Comparison of pre-operative platelet functions by thromboelastogram in patients selective serotonin reuptake inhibitors user and non-user.

BACKGROUND: The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases. METHODS: The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I-II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed. RESULTS: R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year. CONCLUSION: When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.

The place of ultrasonography in confirming the position of the laryngeal mask airway in pediatric patients: an observational study.

BACKGROUND AND OBJECTIVES: Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging. METHODS: A prospective observational study was conducted on 82 patients aged 3-15 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope. RESULTS: The average age of the patients was 6.27 ±â€¯4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (p < 0.001; r = 0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (OR = 2.961; p = 0.046; 95% Cl 2.850-30.745). CONCLUSION: The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective.

The Impact of Surgical Procedures During Septorhinoplasty on the Intraoperative Pain Response.

BACKGROUND: During septorhinoplasty, many different surgical procedures are employed to bring the nose to the desired shape and solve breathing complaints. As a matter of course, intraoperative pain response occurs due to these procedures. OBJECTIVES: With this study, the authors aimed to evaluate the intraoperative pain formed during septorhinoplasty surgery with numerical values and to determine which stage of surgery is more painful. METHODS: Between April 2019 and March 2020, a total of 30 female patients who were planned to undergo septorhinoplasty were included in this prospective study. Standard anesthesia and analgesia were applied to all patients. During surgery, state entropy measure was utilized to evaluate the depth of anesthesia, and Surgical Pleth Index was employed to evaluate the response of the central nervous system to pain "nociception." RESULTS: The age of the patients ranged from 18 to 42 years (average, 25.3 ±â€…6.1 years). The average value of state entropy recorded during the surgery for all patients was found to be 45.43 ±â€…5.37. The mean beginning Surgical Pleth Index value recoded from all of the patients was 23.4 ±â€…8.84 compared with the beginning value; the values recorded during periost dissection, lateral osteotomy, and lower turbinate lateralization were statistically significantly higher (P < 0.005). CONCLUSIONS: Although sufficient depth of anesthesia and standard protocol of analgesia were applied, pain response was found to be significantly higher at some procedures during septorhinoplasty. The authors think that increasing the depth of anesthesia during these procedures will increase the comfort of this operation by inhibiting pain response.