Severe headache following ozone therapy: Pneumocephalus.

Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.

Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia.

OBJECTIVE: Coccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the treatment of coccydynia, including nonsteroidal anti-inflammatory drugs, intrarectal manipulation, epidural injections, ganglion impar blocks, and radiofrequency treatment (RFT). Wemm and Saberski used the transacrococcygeal methods to reduce tissue trauma. RFT is a percutaneous minimally invasive procedure. In this study, we aimed to assess the effect of the transsacrococcygeal approach on ganglion impar RFT in patients with chronic coccydynia. METHODS: We retrospectively examined the data of 41 patients at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Maltepe University (Pain Clinic), between January 1, 2010, and December 31, 2012. RESULTS: The mean age of the patients was 46.68±11.00 years (range 28-67 [46] years). The average pain duration was 3.10±1.37 years. The difference between visual analog scale scores of the pre-and postprocedure was statistically significant. In the examinations carried out in the sixth month of the treatment, 90.2% of patients had a successful outcome, whereas treatment failed in 9.8% of patients. According to our patients' data, most of them had pain due to a trauma, were female, and overweight. Visual analog scale difference between preprocedure and early postprocedure, preprocedure and first month, preprocedure and sixth month were statistically significant (P=0.001). CONCLUSION: Based on the lower pain scores and low complication rates after the operations, the results suggest that application of RFT on ganglion impar by the transsacrococcygeal approach is an effective and safe method for the treatment of chronic coccydynia. Patient selection, technique, and experience are the most important factors affecting the success of this method.

A new technique to simplify the minimally invasive parathyroidectomy: Ultrasound-assisted guided wire localization for solitary parathyroid adenomas.

OBJECTIVE: To investigate the benefits of ultrasound-assisted guided wire localization in MIP for selected cases. METHODS: In this prospective, nonrandomised study, we included 36 patients with solitary parathyroid adenomas diagnosed preoperatively by 99m Tc sesta MIBI scintigraphy and/or neck ultrasonography. An ultrasound-guided wire was placed in the solitary parathyroid adenoma preoperatively. MIPs were performed under local anaesthesia plus sedation. After the excision, the parathyroidectomy was confirmed with postoperative ultrasonography. RESULTS: There were 36 patients included in our study. The mean age was 54.89±11.28 years, and 30 patients were females (83.3%). Preoperative PTH and calcium (Ca) levels were 269.5 pg/mL (83.5-5,000 pg/mL) and 12.2 mg/dL (11.1-20 mg/dL), respectively. Postoperative serum PTH and Ca levels were 42.04±26.65 pg/mL and 8.95±0.74 mg/dL, respectively. The mean operation time was 21.69±6.4 minutes and the average hospitalisation time was 18 hours (range: 10-72 hours). CONCLUSIONS: Ultrasound-assisted guided wire localization may be useful in selected MIP cases. The MIP advantages include higher success rates and being easy to learn and practise.

Evaluation of the Approaches of the Anaesthesiologists on Maintenance of Anaesthesia Machines.

OBJECTIVE: In this study, we aimed to discuss the level of knowledge and approach on 'maintenance, calibration and cleaning of anaesthesia devices' among anaesthesiologists in Turkey. METHODS: A questionnaire was prepared with 21 questions based on the Google document system, and these questionnaires were sent to the anaesthesiologists via e-mail. RESULTS: Overall, 226 anaesthesiologists answered our survey. With respect to the maintenance and calibration, anaesthesiologists had sufficient information about the vaporizer and the carbon dioxide canister devices; however, information about the vital components, such as disassembly of the anaesthesia machine, flow sensor, oxygen sensor, battery and exhaust system, was insufficient. The cleaning and sterilization procedures were performed when the devices became dirty, and the bacteria filter was used only for the protection of the anaesthesia system. There was a lack of knowledge about how and which part of the anaesthesia device should be disinfected. In total, 85% of the survey participants were thinking of the need of additional education on anaesthesia machine maintenance. CONCLUSION: It is observed that education about anaesthesia device maintenance, calibration and cleaning issues is obviously necessary for the anaesthesiology specialists in our country. We believe that it would be useful to highlight this issue to anaesthesia educational institutions and anaesthesia associations.

Is hyperbaric oxygen or ozone effective in experimental endocarditis?

BACKGROUND: Infective endocarditis, a disease with high mortality and morbidity, is most commonly caused by Staphylococcus aureus; mortality and morbidity further increase in the presence of methicillin-resistant strains of S. aureus. Linezolid is the first of the oxazolidinones, a new antibiotic group that has been approved for the treatment of infections caused by gram-positive cocci. Linezolid reduces the quantity of microorganisms in vegetation to some extent; in addition, the use of hyperbaric oxygen (HBO) and ozone (O3) therapies is likely to improve targeted antibacterial effect. MATERIALS AND METHODS: Fifty-six adult male Wistar rats weighing 300-350 g were used. The subjects were divided into groups as follows: Group 1 (n = 8): control group that was not inoculated with microorganisms and was untreated; Group 2 (n = 8): control group that was inoculated with microorganisms but was untreated; Group 3 (n = 8): linezolid treatment group; Group 4 (n = 8): O3 therapy group; Group 5 (n = 8): HBO therapy group; Group 6 (n = 8): linezolid + O3 therapy group; Group 7 (n = 8): linezolid + HBO therapy group. RESULTS: In terms of reducing the number of colonies in the aortic valve, linezolid + HBO therapy was found to be the most effective treatment. Then, respectively linezolid + O3, linezolid, HBO, and O3 were found to be effective. CONCLUSIONS: We found that linezolid significantly reduced the number of bacteria in the vegetation in the experimental endocarditis model, and HBO therapy increases the effectiveness of linezolid and makes this better than O3.

Sedation for transesophageal echocardiography: comparison of propofol, midazolam and midazolam-alfentanil combination.

AIM: The administration of trans esophageal echocardiography (TEE) may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions. METHODS: This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 µg/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS), modified Aldrete Scoring (MAS), recovery time and duration of stay in the hospital. RESULTS: In the group P additional dose requirements were greater (p<0.05), as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05). On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05). CONCLUSION: During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone.

Major Ozonated Autohemotherapy Preconditioning Ameliorates Kidney Ischemia-Reperfusion Injury.

Medical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-α, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 ± 4.30 vs 1.51 ± 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 ± 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.

Experimental Esophagitis Model Preventing Tracheal Aspiration.

BACKGROUND: Corrosive esophagitis injuries are a serious clinical problem with many agents used for diagnosis and treatment. Experimental esophagus burn models use a method described mainly in studies by Gehanno and Guedon, and modified by Liu and Richardson. OBJECTIVES: The aim of this study was to describe a new esophagitis model that prevents tracheal aspiration. MATERIAL AND METHODS: In this study we used 16 Wistar albino rats weighing between 220-240 g. The experimental animals were randomly divided into two groups: the model group (group M, n: 8) and control group (group C, n: 8). The necessary anesthesia was administered. Passing through a median laparotomy incision, the abdomen was entered and in group M and C the esophagus was freed and held by a suture at the gastroesophageal junction. After this procedure, about 1 cm proximal to the gastroesophageal junction, the esophagus was suspended by a suture. The esophagus segment between the two sutures was exposed to 0.1 mL 10% NaOH in group M and 0.1 mL saline in group C for 20 s. Ten days later all experimental animals were sacrificed and their esophagus removed. After dying with hematoxylin and eosine trichrome, the histopathological evaluation results for the rats in all groups were investigated with a light microscope. RESULTS: Histopathological examination indicated submucosal collagen increase, damage to muscularis mucosa and tunica muscularis and collagen deposition. In the model group, the rats had high neutrophils and tissue damage accompanied by necrosis. In the control group, the rats had minimal or no tissue damage and fibrosis was not observed. CONCLUSIONS: Our procedure is relatively less invasive and easy to apply with corrosive esophagitis only in the required region, and at the same time treatment medications can be easily administered.

Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis / Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos

ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30) included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30) included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

RESUMOJUSTIFICATIVA E OBJETIVOS: Tenoxicam é amplamente usado no tratamento da osteoartrite (OA)e o nosso objetivo foi comparar a eficácia de tenoxicam administrado por via oral (VO) e intra-articular (IA) no tratamento da OA.MÉTODOS: Este estudo foi conduzido entre 2011 e 2012 por meio de análise retrospectiva ecomparação dos resultados de 60 pacientes que foram clínica e radiologicamente diagnosticadoscom OA degenerativa de joelhos na Policlínica de Tratamento da Dor do Hospital Estadual deBünyan. Os 60 pacientes incluídos no estudo foram alocados em dois grupos. O primeiro grupo(tenoxicam IA, n = 30) incluiu resultados de pacientes submetidos à injeção nos joelhos porvia IA de 20 mg de tenoxicam uma vez por semana durante três semanas e o segundo grupo(tenoxicam VO, n = 30) incluiu pacientes que receberam 20 mg de tenoxicam por VO uma vezpor dia durante três semanas. Todos os pacientes foram avaliados clinicamente na fase basalpré-tratamento e em uma semana, um mês e três meses pós-tratamento, de acordo com oscritérios especificados.RESULTADOS E CONCLUSÕES: Dos 60 pacientes, 22 eram do sexo masculino e 38 do sexo feminino.Em ambos os grupos, melhorias significativas foram detectadas em todos os parâmetros da escalavisual analógica, do índice Western Ontario and MacMaster (Womac --- dor, atividade física erigidez dos joelhos) e do índice de Lequesne nas avaliações feitas em uma semana, um mês etrês meses e comparadas aos valores basais. Além disso, uma melhor adesão ao tratamento etolerabilidade ao sistema gastrointestinal no grupo tenoxicam IA também foram observadas. Aadministração de tenoxicam IA pode ser considerada como um método opcional de tratamentoem pacientes com OA de joelhos que não podem usar tenoxicam por VO, especialmente porcausa dos efeitos colaterais sobre o sistema gastrintestinal, e naqueles com dificuldades de adaptação ao tratamento.

Effects of sugammadex on the prevention of postoperative peritoneal adhesions.

Many materials and techniques have been used to prevent and repair intra-abdominal adhesions, but an effective solution has not been found. The aim of this study is to research the effect of sugammadex on intra-abdominal adhesions in an experimentally induced intra-abdominal adhesion model. Twenty-four female Wistar albino rats were included in the study. The experimental animals were randomly divided into three groups: the sugammadex group (Group SX, n = 8), the control group (Group C, n = 8), and the sham group (Group S, n = 8). After starvation for 1 night, the rats were injected with a 50 mg/kg intramuscular dose of ketamine and a 5 mg/kg intramuscular dose of xylazine for anesthesia. The rats in the SX group were given 3 mL sugammadex into the peritoneal cavity, while rats in the control group were given 3 mL 0.9% sodium chloride. In the sham group, the peritoneal cavity was opened, but no chemicals were administered. All rats were sacrificed on the 10(th) postoperative day. The adhesions were staged as 0, 1, 2, and 3 according to Evans et al.'s model. Our evaluation of macroscopic adhesion intensity found statistically significant differences between the groups. The sugammadex group was observed to have fewer adhesions in a statistically significant manner compared with the control group (p < 0.05). In our experimental intra-abdominal adhesion model in rats, we observed that sugammadex prevented postoperative intra-abdominal adhesions.

[Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis]. / Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos.

BACKGROUND AND OBJECTIVES: Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. RESULTS AND CONCLUSIONS: 22 of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment.

Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis.

BACKGROUND AND OBJECTIVES: Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment.

Blood gas analyzer utility in evaluating oxygen kinetics of the aqueous humor.

PURPOSE: To measure the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) and the pH of aqueous humor (AH) and arterial blood samples from rabbits using a blood gas analyzer. METHODS: Twenty New Zealand rabbits were anesthetized intramuscularly with ketamine and xylazine and were then allowed to breathe room air. Using a gas blood analyzer, arterial blood and AH samples were analyzed for PO2, PCO2, and pH. RESULTS: The mean arterial blood pressure was 87.14 ± 15.0 mmHg. The mean blood and AH PO2 were 95.18 ± 11.76 mmHg and 88.83 ± 9.92 mmHg, the mean blood and AH PCO2 were 25.86 ± 5.46 mmHg and 29.50 ± 5.36 mmHg, and the mean blood and AH pH were 7.38 ± 0.06 and 7.33 ± 0.09, respectively. CONCLUSIONS: The blood gas analyzer was easily employed to evaluate the aqueous humor in rabbits. When comparing the results of studies evaluating aqueous PO2, care should be taken to determine the methods used in these studies.

Blood gas analyzer utility in evaluating oxygen kinetics of the aqueous humor / Utilidade de um analisador sanguíneo de gás para a avaliação cinética do oxigênio no humor aquoso

Purpose: To measure the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) and the pH of aqueous humor (AH) and arterial blood samples from rabbits using a blood gas analyzer. Methods: Twenty New Zealand rabbits were anesthetized intramuscularly with ketamine and xylazine and were then allowed to breathe room air. Using a gas blood analyzer, arterial blood and AH samples were analyzed for PO2, PCO2, and pH. Results: The mean arterial blood pressure was 87.14 ± 15.0 mmHg. The mean blood and AH PO2 were 95.18 ± 11.76 mmHg and 88.83 ± 9.92 mmHg, the mean blood and AH PCO2 were 25.86 ± 5.46 mmHg and 29.50 ± 5.36 mmHg, and the mean blood and AH pH were 7.38 ± 0.06 and 7.33 ± 0.09, respectively. Conclusion: Conclusions: The blood gas analyzer was easily employed to evaluate the aqueous humor in rabbits. When comparing the results of studies evaluating aqueous PO2, care should be taken to determine the methods used in these studies. .

Objetivo: Medir a pressão parcial de oxigênio (PO2) e dióxido de carbono (PCO2), e o pH de humor aquoso (AH) e de amostras de sangue arterial de coelhos. Método: Vinte coelhos New Zealand foram anestesiados por via intramuscular com cetamina e xilazina, em seguida, foram liberados a respirar o ar ambiente. Utilizando um analisador sanguíneo de gás, amostras de sangue arterial e AH foram analisadas para PO2, PCO2, e pH. Resultados: A pressão arterial média foi de 87,14 ± 15,0 mmHg. A PO2 média do sangue e AH foi 95,18 ± 11,76 mmHg e 88,83 ± 9,92 mmHg; a PCO2 média do sangue e AH foi de 25,86 ± 5,46 mmHg e 29,50 ± 5,36 mmHg; o pH médio do sangue e AH foi 7,38 ± 0,06 e 7,33 ± 0,09, respectivamente. Conclusões: O analisador de gases no sangue foi facilmente empregadas para avaliar o humor aquoso em coelhos. Quando se comparam os resultados de estudos que avaliaram PO2 do humor aquoso, deve ser tomado cuidado para determinar os métodos utilizados nestes estudos. .

Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia.

UNLABELLED: In this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). CONCLUSION: In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.

The investigation of airway management capacity of v-gel and cobra-PLA in anaesthetised rabbits.

PURPOSE: To evaluate the applicability and airway management capacity of v-gel® and Cobra PLA in rabbit anaesthesia during assisted (AV) or controlled ventilation (CV). METHODS: This study was carried out in 44 adult New Zealand white rabbit. Baseline arterial pH, PaCO2 and PaO2 values were recorded. Anaesthesia was induced with 5 mg/kg xylasine and 35 mg/kg ketamine HCI combination. AV rabbits were assigned as; control (CG-AV; n=5), LMA (LMA-AV; n=5), cobra PLA (PLA-AV; n=5) and v-gel (v-gelAV; n=5). Rabbits have CV were also assigned as; ET (ET-CV; n=6), LMA (LMA-CV; n=6), cobraPLA (PLA-CV; n=6) and v-gel (v-gelCV; n=6). All measurements were repeated 1st, 5th, 15th and 30th mins during anaesthesia. RESULTS: The less insertion time, number of attempt and complications are recorded in v-gel applied rabbits compared to other apparatus. For arterial pH values significant differences are recorded in especially at 15th and 30th min between groups of CV (p<0.005 or p<0.001). All groups had similar results with each other during anaesthesia for PaCO2 except for LMA-CV group. CONCLUSION: The v-gel may be used as airway device in rabbit anaesthesia undergoing AV or CV and also can be a suitable alternative to endotracheal tubes and laryngeal mask airway.

The investigation of airway management capacity of v-gel and cobra-PLA in anaesthetised rabbits

PURPOSE: To evaluate the applicability and airway management capacity of v-gel(r) and Cobra PLA in rabbit anaesthesia during assisted (AV) or controlled ventilation (CV). METHODS: This study was carried out in 44 adult New Zealand white rabbit. Baseline arterial pH, PaCO2 and PaO2 values were recorded. Anaesthesia was induced with 5 mg/kg xylasine and 35 mg/kg ketamine HCI combination. AV rabbits were assigned as; control (CG-AV; n=5), LMA (LMA-AV; n=5), cobra PLA (PLA-AV; n=5) and v-gel (v-gelAV; n=5). Rabbits have CV were also assigned as; ET (ET-CV; n=6), LMA (LMA-CV; n=6), cobraPLA (PLA-CV; n=6) and v-gel (v-gelCV; n=6). All measurements were repeated 1st, 5th, 15th and 30th mins during anaesthesia. RESULTS: The less insertion time, number of attempt and complications are recorded in v-gel applied rabbits compared to other apparatus. For arterial pH values significant differences are recorded in especially at 15th and 30th min between groups of CV (p<0.005 or p<0.001). All groups had similar results with each other during anaesthesia for PaCO2 except for LMA-CV group. CONCLUSION: The v-gel may be used as airway device in rabbit anaesthesia undergoing AV or CV and also can be a suitable alternative to endotracheal tubes and laryngeal mask airway. .

Turkish Anaesthesiologist's Experiences of Anaesthetic Management of Patients with Obstructive Sleep Apnea (OSA).

OBJECTIVE: Obstructive sleep apnea (OSA) is an important health problem that is increasing with the increase in the incidence of obesity. For patients with OSA, it is reported that preoperative OSA diagnosis is made in only 10%-20% of the patients. Therefore, it gains importance that these patients are diagnosed in the preoperative period. The aim of this study is to analyze with a survey the experiences of anaesthesia experts working in Turkey about the diagnosis of patients with OSA, anaesthetic methods and postoperative care. METHODS: The study was completed with an online survey form distributed via email. Survey participants were sent an email, and those experts who wished to participate clicked on the link, answered the questions and returned the survey via email. RESULTS: A total of 134 anaesthesia experts participated in this study. While 97% of the participating anaesthetists considered diagnosis of patients with OSA to be important, only 53% trusted themselves to recognize this patient group. Of the total number of participants. 43% did not know the STOP-BANG test used in the preoperative period to diagnose patients with OSA. The percentage who thought that patients with OSA would increase the incidence of difficult intubation was 84%. In the intraoperative period, the percentage who chose inhalation anaesthetics was 35%, whereas the rate of those who chose total intravenous anesthesia (TIVA) was 48%. CONCLUSION: This study indicates that the medical knowledge of Turkish anaesthetists on the topic of OSA requires updating. In addition, we believe a practical guide to standardize the diagnosis and preoperative/perioperative management of patients with OSA should be prepared for Turkish anaesthetists.

Use of Succinylcholine by Anaesthetists in Turkey: A National Survey.

OBJECTIVE: Although succinylcholine (SCh) has side effects, it is among the most commonly used muscle relaxants for rapid induction because of the faster onset of its effects and short effect duration. However, there is no information regarding the frequency of use of SCh by anaesthetists in Turkey. This study aims to investigate the use of SCh by anaesthetists working in Turkey. METHODS: A web-based survey form was sent by e-mail to anaesthetists working in Turkey. The form comprised a total of 24 questions. RESULTS: E-mails were sent to a total of 1882 addresses at two separate times. E-mail replies were received from 433 (23%) anaesthetists. Based on those who responded to the survey, 54.27% anaesthetists routinely used SCh for adult elective cases, 29.33% for paediatric elective cases and 74.13% for emergency cases. In adult elective cases, SCh was most frequently chosen for caesarean section (20.5%), and in paediatric elective and emergency cases, SCh was chosen most frequently because difficult intubation was expected (31.3 and 21.4%, respectively). CONCLUSION: Our study reveals that SCh is still widely used by anaesthetists in Turkey. Majority of physicians who participated our survey were aware of the side effects; however, they reported using SCh in certain special situations. It is evident that creation of a standard care guide for departments is essential. The first stage of creating a standard care guide is to analyse and document the current application. With this aim, more wide-ranging advanced studies should be completed.

Comparison of effects of sugammadex and neostigmine on QTc prolongation in rabbits under general anesthesia.

PURPOSE: To compare the effects of sugammadex and neostigmine, used to antagonize the effects of rocuronium, on the QTc interval. METHODS: This study used 10 adult New Zealand white rabbits of 2.5-3.5 kg randomly divided into two groups: sugammadex group (Group S, n:5) and neostigmine group (Group N, n:5). For general anesthesia administering 2 mg/kg iv propofol and 1 mcg/kg iv fentanyl, 0.6 mg/kg iv rocuronium was given. Later to provide reliable airway for all experimental animals V-Gel Rabbit was inserted. The rabbits were manually ventilated by the same anesthetist. After the V-Gel Rabbit was inserted at 2, 5, 10, 20, 25, 27, 30 and 40 minutes measurements were repeated and recorded. At 25 minutes after induction Group N rabbits were given 0.05 mg/kg iv neostigmine + 0.01 mg/kg iv atropine. Group S were administered 2 mg/kg iv sugammadex. RESULTS: Comparing the QTc interval in the rabbits in Group S and Group N, in the 25th, 27th and 30th minute after muscle relaxant antagonist was administered the QTc interval in the neostigmine group rabbits was significantly increased (p<0.05). CONCLUSION: While sugammadex, administered to antagonize the effect of rocuronium, did not significantly affect the QTc interval, neostigmine+atropine proloned the QTc interval.