The effect of upper transabdominal plane block on diaphragm thickness in adult patients after laparoscopic cholecystectomy operation.

INTRODUCTION: In this prospective and observational study, our objective was to examine the impact of subcostal transversus abdominis plane (SubTAP) block, along with intravenous analgesia techniques, on diaphragm thickness and post-operative pain following laparoscopic cholecystectomy. PATIENTS AND METHODS: This study examined laparoscopic cholecystectomy patients aged 18-60 years with an American Society of Anesthesiologist score of 1-2. This study divided patients into Group 1 for SubTAP block and Group 2 for intravenous analgesia. This study had 67 patients, at least 30 from each group. Thus, diaphragm thicknesses and Visual Analogue Scale (VAS) values were compared between regional anaesthesia and intravenous analgesia groups. RESULTS: Pre-operative data showed no statistically significant changes between the groups, although post-extubation inspiratory thickness was closer to baseline in Group 1 patients who received regional block. The groups had different outcomes after extubation and at the post-operative 30th min (P = 0.028 and P = 0.001, respectively). There was also a significant difference in post-operative oxygen saturation and VAS scores (P = 0.001). Our receiver operating characteristic analysis determined that the threshold values for VAS parameters of 2 or 3 were 0.28 cm in inspiration, 0.18 cm in expiration and 1.29 as i/e ratio. Significant discomfort was defined as diaphragm parameter values below these limits. CONCLUSIONS: We found that the earlier return of diaphragmatic functions to baseline was associated with diaphragm thickness. According to the measurements made in the post-operative care unit, the regional block group effectively prevented the loss of diaphragm function.

Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial.

OBJECTIVES: This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon's direct vision for providing postoperative pain relief after thoracic surgeries. METHODS: Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia + continued RISS block; n = 20) and group C (intravenous patient-controlled analgesia; n = 20). Numeric rating scale at rest and cough, at post-anaesthetic care unit, 1, 2, 6, 9, 12, 24 and 48 h, was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions and the overall satisfaction with pain management. RESULTS: Numeric rating scale scores both at rest and during coughing were significantly lower in group R than in group C at all time intervals (P < 0.001 in each). Tramadol consumption at 24 and 48 h was significantly lower in the group R block than in group C (P < 0.001 for each). None of the patients in group R requires rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (P = 0.047 and P = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than that in group C (P < 0.001). CONCLUSIONS: Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function and patient satisfaction.

Visceral adiposity index in kidney stone patients who have undergone surgery.

Introduction: The visceral adiposity index (VAI) is a gender-specific metabolic index that indirectly measures visceral adipose function and distribution using waist circumference, body mass index (BMI), and triglyceride and high-density lipoprotein (HDL) cholesterol values. To assess visceral fat in the diagnostic pathway of urinary stone patients, we investigated the relationship between the VAI and nephrolithiasis as well as the relationship between the VAI and stone and surgery-related parameters. Material and methods: Patients who underwent percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones were included in the study. The control group comprised of healthy individuals who volunteered to take part in study and did not have urolithiasis as confirmed by abdominal computed tomography imaging. A total of 148 patients were divided into the nephrolithiasis (n = 103) and the control (n = 45) groups. Weight, height, BMI, waist circumference measurements, and VAI were among the metabolic parameters measured. Stone and surgical parameters were evaluated. Results: VAI (4.57 vs 2.76), waist circumference (92.1 vs 87.1), and BMI (28.31 vs 26.51) values were higher in the nephrolithiasis group(p = 0.02,p = 0.04, p <0.001,respectively). The VAI was statistically significant in the multivariate analysis for the presence of nephrolithiasis (p <0.001). The VAI negatively correlated with the stone Hounsfield unit (HU) and positively correlated with very-low-density lipoprotein (VLDL), blood creatinine, and calcium levels. The relationship between VAI and surgical parameters was not significant. Conclusions: A significant relationship was detected between nephrolithiasis and VAI, a new gender-specific metabolic index that distinguishes between subcutaneous and visceral adipose mass and demonstrates metabolic syndrome. No significant effect of this relationship on surgical parameters was demonstrated in the present study.

Anaesthesia-Related Pediatric Neurotoxicity: A Survey Study.

OBJECTIVE: Millions of children are exposed to anaesthetic drugs every day; however, the possible adverse effects of these agents on the central nervous system remain controversial. This study evaluated anaesthesiologists' and pediatric surgeons' knowledge and daily practices regarding anaesthesia-induced neurotoxicity. METHODS: A survey consisting of 12 questions was sent to members of the Turkish Anaesthesiology and Reanimation Association and the Turkish Pediatric Surgery Association via the Google forms program. RESULTS: A total of 202 anaesthesiologists and 51 pediatric surgeons participated in this survey. The results demonstrate that anaesthesiologists and surgeons are aware of the risk of anaesthesia-related neurotoxicity and are willing to take action. Approximately, half of the anaesthesiologists and pediatric surgeons expected to postpone operations lasting at least 3 hours for patients <3 years of age. Also, one-third of the anaesthesiologists would seek feasible and more reliable alternative anaesthetic strategies. CONCLUSIONS: More than two-thirds of the participants knew about the US Food and Drug Administration neurotoxicity warning; however, uncertainty about anaesthesia-related neurotoxicity is ongoing. Many questions remain unanswered. The results of large-scale prospective randomized studies to evaluate the effect of anaesthetics and surgery on the cognitive development of pediatric patients are needed.

Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: a prospective double-blind study.

BACKGROUND: Laparoscopic cholecystectomy is a common surgical procedure that frequently results in substantial postoperative pain. Erector spinae plane block (ESPB) has been shown to have beneficial postoperative analgesic effects when used as a part of multimodal analgesia. The aim of this study was to determine whether ESPB improves postoperative recovery quality in patients undergoing laparoscopic cholecystectomy. Evaluation of the effects of ESPB on postoperative pain, opioid consumption, and nausea and vomiting was the secondary objective. METHODS: In this prospective double-blind study, 82 patients undergoing laparoscopic cholecystectomy were randomised into one of two groups: a standard multimodal analgesic regimen in Group N (control) or an ESPB was performed in Group E. Preoperative and postoperative recovery quality was measured using the 40-item quality of recovery (QoR-40) questionnaire; postoperative pain was evaluated using the numerical rating scale scores. RESULTS: Postoperative mean (standard deviation) QoR-40 scores were higher in Group E (181 [7.3]) than in Group N (167 [11.4]); P<0.01. With repeated measures, a significant effect of group and time was demonstrated for the global QoR-40 score, P<0.01, indicating better quality of recovery in Group E. Pain scores were significantly lower in Group E than in Group N, both during resting and motion at T1-T8 times (P<0.01 at each time). The total amount of tramadol consumed in the first 24 h was lower in Group E [median 0 mg, inter-quartile range (IQR) (0-140)], than in Group N [median 180 mg, IQR (150-240); P<0.01]. CONCLUSIONS: ESPB improved postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy. Moreover, ESPB reduced pain scores and cumulative opioid consumption. CLINICAL TRIAL REGISTRATION: NCT04112394.

The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: A double-blind randomized controlled trial.

STUDY OBJECTIVE: Laparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC. DESIGN: Prospective, randomized, controlled trial. SETTING: University of Health Science. PATIENTS: Sixty-eight adult patients undergoing LC. INTERVENTIONS: Both groups received a standardized analgesia protocol. Patients assigned to the ESP block group received an additional bilateral ESP block. MEASUREMENTS: The primary outcome was assessed as postoperative pain intensity associated with a lower opioid requirement and significant respiratory function improvement. MAIN RESULTS: Numerical rating scale (NRS) scores both at rest and during coughing were significantly lower in the ESP block group than in the control group at all time intervals (p < 0.001 in each) except for hour 2 postoperatively (p = 0.06 and p = 0.13, respectively). Tramadol consumption at 2 h and 24 h postoperatively was significantly lower in the ESP block group than in the controls (p < 0.001 for each). There was significant preservation in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in the ESP group in comparison to the control group at 2 and 24 h after surgery (p < 0.05 in each). FEV1/FVC and peak expiratory flow rate (PEFR) values were similar in each time interval. CONCLUSIONS: Bilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Elective and Emergency Procedures in Turkey?

BACKGROUND: Informed consent is an important aspect of ethical medical practice. In legal terms, making an intervention without informed consent may mean negligence or malpractice and may lead to legal action, maltreatment, and even attack against the doctor. This study aims to evaluate the readability of informed consent forms (ICFs) used for elective (urology and general surgery) and emergency procedures (emergency medicine and intensive care) by comparing through readability formulas. METHOD: Elective and emergency ICFs were accessed through the web sites of national health care associations. A total of 387 consent forms were evaluated and the same forms were included only once. A total of 35 consent forms were evaluated for emergency procedures, while a total of 55 consent forms were evaluated for elective procedures. Atesman and Bezirci-Yilmaz formulas defined for determining the readability level of Turkish texts and Gunning fog and Flesch Kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Even though elective ICFs are more readable compared to those of emergency procedures according to Bezirci-Yilmaz formulas, this was statistically insignificant ([Formula: see text]). The readability of elective consent forms was found to be at a significantly more difficult level to read compared to Atesman, Gunning fog, and Flesch Kincaid formulas ([Formula: see text], [Formula: see text], [Formula: see text], respectively). CONCLUSION: Even though the procedure is emergency or elective, a difficult readability level may cause problems for the doctor in legal phases. Readable and understandable consent forms should be available to be able to explain morbidity and mortality and improve prognosis. Education level of our country should also be considered while preparing these consent forms.

Assessment of Postoperative Cognitive Dysfunction: Results From a Survey of Turkish Anaesthesiologists.

OBJECTIVE: Postoperative cognitive dysfunction (POCD) is one of the most common complications in elderly surgical patients. We conducted a survey study to evaluate the perspectives of Turkish anaesthesiologists on postoperative cognitive disorders. METHODS: We conducted a prospective online survey with questions and answers were recorded either in a Likert scale from 1 to 5 (completely disagree to completely agree) or as yes/no/do not know types of answers. Potential participants were contacted through an e-mail that included a brief introductory note, instructions, a link to the survey and the authors' contact information. RESULTS: We analysed 129 surveys (9.9% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anaesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (74.4%). When caring for an agitated and confused patient postoperatively, 56.6%, protocols to screen and manage postoperative cognitive disorders were rarely used. Nearly all respondents believe that postoperative delirium and POCD are neglected areas in anaesthesiology. CONCLUSION: Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anaesthesia. They are aware of the main risk factors for their development but may lack information on the prevention and management postoperatively.

Thiol-disulfide homeostasis in breast cancer patients.

OBJECTIVE: The aim of our study is to assess thiol-disulfide homeostasis (TDH), which is a biomarker of systemic oxidative stress, in breast cancer patients. MATERIALS AND METHODS: Thirty-seven breast cancer patients and 31 age-matched healthy volunteers were enrolled in this study. Serum native thiol, disulfide, and total thiol levels and disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were analyzed using a novel colorimetric method. RESULTS: Serum native thiol level was statistically significantly lower in breast cancer patients (350.39 ± 7.15) than in healthy controls (380.60 ± 7.35) (P = 0.008). Serum disulfide level was statistically significantly higher in breast cancer patients (24.96 ± 0.85) than in healthy controls (19.25 ± 1.34) (P = 0.002). CONCLUSION: To our knowledge, this study is the first study in the literature that investigated TDH in breast cancer patients. We have concluded that an alteration in TDH due to oxidative stress is likely to have a role in the pathogenesis of breast cancer.

Evaluation of the readability of informed consent forms used in urology: Is there a difference between open, endoscopic, and laparoscopic surgery?

OBJECTIVE: The aim of this study is to evaluate the readability levels of informed consent forms used in Turkey before urological surgery and to compare the readability levels of open, endoscopic, and laparoscopic surgical informed consent forms. MATERIAL AND METHODS: A total of 529 informed consent forms used for urological open, endoscopic, and laparoscopic surgical procedures were collected from different hospitals in Turkey. Evaluating informed consent forms that have exactly the same text only once, a total of 69 consent forms were evaluated. The Gunning Fog Index and Flesch-Kincaid test measuring the general readability level were used to calculate the readability level of informed consent forms in addition to the Atesman and Bezirci-Yilmaz formulas defined to determine the readability level of Turkish texts. Informed consent forms were evaluated and divided into three groups as open, endoscopic, and laparoscopic surgery forms, depending on their content. RESULTS: Among 69 informed consent forms evaluated, 35 were open, 19 were endoscopic, and 15 were laparoscopic surgery consent forms. The readability level of all informed consent forms was detected as average according to the Atesman formula, very difficult according to the Flesch-Kincaid test, difficult according to the Gunning Fog Index, and at the high school education level according to the Bezirci-Yilmaz formula. A statistical evaluation of the three groups did not show a significant difference in the readability level. CONCLUSION: In this study, it was detected that the informed consent form readability levels used for urological surgical procedures in our country were rather low. We think that the cooperation of the concerned institutions is required for the revision of the consent information texts available and the improvement of the texts according to the strategies recommended.

Is oxidative stress measured by thiol/disulphide homeostasis status associated with prostate adenocarcinoma?

AIM OF THE STUDY: We aim to examine the relation between thiol/disulphide homeostasis and transrectal ultrasound guided prostate biopsy (TRUS-Bx) results and evaluate whether it was effective on the distinction of benign and malign prostate disease. MATERIAL AND METHODS: The study included 29 men histopathologically diagnosed as prostate adenocancer (Pca) (group 1), 30 men having benign prostate hyperplasia (BPH) (group 2) and age match 30 healthy individuals in the control group (group 3). Thiol/disulphide homeostasis was measured using a novel automatic and spectrophotometric method. RESULTS: Among the three groups, a statistically significant difference was detected among native thiol, total thiol levels and disulphide/total thiol, disulphide/native thiol and native thiol/total thiol ratios which are thiol/disulphide homeostasis parameters apart from disulphide (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). Additionally, no significant difference was detected in albumin and total protein levels among the groups (p = 0.223, p = 0.316 respectively). Serum native and total thiol levels were high and disulphide level was low in group 1 when compared to the group 2 (p = 0.003, p = 0.007, p = 0.265 respectively). In addition, serum native thiol, total thiol and disulphide levels were low in group 1 when compared to the group 3, but while low native and total thiol levels were significant, low disulphide levels were not found significant (p < 0.001, p < 0.001, p = 0.331, respectively). CONCLUSIONS: Thiol/disulphide homeostasis was found to be disturbed in Pca patients detected with TRUS-Bx. This is suggesting serum native thiol, total thiol level and ratios provides a novel biomarker for the role for oxidative stress in disease etiopathogenesis.

Anesthetic management of two patients with alkaptonuric ochronosis for total knee arthroplasty / Manejo anestésico de dois pacientes com ocronose alcaptonúrica para artroplastia total do joelho

Abstract The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. However respiratory, airway, cardiovascular and genitourinary systems complications can occur with age progressing. Restricted range of motion of cervical spine may lead to difficulty with airway management. In addition, degenerative changes and stiffness of lumbar spine due to ochronosis would make neuraxial blockade challenging. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for management of potential challenging problems. This report highlights special care and precautions that need to be taken during anesthetic management.

Resumo Este relato descreve o manejo anestésico em dois casos de ocronose alcaptonúrica. Alcaptonúria é uma doença genética rara do metabolismo de tirosina caracterizada por acúmulo de ácido homogentísico em cartilagem e tecidos conjuntivos. Os pacientes geralmente recorrem à cirurgia ortopédica devido à artropatia progressiva, que, muitas vezes, pode ser diagnosticada incorretamente. No entanto, complicações das vias respiratórias, cardiovasculares e geniturinárias podem ocorrer com o avanço da idade. A restrição de mobilidade da coluna cervical pode levar ao manejo difícil das vias aéreas. Além disso, as alterações degenerativas e a rigidez da coluna lombar devido à ocronose podem tornar o bloqueio neuroaxial um desafio. Embora essa condição hereditária seja extremamente rara, os anestesiologistas devem estar cientes de sua existência e se preparar para o manejo de potenciais problemas desafiadores. Este relato destaca os cuidados e as precauções especiais que devem ser tomadas durante o manejo anestésico.

The influence of the menstrual cycle on acute and persistent pain after laparoscopic cholecystectomy / A influência do ciclo menstrual na dor aguda e persistente após colecistectomia laparoscópica

Abstract Background and objectives: Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. Methods: 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4 h in the first 24 h. Adverse effects were questioned every 4 h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. Results: There was no difference in acute pain scores and analgesic consumption through the 24 h period, Visual Analog Scale at 24 h was 1.5 ± 1.5 cm for follicular group 1.4 ± 1.7 cm for luteal group (p = 0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6 ± 0.7 cm and 1.8 ± 0.8 cm for follicular group and 2.7 ± 1.3 cm and 2.9 ± 1.7 cm in the luteal group (p = 0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p = 0.01) and oral feeding time was shorter in follicular phase (5.9 ± 0.9 h) than in luteal phase (6.8 ± 1.9 h, p = 0.02). Conclusions: Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.

Resumo Justificativa e objetivos: As flutuações dos hormônios sexuais femininos durante o ciclo menstrual influenciam a percepção da dor. A inibição endógena da dor é prejudicada na fase folicular do ciclo menstrual. Testamos a hipótese primária de que cirurgias em mulheres durante a fase folicular têm mais dor aguda e precisam de mais opioide do que aquelas na fase lútea e a hipótese secundária testada foi que as cirurgias em mulheres durante a fase folicular têm mais dor incisional aos três meses de pós-operatório. Métodos: No total, 127 mulheres adultas submetidas à colecistectomia laparoscópica foram randomizadas para serem operadas durante a fase lútea ou folicular de seus ciclos menstruais. Um regime padronizado para anestesia e tratamento da dor foi administrado a todas as pacientes. A dor e o consumo de analgésico foram avaliados na sala de recuperação pós-anestésica e a cada quatro horas nas primeiras 24 horas. Efeitos adversos foram avaliados a cada quatro horas. Os tempo para ingestão oral e deambulação foram registrados. Dor pós-cirúrgica, ansiedade hospitalar, escala de depressão e questionário SF-12 foram avaliados em visitas feitas no primeiro e terceiro meses. Resultados: Não houve diferença nos escores de dor aguda e no consumo de analgésicos durante o período de 24 horas, Escala Visual Analógica em 24 horas foi de 1,5 ± 1,5 cm para o grupo folicular e 1,4 ± 1,7 cm para o grupo lúteo (p = 0,57). A dor persistente no pós-operatório foi significativamente mais prevalente no primeiro e terceiro mês, com incidência de 33% e 32% nas pacientes em fase folicular versus 16% e 12% na fase lútea, respectivamente. A Escala Visual Analógica no primeiro e terceiro mês foi 1,6 ± 0,7 cm e 1,8 ± 0,8 cm no grupo folicular e 2,7 ± 1,3 cm e 2,9 ± 1,7 cm no grupo lúteo (p = 0,02), respectivamente. Não houve diferença significativa entre os grupos em relação à ansiedade e à depressão, escore SF-12 em ambos os tempos. Náusea foi mais comum no grupo na fase folicular (p = 0,01) e o tempo para alimentação oral foi menor na fase folicular (5,9 ± 0,9 horas) do que na fase lútea (6,8 ± 1,9 horas, p = 0,02). Conclusões: Embora a dor persistente no pós-operatório tenha sido significativamente mais prevalente no primeiro e no terceiro mês após a cirurgia, a magnitude da dor foi baixa. Nossos resultados não apoiam o agendamento de cirurgias tendo como alvo fases específicas do ciclo menstrual.

[The influence of the menstrual cycle on acute and persistent pain after laparoscopic cholecystectomy]. / A influência do ciclo menstrual na dor aguda e persistente após colecistectomia laparoscópica.

BACKGROUND AND OBJECTIVES: Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. METHODS: 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. RESULTS: There was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). CONCLUSIONS: Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.

[Anesthetic management of two patients with alkaptonuric ochronosis for total knee arthroplasty]. / Manejo anestésico de dois pacientes com ocronose alcaptonúrica para artroplastia total do joelho.

The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. However respiratory, airway, cardiovascular and genitourinary systems complications can occur with age progressing. Restricted range of motion of cervical spine may lead to difficulty with airway management. In addition, degenerative changes and stiffness of lumbar spine due to ochronosis would make neuraxial blockade challenging. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for management of potential challenging problems. This report highlights special care and precautions that need to be taken during anesthetic management.

Complete response to acupuncture therapy in female patients with refractory interstitial cystitis/bladder pain syndrome.

OBJECTIVES: Interstitial Cystitis/Bladder Pain syndrome (IC/BPS) is a considerable issue in urology and gynecology and unfortunately, the treatment options recommended are not fully efficient. Therefore, in this study we aimed to determine the effectiveness of acupuncture treatment in patients with refractory IC/BPS. MATERIAL AND METHODS: 12 refractory IC/BPS female patients received ten sessions of acupuncture twice a week. The visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. RESULTS: There was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant, measurements of ICSI, OSS and PUF scores and MVV values in the 6th and 12th months and ICPI and PHQ scores in the 12th month were not found statistically significant compared to the pre-treatment period. Response to treatment for the first three months after acupuncture application was (100%), but this ratio was measured as 33.3% (4/12) in the sixth month and 16.6% in the 12th month (2/12). CONCLUSIONS: The results of this study suggest that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. It can be used as an appropriate treatment method not only in refractory but also in IC patients since it is rather advantageous compared to other treating agents.

Red cell distribution width as a novel predictor of postoperative respiratory adverse events after adenotonsillectomy.

BACKGROUND: Respiratory adverse events are commonly observed after adenotonsillectomy in children with sleep-disordered breathing. Preoperative prediction of these events enhances quality of care and resource management in facilities while encouraging precautions against them. Red cell distribution width, a measure of erythrocyte size variability, has recently been linked to adverse outcomes in a variety of disorders. Red cell distribution width has also been found to be associated with severity of obstructive sleep apnea in adults due to hypoxia-mediated inflammation. AIM: The objective of this study was to evaluate whether elevated red cell distribution width is associated with postoperative respiratory adverse events in children with symptoms of sleep-disordered breathing. METHODS: A prospective, observational, assessor-blinded study was conducted with consecutive children undergoing elective adenotonsillectomy for treatment of sleep-disordered breathing. Under general anesthesia, adenoidectomy was performed by curettage, and tonsillectomy was carried out by dissection. The primary outcome was the occurrence of an adverse event during emergence or in the postanesthesia care unit (PACU). RESULTS: Among 287 patients, with mean ± sd age 7.49 ± 3.21, the frequency of respiratory complications during emergence was 62 (22.30%) and in PACU was 56 (20.14%). Mean ± sd red cell distribution width was 14.36 ± 1.06 in patients with complications and higher than that in those without complications 13.53 ± 0.59. Red cell distribution width had an adjusted odds ratio 7.28 (95% CI: 4.30-13.28) and area under the curve value 0.74 (95% CI: 0.67-0.81) to predict postoperative complications. A cutoff value for red cell distribution width was found to be 14.7. CONCLUSION: Our study showed that preoperative elevated red cell distribution width is associated with an increased risk of respiratory adverse events in children undergoing adenotonsillectomy for sleep-disordered breathing.

What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy?

INTRODUCTION: The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. MATERIAL AND METHODS: TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. RESULTS: Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p <0.001, p <0.001, p <0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). CONCLUSIONS: Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.