Evaluation of the effect of trendelenburg position duration on intracranial pressure in laparoscopic hysterectomies using ultrasonographic optic nerve sheath diameter measurements.

BACKGROUND: During laparoscopic surgery, pneumoperitoneum and Trendelenburg positioning applied to provide better surgical vision can cause many physiological changes as well as an increase in intracranial pressure. However, it has been reported that cerebral autoregulation prevents cerebral edema by regulating this pressure increase. This study aimed to investigate whether the duration of the Trendelenburg position had an effect on the increase in intracranial pressure using ultrasonographic optic nerve sheath diameter (ONSD) measurements. METHODS: The near infrared spectrometry monitoring of patients undergoing laparoscopic hysterectomy was performed while awake (T0); at the fifth minute after intubation (T1); at the 30th minute (T2), 60th minute (T3), 75th minute (T4), and 90th minute (T5) after placement in the Trendelenburg position; and at the fifth minute after placement in the neutral position (T6). RESULTS: The study included 25 patients. The measured ONSD values were as follows: T0 right/left, 4.18±0.32/4.18±0.33; T1, 4.75±0.26/4.75±0.25; T2, 5.08±0.19/5.08±0.19; T3, 5.26±0.15/5.26±0.15; T4, 5.36±0.11/5.37±0.12; T5, 5.45±0.09/5.48±0.11; and T6, 4.9±0.24/4.89±0.22 ( p < 0.05 compared with T0). ). No statistical difference was detected in all measurements in terms of MAP, HR and ETCO2 values compared to the T0 value (p > 0.05). CONCLUSIONS: It was determined that as the Trendelenburg position duration increased, the ONSD values ​​increased. This suggests that as the duration of Trendelenburg positioning and pneumoperitoneum increases, the sustainability of the mechanisms that balance the increase in intracranial pressure becomes insufficient. TRIAL REGISTRATION: This study was registered at Clinical Trials.gov on 21/09/2023 (registration number NCT06048900).

The Evaluation of Hydroxyethyl Starch (6% HES 130/0.4) Solution's Potential Preventive Effects on Coagulation Status in Women with Gynecologic Malignancies Using Rotation Thromboelastography.

OBJECTIVE: The aim of this study was to determine the effects of in vitro hemodilution with 6% hydroxyethyl starch (HES) 130/0.4 solution on the coagulation status of women with gynecologic malignancies by using rotation thromboelastogram (ROTEM®). MATERIALS AND METHODS: Twenty-two patients with gynecological tumors scheduled for anesthesia were enrolled. Blood samples were diluted by 20% with 6% HES (130/0.4) solution. RESULTS: In the INTEM assay, clotting time (CT) (p<0.01) and clot formation time (CFT) (p<0.001) were significantly increased and maximum maximum clot formation (MCF) (p<0.001) was significantly decreased in HES hemodilution compared with the undiluted control samples. In the EXTEM assay, there was a similar significant increase in increase in CFT (p<0.01) and a decrease in maximum a decrease in MCF (p<0.01) in HES hemodilution when compared with control samples. CONCLUSION: HES 130/0.4 solution causes significant hypocoagulable changes in the thromboelastographic profile of gynecologic cancer patients in vitro.

Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer.

INTRODUCTION: Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS: We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and third months of follow-up in 43 patients were analyzed.  Results: The study population consisted of 31 male and 12 female patients, with a mean age of 56.7 years. The mean pre-procedure VAS score was 8.9±0.8, which showed a significant decrease on the first day (2.9), first month (3.6), and third month (4.6) of the follow-up. Four patients experienced minor complications (pain at the procedure site and hypotension); however, no major complications were observed. CONCLUSION: We observed a prolonged effect of repeated ESPBs for ≥3 months. The block efficacy decreased with time; however, an approximately 50% reduction in the VAS score persisted even in the third month. Repetitive ESPBs may be regarded as a straightforward, safe, and replicable intervention to complement medical treatment and diminish the need for opioids in managing lung cancer-related pain.

Cholorhexidine, octenidine or povidone iodine for catheter related infections: A randomized controlled trial.

BACKGROUND: Protection of the catheter site by antimicrobial agents is one of the most important factors in the prevention of infection. Povidone iodine and chlorhexidine gluconate are the most common used agents for dressing. The purpose of this study was to compare the effects of povidone iodine, chlorhexidine gluconate and octenidine hydrochloride in preventing catheter related infections. MATERIALS AND METHODS: Patients were randomized to receive; 4% chlorhexidine gluconate, 10% povidone iodine or octenidine hydrochlorodine for cutaneous antisepsis. Cultures were taken at the site surrounding catheter insertion and at the catheter hub after removal to help identify the source of microorganisms. RESULTS: Catheter related sepsis was 10.5% in the povidone iodine and octenidine hydrochlorodine groups. Catheter related colonization was 26.3% in povidone iodine group and 21.5% in octenidine hydrochlorodine group. CONCLUSION: 4% chlorhexidine or octenidine hydrochlorodine for cutaneous disinfection before insertion of an intravascular device and for post-insertion site care can reduce the catheter related colonization.

Peripheral nerve pulsed radiofrequency for trigeminal neuralgia treatment: Is it an effective method?

OBJECTIVES: Trigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures, and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform. This retrospective study aims to evaluate the analgesic effect, duration of efficacy, and side effects of PRF procedures in the peripheral branches of the trigeminal nerve. METHODS: The data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18 and 70 who did not respond to medical treatment or could not use medication due to side effects were treated with PRF procedure for peripheral branches of trigeminal nerve that was selected for this study. Demographic profile, clinical presentation, pain intensity, duration of efficacy, and complications were evaluated from their files. RESULTS: Twenty-one patients who underwent ultrasonography guided PRF procedures were included the study. Mean visual analog scale value of the patients was found to have decreased from 9.25±0.63 to 1.55±0.88 at the end of the 1st month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred. CONCLUSION: PRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.

Effect of Intrathecal Morphine on Postdural Puncture Headache in Obstetric Anaesthesia.

Objective: Intrathecal morphine is used as an effective component of multimodal analgesia in postoperative analgesia in cesarean section patients. We aimed to analyze the relationship between intrathecal morphine administration and postdural puncture headache (PDPH), pain score and analgesia consumption in the postoperative period, and maternal fetal effects. Methods: One hundred four pregnant women aged ≥18 years (American Society of Anesthesiology physical status I or II, >36 weeks gestation) who were scheduled for elective cesarean section under spinal anaesthesia were included in this study. Spinal anesthesia consisted of bupivacaine with or without morphine (Group M: 10 mg heavy marcaine + 25 mcg fentanyl + 100 mcg morphine; Group F: 10 mg heavy marcaine + 25 mcg fentanyl). The effect of intrathecal morphine on PDPH, postoperative pain score, analgesia consumption, and maternal and fetal effects were recorded for 5 days. Results: PDPH developed in a total of 33 patients (Group M: 18 and Group F: 15, P=0.274). When we evaluated PDPH with the VAS, there was no significant difference between the groups. The postoperative visual analogue scale (VAS) was lower in the morphine group, and no statistically significant difference was found in the VAS 1st hr and VAS 2nd hr, whereas the VAS 6th hr and VAS 24th hr were found to be statistically significant. There was no difference in terms of PDPH, the first analgesic requirement and postoperative nausea-vomiting, but meperidine consumption was lower in the morphine group. Conclusion: Low-dose intrathecal morphine did not affect the incidence of PDPH. It is an effective method that can be used in cesarean section patients without increasing the maternal and fetal side effects from postoperative analgesia.

The Role of NLRP1 Inflammasome and Interleukin 1ß in Experimental Neuropathic Pain Model in Rat and the Effect of Tramadol Treatment.

AIM: Neuropathic pain can be caused by diabetes, nerve damage, postherpetic neuralgia, multiple sclerosis, and spinal cord injury, originating either in the peripheral or central nervous system. Several inflammatory mediators have a role in the pathogenesis of neuropathic pain. In this study, we evaluated the effects of tramadol on inflammation by measuring NLRP1 and IL-1 beta (IL-1ß) levels in an experimental neuropathic pain model. MATERIAL AND METHODS: Sprague-Dawley rats were divided into three groups: control, chronic constriction injury (CCI), and CCI + tramadol. Neuropathic pain was assessed using mechanical allodynia, thermal hyperalgesia, and cold allodynia. IL-1ß and NLRP1 levels were evaluated using ELISA on sciatic nerve (SN), dorsal root ganglion (DRG), and serum either on day 3 or days 8 postsurgery. RESULTS: On day 3, paw withdrawal latency (PWL) was lower in the CCI and CCI + tramadol groups than the control group in both mechanical and cold allodynia tests. On day 8, the PWL in the CCI group was also lower than in the control group. In contrast, tramadol increased the PWL on day 8 compared to day 3 in the CCI group. During cold allodynia, PWL decreased in the CCI group, however, tramadol reversed this effect on days 3 and 8. Tramadol, therefore, ameliorated pain hypersensitivity in mechanical/cold allodynia tests. Serum IL-1ß levels were higher in the CCI + tramadol and CCI groups than the control group, although serum IL-1ß levels in the CCI and CCI + tramadol groups were comparable. Tramadol decreased the IL-1ß and NLRP1 in DRG compared with the CCI group. A similar trend was observed in the SN samples. CONCLUSION: Our experiments revealed an increase in IL-1ß and NLRP-1 levels in a neuropathic pain model and found that tramadol had an anti-inflammatory effect on the IL-1ß and NLRP1 inflammasomes.

Anesthesia for a Child with Congenital Long QT Syndrome, a Case Report and Literature Review.

Long QT syndrome is an inherited disorder of the heart's electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. We present here a 17-month-old male patient who underwent general anesthesia for a cochlear implant. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied.

Frequency of electrocardiographic changes indicating myocardial ischemia during elective cesarean delivery with regional and general anesthesia: detection based on continuous Holter monitoring and serum markers of ischemia.

STUDY OBJECTIVE: To determine the frequency of electrocardiographic (ECG) changes and to assess the occurrence of myocardial ischemia during elective cesarean delivery with either regional or general anesthesia. DESIGN: Randomized, prospective, single-blinded clinical trial. SETTING: Large referral hospital. PATIENTS: 40 ASA physical status I and II term parturients. INTERVENTIONS: Patients were divided randomly into two groups as follows: the regional anesthesia group (group 1, n = 20) and the general anesthesia group (group 2, n = 20). MEASUREMENTS: In each case, continuous ECG was done using a 7-lead Holter monitor in the operating room, continuing for 24 hours after surgery. All Holter traces were analyzed by a study-blinded cardiologist. Blood samples were collected preoperatively (baseline) and at one, 5, and 24 hours postoperatively. Serum troponin T, creatinine kinase-MB, and myoglobin levels were measured. MAIN RESULTS: Two patients in group 1 (10%) and one patient in group 2 (5%) showed one mm ST-segment depression for two to 5 minutes. In all 40 cases, troponin T levels were in the normal range at all time points studied. In both groups, mean serum creatinine kinase-MB and myoglobin levels at one and 5 hours postoperatively were significantly higher than at baseline (P < 0.05). These high CK-MB and myoglobin levels were returned to normal ranges at the end of the study period; none of these women showed ST-segment changes. CONCLUSION: The ST-segment changes are not frequent in healthy women undergoing elective cesarean delivery during either regional or general anesthesia, and we found no evidence of myocardial injury.

Magnesium added to prilocaine prolongs the duration of axillary plexus block.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of the addition of magnesium to prilocaine on the duration of sensory and motor-nerve block. METHODS: After institutional approval, 60 ASA physical status I and II patients, between 18 and 60 years of age and scheduled for forearm and hand surgery under axillary brachial plexus block, were included in the study. Patients were randomly assigned to 1 of 4 groups. All of the patients received 5 mg/kg of 2% prilocaine and isotonic sodium chloride solution in 35 mL total volume for axillary brachial plexus block. Group I received intravenous saline, and group II received 150 mg intravenous magnesium at the same time as local anesthetic administration. In group III, 100 mg of magnesium, and in group IV, 150 mg of magnesium, were added to local anesthetic solution. Sensory block and motor block of musculocutaneous, radial, median, and ulnar nerves were recorded at 5-minute intervals. RESULTS: The duration of motor block was significantly longer in group IV than in other groups (167 +/- 30, 177 +/- 17, 180 +/- 20, and 250 +/- 19 minutes in groups I to IV, respectively) (P < .01). Mean duration of sensory block in both of the perineural magnesium groups was statistically different than in groups I and II (P < .001). Duration of sensory block in group IV (304 +/- 30 minutes) was significantly longer than in group III (253 +/- 23 minutes) (P < .001). CONCLUSION: The admixture of magnesium to prilocaine for axillary brachial plexus block provided a pronounced prolongation of sensory and motor block without side effects.

Cauda equina syndrome after epidural steroid injection: a case report.

OBJECTIVE: Conventional treatment methods of lumbusacral radiculopathy are physical therapy, epidural steroid injections, oral medications, and spinal manipulative therapy. Cauda equina syndrome is a rare complication of epidural anesthesia. The following case is a report of cauda equina syndrome possibly caused by epidural injection of triamcinolone and bupivacaine. CLINICAL FEATURES: A 50-year-old woman with low back and right leg pain was scheduled for epidural steroid injection. INTERVENTION AND OUTCOME: An 18-gauge Touhy needle was inserted until loss of resistance occurred at the L4-5 level. Spread of the contrast medium within the epidural space was determined by radiographic imaging. After verifying the epidural space, bupivacaine and triamcinolone diacetate were injected. After the injection, there was a reduction in radicular symptoms. Three hours later, she complained of perineal numbness and lower extremity weakness. The neurologic evaluation revealed loss of sensation in the saddle area and medial aspect of her right leg. There was a decrease in the perception of pinprick test. Deep-tendon reflexes were decreased especially in the right leg. She was unable to urinate. The patient's symptoms improved slightly over the next few hours. She had a gradual return of motor function and ability of feeling Foley catheter. All of the symptoms were completely resolved over the next 8 hours. CONCLUSION: Complications associated with epidural steroid injections are rare. Clinical examination and continued vigilance for neurologic deterioration after epidural steroid injections is important.

The effects of dopexamine in bupivacaine and ropivacaine induced cardiotoxicity in isolated rat heart.

OBJECTIVE: To compare the inotropic and chronotropic effects of ropivacaine and bupivacaine in an isolated, spontaneously beating rat heart, and to determine the reversal effects of dopexamine on these effects. METHODS: The study was conducted at the Department of Physiology, Medical Faculty, Osmangazi University, Eskisehir, Turkey in November 2001. Fifty animals were randomly assigned to 5 groups. Hearts were perfused with a modified Krebs Henseleit solution. In group I (n=10) hearts were exposed to bupivacaine 5 x 10-6 M and in group II (n=10) hearts were exposed to ropivacaine 5 x 10-6 M for 15 minutes. Group III (n=10) was the dopexamine control group and hearts were exposed to dopexamine 1 x 10-6 M for 5 minutes. In group IV (n=10) and in group V (n=10) hearts were exposed to dopexamine in 1 x 10-6 M doses immediately after the bupivacaine and ropivacaine infusions. Heart rates and contractile forces were recorded continuously during the study. RESULTS: Both of the local anesthetics had cardiac depressant effect on isolated hearts. Bupivacaine created more significant effect on heart rate and contractility than ropivacaine. Hearts receiving dopexamine after the infusion of local anesthetic, recovered more quickly. CONCLUSION: Bupivacaine had more depressant effects on cardiac contractility and chronotropy than ropivacaine. Dopexamine may provide an alternative to presently recommended pharmacological therapy in cases of bupivacaine and ropivacaine induced cardiotoxicity. But, the clinical impact of the use of dopexamine in this situation deserves further evaluation.

[Pain in trauma and burns]. / Travma ve yanik agrisi.

Trauma is tissue damage caused by an extrinsic force. The stress response comprises an activation of neurohumoral and physiologic process that would lead to improved survivability of an untreated organism following a traumatic injury. The sequelae of inadequate pain control following an injury are more than physiological. Chronic neuropathic pain is a frequent sequelae of trauma. Trauma and burn victims usually have poor pain management, because of the fear of hemodynamic alterations and respiratory depression. Early or even preemptive treatment of pain have been shown to reduce analgesic requirements over time. Individual patients will have widely variant requirements for pain medications, so induction of analgesia must be carefully adjusted, ideally in a closely monitored environment. Pharmacotherapy and interventional methods can be used in a wide variety for the management of pain in trauma and burns.

Evaluation of the Analgesic Efficacy of Dexketoprofen Added to Paracetamol.

OBJECTIVE: Multimodal analgesic methods are preferred for the treatment of postoperative pain; as a result, the additive effects of analgesics are provided while probable side effects are avoided. The current study aimed to compare the effects of the combination of dexketoprofen and paracetamol with regard to postoperative pain therapy. METHODS: Ninety-six patients who underwent non-malignant gynaecological laparotomy operations were included in this study. Patients were randomized into 3 groups. Group D received 50 mg intravenous dexketoprofen 15 minutes before the end of the operation and 8 and 16 hours after the operation. Group P received 1 g intravenous paracetamol and Group DP received the combination of 500 mg paracetamol and 25 mg dexketoprofen at the same time intervals. All patients received morphine infusion after operation. Total morphine consumption at 24 hours, visual analog scale, patient satisfaction and side effects were investigated. RESULTS: Comparison of the visual analog scale scores revealed that the Group DP presented lower scores at 24th hours compared to the other groups; and the difference between Group DP and Group D was statistically significant. Total morphine consumption was not significantly different between the three groups. The minimum number of side effects was observed in the Group DP. CONCLUSION: Co-administration of paracetamol, dexketoprofen and morphine provided good analgesia and fewer side effects in gynaecological abdominal surgery.

Does tramadol affect coagulation status of patients with malignancy?

AIM: The study investigated the direct effects of tramadol on the coagulation status of women with gynecologic malignancies in vitro. MATERIALS AND METHODS: Citrated whole-blood samples from 21 patients with gynecologic tumors were spiked ex vivo with 2 or 6 µl/ml tramadol. Thrombelastography (TEG) analysis was performed using ROTEM(®) to assess clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF). RESULTS: In the INTEM assay, CT (P < 0.05) and CFT (P < 0.01) were significantly prolonged with tramadol at a 6 µl/ml concentration compared with baseline. There were no significant differences in MCF values between the baseline and the tramadol-treated samples (P > 0.05). Blood medicated with tramadol (6 µl/ml) clotted slowly (increased CT and CFT). CONCLUSION: The changes observed by TEG demonstrated that tramadol impairs hemostasis in a concentration-dependent manner in the whole blood of women with gynecologic malignancies in vitro.

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery.

OBJECTIVE: The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. METHODS: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2% . Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. RESULTS: Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10th minute and 20th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. CONCLUSION: Sevoflurane provides a better myocardial protection than isoflurane, as may be inferred by the lower levels of the myocardial injury markers troponin-T and CK-MB observed with sevoflurane.

[The effect of flunarizine pretreatment on postoperative morphine consumption]. / Flunarizin ön tedavisinin postoperatif morfin tüketimine etkisi.

OBJECTIVES: This study was designed to document the effects 10 mg flunarizine, administrated in the preoperative period, on postoperative morphine requirement and analgesic quality, in abdominal surgery. METHODS: Thirty patients, aged 18 to 55 years, were studied. Patients were randomly allocated to one of two equally sized groups, and received either 2 capsules of 5 mg flunarizine (Group I) or 2 placebo capsules (Group II) 2 hours before the operation, immediately after the extubation and at the 15th minute, Aldrete postanesthesia recovery scores were assessed. In the postoperative period, patients were connected to a patient-controlled analgesia device for intravenous morphine, and the first analgesic requirement time was recorded. Ramsay sedation scale, visual analogue pain scale and morphine consumption were assessed after the extubation. RESULTS: Systolic arterial pressures at the 5th minute of the preoperative period were significantly lower in the flunarizine group than placebo group. Heart rates in the 45th minute were also lower in the flunarizine group. Flunarizine patients reported statistically lower visual analogue pain scale values in the postoperative 12th hour. There was no significant difference in postoperative sedation scores between the groups. Flunarizine did not lengthen the first analgesic requirement time and similarly did not lessen the morphine requirement. CONCLUSION: We conclude that 10 mg flunarizine administered in the preoperative period had no significant effects on clinical parameters, had no analgesic effect and did not augment the analgesic effects of morphine at this dose.