Preoperative Use of 10-mg Metoclopramide and 50-mg Dimenhydrinate in the Prophylaxis of Postoperative Nausea and Vomiting in Elective Caesarean Births: A Prospective Randomized Clinical Study.

BACKGROUND: The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births. METHODS: Participants (n = 84) scheduled for elective cesarean births were randomized equally into placebo (10 cc 0.9 % NaCl), 10-mg metoclopramide or 50-mg dimenhydrinate groups. Oral alimentation was prohibited 8 h before the surgery; however, patients continued drinking water until 4 h before surgery. Placebo and antiemetics were administered 1 h before the anticipated procedure in a 5-ml syringe. In metoclopramide and dimenhydrinate group, an ampoule of the agents was completed to 5 ml by adding 0.9 % NaCl. In the control group 5 ml of 0.9 % NaCl was used. All prophylactic agents were administered intramuscularly. All patients received a general anesthesia. The placebo group (control group) was compared with the metoclopramide and dimenhydrinate groups. RESULTS: Demographic data including maternal age, height, weight, body mass index, gravidity, parity, miscarriage, induced abortion, the number of offspring, and the medical history did not show significant differences among the three groups. Postoperative nausea, vomiting, and the use of rescue medication ratios were significantly lower in metoclopramide and dimenhydrinate groups compared with the placebo group (p < 0.05); however, the difference between the metoclopramide and dimenhydrinate groups was not significant (p > 0.05). CONCLUSION: Dimenhydrinate and metoclopramide significantly decrease postoperative nausea, vomiting, and the need for rescue antiemetic medication. Both agents have similar efficacy and may be used as an alternative to each other.

Early postoperative pain after keyless abdominal rope-lifting surgery.

BACKGROUND AND OBJECTIVES: Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts. METHODS: During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements. RESULTS: Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05). CONCLUSION: Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy.

Endometriosis presenting with right side hydroureteronephrosis only: a case report.

INTRODUCTION: Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis. CASE PRESENTATION: A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3 cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue. CONCLUSIONS: Clinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Clinical and radiological comparison of posterolateral fusion and posterior interbody fusion techniques for multilevel lumbar spinal stabilization in manual workers.

STUDY DESIGN: Eighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively. PURPOSE: We aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine. OVERVIEW OF LITERATURE: Previous studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques. METHODS: After standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months. RESULTS: Patients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154). CONCLUSIONS: PLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients.

Reduction of conjunctival fibrosis after trabeculectomy using topical α-lipoic acid in rabbit eyes.

PURPOSE: To evaluate the efficacy of α-lipoic acid (ALA) in reducing scarring after trabeculectomy. MATERIALS AND METHODS: Eighteen adult New Zealand white rabbits underwent trabeculectomy. During trabeculectomy, thin sponges were placed between the sclera and Tenon's capsule for 3 minutes, saline solution, mitomycin-C (MMC) and ALA was applied to the control group (CG) (n=6 eyes), MMC group (MMCG) (n=6 eyes), and ALA group (ALAG) (n=6 eyes), respectively. After surgery, topical saline and ALA was applied for 28 days to the control and ALAGs, respectively. Filtrating bleb patency was evaluated by using 0.1% trepan blue. Hematoxylin and eosin and Masson trichrome staining for toxicity, total cellularity, and collagen organization; α-smooth muscle actin immunohistochemistry staining performed for myofibroblast phenotype identification. RESULTS: Clinical evaluation showed that all 6 blebs (100%) of the CG had failed, whereas there were only 2 failures (33%) in the ALAG and no failures in the MMCG on day 28. Histologic evaluation showed significantly lower inflammatory cell infiltration in the ALAGs and CGs than the MMCG. Toxicity change was more significant in the MMCG than the control and ALAGs. Collagen was better organized in the ALAG than control and MMCGs. In immunohistochemistry evaluation, ALA significantly reduced the population of cells expressing α-smooth muscle action. CONCLUSIONS: ΑLA prevents and/or reduces fibrosis by inhibition of inflammation pathways, revascularization, and accumulation of extracellular matrix. It can be used as an agent for delaying tissue regeneration and for providing a more functional-permanent fistula.

Comparison of tubal sterilization procedures performed by keyless abdominal rope-lifting surgery and conventional CO2 laparoscopy: a case controlled clinical study.

OBJECTIVE: To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS), for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. MATERIAL AND METHODS: During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N = 38) and KARS (N = 33) were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. RESULTS: All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P > 0.05). Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P > 0.05). CONCLUSION: KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.

Management of benign ovarian cysts by a novel, gasless, single-incision laparoscopic technique: keyless abdominal rope-lifting surgery (KARS).

BACKGROUND: To find the most efficacious method to minimize the side effects and maximize the advantages of laparoscopic surgery, this study aimed to define and document a gasless, single-incision abdominal access technique for the management of benign ovarian cysts. METHODS: During a 1½ year period, 55 women underwent surgery for a benign ovarian cyst. Conventional carbon dioxide (CO(2)) laparoscopy was used for 33 of the women, and 22 of the women underwent a novel, gasless, single-incision laparoscopic surgery. An abdominal access pathway through a single intraabdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intra-umbilical entry without the use of trocars. Thus, the new technique was called keyless abdominal rope-lifting surgery (KARS). Two operative groups were compared to assess the feasibility of the new technique. RESULTS: All the operations could be performed by KARS without conversion to CO(2) laparoscopy or laparotomy. However, for two patients in the conventional laparoscopy group, minilaparotomy had to be performed for tissue retrieval. Although the two techniques had many similar results, the total operative times and the abdominal access times in the KARS group were significantly longer than in the conventional laparoscopy group (p < 0.05). Simple oral analgesics were adequate for postoperative pain relief in both groups. CONCLUSIONS: The KARS technique is a gasless, single-incision laparoscopic procedure that can be performed safely and effectively in terms of cosmesis, postoperative pain, and fertility preservation for the management of benign adnexal pathologies.

Alpha-lipoic acid reduces peridural fibrosis after laminectomy of lumbar vertebrae in rabbits.

BACKGROUND: Peridural fibrosis is an inevitable healing process causing failed back surgery syndrome after lumbar spinal operations. In this study, alpha-lipoic acid (ALA), reported to reduce fibrosis in liver, oral mucosa, and peritoneum, investigated as a potential candidate for prevention of peridural fibrosis. METHOD: Twelve adult New Zealand white male rabbits were divided into control (n = 5) and ALA groups (n = 7). Laminectomy of lumbar spine was performed and ALA was applied on the exposed dura mater topically in ALA group. RESULTS: According to histological peridural grading, the ALA group (median grade 1) showed significantly less peridural fibrosis than the control group (median grade 3, p = 0.005). CONCLUSIONS: ALA is a promising substance in the prevention of peridural fibrosis, especially in early preoperative and postoperative period.

Glutamine supplemented parenteral nutrition to prevent ventilator-associated pneumonia in the intensive care unit.

OBJECTIVE: Ventilator-associated pneumonia (VAP) is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN). We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU). MATERIAL AND METHODS: With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20), and the second was prescribed TPN (n=20) while the third group was given glutamine-supplemented TPN (n=20). C-reactive protein (CRP), sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs. RESULTS: No statistically significant difference was found among groups in terms of development of VAP (p=0.622). CONCLUSION: Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP.

Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion.

OBJECTIVE: The effects of desflurane and sevoflurane on QT interval and QT dispersion have been investigated in a prospective, double-blind, randomized study of patients undergoing noncardiac surgery. INTERVENTIONS: Sixty American Society of Anaesthesiologists physical status I-II adult patients were randomly assigned to two groups. Anaesthesia was induced with inhalation of desflurane (desflurane group) or sevoflurane (sevoflurane group) in increasing concentrations to 3 minimal alveolar concentration level. The maintenance of anaesthesia was provided with 2 minimal alveolar concentration agents in both groups until the end of the study. Electrocardiogram, heart rate and blood pressure were recorded as follows: before premedication, before induction, 1 and 3 min after the induction of anaesthesia, after the administration of vecuronium and after the tracheal intubation. The induction times and the complications were recorded. MEASUREMENTS AND RESULTS: The QTc interval was significantly more prolonged with desflurane than with sevoflurane at the first and third minute after the induction, and at the third minute after the administration of vecuronium. There were no significant differences in the QT dispersion between the two groups. Heart rate and blood pressure were found to be significantly higher in the desflurane group. CONCLUSION: The QTc interval was more prolonged with desflurane than sevoflurane, and QT dispersion was normal with both agents.

Does benzydamine hydrochloride applied preemptively reduce sore throat due to laryngeal mask airway?

Sore throat is a common postoperative complaint. We investigated whether preemptive benzydamine hydrochloride (BH) treatment could prevent sore throat due to a laryngeal mask airway (LMA) cuff inflated with air. One-hundred ASA status I-II patients who underwent general anesthesia were randomly divided into two groups. In the first group, four puffs of BH were applied to the pharynx 30 min before the operation and 5 min before the induction of anesthesia. Distilled water with a similar bottle was applied with the same protocol in the second group. Anesthetic induction was provided with propofol and fentanyl. The pressure of the LMA cuff inflated with room air was measured after the first adjustment and after 30, 60, and 90 min of inflation in both groups. At the end of operation, the LMA was removed after the recovery of spontaneous breathing. After the operation, patients were asked about sore throat symptoms at the first, second, and fourth hours. There were no significant differences between groups for cuff pressures, cuff volumes, analgesic doses, or operation times. However, sore throat symptoms were significantly less severe for the BH group during both resting and swallowing. In conclusion, preemptive topical BH may decrease the incidence of sore throat due to LMA use.

Comparison of propofol and sevoflurane for laryngeal mask airway insertion.

In this study, we compared haemodynamic changes, laryngeal mask airway (LMA) insertion time, and complications in patients anesthetized by inhalation of sevoflurane with those of intravenous induction with propofol. One hundred patients, aged between 20-40 years were enrolled in this study. Group 1 received propofol (2.5 mg/kg i.v.) and group 2 received sevoflurane (6%+50% N2O+50% O2) by inhalation using the tidal volume technique. LMA insertion time was found to be significantly longer in sevoflurane group than in propofol group. Mean arterial blood pressure was significantly lower within each group after induction in comparison to before induction values. In both groups, the LMA was successfully inserted in all patients. The quality of anaesthesia according to patients was significantly higher in the propofol group (80%) than in sevoflurane group (30%). Odor perception was significantly higher in sevoflurane group (84%) than in propofol group (38%). Apnoea was significantly higher in propofol group (40%) than in sevoflurane group (0%). Sevoflurane is an alternative to propofol for induction of anaesthesia and has a lower incidence of apnoea. Other complication rates are not higher than which propofol but the longer duration of induction time is a disadvantage.

An unusual complication of total intravenous anesthesia: mutism.

IMPLICATIONS: We report a case of mutism secondary to total IV anesthesia with propofol, as an unusual complication that we have not found in the literature.