Does surgical experience really matter on the treatment approach to acute cholecystitis. A randomised clinical trial.

AIM: Experienced surgeons usually prefer early laparoscopic cholecystectomy (ELC) instead of delayed laparoscopic cholecystectomy (DLC) for the treatment of acute cholecystitis (AC). However, the question remains, if ELC is also safe for beginner surgeons. This study compares ELC versus DLC for the treatment of AC as a beginner surgeon approach. MATERIAL AND METHODS: In this prospective randomized clinical trial, patients suffering AC in their first 72 hours of pain were enrolled either in Group L (n:88); patients were treated surgically with ELC immediately or Group D (n:88); patients were first treated medically and than treated surgically with DLC 4-8 weeks later. All operations and medical treatments were done by the same beginner surgeon. RESULTS: In Group L operation time was 60 (50-65) minutes, total hospital stay was 1.5 (1-7) days and total cost was 337.38±78.46 (287-827) USD. In Group D operation time was 50.5 (45-60) minutes, total hospital stay was 5.5(3-15) days and total cost was 499.29±199.38 (321-1506) USD. There were no significant differences regarding to the complications (p>0.05). Hospital stay and total costs were significantly higher in Group D (p<0.001). CONCLUSIONS: This study indicates, that ELC can definitely be chosen as a treatment approach for AC even by beginner surgeons, considering that it reduces hospital stay and total cost. KEY WORDS: Acute Cholecystitis, Delayed laparoscopic cholecystectomy, Early laparoscopic cholecystectomy, Surgical work experience.

Esophagoduodenoscopy or colonoscopy: which should be done first?

OBJECTIVES: Esophagoduodenoscopy and colonoscopy can be done as bidirectional endoscopy in the same session. The aim of this study was to compare anesthetic requirements and hemodynamic effects in esophagoduodenoscopy or colonoscopy done first for bidirectional endoscopy. MATERIAL AND METHODS: Eighty patients, aged 18-70 years with an American Society of Anesthesiologists Classification (ASA) as I-III, were included randomly into this study. The patients were allocated into two groups: Group C: first colonoscopy followed by esophagoduodenoscopy. Group E: first esophagoduodenoscopy followed by colonoscopy. All patients received standard anesthesia with 1 µg/kg fentanyl and 1 mg/kg propofol. Demographical variables, Heart rate SpO2, Ramsey Sedation Score were recorded every 10 minutes. Total propofol consumption, retching during esophagoduodenoscopy and time to reach cecum were also recorded. Endoscopist and patient satisfaction were questioned. RESULTS: Retching during esophagoduodenoscopy was not statistically significantly different in both groups. Total procedure duration and esophagoduodenoscopy duration were statistically significant longer in Group E. Complication frequency was higher in Group E. Endoscopist and patient satisfaction were lower in Group E. There was no difference in time to reach the cecum and the recovering period. Additional propofol dose was increased in Group E. CONCLUSION: Regarding shorter procedural duration, lower consumption amount of propofol and fewer complications, it could be a better choice to start bidirectional procedure with colonoscopy first.

Evaluation of Neurotoxicity of Multiple Anesthesia in Children Using Visual Evoked Potentials.

OBJECTIVES: Anesthetic applications may cause increased neuronal damage in infants and children. Commonly cognitive or learning disability tests were used to investigate the neurological progress in children. Visual Evoked Potential is a gross electrical signal generated by the occipital regions of the cerebral cortex in response to visual stimulation and an objective assessment of brain function. In this study, to acquire more objective results, Visual Evoked Potential responses of children who had multiple exposures to anesthesia during the treatment of corrosive esophagitis were compared to children who have never received anesthesia before. METHODS: In this prospective, single-blinded, randomized, controlled study, 25 children, who were admitted to our pediatric surgery clinic because of corrosive esophagitis and who received general anesthesia more than 15 times composed Group-P; 25 children, who admitted to our well-child-clinic and who had never received anesthesia before consisted Group-C. The flash and pattern VEP responses of both groups were measured at the electrophysiology laboratory without any anesthetic drug application. The VEP responses of children in Group-P were recorded at least three days after the last exposure to anesthesia. RESULTS: Latencies and amplitudes of the N2 and P2 components of the pattern and flash VEP responses were statistically significantly different between the two groups (p=0.000). CONCLUSION: This study shows that in children who had repeated anesthetic applications VEP parameters are significantly altered. We believe that VEP responses may be a reliable objective criterion for the evaluation of anesthesia neurotoxicity.

Is it Necessary to Measure Blood Glucose Level Before and After Colonoscopy in Diabetic and Nondiabetic Patients?

OBJECTIVES: The aim of this study was to examine the necessity of measuring the blood glucose level before and after a colonoscopy in diabetic and nondiabetic patients. METHODS: A total of 200 patients who were over the age of 18 with an American Society of Anesthesiologists (ASA) score I-IV and were to undergo an elective colonoscopy procedure were included in this randomized, controlled, prospective trial. In the study group, 100 patients were diabetic and 100 were nondiabetic. Patient age, sex, body mass index, ASA classification, comorbid diseases, daily medications, and the length of preprocedure fasting were recorded. Before the procedure, the capillary glucose level was measured and recorded as an initial value. This glucose assessment was repeated and recorded 15 minutes after the beginning of the colonoscopy and 60 minutes after the procedure. All complications related to the anesthesia or the colonoscopy were recorded. RESULTS: The sex and age distribution was not statistically significant in a comparison of the diabetic and nondiabetic groups. The body mass index value and presence of comorbid diseases, particularly hypertension, was statistically significantly higher in the diabetic group. There was no significant difference in complications between the groups. The mean fasting time in the diabetic group was statistically significantly shorter than that of the nondiabetics. The blood glucose level of the diabetic patients was consistently higher than that of the nondiabetics. CONCLUSION: Blood glucose measurement is necessary for diabetic patients before and after a colonoscopy procedure; however, assessment is not necessary for nondiabetics.

Comparative analysis of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures for the treatment of morbid obesity.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has been considered as the most efficient method in bariatric surgery. Indeed, Laparoscopic Sleeve Gastrectomy (LSG) which is easier to do, has been increasingly used in the recent years. The aim of the present study was to compare short-and mid-term outcomes of RYGB and LSG. METHODS: Medical records of 62 patients who underwent either RYGB (GroupR) or LSG (GroupL) in our General Surgery Department between 2010 and 2013 were retrospectively reviewed. Demographics, comorbidities, preoperative laboratory values, length of hospital stay and postoperative complications were recorded. During follow-up in the postoperative period, body-mass-index (BMI), excess weight loss (EWL), triglyceride levels (TG), and low-density lipoprotein (LDL) levels were recorded at the 1st, 3rd, 6th, and 12th months. RESULTS: Mean length of hospital stay was significantly higher in GroupR (p = 0.001), which was also correlated with BMI. EWL at 1st, 3rd, 6th, and 12th months was significantly higher in GroupR. Hair loss was significantly higher in GroupR (p < 0.05). The rates of diabetes mellitus and hypertension in the preoperative period and at 6th and 12th months did not significantly differ between the groups. Preoperative TG and LDL values were significantly higher in GroupR (p < 0.05). CONCLUS ONS: This study indicated, that RYGB is statistically more effective than LSG, but LSG has clinically almost the same effect as RYGB, and also hospital stay, postoperative complications as hair loss are decreased in LSG. KEY WORDS: Laparoscopic Sleeve Gastrectomy, Morbid Obesity, Roux-en-Y Gastric Bypass.

Comparison of the Supreme™ and ProSeal™ laryngeal mask airways in infants: a prospective randomised clinical study.

BACKGROUND: The Supreme™ and ProSeal™ laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia; however, LMA use in infants is limited because many anaesthesiologists prefer to use tracheal intubation in infants. In this study, we compared the Supreme and ProSeal LMAs in infants by measuring their performance characteristics, including insertion features, ventilation parameters, induced changes in haemodynamics and rates of postoperative complications. METHODS: Infants of ASA physical status I scheduled for elective, minor, lower abdominal surgery were divided into two groups: the Supreme LMA group and the ProSeal LMA group. Times and ease of LMA insertion were noted. The percentages of tidal volume leakage as well as peak, mean and leakage pressures for all infants were measured. Heart rate (HR), oxygen saturation (SpO2) and end tidal carbon dioxide (EtCO2) values were recorded before and after LMA insertion and before and after extubation. After extubation, complications and adverse effects were noted. RESULTS: Demographic and surgical data were similar between the two groups. LMA insertion times were shorter for the ProSeal group than for the Supreme group (P < 0.002). The mean HR value for the ProSeal group was lower than for the Supreme group (P < 0.011). Both the peak pressure and the leakage percentage for the ProSeal group were statistically lower than for the Supreme group. The leakage pressure for the ProSeal group was statistically higher than for the Supreme group (P < 0.001). CONCLUSIONS: The ProSeal LMA is superior to the Supreme LMA for use in infants due to the ease of insertion, high oropharyngeal leakage pressure and fewer induced changes in haemodynamics. TRIAL REGISTRATION: ClinicalTrial.gov, NCT03251105 , retrospectively registered on 15 Aug 2017.

Effects of Laparoscopic Sleeve Gastrectomy on Parathyroid Hormone, Vitamin D, Calcium, Phosphorus, and Albumin Levels.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) reduces obesity-related co-morbidities, such as diabetes, hypertension, and hyperlipidemia. Endocrinological abnormalities may occur as undesired side effects. Most centers routinely prescribe folic acid, cyanocobalamin (vitB12), and protein replacement in the postoperative period, but 25-OH-vitamin-D3 (vitD) and intact parathyroid hormone (iPTH) levels are not routinely followed up. The aim of this study was to identify the effects of LSG on iPTH, vitD, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and albumin levels. METHODS: Data of morbidly obese patients who underwent LSG between January and December 2014 were studied in this prospectively designed study. Serum levels of iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin were measured preoperatively and postoperatively at the 3rd, 6th, and 12th months. RESULTS: In total, 119 patients were analyzed. All patients had normal iPTH, vitD, Ca, P, folic acid, vitB12, ALP, and albumin values preoperatively, and 31.6% had received vitD supplementation during their nutritionist observation time before surgery. At the 3rd, 6th, and 12th postoperative months, 21 (17.6%), 17 (17.3%), and 1 (0.8%) patients, respectively, had increased iPTH and ALP and decreased vitD levels. A total of 39 (32.7%) patients needed high-dose vitD treatment during a 1 year follow-up. Approximately 37.5% of the patients who received vitD supplementation preoperatively needed vitD supplementation postoperatively. Hospital records of 101 of 119 patients who underwent LSG could be screened to determine their vitD supplementation requirements previously ordered by their nutritionist for a 1-year period before LSG. Thirty-two (31.6%) of the 101 patients had received vitD supplementation during the 1-year period preoperatively. CONCLUSIONS: Although serum levels of iPTH, vitD, Ca, P, vitB12, ALP, and albumin may be normal preoperatively, severe vitD insufficiency requiring high-dose vitD replacement may develop in morbidly obese patients postoperatively. Instead of iPTH and vitD, which are expensive to measure, ALP serum level, which is correlated with iPTH levels, can be a good indicator to monitor calcium metabolism.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

BACKGROUND: Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. METHODS: Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. RESULTS: Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. CONCLUSION: Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

Postoperative effects of laparoscopic sleeve gastrectomy in morbid obese patients with type 2 diabetes.

BACKGROUND: Laparoscopic Sleeve Gastrectomy has become one of the most popular bariatric surgery types and helps treating not only obesity but also endocrinological diseases related to obesity. Therefore we aimed to evaluate the effects of laparoscopic sleeve gastrectomy on the treatment of type 2 diabetes. METHODS: All patients, who underwent morbid obesity surgery during 2013-2014 and had a HbA1c >6 % were included in this prospective study. Demographical data, usage of oral antidiabetic drugs or insulin were recorded, and laboratory findings as HbA1c and fasting plasma glucose were evaluated preoperatively and postoperatively at the 6th and 12th months. Diabetes remission criteria were used to assess success of the surgical treatment. RESULTS: Totally 88 patients were included in this study. 55 patients were using oral antidiabetic drugs and 33 patients were using insulin. At the 6th month complete remission was observed in 80 (90.9 %), partial remission in 3 (3.4 %) and persistent diabetes in 5 (5.6 %) patients. At the 12th month complete remission was observed in 84 (95.4 %), partial remission in 1 (1.1 %) and persistent diabetes in 3 (3.4 %) patients. CONCLUSIONS: This study indicated that laparoscopic sleeve gastrectomy surgery achieved a complete remission of diabetes in 95.4 % patients having type 2 diabetes during a 1 year fallow up period. However, complete remission of type 2 diabetes has been reported as 80 % during long term fallow up in the literature. In our opinion this rate may change with longer follow up periods and studies involving more patients suffering type 2 diabetes.

Caudal ropivacaine and bupivacaine for postoperative analgesia in infants undergoing lower abdominal surgery.

OBJECTIVE: To compare the postoperative analgesic efficacy of ropivacaine 0.175% and bupivacaine 0.175% injected caudally into infants for lower abdominal surgery. METHODS: Eighty infants, aged 3-12 months, ASA I-II scheduled to undergo lower abdominal surgery were randomly allocated to one of the two groups: Group R received 1ml.kg(-1) 0.175% ropivacaine and Group B received 1ml.kg(-1) 0.175% bupivacaine via caudal route. Postoperative analgesia, sedation and motor block were evaluated with modified objective pain scale, three-point scale and modified Bromage scale respectively. Postoperative measurements including mean arterial pressure (MAP), heart rate (HR), pain (OPS), sedation and motor block score were recorded for four hours in the postoperative recovery room. Parents were contacted by telephone after 24 hours to question duration of analgesia and side effects. RESULTS: No significant differences were found among the groups in demographic data, MAP, HR, OPS and sedation scores during four hours postoperatively. The duration of analgesia was 527.5±150.62 minutes in Group R, 692.77±139.01 minutes in Group B (p=0.004). Twelve (30%) patients in Group R, 16 (40%) patients in groupB needed rescue analgesics (p=0.348). Rescue analgesics were administered (1 time/2 times) (9/3) (22.5/7.5%) in Group R and 16/0 (40/0%) in Group B, where no statistically significant difference was determined between the groups (p=0.071). Motor blockade was observed in 7 (17.5%) patients in Group R, and 8 (20%) patients in Group B (p=0.774). CONCLUSION: This study indicated, that a concentration of 0.175% ropivacaine and 0.175% bupivacaine administered to the infants via caudal route both provided effective and similar postoperative pain relief in infants, who underwent lower abdominal surgery.

Comparison of Two Different Intranasal Doses of Dexmedetomidine in Children for Magnetic Resonance Imaging Sedation.

OBJECTIVE: Anaesthetic agents used for magnetic resonance imaging (MRI) in paediatric patients should cause few adverse effects and allow fast anaesthetic induction and recovery. The administration route is also important and should be minimally invasive. In this study, we aimed to compare two different doses of intranasal dexmedetomidine applied to children for MRI sedation. METHODS: Sixty patients between 1 and 10 years of age with American Society of Anesthesiologists Physical Status classification I or II who were scheduled for MRI were recruited into this prospective, randomized, double-blind study. Intranasal dexmedetomidine was administered at doses of 3 µg kg(-1) (Group 1) and 4 µg kg(-1) (Group 2) before imaging. Heart rate (HR), peripheral oxygen saturation, respiratory rate and Ramsay Sedation Scale (RSS) scores were recorded before the anaesthetic induction of sedation and every 10 min until discharge. If intranasal sedation failed, an intravenous cannula was placed and propofol was applied as a rescue anaesthetic. Bispectral Index (BIS) scores were also recorded before and after MRI. We recorded onset time of sedation, mood at separation from parents (defined as parental separation score), imaging quality, MRI duration, rescue anaesthetic requirement, total duration of sedation, recovery duration, parents' satisfaction and adverse effects. RESULTS: The results related to age, weight and adverse effects were not statistically different between the groups. The parental separation score was significantly higher in Group 2 (P = 0.003). Rescue anaesthetic requirement was significantly higher in Group 1 (P = 0.002). The results related to recovery duration, MRI duration, parents' satisfaction, onset time of sedation and total duration of sedation were not statistically different. HR was significantly lower in all time intervals compared with basal values in both groups. In Group 2, RSS scores were significantly higher in the 30th, 40th and 50th min. The BIS scores in Group 2 were lower at the 50th min. Neither bradycardia nor oxygen desaturation were observed. Imaging studies were completed successfully in all patients. CONCLUSIONS: Based on lower rescue anaesthetic requirements, sufficient sedation and parental separation scores in Group 2, intranasal dexmedetomidine 4 µg kg(-1) was more efficient than intranasal dexmedetomidine 3 µg kg(-1). The intranasal route may be an alternative noninvasive route to apply drugs for MRI sedation in paediatric patients. Trial registration ClinicalTrials.gov: NCT02299232.

Effects of intra-articular levobupivacaine, fentanyl-levobupivacaine and tramadol-levobupivacaine for postoperative pain in arthroscopic knee surgery.

OBJECTIVE: The aim of this study was to compare the postoperative analgesic efficacy of intra-articularly injected levobupivacaine, levobupivacaine-fentanyl, and levobupivacaine-tramadol combinations. METHODS: Eighty patients scheduled for elective knee arthroscopy were divided randomly into 4 groups of 20 patients each. Group 1 (the control group) received intra-articular saline, Group 2 received levobupivacaine 2.5 mg/ml, Group 3 received levobupivacaine 2.5 mg/ml + tramadol 50 mg, and Group 4 received levobupivacaine 2.5 mg/ml + fentanyl l50 mcg. All patients were operated on under general anesthesia, and a total of 20 ml study solution was injected: 7 ml subcutaneously before surgery and 13 ml intra-articularly upon completion of surgery. For postoperative, pain visual analogue scale (VAS) was assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th hours postoperatively. Patients with a VAS score over 5 received diclofenac sodium, and the need for rescue analgesics was recorded. RESULTS: At the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, Group 3 and Group 4 had statistically significant lower VAS scores of pain (p<0.01). Postoperative rescue analgesic requirements were different among the groups. The postoperative 1st hour analgesic requirement was statistically significantly lower in Group 3 and Group 4 when compared to the other groups (p<0.01). At the postoperative 2nd and 4th hours, analgesic requirements were statistically significantly lower in Group 3 than in the other groups (p<0.01). Analgesic requirements were statistically significantly lower in Group 3 and Group 4 than in the other groups (p<0.01). Analgesic requirements at the 12th and 24th postoperative hours did not show any statistically significant difference (p>0.05). CONCLUSION: The results indicated that levobupivacaine combined with either fentanyl or tramadol decreased rescue analgesic requirements when compared to levobupivacaine alone.

Risk factors and outcome of increased red blood cell transfusion in cardiac surgical patients aged 65 years and older.

BACKGROUND: The use of blood products is not uncommon during cardiac surgery in elderly patients. We conducted this study to investigate the risk factors and adverse outcomes of increased red blood cell (RBC) transfusion in the patients aged ≥ 65 years undergoing cardiac surgery. METHODS: During 1 year period, 288 patients (197 male/91 female) aged ≥ 65 years who underwent coronary and/or valvular surgery were retrospectively reviewed. Patients were stratified into groups on the basis of the number of transfusions received (< 4 and ≥ 4 U) which was classified as increased transfusion. Univariate analysis and multivariate logistic regression were used to identify risk factors for increased transfusion. RESULTS: The mean unit of RBC transfusion was 4.5 ± 3.1 and 55.9% (n = 161) of patients received ≥ 4 U RBC. The overall postoperative complication rate was 36% and significantly higher in those with ≥ 4 U) RBC transfusion (p < 0.01). Risk factors including age, EuroSCORE, and low body surface were significantly higher in patient with ≥ 4 U RBC transfusion. Besides, preoperative anemia, postoperative drainage volume, and fresh frozen plasma (FFP) transfusion during hospital stay were found to be significantly associated with increased transfusion requirements. No difference was observed in mortality (p = 0.13). CONCLUSION: These results suggest that improvement in blood transfusion policy in elderly patients undergoing cardiac surgery requires elimination of preoperative anemia, careful attention to surgical hemostasis, and FFP use.

[Sugammadex versus neostigmine in pediatric patients: a prospective randomized study]. / Sugammadex versus neostigmina em pacientes pediátricos: estudo prospectivo e randomizado.

BACKGROUND AND OBJECTIVES: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. METHODS: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6mgkg(-1) rocuronium and monitorized with train-of-four. Group RN (n=40) received 0.03mgkg(-1) neostigmine, Group RS (n=40) received 2mgkg(-1) sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four>0.9, and probable complications were recorded. RESULTS: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four>0.9 were significantly higher in Group RN (p=0.001, p=0.002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p=0.020). Extubation train-of-four ratio was significantly lower in Group RN (p=0.002). CONCLUSION: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.

Sugammadex versus neostigmine in pediatric patients: a prospective randomized study / Sugammadex versus neostigmina em pacientes pediátricos: estudo prospectivo e randomizado / Sugammadex versus neostigmina en pacientes pediátricos: estudio prospectivo y aleatorizado

Background and objectives: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. Methods: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mgkg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40) received 0.03 mgkg−1 neostigmine, Group RS (n = 40) received 2 mgkg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded. Results: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (p = 0.001, p = 0.002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p = 0.020). Extubation train-of-four ratio was significantly lower in Group RN (p = 0.002). Conclusion: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures. .

Justificativa e objetivos: Os inibidores da acetilcolinesterase podem causar curarização residual no pós-operatório quando usados para reverter o bloqueio neuromuscular. Sugamadex reverte o bloqueio neuromuscular por encapsulação química e não está associado aos efeitos colaterais que podem ocorrer com o uso de agentes anticolinesterase. Devido ao aumento dos procedimentos cirúrgicos ambulatoriais. A curarização residual e a rápida recuperação no pós-operatório são muito importantes para a população de pacientes pediátricos. O objetivo deste estudo foi comparar a eficácia de sugamadex e neostigmina na reversão do bloqueio neuromuscular em pacientes pediátricos submetidos a procedimentos cirúrgicos ambulatoriais. Métodos: 80 pacientes, com idades entre 2-12 anos, programados para cirurgias ambulatoriais foram incluídos neste estudo prospectivo e randomizado. O bloqueio neuromuscular foi obtido com 0,6 mgkg−1 de rocurônio e monitorizado com a interpretação da sequência de quatro estímulos. O Grupo RN (n = 40) recebeu 0,03 mgkg−1 de neostigmina e o Grupo RS (n = 40) recebeu 2 mgkg−1 de sugamadex para a reversão de rocurônio. O tempo de extubacão (tempo desde a reversão do bloqueio neuromuscular até a extubação), a razão da sequência de quatro estímulos durante esse tempo, o tempo para atingir uma sequência de quatro estímulos > 0,9 e as complicações prováveis foram registrados. Resultados: Não houve diferença significativa entre as características dos pacientes. Os tempos de extubação e para atingir uma sequência de quatro estímulos >0,9 foram significativamente maiores no Grupo RN (p = 0,001, p = 0,002). A sequência de quatro estímulos ...

Introducción y objetivos: Los inhibidores de la acetilcolinesterasa pueden causar anestesia residual en el postoperatorio cuando se usan para revertir el bloqueo neuromuscular. El sugammadex revierte el bloqueo neuromuscular por encapsulación química y no está asociado con los efectos colaterales que pueden ocurrir con el uso de agentes anticolinesterasa. Debido al aumento de los procedimientos quirúrgicos ambulatorios, la anestesia residual y la rápida recuperación en el postoperatorio son muy importantes para la población de pacientes pediátricos. El objetivo de este estudio fue comparar la eficacia del sugammadex y la neostigmina en la reversión del bloqueo neuromuscular en pacientes pediátricos sometidos a procedimientos quirúrgicos ambulatorios. Métodos: 80 pacientes, con edades entre 2 y 12 años, programados para cirugía ambulatoria fueron incluidos en este estudio prospectivo y aleatorizado. El bloqueo neuromuscular se obtuvo con 0,6 mg kg−1 de rocuronio y fue monitorizado con la interpretación de la secuencia de 4 estímulos. El grupo RN (n = 40) recibió 0,03 mg kg−1 de neostigmina y el grupo RS (n = 40) recibió 2 mg kg−1 de sugammadex para la reversión de rocuronio. Se registraron el tiempo de desintubación (tiempo desde la reversión del bloqueo neuromuscular hasta la desintubación), la razón de la secuencia de 4 estímulos durante ese tiempo, el tiempo para alcanzar una secuencia de 4 estímulos > 0,9 y las complicaciones probables. Resultados: No hubo diferencia significativa entre las características de los pacientes. Los tiempos de desintubación y para alcanzar una secuencia de 4 estímulos > 0,9 fueron significativamente mayores en el grupo RN (p = 0,001, p = 0,002). La secuencia de 4 estímulos en el momento de la inyección de neostigmina/sugammadex ...

Comparison of Spinal Anaesthesia and Paravertebral Block in Unilateral Inguinal Hernia Repair.

OBJECTIVE: We aimed to compare the efficacy of spinal anaesthesia (SA) and paravertebral block (PVB) in unilateral inguinal hernia repair. METHODS: Sixty American Society of Anesthesia physical status (ASA) I-III patients aged between 18-64 years with unilateral inguinal hernia were enrolled in this study. Two patients in Group SA and 4 patients in Group PVB were excluded, and statistical analyses were done on 54 patients. In regard to anaesthetic choice, patients were divided into two groups, with 30 patients in each: Group SA, spinal anaesthesia and Group PVB, paravertebral block. Standard monitoring was done, and mean arterial pressure (MAP) and heart rate (HR) were recorded during the surgical procedure. Demographic variables, surgical data, patient satisfaction, the onset times to reach T10 dermatome and to reach peak sensory level, and onset time to reach modified Bromage 3 motor block were recorded. Postoperative nausea and vomiting and pain at postoperative hours 0-24 with the visual analog scale (VAS) were also measured. RESULTS: Compared to pre-anaesthesia measurements, the decrease in HR and MAP during the 10(th)-90(th) minute period was significant in Group SA (p<0.01). In Group PVB, sensory block duration time was higher, whereas paralysis rate was higher in Group SA (p<0.01). Bromage scores were significantly different between the groups (p<0.01). In Group SA, VAS score at the 24(th) postoperative hour, nausea, and vomiting were significantly higher compared to Group PVB (p<0.01). CONCLUSION: In conclusion, paravertebral block provides acceptable surgical anaesthesia, maintaining good quality and long duration on postoperative analgesia in unilateral hernia repair.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study.

BACKGROUND/AIMS: Different drug combinations are used for sedation in colonoscopy procedures. A ketamine-propofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. MATERIALS AND METHODS: A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. RESULTS: The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. CONCLUSION: Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.