Previous chemotherapy can cause PONV.

BACKGROUND: Although the treatment and mechanisms of postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV) are similar, the interactions between these 2 morbidities require more research. OBJECTIVES: In our prospective observational study, we investigated whether previous chemotherapy has an effect on PONV in breast cancer surgery. MATERIAL AND METHODS: One hundred and forty-eight female patients with the American Society of Anesthesiologists (ASA) physical status I or II, aged 18-65 years and with a scheduled breast cancer surgery were recruited into the study. After they completed preoperative follow-up questionnaires, anesthesia was induced with propofol (2 mg/kg), remifentanil (1.0 µg/kg) and rocuronium (0.6 mg/kg), and maintained with sevoflurane (1.5-2.0%), 45% oxygen/air mixture and infusion of remifentanil (0.1-0.2 µg/kg/min). After extubation, the intensity of PONV was assessed during the first 2 h and at 2-24 h after surgery. The symptoms of PONV were classified as mild (mild nausea, vomiting once, and nausea caused by an external stimulant (eating, drinking or motion)), moderate (vomiting twice, mild nausea without an external stimulant, and antiemetic medication required once) and severe (vomiting more than twice, severe nausea, antiemetic medication required more than once) by a different researcher. Preoperative interview forms, perioperative anesthetic follow-up forms and postoperative assessment forms were recorded and evaluated by different members of this research group. RESULTS: Data of 143 patients were analyzed. In the group of patients who received chemotherapy, the prevalence of nausea and vomiting within the postoperative period of 2-24 h significantly increased (p < 0.05). CONCLUSION: Previous chemotherapy may be a risk factor for the presence of PONV.

Relationship between daily testosterone production and bispectral index (BIS) values in patients who underwent septoplasty operation.

AIM: The study aimed to investigate the effect of varying testosterone levels in the morning and evening on the depth of anaesthesia in patients who underwent a septoplasty. MATERIALS AND METHODS: Male patients who underwent septoplasty under general anaesthesia between September 2016 and September 2017 were included in the study. The patients were divided into two groups. The first group consisted of patients who were operated on in the morning hours (between 8.00 and 10.00) when the testosterone level was the highest and the second group consisted of patients who had the lowest testosterone level in the afternoon (between 14.00 and 16.00). Blood was taken from the brachial vein to measure the testosterone level of the patients and blood testosterone levels were measured by mass spectrometry before the induction of anaesthesia. RESULTS: Sixty patients were included in the study. The mean age of the patients was 33.77 ± 10.98 years. The rocuronium and propofol doses used in the morning group were significantly higher (P = .012 for propofol, P = .002 for rocuronium, P < .001 for rocuronium dose) (Table 2). Additionally, the time to reach saturation of sevoflurane doses in expirium and inspiration was later in the morning group (morning group at 15th minute, evening group at 10th minute). CONCLUSIONS: Sedation anaesthesia applied in patients who underwent septoplasty operation was associated with testosterone level and it was more difficult for patients to switch to sedation with increased testosterone level.

Bispectral-Index-measured sevoflurane requirement might be decreased in individuals with major depressive disorder.

BACKGROUND: GABA (γ-aminobutyric acid) is the primary inhibitory neurotransmitter in the CNS and well-known target for general anesthetics. In addition, the dysregulation of GABA could be involved in the etiology of major depressive disorder (MDD). In this study, we aimed to determine whether MDD has any effect on anesthetic requirement measured by Bispectral Index (BIS). METHODS: This study was designed as a prospective, observational study, registered ANZCTR (ACTRN 12616001295437), with institutional review board approval and written informed consent. Inpatients who were planned to undergo laparoscopic cholecystectomy as an elective surgery, were enrolled in this study. Patients were divided into two groups, based on the results of the Beck Depression Inventory (BDI) which was assessed the 21-item self-administered scale measuring various symptoms of depression. If the BDI score was under 10, it was accepted as control group. Patients were consulted to the psychiatrist if the BDI score was 17 or more. Patients who were diagnosed as MDD by the psychiatrist, were classified as MDD group. Anesthesia was standardized, and delivered sevoflurane concentration was adjusted according to BIS value in both groups. Parameters of the study were heart rate, non-invasive arterial blood pressure, arterial oxygen saturation, BIS, end-tidal carbon dioxide, and end-tidal concentration of sevoflurane at 5-minute intervals during the operation. RESULTS: End-tidal concentration of sevoflurane was found to be lower in MDD group during the maintenance phase of anesthesia. Mean end-tidal concentration of sevoflurane were significantly lower in MDD group (1.28±0.15) than control group (1.52±0.22) (P<0.0001). BIS values were lower at 5- and 10-minute intervals in MDD group in comparison with control group. BIS values were similar at other time intervals in both groups during surgery. CONCLUSIONS: MDD might result in decreased end-tidal concentration of sevoflurane. Further study is required to identify the relationship between MDD and anesthetics.

[Postoperative analgesic effect of acupuncture in laparoscopic cholecystectomy surgery]. / Laparoskopik kolesistektomi operasyonlarinda akupunktur uygulamasinin ameliyat sonrasi analjeziye etkisi.

OBJECTIVES: In surgery clinics, postoperative pain is a common occurrence and care is needed in its treatment. One form of treatment is various acupuncture techniques. This study investigated the effect of acupuncture on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 59 patients undergoing laparoscopic cholecystectomy were included in the study; 31 comprised the acupuncture group (Group A), and 29 constituted the control group (group C). All patients underwent standard anesthesia procedures. Patient-controlled analgesia with tramadol was administered postoperatively. Patients' postoperative pain scores, results of the satisfaction questionnaire and amounts of tramadol used were recorded. Postoperative 0, 1st, 2nd, 6th, 12th and 18th hour controls were performed. RESULTS: A comparison of the groups showed Group A pain scores to be significantly lower statistically than those of Group C at all postoperative controls. There was no statistically significant difference for postoperative analgesic consumption and satisfaction level between the groups. CONCLUSION: Despite detection of a reduction in postoperative pain scores, the application of acupuncture did not cause any change in the consumption of tramadol.

Gastric Decompression Decreases Postoperative Nausea and Vomiting in ENT Surgery.

There is a passive blood flow to the stomach during oral and nasal surgery. It may cause postoperative nausea and vomiting (PONV). We researched the relationship between gastric decompression (GD) and severity of PONV in ear, nose, and throat (ENT) surgery. 137 patients who have been into ENT surgery were included in the study. In Group I (n = 70), patients received GD after surgery before extubation; patients in Group II (n = 67) did not receive GD. In postoperative 2nd, 4th, 8th, and 12th hours, the number and ratio of patients demonstrating PONV were detected to be significantly more in Group II as compared to Group I. PONV was also significantly more severe in Group II as compared to Group I. In Group I, the PONV ratio in the 2nd hour was significantly more for those whose amounts of stomach content aspired were more than 10 mL as compared to those whose stomach content aspired was less than 10 mL. In the 4th, 8th, and 24th hours, there is no statistically significant difference between the stomach content aspired and PONV ratio. GD reduces the incidence and severity of PONV in ENT surgery.

Spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery.

OBJECTIVE: In lower extremity orthopedic surgeries, central and peripheral regional anesthesia techniques can be used along with general anesthesia, mainly in elderly patients with accompanying maladies. This study investigates the efficiency of spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery in terms of patient-surgeon satisfaction. METHODS: Fifty consecutive patients (age range: 50-90 years), with an ASA score of 2-3 were scheduled for lower extremity orthopedic surgery. The patients were randomly divided into two groups according to anesthesia type. Group 1 (25 patients) received spinal anesthesia (SA) and Group 2 (25 patients) a combined sciatic/lumbar plexus nerve block (CSLPB). Spinal anesthesia was performed with 3 ml of 0.75% ropivacaine, and the combined sciatic/lumbar plexus nerve block was obtained with 10 ml 0.75% of ropivacaine and 10 ml of normal saline (20 ml in total). We recorded the time elapsed during the administration of the anesthesia and the initiation of its effect. Evaluation was made on patient-surgeon satisfaction. RESULTS: Regional anesthesia duration was significantly longer in the CSLPB group (p<0.0001). The time required to prepare the patients for surgery was statistically and significantly shorter in the SA group (p<0.001). Values of patient and surgeon satisfaction did not significantly correlate (p>0.05). CONCLUSION: Both standard anesthesia and combined sciatic/lumbar plexus nerve block were effective in lower extremity orthopedic surgeries. Although surgery preparation time was longer in the CSLPB group, patient-surgeon satisfaction was similar in both groups.

Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting.

OBJECTIVE: The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types. STUDY DESIGN: A prospective, randomized, controlled trial. SETTING: A tertiary referral center. SUBJECTS AND METHODS: After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery. RESULTS: There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two (P = 0.41), four (P = 0.54), eight (P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used (P = 0.02). CONCLUSION: Pharyngeal packing in nasal surgery has no impact on PONV.

[Accidental hypothermia (a case report)]. / Donma (Olgu sunumu).

Severe accidental hypothermia (core body temperature of less than 28 degrees C) is a life threatening state and a medical emergency associated with a high mortality rate. The prognosis depends on underlying diseases, advanced or very early age, the duration prior to treatment, the degree of hemodynamic deterioration, and especially, the methods of treatment, including active external or internal rewarming. We report a 70-year-old male patient with severe accidental hypothermia (core temperature 28 degrees C). The homeless man was found in the street. He died, in spite of all resuscitation efforts and rewarming methods. In this case report reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia.

Increased progesterone production during the luteal phase of menstruation may decrease anesthetic requirement.

UNLABELLED: Besides having important hormonal effects, progesterone has depressant and hypnotic effects on the brain. In this study, we compared women in the follicular phase with low progesterone levels and in the luteal phase with high progesterone levels regarding their anesthetic requirements. Twenty patients with menstrual cycle days from 1 to 10 (follicular group) and 20 patients with menstrual cycle days from 18 to 24 (luteal group) were included in the study. Anesthesia was induced with fentanyl and thiopental; relaxation was secured with rocuronium, and anesthesia was maintained with a mixture of nitrous oxide 2 L/min and oxygen 2 L/min plus sevoflurane. The delivered sevoflurane concentration was adjusted to sustain a constant bispectral index value that averaged 46 in both groups. To determine the progesterone levels, blood samples were taken from all patients before surgery. We found that progesterone levels were 0.86 +/- 0.30 ng/mL in the follicular group and 7.48 +/- 3.86 ng/mL in the luteal group. The minimum alveolar anesthetic concentration (MAC)-hour (MAC-h) value of sevoflurane in the follicular group (1.55 +/- 0.18 MAC-h) was significantly larger than in the luteal group (1.3 +/- 0.13 MAC-h) (P < 0.0001). The sevoflurane requirements were larger in the follicular group during the maintenance phase of anesthesia. In conclusion, high progesterone levels during the luteal phase might be the cause of decreased anesthetic requirement. IMPLICATIONS: The aim of this study was to determine the effect of high progesterone levels on anesthetic requirement. We measured progesterone levels before surgery and calculated the sevoflurane dose (MAC-h) required to maintain a constant bispectral index value. The dose of sevoflurane correlated inversely with serum progesterone concentrations.

[Evaluation of percutaneous endoscopic gastrostomy and results]. / Perkütan endoskopik gastrostomi ve sonuçlarinin degerlendirilmesi.

BACKGROUND: The aim of this study is evaluate the percutaneous endoscopic gastrostomy (PEG) and its complications in order to provide enteral nutrition support for a long time period. METHODS: PEG tube was applied to 15 patients aged between 18-95 years, who could not feed orally prophylactic antibiotic didn't use to any patient. After 8 hours hungry PEG was applied by using pull technique and the results were evaluated prospectively. RESULTS: PEG was successfully done in 14 patients. Gastric juice drainage at the sides of the tube were seen in two patients, and PEG was pulled out in one of them. CONCLUSIONS: PEG is the route of choice for a long lived enteral nutrition, because, it can be applied without general anesthesia, easy to apply, patients can start feeding in a short time period, need shorter hospital stay, can be changed easily, cost effective and has a low rate of mortality and morbidity.