia/reperfusion injury in regional ischemia in this rat model but had no effect on the incidence of arrhythmias. Future studies are needed to clarify these findings.

The effect of prilocaine and prilocaine plus meperidine infiltration on the pain during nasal packing removal.

OBJECTIVE: Removing the nasal packing after nasal surgery is an uncomfortable and painful procedure. Since there is no controlled trial described in the literature about the local use of meperidine during packing removal, we aimed to compare the analgesic and sedative effects of the meperidine-prilocaine combination, injected into the packing 15 minutes before the procedure, with that of prilocaine during packing removal. METHODS: Fifty adult patients, for whom nasal packing removal after nasal septoplasty was scheduled, were randomly allocated into one of two groups. In the prilocaine group (Group P, n = 25), 5 ml of 1% prilocaine in saline was injected into the pack 15 minutes before removal. In the prilocaine-meperidine group (Group MP, n = 25), 5 ml fluid combination containing prilocaine (10 mg/ml) and meperidine (1 mg/kg) was injected in nasal packs. Five ml saline was injected into the package in the contra-lateral nostril in both groups as control. Visual analogue scale (VAS) score was recorded during injections (t) and packing removal (t), and the Ramsay sedation score was evaluated. RESULTS: VAS score was not different from the control nostril in Group P (p > 0.05), where as it was significantly lower than the control nostril in Group MP (p < 0.05). Ramsay sedation scores were significantly higher in Group MP compared to the control nostril and actively treated nostril of Group P (p < 0.05). CONCLUSION: The injection of prilocaine plus meperidine into the nasal pack 15 minutes before nasal packing removal provides effective analgesia and mild sedation during the procedure.

Relation between middle ear pressure changes and postoperative nausea and vomiting in pediatric strabismus surgery.

STUDY OBJECTIVE: To investigate the effects of tympanometric changes on the frequency of postoperative nausea and vomiting (PONV). DESIGN: Prospective, observational study. SETTING: University hospital. PATIENTS: 49 ASA physical status I, nonpremedicated children undergoing elective strabismus surgery. INTERVENTIONS: Frequency of PONV was assessed at various time intervals (0-2, 2-6, and 6-24 hours) with a 4-point scale (0, no nausea; 1, nausea but no vomiting; 2, one episode of vomiting; 3, two or more episodes of vomiting), and correlation with tympanometric data was investigated. MEASUREMENTS: Tympanogram was obtained before induction of standardized anesthesia and after full recovery. Fourteen (28.6%) patients had nausea, and 10 (20.4%) patients vomited. The tympanic gradient, compliance, and pressure values were found to be significantly higher in postoperative measurements than their preoperative counterparts (P < 0.05). The volumes of both ears increased postoperatively, but these differences were not statistically significant (P > 0.05). Changes in middle ear pressure, volume, compliance, and gradient did not correlate with PONV (P > 0.05). CONCLUSIONS: Gradient, compliance, volume, and pressure changes in middle ears were not found to be related to the frequency of nausea and vomiting after strabismus surgery.

Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study.

UNLABELLED: Abstract. BACKGROUND: Monitored anesthesia care (MAC) may be applied for septoplasty or endoscopic sinus surgery in which an adequate sedation and analgesia without respiratory depression are desired for comfort of both the patient and the surgeon. Several combinations with different agents have been used for this purpose in these patients. However, analgesic properties for these agents have not been reported. OBJECTIVE: The aim of this study was to investigate the analgesic and sedative effects of dexmedetomidine or midazolam infusion combined with tramadol that was used via patient-controlled analgesia (PCA), and to document the effects of these drugs on early cognitive functions. METHODS: This prospective, randomized, double-blind, clinical study enrolled patients undergoing septoplasty or endoscopic sinus surgery at the Abant Izzet Baysal University Hospital, Bolu, Turkey, between February and September 2006. Patients were randomly allocated in a 1:1 ratio into 1 of 2 groups: the dexmedetomidine group (group D) patients received IV dexmedetomidine 1 µg/kg for 10 minutes followed by continuous infusion of 0.5 µg/kg · h(-1); and the midazolam group (group M) patients were administered a loading dose of IV midazolam 40 µg/kg for 10 minutes followed by infusion at the rate of 50 µg/kg · h(-1). A 1-minute bolus dose of IV tramadol (1.5 mg/kg) was administered in both groups 10 minutes after the administration of the primary drug, and continued via infusion using a PCA device. After baseline measurements, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and rate of respiration were recorded after the loading dose of study drug, after the bolus tramadol dose, at 10-minute intervals during the operation, and twice in the recovery rooms; 5 minutes after arrival and 5 minutes before discharge. Verbal rating score (VRS) and Ramsay sedation score were determined at baseline (after surgery was started), every 10 minutes thereafter until the end of the operation, and 2 times during recovery. All patients were assessed with the Wechsler Memory Scale-Revised at baseline (preoperatively) and 4 hours after the operation. RESULTS: Seventy patients were enrolled in the study and randomly assigned to 1 of 2 groups: group D (sex, male/female, 23/12; mean [SEM] age, 32.53 [2.07] years; mean [SEM] weight, 73.03 [2.41] kg) or group M (sex, male/female, 21/14; mean [SEM] age, 34.43 [1.83] years; mean [SEM] weight, 67.90 [2.32] kg). All hemodynamic parameters (SAP, DAP, MAP, HR) were significantly higher in group M compared with group D from the onset of the surgery to discharge time (P < 0.05). Pain and sedation scores were similar in both groups, but the amount of PCA-administered rescue tramadol was significantly higher in group M (P = 0.001). A higher, though not statistically significant, prevalence of adverse events (ie, hypotension, bradycardia, and perioperative nausea and vomiting) were observed in group D. Postoperative logical verbal memory and digit span values were significantly higher in group D when compared with group M (P < 0.05). Postoperative digit span and visual reproduction scores were significantly higher than preoperative values in group D (P < 0.05). Postoperative personality functioning scores were significantly higher than preoperative values in group M (P < 0.05). CONCLUSIONS: Based on VRS, Ramsay sedation scores, and surgeon and anesthesiologist satisfaction scores, dexmedetomidine or midazolam combined with tramadol PCA provided adequate analgesia and sedation in these adult patients undergoing septoplasty or endoscopic sinus surgery with MAC. A significantly larger amount of rescue tramadol was used by group M, suggesting that a better analgesic effect was achieved with dexmedetomidine.