A novel approach to managing COVID-19 patients; results of lopinavir plus doxycycline cohort.

This manuscript aims to present a treatment algorithm we applied to manage COVID-19 patients admitted to our hospital. During the study period, 2043 patients with suspected COVID-19 were admitted to the emergency department. Molecular tests indicated that 475 of these patients tested positive for COVID-19. We administered hydroxychloroquine plus doxycycline to mild cases (isolated at home) for 3 days and lopinavir plus doxycycline to moderate and severe cases (hospitalized) for 5 days. The overall case fatality rate was 4.2% (20/475).

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.

Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy.

OBJECTIVES/AIM: The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients. BACKGROUND: Tonsillectomy surgery is frequently associated with postoperative pain, which usually requires substantial consumption of analgesics including opioids. Safe and effective post-tonsillectomy pain control is still a clinical dilemma, in spite of the use of various surgical and anesthetic techniques. METHODS: A total of 60 children, aged between 4 and 10 years, scheduled for tonsillectomy, were randomly assigned to one of three groups. Study drugs were administered to both tonsillar fossae for 5 min. In 5 ml artificial saliva, Group K (n = 20) received 0.4 ml (20 mg) ketamine and Group T (n = 20) received 0.8 ml tramadol HCl solution. Group C (n = 20) received only 5 ml saline as a control. Ramsay Sedation Scale and FACES PRS Score, nausea, vomiting, difficulty in swallowing, and sore throat were evaluated. RESULTS: There was no difference among the groups in terms of baseline characteristics, including age, sex, and ASA profile (P > 0.05 for all). Systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen (SpO2 ) values were not significantly different among the groups in all time points (P > 0.05 for all). There was a statistically significant difference among the groups according to Ramsay Sedation Scales in 40th minute (P < 0.001). There were statistically significant differences among the groups in terms of Wong-Baker FACES Pain Rating Scale Score in all time points (P < 0.004 for all). There was a statistically significant difference among the groups in terms of rescue analgesia necessity in 5th and 10th minute (P < 0.001 and P = 0.003). There was a statistically significant difference among the groups in terms of sore throat in 5th and 10th minute (P < 0.001 for both). Neither rescue analgesia necessity nor sore throat characteristics was different between the Group T and Group K in all time points. CONCLUSION: Topical tramadol and ketamine seem to be safe, effective, and easy analgesic approach for decreasing tonsillectomy pain.

Effect of pregabalin and dexamethasone addition to multimodal analgesia on postoperative analgesia following rhinoplasty surgery.

BACKGROUND: We investigated the effect of a combination of pregabalin and dexamethasone, when used as part of a multimodal analgesic regimen, on pain control after rhinoplasty operations. METHODS: Sixty patients were enrolled in this study. They were randomly assigned into three groups: Group C (placebo + placebo), Group P (pregabalin + placebo), and Group PD (pregabalin + dexamethasone). Patients received either pregabalin 300 mg orally 1 h before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain was treated with intravenous patient-controlled analgesia (tramadol, 20-mg bolus dose, 45-min lockout time). The numeric rating scale (NRS), side effects, and consumption of tramadol, pethidine, and ondansetron were assessed. RESULTS: The median NRS scores at 0, 1, and 6 h after surgery were significantly higher in Group C than in Group PD (p < 0.001 for all). The 24-h consumption of tramadol and pethidine was significantly reduced in Groups P and PD compared to Group C (p < 0.01 and p < 0.01). The total tramadol consumption was decreased by 54.5 % in Group P and 81.9 % in Group PD compared to Group C (p < 0.001 for both). The incidence of nausea was higher in Group C than in Groups P and PD between the postoperative 0-2 and 0-24-h periods (p < 0.05 for both). The frequency of blurred vision was significantly higher in Groups P and PD than in Group C within the 0-24-h period (p < 0.05 for both). CONCLUSION: We found that the addition of a single dose of pregabalin and dexamethasone to multimodal analgesia in rhinoplasty surgeries provided efficient analgesia and thus decreased opioid consumption. LEVEL OF EVIDENCE I: 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 .

The effect of extubation in prone position on emergence and recovery in lumbar spinal surgery.

BACKGROUND: Extubation of patients in supine position after prone operations may lead to unwanted effects on hemodynamic and respiratory parameters during emergence and recovery period. We aimed to observe the effects of prone position on emergence and recovery periods after prone surgery. METHODS: This randomized controlled trial was studied with sixty patients extubated either in prone position (30 patients) or in supine position (30 patients) after lumbar spinal surgery in tertiary educational hospitals. Heart rate, non-invasive arterial blood pressure, peripheral oxygen saturation and Bispectral Index values were measured, and recorded in all patients during operation, at the time an anesthetic agent was discontinued, before and after extubation. The number of the mouth suctioning, Aldrete recovery score, and Ricker agitation score were recorded together with the severity of cough during emergence and recovery. Incidents such as nausea, vomiting, respiratory failure, uncontrolled airway, and decreased saturation were also recorded. RESULTS: Heart rate and mean arterial pressure values were significantly lower in the prone group during emergence and recovery period compared with the supine group (P<0.05). Aldrete Recovery Scores were higher in the prone group (P<0.001). The number of the mouth suctioning and the cough severity were lower in the prone group (P<0.001). CONCLUSIONS: Extubation in the prone position provides a more comfortable emergence and recovery periods by less altering the hemodynamic and respiratory status with better recovery profile.

Association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males.

PURPOSE: Aging in men is characterized by a moderate decrease in plasma testosterone (T) levels. However, the association between partial androgen deficiency of the aging male and clinical symptoms and the ideal screening test are controversial. In this study, we investigated the association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males. MATERIALS AND METHODS: We investigated the association between total (TT), calculated free (FT) and bioavailable (BT) testosterone, and various clinical and laboratory parameters in 103 healthy males, 50-80 years old. Biochemical assessment was done after overnight fasting. Questionnaires were used to test for hypogonadism symptoms, erectile and cognitive functions. RESULTS: TT levels were not correlated with aging in this study. However, FT and BT were found to decrease with age due to rising sex hormone binding globulin. TT levels were strongly correlated with FT and BT levels (respectively p = 0.0001, p = 0.0001). TT, FT and BT were only correlated with cognitive functions (p = 0.012, p = 0.004, p = 0.02 respectively). There was no correlation between TT, FT and BT levels and erectile function and hypogonadism symptoms. CONCLUSION: T values in our study sample did not correlate with clinical signs and symptoms of hypogonadism. Thus, according to our data, symptoms in the aging male should not be indiscriminately assigned to a decrease in TT, FT or BT levels.

Ultrasound-guided X-ray free percutaneous nephrolithotomy for treatment of simple stones in the flank position.

The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney's proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient's flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20-41) mm, duration of surgery was 87.1 ± 43.2 (55-210) min and duration of hospital stay was 3.1 (2-8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.

Unexpected severe hepatotoxicity of ciprofloxacine: two case reports.

Ciprofloxacin is a fluoroquinolone antibiotic that has a relatively low rate of occurence of adverse side effects. However, increasing evidences suggest that ciprofloxacin may cause unexpected severe liver damage. Especially, the risk of hepatotoxicity is significantly higher in elderly men receiving drug for a long time. In this article, 2 cases of unexpected severe hepatoxicity of ciprofloxacin are presented.

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 Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography.

INTRODUCTION: The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain. METHODS: The present study includes 80 ASA 1-2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg  kg-1 intravenous midazolam, 1 mg  kg-1 lidocaine, 1 µ kg-1 fentanyl, and then a bolus dose of 1 mg kg-1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg  kg-1 h-1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg  kg-1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65-75, and the propofol infusion was halted once the BIS value dropped below 65. RESULTS: STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T. CONCLUSION: The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption. TRIAL REGISTRATION: The study was registered with the number NCT03114735 on ClinicalTrials.gov.

Nephroprotective Efficacy of Sugammadex in Ischemia-Reperfusion Injury: An Experimental Study in a Rat Model.

BACKGROUND: It is known that ischemia-reperfusion damage in the kidney is one of the most common causes of acute kidney failure. It is also known that reduced renal damage has a nephroprotective effect by reducing the release of inflammatory and vasoactive peptides that cause tissue damage. Therefore, we think that reperfusion caused by ischemia in kidney damage may be an important focus for clinical research. METHODS: A total of 21 healthy 230-250 g female rats were used in our experimental study. During the experiment, animals were randomly divided into three groups, each containing seven rats. Group 1: The group that underwent left nephrectomy with a sham operation. Group 2: Left renal ischemia for 60 minutes, then left nephrectomy followed by 45 minutes of reperfusion. Group 3: Left renal ischemia for 60 minutes, then reperfusion for 45 minutes, followed by left nephrectomy. In this group, sugammadex was given intravenously at a dose of 100 mg/kg at the beginning of reperfusion. In the histomorphological examination, damage findings of tubules atrophy, dilation and cast formation, tubular epithelial brush border loss and vacuolization, presence of fibrosis as interstitial structural change, capillary vasodilatation/congestion and neutrophilic cell infiltrates in interstitial spaces, and morphological changes in glomeruli were evaluated. RESULTS: When evaluated based on tubular brush border, there were no significant differences between Group 2 and Group 1 (P = 0.454), while the damage in Group 3 was less significant than Group 2 (P = 0.017). When evaluated in terms of tubular vacuolization, there was no significant difference between Group 2 and Group 1 (P = 0.902), while the damage in Group 3 was less significant than Group 2 (P = 0.017). CONCLUSION: We believe that 100 mg/kg sugammadex given at the beginning of reperfusion after one hour of ischemic condition on rats has a histochemically detectable nephroprotective effect.

Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain.

OBJECTIVE: The Pain Sensitivity Questionnaire (PSQ) is a clinically beneficial instrument that has been proven to be correlated with various experimental pain sensitivity assessments in healthy people and in patients with chronic pain. In this study, we aimed to translate the PSQ into Turkish (PSQ-T) and validate it for the measurement of pain sensitivity among Turkish people. METHODS: Seventy-three patients with chronic back pain who were planning to undergo an interventional procedure completed the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory (BDI), Beck Anxiety Inventory, Pain Catastrophizing Scale, and PSQ prior to their procedure. Subcutaneous infiltration of lidocaine was used as a standardized experimental pain stimulus. Pain was evaluated using a visual analog scale (VAS 1: infiltration in the hand, and VAS 2: infiltration in the procedure area). RESULTS: Scores on the PSQ-T were significantly correlated with those on the BPI-SF. A significant positive relationship was observed between VAS 1 and VAS 2 values and the PSQ-T score, BPI pain score, and BPI interference score. CONCLUSIONS: The PSQ-T can be used as a valid and reliable tool for the assessment of pain sensitivity in the Turkish population.

Evaluation of bispectral index monitoring efficacy in endoscopic patients who underwent retrograde cholangiopancreatography and received sedoanalgesia.

INTRODUCTION: Bispectral index (BIS) monitoring provides an objective, non-invasive measurement of the level of consciousness in a sedated patient. AIM: In this prospective study, we aimed to investigate the hypothesis that risk of respiratory depression could be reduced and the desired level of sedation with minimal doses of propofol could be achieved by using BIS monitoring in endoscopic retrograde cholangiopancreatography (ERCP) procedures. MATERIAL AND METHODS: Sixty patients in the ASA 1-2 category, who were scheduled for an ERCP with sedation, were randomly divided into two groups. The procedure was performed, and sedation was administered so that the patient's Ramsay Sedation Score (RSS) would be 4-5 in the first group (group 1) and the patient's BIS value would be 65-75 in the second group (group 2). Cardiopulmonary complications, the total duration of the procedure, and the total amount of propofol administered were recorded. RESULTS: The mean SpO2 measurements at the third minute, fifth minute, and 10th minute were higher in the BIS group (p < 0.001) (p < 0.05). The mean number of respirations during the third, fifth, 10th, and 15th minute of sedation was significantly higher in the RSS group than in the BIS group (p < 0.05). There was no difference between the groups in terms of recovery time, total propofol amount, and additional doses of bolus propofol. CONCLUSIONS: BIS monitoring during sedation with propofol for ERCP did not reduce total propofol use, but it may be an efficient guide for the timing of additional dose administration, which could reduce the risk of respiratory depression, and it could be used safely as an objective method in the follow-up of level of sedation.

A lateral percutaneous technique for stellate ganglion blockade in rats.

BACKGROUND: In the present study, we describe and show the efficacy of a lateral approach to stellate ganglion block (SGB) in rats. METHODS: Twenty-one rats were randomized into three groups: the posterior technique group (n = 7), the lateral technique group (n = 7), and the control group (n = 7). Thiopental was administered intraperitonally as 5 mg per 100 g of each rat's weight for sedation during the procedure. In the posterior technique group, SGB was performed by a posterior percutaneous approach as described previously. In the lateral technique and control groups, the cervical vertebrae was fixed between the left first and third fingers of the physician's left hand while palpating the C7 process with the second finger. The study drug was 0.2 mL 0.25% plain bupivacaine for the two percutaneous treatment groups, and 0.2 mL saline in the controls. RESULTS: Two animals in the posterior technique group died immediately after local anesthetic injection (P < 0.01). There were no deaths in the new technique group or in the controls. Ptosis appeared at 300 +/- 120 s in the posterior group, whereas it was seen almost immediately after withdrawing the needle in the lateral technique group (6 +/- 4 s) (P < 0.001). Ptosis did not occur in the control group. There was no statistically significant difference in heart rate among groups (P > 0.069). CONCLUSION: The lateral approach to SGB does not require the induction of general anesthesia. The approach is associated with early development of ptosis and may be associated with a lower mortality rate compared to the conventional posterior approach.

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.

Effect of dexmedetomidine on ischemia-reperfusion injury in rat kidney: a histopathologic study.

Ischemia-reperfusion (I-R) injury remains the leading cause of acute renal failure. The purpose of this experimental study was to determine the role of dexmedetomidine on histologic alterations induced by renal I-R in rats. In the present study, thirty male Sprague-Dawley rats weighing 200-220 g were randomly assigned into three groups: the sham-control group (group 1, n = 10), the R/untreated group (group 2, n = 10), and the I-R/dexmedetomidine-treated group (group 3, n = 10). For group one, we performed a sham operation. The abdomen was dissected, the right kidney was harvested, and then the left renal pedicle exposed. Renal clamping was not applied. For group 2, rats underwent left renal ischemia for 60 minutes followed by reperfusion for 45 minutes. For group 3, the same surgical procedure as in group 2 was performed, and dexmedetomidine (100 microg/kg, intraperitoneal) was administrated at the starting time of reperfusion. The rats were sacrificed after reperfusion, and the kidney tissue was harvested. The histopathological score in the kidney of the I-R/dexmedetomidine-treated group rats was significantly lower than that of I-R/untreated group rats. This score in I-R/untreated group rats was higher than the other two groups, which was statistically significant. In the I-R/untreated group rats, kidneys of untreated ischemia rats showed tubular cell swelling, cellular vacuolization, pyknotic nuclei, medullary congestion, and moderate to severe necrosis. Treatment with dexmedetomidine shows normal glomeruli and slight edema of the tubular cells. These findings provide the first evidence that dexmedetomidine can reduce the renal injury caused by I-R of the kidney, and may be useful in enhancing the tolerance of the kidney against renal injury.

Comparison of General Anesthesia with Spinal Anesthesia in Laparoscopic Cholecystectomy Operations.

OBJECTIVE: Laparoscopic cholecystectomy (LC) operations are being performed under general anesthesia (GA). Further studies are needed on the issue whether these operations can be performed under spinal anesthesia (SA). In this study we aimed to compare SA with (GA) in terms of efficacy and complications in patients who will undergo LC operations, and to investigate the effects of preemptive analgesia on the development of shoulder pain, transition to general anesthesia, and postoperative analgesia. METHOD: Sixty patients in ASA I-II risk group between 18-65 years of age undergoing laparoscopic cholecystectomy were randomly divided into general anesthesia (GA, n=30) and spinal anesthesia (SA, n=30) groups. Patients were premedicated with i.v. midazolam and fentanyl preoperatively. Anesthesia was induced with propofol in the GA group, and maintained with Desflurane and remifentanil. In the SA group, spinal anesthesia was provided with intratechal administration of 15 mg bupivacaine at L2-3 level, and block level was increased to T4 by keeping the patient in Trendelenburg position for 7-10 minutes. Demographic data, hemodynamic parameters, operation time, visual analog scale (VAS) scores at postoperative 0th,1st, 4th, 8th,12th and 24th hours, patient-surgeon satisfaction, side effects, and occurrence of right shoulder pain in SA group were inquired and recorded. RESULTS: Effective anesthesia was produced in both groups. Hypotension was observed in 5, bradycardia requiring atropin administration in 4, and perioperative shoulder pain in 9 patients in Group SA, but none of them required general anesthesia. Hypotension developed in one patient in Group GA. The postoperative VAS scores were significantly lower in Group SA at 0th,1st, 4th hours. Patient satisfection scores were higher in Group SA. CONCLUSION: We concluded that spinal anesthesia may be an alternative method to general anesthesia in patients who will undergo laparoscopic cholecystectomy operations especially when the risk of general anesthesia is too high.

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study.

BACKGROUND: The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. METHODS: Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. RESULTS: A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients' fears of feeling pain during surgery. CONCLUSION: We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients' refusals to choose this procedure.

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.