The Relationship between Preoperative Smoking Cessation, Anxiety, and Postoperative Anxiety and Pain: A Prospective Clinical Trial at a University Hospital in the East of Turkey on 120 Participants.

Objectives: To reveal the relationship between smoking cessation before surgery, pre- and post-operative anxiety, and pain among chronic smokers. METHODS: The cross sectional prospective clinical study was conducted in 2018 on the east of Turkey, in Van Yüzüncü Yil University Dursun Odabas Medical Center in city of Van. After approval from the ethics committee participants of either gender aged 20-60 years scheduled to undergo rhinoplasty surgery and graded as American Society of Anaesthesiologists I-II were included. The participants were categorised into smokers group S and non-smokers group NS. Spielberger State-Trait Anxiety Inventory values for preoperative period, postoperative 0, which is the moment when the modified Aldrete score is >9, as well as for 2, 4 and 6 hours, and visual analogue scale values for the postoperative 0, 2, 4 and 6 hours were recorded. Data was analysed using SPSS 26. RESULTS: Of the 120 patients, there were 60(50%) in group S; 28(46.7%) females, 32(52.3%) males, overall mean age 33.0±9.7 years. In group NS, there were 34(56.7%) females and 26(43.3%) males with an overall mean age of 34.7±10.1 years (p>0.05). Group S had Spielberger State-Trait Anxiety Inventory preoperative and postoperative values significantly higher than group NS (p˂0.05). While the values for postoperative 4 and 6 hours increased in group S, corresponding values decreased in group NS (p˂0.05). CONCLUSIONS: High anxiety scores in preoperative period appeared to be associated with stress from surgery and anaesthesia and could have been caused by smoking dependency during the preoperative and postoperative periods.

A case of primary hydatid cyst in the thyroid gland.

Hydatid disease is a significant infestation caused by the tapeworm Echinococcus granulosus. Primary hydatid disease of the head and neck without systemic involvement is quite rare in endemic regions.

Intraoperative and Postoperative Effects of Dexmedetomidine and Tramadol Added as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block.

Background: We aimed to evaluate the intraoperative hemodynamics, opioid consumption, muscle relaxant use, postoperative analgesic effects, and possible adverse effects (such as nausea and vomiting) of dexmedetomidine and tramadol added as adjuvants to bupivacaine in the transversus abdominis plane block (TAP block) to provide postoperative analgesia. Materials and Methods: This was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. After obtaining ethical approval at the Van Yuzuncu Yil University and written informed consent, this investigation was registered with ClinicalTrials.gov (NCT05905757). The study was conducted with 67 patients with ASA I-II physical status, aged 20-60 years, of either sex who were scheduled for an elective laparoscopic cholecystectomy under general anesthesia. Exclusion criteria were the patient's refusal, ASA III and above, a history of allergy to the study drugs, patients with severe systemic diseases, pregnancy, psychiatric illness, seizure disorder, and those who had taken any form of analgesics in the last 24 h. The patients were equally randomized into one of two groups: Group T (TAP Block group) and Group D (Dexmedetomidin group). Standard general anesthesia was administered. After intubation, Group T (Bupivacaine + adjuvant tramadol) = solutions containing 0.250% bupivacaine 15 mL + adjuvant 1.5 mg/kg (100 mg maximum) tramadol 25 mL and Group D (Bupivacaine + adjuvant dexmedetomidine) = solutions containing 0.250% bupivacaine 15 mL + 0.5 mcg/kg and (50 mcg maximum) dexmedetomidine 25 mL; in total, 40 mL and 20 mL was applied to groups T and D, respectively. A bilateral subcostal TAP block was performed by the same anesthesiologist. Intraoperative vital signs, an additional dose of opioid and muscle relaxant requirements, complications, postoperative side effects (nausea, vomiting), postoperative analgesic requirement, mobilization times, and the zero-hour mark (patients with modified Aldrete scores of 9 and above were recorded as 0 h), the third-hour, and sixth-hour visual analog scale (VAS) scores were recorded. The main outcome measurements were the effect on pain scores and analgesic consumption within the first 6 h postoperatively, postoperative nausea and vomiting (PONV), and time to ambulation. The secondary aim was to evaluate intraoperative effects (on hemodynamics and opioid and muscle relaxant consumption). Results: It was observed that dexmedetomidine and tramadol did not have superiority over each other in terms of postoperative analgesia time, analgesic consumption, side effect profile, and mobilization times (p > 0.05). However, more stable hemodynamics were observed with dexmedetomidine as an adjuvant. Conclusions: We think that the use of adjuvant dexmedetomidine in the preoperative TAP block procedure will provide more stable intraoperative hemodynamic results compared with the use of tramadol. We believe that our study will be a guide for new studies conducted with different doses and larger numbers of participants.

Evaluation of Computed Tomography Angiography as an Ancillary Test to Reduce Confusion After Clinical Diagnosis of Brain Death.

BACKGROUND: The diagnosis of brain death (BD) is mainly a clinical diagnosis. Ancillary tests may be used in confusing situations. Although computed tomography angiography (CTA) has high sensitivity and specificity, it can give false-positive results in cases with craniotomy. OBJECTIVE: The aim of this study is to emphasize the importance of accurate and detailed clinical diagnosis and to reveal that there is organ loss as a result of prolonged supportive tests, especially in developing countries. MATERIAL AND METHODS: This retrospective study included patients who were diagnosed with BD in the intensive care unit of Van Yüzüncü Yil University, between September 2014 and August 2017 in Turkey. The study included 14 male and 8 female patients. Patients who did not show any spontaneous respiratory symptoms after the apnea test were diagnosed with clinical BD. Patients on neurodepressant medications who were hypothermic or hypoxic or had a severe endocrine or metabolic disorder were excluded from the study. CTA was used as an ancillary test in compliance with legal requirements. Age, sex, hospitalization days, day of clinical diagnosis of BD, first radiologic evaluation by CTA, clinical diagnosis, and radiologic evaluation were recorded for all patients. RESULTS: Radiologic evaluation was not compatible with the clinical evaluation in 5 patients. Although 2 of these 5 patients had BD diagnosis clinically, blood flow could be expected during CTA because of cranial injury. Unlike in the literature, false positivity was found in 3 patients with hypoxic ischemic encephalopathy in the present study. CONCLUSIONS: Proper management of limited resources and the facilitation of cadaver organ donation in developing countries are important and humanitarian global responsibilities. Revision of the country's legal regulations is important and is warranted in this regard.

Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness.

Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.

The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: a retrospective evaluation of 515 patients.

OBJECTIVE: To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy. METHODS: This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting. RESULTS: A total of 515 patients were included (group A, n = 247; group T, n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A. CONCLUSIONS: Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.

Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy.

BACKGROUND: Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy. METHODS: The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 µg/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of ≥4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses. RESULTS: In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation. CONCLUSION: Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.

The Effect of Nitrous Oxide on the Outcomes of Underlay Tympanoplasty: A Prospective Study.

The main aims of tympanoplasty are eradication of chronic middle ear disease, repair of the tympanic membrane, and restoration of hearing. Nitrous oxide (N2O) is not a commonly preferred anesthetic agent for tympanoplasty because this agent may increase middle ear pressure and displace the graft. In this study, we researched the surgical outcomes of the underlay tympanoplasty performed with N2O anesthesia. Patients who underwent tympanoplasty were included in this prospective study. A type 1 tympanoplasty was performed in all patients using the underlay technique. Patients were randomized to groups that did and did not receive N2O. Preoperative and postoperative hearing thresholds were evaluated, postoperative pain scores were recorded, and the differences between the groups were statistically evaluated. There were 44 patients who received N2O and 44 who did not. The graft success rate was 93.2% in the N2O-receiving group and 84.1% in the nonreceiving group (P > .05). Hearing levels improved significantly after surgery in each group (P < .05), but the difference between the groups was not significant (P > .05). The postoperative pain score was 3.72 ± 1.3 in the N2O-receiving group and 4.45 ± 2.3 in the nonreceiving group (P > .05). Nitrous oxide is a cheap, safe, and readily available anesthetic agent that provides acceptable success rates in patients undergoing tympanoplasty.