Effects of Osteotomy on Hemodynamic Parameters and Depth of Anesthesia in Rhinoplasty Operations.

BACKGROUND: Bleeding during rhinoplasty leads to many undesirable effects, such as loss of vision in the surgery area, complications during the procedure, and postoperative complications. The most important effect that increases bleeding is hemodynamic changes during surgery. Considering that osteotomy is the most challenging process in rhinoplasty, this study aimed to examine the hemodynamic changes during osteotomy and changes in the depth of anesthesia. METHODS: A total of 50 patients, aged 18 to 65 years with an ASA (American Society of Anesthesiology) score of 1 and 2, who underwent osteotomy during rhinoplasty under general anesthesia, were examined retrospectively. After routine monitoring, the patients underwent general anesthesia induction and endotracheal intubation. Before the surgery, they received remifentanil 1 µg/kg as an intravenous bolus followed by 0.5 µg/(kg·min) as intravenous infusion until the end of the surgery. The hemodynamic parameters and depth of anesthesia [bispectral index (BIS) values] of the patients were examined before anesthesia, 10 minutes before osteotomy, during osteotomy, and 10 minutes after osteotomy. RESULTS: A significant difference was found in heart rate (beats/min), systolic and diastolic blood pressures (mm Hg), and BIS values of the patients measured before, during, and after osteotomy (P < 0.001). The heart rate, systolic and diastolic blood pressures, and BIS values were significantly higher during osteotomy. Until the 10th minute after osteotomy, all 4 parameters nearly reached the values measured before osteotomy. CONCLUSIONS: Osteotomy directly affects hemodynamic parameters and depth of anesthesia. Hence, it is of utmost importance that the analgesic need and depth of anesthesia are adequately monitored and adjusted during osteotomy. By suppressing hemodynamic stress responses, the amount of bleeding can be reduced, thus increasing the surgical success and the patient's comfort.

Video head impulse test in children with otitis media with effusion and dizziness.

OBJECTIVE: The objectives of the study were to evaluate the vestibular impairment in children with otitis media with effusion (OME) and dizziness by using vHIT test, and to compare their results with healthy children. METHODS: The study population consisted of 30 pediatric patients with OME and dizziness and 30 healthy children, age between 4 and 15. Otoscopic and tympanometric examination and vHIT testing were performed to all subjects. vHIT test parameters were compared between pediatric patients with OME and dizziness and healthy children. Additionally, the differences of the mean vHIT gains between tympanogram types, otoscopic findings and the presence of saccades were analyzed. RESULTS: The mean vHIT gains and gain asymmetry values of patients with OME and dizziness and healthy children were comparable. No significant difference was observed between the mean vHIT gains of patients with type B and type C2 tympanogram. Covert saccades were observed in 57% of the patients with OME and dizziness. None of the patients had over saccades and none of the healthy children had saccades. CONCLUSION: Our study is a preliminary study analyzing the vestibular impairment in children with OME and dizziness using vHIT test. Based on our results, it can be assumed that the children with OME and dizziness usually don't have a great vestibular impairment that can be detected with vHIT test. The covert saccades detected in this patient group are accepted as a sign of slight vestibular impairment.

Seasonal variation of C-reactive protein and atherosclerotic cardiovascular events in hemodialysis patients.

BACKGROUND: Atherosclerotic cardiovascular diseases (ACVD) is the most common cause of mortality in hemodialysis (HD) patients and the annual mortality in this population is about 10%. Inflammation is one of the most important predictor of ACVD morbidity and mortality in these patients. Recent studies demonstrated that levels of inflammatory markers and ACVD mortality vary seasonally in healthy population and in high-cardiac-risk populations. In this retrospective analysis, we aimed to determine seasonal variation of inflammation and ACVD morbidity and mortality in HD patients. MATERIAL AND METHODS: Data were retrieved retrospectively for 1 year. Patients with acute or chronic infections or inflammatory conditions were excluded from the analysis. Laboratory data and ACVD-related events were retrieved from patients' files and these data were classified into seasonal periods. RESULTS: Sixty-two patients were included in the final analysis. During follow-up period, geometric means of serum hsCRP levels were similar in all of the seasonal periods (4.17, 4.17, 4.57, and 4.17 mg/L in winter, spring, summer, and autumn, respectively). Means of hsCRP values were significantly higher in patients with active-ACVD compared to patients with no-ACVD in winter (3.38 vs. 13.18 mg/L, p < 0.05) and in autumn (3.63 vs. 23.4 mg/L, p < 0.05). There were 5 mortality and 7 morbidity and 12 combined morbidity and mortality related to ACVD and the distribution of these events were similar in all of the seasonal periods. CONCLUSIONS: Our study demonstrates that hsCRP levels and ACVD events do not show seasonal variation in HD patients.