Detection method of intraoperative awareness: a randomized comparative study.

BACKGROUND: : The incidence of intraoperative awareness varies in a wide range in the literature. The reasons for these different results include the questioning method used and the questioning time. The goal of this study is to compare the effectiveness of different questioning methods and times used in intraoperative awareness research for detecting the incidence. METHODS: We recruited patients between the ages of 18-70 years, with normal cognitive functions and able to speak after general anesthesia to the study. The patients were randomly divided into two groups. In Group 1 we applied the modified Brice questionnaire in the first 2 h and 24 h after surgery for investigating intraoperative awareness. In Group 2, 24 h after surgery, we asked about anesthesia satisfaction and patients' complaints, if any. RESULTS: There was no statistically significant difference between the groups in terms of age (p = 0.514).The proportion of women was significantly higher (p = 0.002), the duration of anesthesia was shorter, and the rate of narcotic analgesic use was higher in Group 2 (p < 0.001). The assessment in the first 2 h showed the frequency of awareness was statistically higher in Group 1 than in Group 2 (p = 0.016). In the postoperative 24-h assessment, we found no significant difference in the incidence of intraoperative awareness between the groups (p < 0.05). In Group 1, there was no statistically significant difference in terms of incidence of awareness according to evaluation time (p = 250). DISCUSSION: The incidence of intraoperative awareness in Group 1 was significantly higher than in Group 2 in the evaluation conducted in the first 2 h. There was no significant difference in the determination of intraoperative awareness between questioning times in group 1.

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain

Background/aim: The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA). Materials and methods: Forty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure. Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure. Conclusion: In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.

Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?

Background/aim: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient's airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP. Material and methods: Sixty-one patients underwent ERCP (Group I: propofol, n = 31; Group II, sevoflurane, n = 30), with sedation controlled by the Ramsay sedation scale (RSS). The patients' demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated. Results: The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II's saturation levels increased during sedation. Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients.

Antioxidant effects of dexmedetomidine against hydrogen peroxide-induced DNA damage in vitro by alkaline Comet assay

Background/aim: Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist that is commonly used as a sedative and anesthetic. The protective effects of DEX against oxidative damage under both in vitro and in vivo conditions have been demonstrated. It was aimed to evaluate and compare the protective effects of DEX and vitamin C (Vit C) on DNA against H2O2-induced DNA damage in human lymphocyte cell cultures in vitro by alkaline Comet assay. Materials and methods: Lymphocyte cell cultures were divided into 5 groups, as the negative control, solvent control, positive control, hydrogen peroxide (H2O2; 150 µM) + DEX (1 µM; 2.5 µM; 5 µM), and H2O2 (150 µM) + Vit C (1 µM; 2.5 µM; 5 µM), and incubated at 37 °C for 1 h. Cell viability was measured using the Trypan blue test. DNA damage was measured using the Alkali Comet Technique and the % percent tail intensity was evaluated. Statistical analysis was performed using 1-way ANOVA and the Tukey multiple comparison test. Results: It was observed that H2O2 significantly induced DNA damage in the lymphocytes and this damage was decreased significantly with Vit C and DEX. It was observed that Vit C at doses of 1 µM and 2.5 µM had a significantly stronger antioxidant effect, but there was no significant difference between the antioxidant effects of Vit C and DEX with a dose of 5 µM. The dose of 5 µM DEX was found to be the most effective in reducing oxidative DNA damage. Conclusion: There is limited data on the protective effects of DEX against oxidative DNA damage. The primary effect might be cytoprotection. The results herein showed that DEX was protective against H2O2-induced in vitro oxidative DNA damage in lymphocyte cell cultures in a dose-dependent manner. DEX might have a potential therapeutic value in the prevention of oxidative DNA damage in patients.

Comparison of reversal and adverse effects of sugammadex and combination of - Anticholinergic-Anticholinesterase agents in pediatric patients.

BACKGROUND: We aimed to compare clinical effects of sugammadex versus combination of anticholinergic-anticholinesterase agents for reversing of nondepolarizing neuromuscular block in pediatric patients. MATERIALS AND METHODS: A total of 60 pediatric patients whom should be performed general anesthesia in the supine position were enrolled to this randomized double-blinded clinical trial. Fentanyl 1 µg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg were used in induction and sevofluran, 50% O2-50% N2O in maintenance of anesthesia. Neuromuscular conductions were assessed by train of four (TOF)-Watch SX (Organon, Schering-Plough, Ireland) acceleromyograph. Patients were intubated at the moment of TOF 0. At the end of the operation emergence of T2 point was replied by 2 mg/kg sugammadex administration in group 1 and 0.06 mg/kg neostigmine +0.02 mg/kg atropine in group 2. At the moment of T0.9 inhalation, gases were ceased, and patients were extubated. Hemodynamic alterations, access to T0.9, extubation time, recovery parameters, drug consumptions and adverse effects were recorded. RESULTS: Train of four scores showed a lesser increase in group 2 than group 1 from 15(th) s to 30(th) min during post reverse period (from 6.9 ± 6.4 to 91.7 ± 7.2 in group 2 vs. from 35.4 ± 21.4 to 99.5 ± 1.0 in group 1) (p < 0.0004). Group 1 patients exhibited much more complete muscle strength rates than group 2 (P < 0.001). T0.9 and extubation times were significantly longer in group 2 than group 1 (P < 0.001). Comparison of adverse effects yielded no difference. CONCLUSION: Sugammadex can be considered as a safe agent in order to reverse neuromuscular block in pediatric patients.

Comparison of analgesic efficacy of intravenous Paracetamol and intravenous dexketoprofen trometamol in multimodal analgesia after hysterectomy.

BACKGROUND: [corrected] We aimed to evaluate analgesic efficacy, opioid-sparing, and opioid-related adverse effects of intravenous paracetamol and intravenous dexketoprofen trometamol in combination with iv morphine after total abdominal hysterectomy. MATERIALS AND METHODS: Sixty American Society of Anesthesiologist Physical Status Classification I-II patients scheduled for total abdominal hysterectomy were enrolled to this double-blinded, randomized, placebo controlled, and prospective study. Patients were divided into three groups as paracetamol, dexketoprofen trometamol, and placebo (0.9% NaCl) due to their post-operative analgesic usage. Intravenous patient controlled analgesia morphine was used as a rescue analgesic in all groups. Pain scores, hemodynamic parameters, morphine consumption, patient satisfaction, and side-effects were evaluated. RESULTS: Visual Analog Scale (VAS) scores were not statistically significantly different among the groups in all evaluation times, but decrease in VAS scores was statistically significant after the evaluation at 12(th) h in all groups. Total morphine consumption (morphine concentration = 0.2 mg/ml) in group paracetamol (72.3 ± 38.0 ml) and dexketoprofen trometamol (69.3 ± 24.1 ml) was significantly lower than group placebo (129.3 ± 22.6 ml) (P < 0.001). Global satisfaction scores of the patients in group placebo was significantly lower than group dexketoprofen trometamol after surgery and the increase in global satisfaction score was significant only in group placebo. CONCLUSION: Dexketoprofen trometamol and Paracetamol didn't cause significant change on pain scores, but increased patients' comfort. Although total morphine consumption was significantly decreased by both drugs, the incidence of nausea and vomiting were similar among the groups. According to results of the present study routine addition of dexketoprofen trometamol and paracetamol to patient controlled analgesia morphine after hysterectomies is not recommended.

A Rare Cause of Epistaxis: Nasopharyngeal Leech Infestation.

Leeches are rare cause of foreign body in airways. A 23-year-old male, experiencing epistaxis and difficulty in swallowing is presented. During nasopharyngoscopy, a moving leech was observed on the nasopharynx posterior wall in midline location, and removal of the leech was decided under general anaesthesia. The flexible nasopharyngoscopy was inserted, but removal was unsuccessful due to the leech's movements. Leeches are blood-sucking parasites, so neuromuscular blocking agent was given to prevent the movement. After administration, motion of the leech was lost and easily removed undamaged. In patients presenting with unexplained epistaxis, hemoptysis, dyspnea, and foreign body sensation in the airway, leech infestation should be included as the differential diagnosis and history of contact with stream water should be questioned. We concluded that use of low dose neuromuscular blocking agents facilitates the gentle removal, and could be necessary for successful management of removal of leech under general anaesthesia.

Preventive effect of dexmedetomidine in ischemia-reperfusion injury.

BACKGROUND: The aim of this study was to evaluate the effects of dexmedetomidine on ischemia-reperfusion injury of epigastric island flaps of rats. METHODS: Eighty Wistar rats were divided into 4 groups. After the flap elevation, in group 1, the flaps were sutured back without ischemic insult. Groups 2, 3, and 4 were exposed to ischemia for 12 hours. In groups 1 and 2, saline, in group 3, 10 µg/kg dexmedetomidine, and in group 4, 30 µg/kg dexmedetomidine were administered i.p. 45 minutes before I/R periods. Each group was subdivided further into 2 equal groups (a and b). Tissue samples of groups 1a, 2a, 3a, and 4a were obtained 12 hours after the reperfusion, and those of groups 1b, 2b, 3b, and 4b were obtained after 7 days. The necrotic areas were also calculated. Nitric oxide, malondialdehyde (MDA), and myeloperoxidase (MPO) activity were assessed in the tissue samples. RESULTS: Nitric oxide, MDA, and MPO activity levels in group 2a were significantly higher those in group 1a (P < 0.05). The levels in groups 3a and 4a were lower than those in group 2a (P < 0.05). Nitric oxide, MDA, and MPO activity levels were significantly higher in group 2b compared with group 1b (P < 0.05). The levels were lower in Groups 3b and 4b compared with group 2b (P < 0.05). Flap necrosis area was significantly lower in groups 3b and 4b than that in group 2b (P < 0.05). CONCLUSIONS: We conclude that administering dexmedetomidine before I/R periods can reduce ischemia-reperfusion injury of flaps, and it has a beneficial effect on flap survival.

Comparison of the effects of fentanyl, remifentanil, and dexmedetomidine on neuromuscular blockade.

PURPOSE: The aim of our study was to compare the effects of fentanyl, remifentanil, and dexmedetomidine on neuromuscular blockade under sevoflurane anesthesia. METHODS: Eighty-four patients were randomized to fentanyl, remifentanil, and dexmedetomidine groups. In the fentanyl group, fentanyl 1.5 µg/kg was given before induction of anesthesia, and additional 50-µg boluses were administered. In the remifentanil group, the initial dose of remifentanil 1 µg/kg was infused in 10 min before induction and 0.1 µg/kg/min infusion was continued during anesthesia. In the dexmedetomidine group, the initial dose of dexmedetomidine 1 µg/kg was infused in 10 min before induction and 1 µg/kg/h infusion was continued during anesthesia. Heart rate, blood pressure, SpO(2), EtCO(2), and TOF (train-of-four) values of all patients were monitored during anesthesia. Times to reach TOF 0 and TOF 25% and intubation quality were recorded. RESULTS: T (0) times and quality of intubation were found to be similar among the groups. T (25) time was found to be significantly longer in the dexmedetomidine group than in the fentanyl and remifentanil groups. CONCLUSION: Dexmedetomidine infusion increased the duration of neuromuscular blockade with vecuronium during general anesthesia. In addition to analgesic and sedative effects, dexmedetomidine may enhance the duration of neuromuscular blockade and may be used as an adjuvant anesthetic during general anesthesia.

The effects of dexmedetomidine on hemodynamic responses to tracheal ntubation in hypertensive patients: A comparison with esmolol and sufentanyl.

BACKGROUND: Hypertension and tachycardia caused by tracheal intubation can be detrimental in hypertensive patients. This study was conducted in order to compare the effects of dexmedetomidine on hemodynamic response to tracheal intubation in hypertensive patients with esmolol and sufentanyl. METHODS: Sixty hypertensive patients scheduled for noncardiac surgery under general anesthesia were randomly assigned to receive one of the three drugs before induction of anesthesia. Groups I, II, and III respectively received esmolol (100 mg) dexmedetomidine (1 µg/kg) and sufentanyl (0.25 µg/kg). Heart Rate (HR), systolic (SAP) and diastolic (DAP) arterial pressures were recorded before drug administration (baseline; T1), after drug administration (T2), after induction of anesthesia (T3), immediately after intubation (T4) and 3, 5 and 10 minutes after intubation (T5, T6, and T7, respectively). The mean percentage variations from T1 to T4 were calculated for all variables (HR, SAP and DAP). Thiopental dose, onset time of vecuronium and intubation time were also assessed. RESULTS: No differences were observed between the three groups regarding demographic data (p > 0.05). Median thiopental dose was significantly lower in Group II (325 mg; range: 250-500) compared to Group I (425 mg; range: 325-500; p < 0.01) and Group III (375 mg; range: 275-500; p = 0.02). The onset time of vecuronium was longest in Group I (245.2 ± 63 s vs. 193.9 ± 46.6 s and 205.5 ± 43.5 s; p < 0.01 and p < 0.05). In Group I, HR significantly decreased after drug administration compared to baseline (83.8 ± 20.4 vs. 71.7 ± 14.8; p = 0.002). Compared to the baseline (90.4 ± 8.4), DAP decreased after induction and remained below baseline values at T5, T6 and T7 (71.3 ± 12.8, 76.2 ± 10.7, 68.9 ± 10.8 and 62.1 ± 8.7, respectively; p < 0.05) in Group II. According to the mean percentage variation, a significant reduction in HR was assessed in Group II compared to Group III (-13.4 ± 17.6% vs. 11.0 ± 27.8%; p = 0.003). Increment in SAP was significant in Group I when compared to Group II (9.8 ± 20.9% vs. -9.2 ± 20.2%; p < 0.05). Increment in DAP in Group III was significant compared to Group II (0.07 ± 19.8 vs. 24.5 ± 39.1; p < 0.05). CONCLUSIONS: In hypertensive patients, administration of dexmedetomidine before anesthesia induction blunts the hemodynamic response to tracheal intubation and reduces the thiopental dose.

Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy.

BACKGROUND: We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. MATERIALS AND METHODS: Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO(2) insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1(st), 5(th), 15(th), 30(th) and 45(th) minutes after the insertion of airway devices. RESULTS: No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05). Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05). Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO(2) insufflation in PLMA group were significantly lower than the ETT group (p = 0.024). When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO(2) insufflation were significantly higher (46.1 (9.5-175.7) and 27.0 (8.3-119.4) in the ETT and PLMA groups, respectively) than cortisol levels after anaesthesia induction (11.3 (2.8-92.5) and 16.6 (4.4-45.4) in the ETT and PLMA groups, respectively) in both groups (p = 0.001). CONCLUSION: PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.

A complicated pregnancy: Eclampsia or COVID-19?

Pregnant women may be infected with SARS-CoV-2 virus and develop serious complications of the disease. Covid-19 causes primarily a respiratory system infection but can also affect cardiovascular, renal, gastrointestinal, and neurological systems. Cardiovascular involvement includes new onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism, and pre-eclampsia like syndrome. We report a confirmed Covid-19 pregnant case presented with eclampsia to the emergency department and undergone emergent cesarean section. Following surgery, she was admitted to the intensive care unit due to hypoxemia and hypertension. After observing lymphopenia and high CRP level with hypoxemia, radiological imaging revealed typical findings for viral pneumonia and nasopharyngeal swab, which was not carried out at admission, was positive for Covid-19. On the 20th hour of follow-up, she became hypotensive requiring noradrenalin infusion. Echocardiography diagnosed cardiomyopathy with left ventricular ejection fraction of 35-40 % with high levels of NT pro-BNP, hs-troponin, and CK-MB in the patient. Covid-19 should be considered in complicated pregnancies. In complicated cases, a chest CT scan upon admission may aid in quickly detecting the presence of infection and preventing nosocomial spread of the virus. Cardiomyopathy could be found in pregnant patients with Covid-19 infection. Since cardiomyopathy can be seen in late pregnancy and early postpartum period, it is difficult to distinguish between viral and postpartum cardiomyopathy in these patients. Recognizing the infection earlier will help to anticipate the complications that might contribute to deterioration of the patients, perioperatively.

Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients.

BACKGROUND: This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients. METHODS: This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, ≥18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale. RESULTS: Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". CONCLUSION: When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.

Treatment of post-dural puncture headache with bilateral greater occipital nerve block.

(Headache 2010;50:869-881) Epidural blood patch is an effective treatment with a low complication rate. It is also an invasive method that can cause permanent neurological sequelae such as early and late back pain, radiculopathy, spinal-subdural hematoma, spinal-epiarachnoid hematoma, intrathecal hematoma, arachnoiditis, and infection. We report a case in which a postdural puncture headache resolved within 2 minutes of a greater occipital nerve block, a minimally invasive and easy procedure with a low complication rate. This case report suggests that a greater occipital nerve block may be a successful alternative treatment for patients with post-dural puncture headache.

Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl.

BACKGROUND: The objective ofthe present study was double fold; to compare the characteristics of spinal blocks produced by 0.5% levobupivacaine with and without fentanyl in transurethral resection and to test the hypothesis that, fentanyl added to levobupivacaine, may be used as an alternative to pure levobupivacaine solution, in spinal anesthesia. METHODS: Forty males, aged >60 years, ASA I-III patients scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study. Following a spinal tap, intrathecal injection in Group L (n=20), 2.5 mL of 0.5% levobupivacaine and in Group LF (n=20), 2.2 mL of 0.5% levobupivacaine with fentanyl 15 microg (0.3 mL) was performed. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Patients were observed until the level of sensory block was S1 and the Bromage score was 0. RESULTS: There were no significant differences between the two groups forpatient demographic, intraoperative, hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T6 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (291.00 +/- 81.08 min in Group L; 213.75 +/- 59.49 min in Group LF) (p = 0.001). CONCLUSION: Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers the advantage of shorter duration of motor block and may be used as an alternative to pure levobupivacaine solution in spinal anesthesia, for transurethral resections.

Effect of hydroxyethyl starch 130/0.4 on ischaemia/reperfusion in rabbit skeletal muscle.

BACKGROUND AND OBJECTIVE: Tourniquet use is a common tool in surgical procedures of the limbs. Hydroxyethyl starch (HES) 130/0.4 not only has a role in replacement of the liquid deficits due to trauma, bleeding or shock, but it is also effective in enhancing tissue oxygen tension and regulation of microcirculation. The aim of this study was to investigate how 6% HES 130/0.4 affects ischaemia and reperfusion in skeletal muscle. METHODS: An ischaemia/reperfusion model (3 and 2 h, respectively) was applied in 14 rabbits. Group S (n = 7) was infused with 0.9% NaCl (0.2 ml kg(-1) min(-1)) and group HES was infused with 6% HES 130/0.4 (0.2 ml kg(-1) min(-1)). The total liquid was divided into equal one-thirds and given in the preischaemia, ischaemia and reperfusion phases. Ketamine HCl (30 mg kg(-1)) was used for anaesthesia, and blood pressure, pulse and blood gases were monitored. Muscle biopsies were taken in the preischaemic (A), ischaemic (B) and reperfusion (C) phases. In these samples, nitrite, nitrate, reduced glutathione (GSH) and myeloperoxidase (MPO) were measured to assess oxidative stress elements, and malondialdehyde (MDA) was measured to assess lipid peroxidation. Repeated variance analysis, Mann-Whitney U test and Student's t test were used for statistical analysis of these parameters. RESULTS: In group S, the MPO levels were significantly increased in the reperfusion phase compared with baseline, whereas there was a decrease in MPO levels in the reperfusion period in the HES group. This difference between groups was statistically significant (P = 0.011). CONCLUSION: The results of this study showed that 6% HES 130/0.4 solution is more effective in the prevention of ischaemia/reperfusion injury than saline when given in the same volume.

Left-molar approach for direct laryngoscopy: is it easy?

PURPOSE: For direct laryngoscopy, we compared midline and left-molar approaches with respect to ease of intubation, using a Macintosh blade. We investigated the relationship between failure of the left-molar approach and preoperative risk factors for difficult intubation. METHODS: With local ethics committee approval, 200 consecutive adult, nonpregnant patients were included in the study. The demographic data, body mass index, Mallampati modified score, interincisor gap, and mentohyoid and thyromental distances were measured preoperatively. First, the Macintosh blade was inserted using the midline approach, and then optimal external laryngeal manipulation (OELM) was applied. Second, the blade was inserted using the left-molar approach. The glottic views were assessed according to the Cormack-Lehane classification before and after OELM in both approaches. In cases where tracheal intubation failed with the left-molar approach, the midline approach was applied again and endotracheal intubation took place. RESULTS: The grade I glottic view obtained using the midline approach without OELM did not change in 94.3% of the patients with the left-molar approach without OELM; in addition, the grade II glottic view improved to grade I in 52.8% of the patients with the same technique (P < 0.001). Although the number of patients with a grade I or II glottic view in the left-molar approach was 197, only 37 patients could be intubated using the left-molar approach. In addition, 59.5% of them were intubated at the second attempt with the left-molar approach, while the incidence of a second attempt was 1.2% with the midline approach (P < 0.001). There was no correlation between the preoperative risk factors for difficult intubation and failure of the left-molar approach. CONCLUSION: Difficulty in the insertion of the endotracheal tube limits the efficacy of the left-molar approach. It is not possible to predict the failure of intubation with the left-molar approach by considering the preoperative risk factors.

[The effects of two different multimodal analgesic regimens in total hip replacement surgery]. / Total kalça protezi operasyonlarinda iki multimodal analjezi yönteminin etkinligi.

OBJECTIVES: This study evaluated the effectiveness of two different multimodal analgesia protocols in terms of postoperative pain relief, tramadol consumption during patient-controlled analgesia (PCA) and side effects after total hip replacement surgery. METHODS: Group F (n=18) received general anesthesia after a 3-in-1 femoral nerve block (FNB) was applied using 40 ml of bupivacaine 0.25%. Group FD (n=18) received general anesthesia after the same block and dexketoprofen p.o. was given. All patients received intravenous tramadol at the end of surgery via a PCA device. Group FD was given dexketoprofen 75 mg/day for 48 hours postoperatively. Pain scores were evaluated at 0, 1/2, 1, 4, 8, 12, 24 and 48h at rest and on movement of the hip. Side effects and global satisfaction scores in both groups were also evaluated in this setting. RESULTS: Total tramadol consumption was lower in Group FD (377.7+/-137.4) than in Group F (593.9+/-132.3) (p<0.05). Visual analogue scale (VAS) scores were

Dexmedetomidine reduces the ischemia-reperfusion injury markers during upper extremity surgery with tourniquet.

PURPOSE: We examined the effect of dexmedetomidine on ischemia-reperfusion injury due to tourniquet application during upper-extremity surgery by determining blood malondialdehyde and hypoxanthine levels. Alterations in aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, lactate dehydrogenase, uric acid, and creatinine levels were also assessed. METHODS: Forty patients of American Society of Anesthesiologists physical status I to II having hand and forearm surgery with tourniquet were randomly allocated into 2 groups. Brachial plexus anesthesia via axillary approach was performed for upper-limb block in all patients. In the dexmedetomidine group, a continuous infusion of dexmedetomidine (1 microg/kg for 10 minutes, followed by 0.5 microg kg(-1) h(-1)) was used until the end of surgery, whereas the control group received an equivalent volume of saline. Venous blood samples were obtained before brachial plexus anesthesia, at 1 minute before tourniquet release, and 15 minutes after tourniquet release for biochemical analysis. RESULTS: Dexmedetomidine significantly attenuated plasma hypoxanthine production in the ischemia and plasma malondialdehyde production in the reperfusion periods. Blood creatine phosphokinase and uric acid levels were significantly lower in the dexmedetomidine group compared with those in the control group after reperfusion. CONCLUSIONS: Our results suggest that dexmedetomidine may offer advantages by inhibiting lipid peroxidation in the case of anticipated ischemia-reperfusion injury, such as would occur in upper-extremity surgery requiring tourniquet application. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters.

STUDY OBJECTIVES: To investigate the hemodynamic, cardiovascular, and recovery effects of dexmedetomidine used as a single preanesthetic dose. DESIGN: Randomized, prospective, double-blind study. SETTING: University Hospital of Kirikkale, Kirikkale, Turkey. PATIENTS: 40 ASA physical status I and II patients, aged 20 to 60 years, who were scheduled for elective cholecystectomy. INTERVENTIONS: Patients were randomly divided into two groups to receive 0.5 microg kg(-1) dexmedetomidine (group D, n = 20) or saline solution (group C, n = 20). Anesthesia was induced with thiopental sodium and vecuronium, and anesthesia was maintained with 4% to 6% desflurane. MEASUREMENTS: Mean arterial pressure (MAP), heart rate (HR), ejection fraction (EF), end-diastolic index (EDI), cardiac index (CI), and stroke volume index (SVI) were recorded at 10-minute intervals. The times for patients to "open eyes on verbal command" and postoperative Aldrete recovery scores were also recorded. MAIN RESULTS: In group C, an increase in HR and MAP occurred after endotracheal intubation. In group D, HR significantly decreased after dexmedetomidine was given. The EDI, CI, SVI, and EF values were similar in groups D and C. The modified Aldrete recovery scores of patients in the recovery room were similar in groups C and D at the 15th minute. CONCLUSIONS: A single dose of dexmedetomidine given before induction of anesthesia decreased thiopental requirements without serious hemodynamic effects or any effect on recovery time.