Effects of Perioperative Hypothermia on Extubation, Recovery Time, and Postoperative Shivering in Breast Surgery.

Women undergoing breast surgery seem to be under the risk for hypothermia (central body temperature <36°) due to the uncertainty caused by the preoperative preparation time and the variety of operations, leading to neglect of warming precautions. The study examines the perioperative hypothermia (PH) in breast surgery and the relationships between the depth of decrease in body temperature and individual or clinical variables. This prospective, cross-sectional, observational study includes 120 female patients 18-65 years of age who were given general anesthesia for breast surgery. The incidence of hypothermia was 68.1%. The given patients were discriminated as body temperature <36°, hypothermia was significantly related with lower weight, body mass index, American Society of Anesthesiology (ASA) score, baseline body temperatures, higher extubation, and recovery times. When patients' temperature decreases by >1 or 1.5°, lower age and longer durations of operation and anesthesia were also significant variables. The incidence of shivering is quite high at temperatures below 36°C or at 1 and 1.5°C reductions from baseline (72.7%, 84%, 94.1%, respectively). Body temperature changes of the patients had no effect on nausea-vomiting and pain scores. It turned out that the incidence of PH and shivering is high in women who underwent breast surgery. We think that the depth of decrease in body temperature should be taken into account when evaluating the predictors or clinical consequences of hypothermia, except for the 36°C limit for body temperature.

Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children.

OBJECTIVE: To investigate the effects of sociodemographic factors and maternal anxiety levels on behaviour in children undergoing surgery. METHODS: This study included children aged 3-12 years who were scheduled for surgery, and their respective mothers. Each mother completed a questionnaire concerning sociodemographic and economic characteristics. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) form Tx-1, following transfer of the child to the operating room. An anaesthesiologist rated preoperative anxiety in each child using the Frankl Behaviour Rating Scale (FBRS) and Venham Picture Test (VPT). RESULTS: One hundred children (mean ± SD age 7 ± 2.7 years) who received dental (47%), plastic (39%) or urological (14%) surgery, and 100 mothers (mean ± SD age 34 ± 6.6 years) were included. A statistically significant difference between maternal STAI Tx-1 scores and children's VPT scores was revealed. There was no significant difference between maternal STAI Tx-1 scores and children's FBRS scores. Maternal education level and socioeconomic status had no effect on FBRS, VPT and STAI Tx-1 scores. CONCLUSION: Maternal knowledge and experience of anaesthesia, and high levels of maternal anxiety, may be related to increased anxiety in children undergoing surgery.

Evaluation of a Multimodal Approach to Postoperative Pain in Patients Undergoing Flank Incision in the Urology Operating Room.

OBJECTIVE: In this study, we evaluated subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. METHODS: Forty-nine patients under The American Society of Anesthesiologists Physical Status classification (ASA) I-III aged 18-85 years undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomised study. The patients were divided into two groups (Group O [n=25] and Group M [n=24]) and received standard general anaesthesia. Tramadol (100 mg) and paracetamol (100 mg) were given intravenously before fascia closure and 20 mL of 0.25% levobupivacaine was injected locally at surgical incisions in all patients. Patients in Group M also received 0.1 mg kg(-1) morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively, and patient satisfaction were recorded. RESULTS: Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects, or vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60, and 120 minutes compared to Group O (p<0.05). CONCLUSION: In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.

The effect of preoperative intravenous dexketoprofen trometamol on postoperative pain in minor outpatient urologic surgery.

OBJECTIVE: The aim of this prospective double-blind randomized study was to compare the effectiveness of preoperative dexketoprofen trometamol for acute postoperative pain in patients undergoing minor outpatient urologic surgery. MATERIAL AND METHODS: Sixty male patients (ASA I and II) undergoing varicocelectomy and testicular sperm extraction (TESE) with standard laryngeal mask airway (LMA) anesthesia were randomly divided into two groups. Patients in Group I (n=30) received 50 mg of dexketoprofen trometamol iv before induction, whereas patients in Group II (n=30) received saline. All patients received standard LMA anesthesia (propofol, sevoflurane and N2O/O2). Analgesic efficacy was evaluated by self-assessment of pain intensity (VAS) at regular intervals. Vital signs, side effects and time to reach a postanesthesia discharge score (PADS) of ≥9 were also recorded. Paracetamol 1 gr iv and tramadol 100 mg iv were used for rescue analgesia. RESULTS: Demographic data and duration of surgery were similar in both groups. There was no significant difference between groups with respect to postoperative pain scores and side effects. Although more patients in Group II (60%) required rescue analgesia compared to Group I (33.3%), the difference did not reach statistical significance. CONCLUSION: Preoperative IV use of dexketoprofen trometamol iv did not decrease the need for rescue analgesia in patients undergoing minor outpatient urological surgery.