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One-lung ventilation may cause negative changes in the oxygenation of cerebral tissue which results in post-operative cognitive dysfunction. We compared the potential effects of total intravenous anesthesia and inhalation general anesthesia techniques on cerebral tissue oxygenation.In this prospective double-blind trial, patients whose standard anesthesia induction was done were randomly divided into two groups as group total intravenous anesthesia using propofol (Group T, n = 30) and group inhalation general anesthesia using sevoflurane (Group I, n = 30) based on anesthesia maintenance. The intraoperative cerebral oxygen saturation and pre-post-operative mini-mental status test scores of the patients were monitored and recorded.Baseline characteristics were similar between the two groups. The decrease of cerebral oxygen saturation more than 20% in total intravenous anesthesia group was significantly higher than inhalation group (p0.05). In both groups, the mini-mental status test values at the post-operative 3Inhalation general anesthesia provided better cerebral tissue oxygenation in thoracic surgery with one-lung ventilation compared to total intravenous anesthesia. However, there was no significant correlation between the presence of desaturation and post-operative cognitive dysfunction.La ventilación unipulmonar puede provocar cambios negativos en la oxigenación del tejido cerebral que se traduce en una disfunción cognitiva postoperatoria. Comparamos los efectos potenciales de la anestesia total intravenosa y las técnicas de anestesia general por inhalación en relación con la oxigenación del tejido cerebral.En este ensayo prospectivo doble ciego, los pacientes en los que se realizó una inducción estándar de anestesia se dividieron aleatoriamente en dos grupos: grupo de anestesia intravenosa total con propofol (Grupo T, n = 30) y grupo de anestesia general por inhalación con sevoflurano (Grupo I, n = 30) basados en el mantenimiento de la anestesia. Se controlaron y registraron la saturación de oxígeno cerebral intraoperatoria y las valoraciones de la miniprueba de estado mental preoperatoria de los pacientes.Las características de base fueron similares entre los dos grupos. La disminución de la saturación de oxígeno cerebral de más del 20% en el grupo de anestesia intravenosa total fue significativamente mayor que en el grupo de inhalación (p0.05). En ambos grupos, los valores de la mini prueba del estado mental al cabo de la 3La anestesia general por inhalación facilitó una mejor oxigenación del tejido cerebral en la cirugía torácica con ventilación unipulmonar en comparación con la anestesia intravenosa total. Sin embargo, no hubo una correlación significativa entre la presencia de desaturación y la disfunción cognitiva posoperatoria.

Objective: We compared the air or saline insufflated endotracheal tube (ETT) cuff pressures and their effects on postoperative respiratory complications in gynecological laparoscopic surgeries in the Trendelenburg position (TP). Patients and Methods: This prospective study was carried out on a total of 60 patients, whose ages ranged from 18 to 65 years and who were classified by the American Society of Anesthesiologists (ASA) as I-III. They were scheduled for gynecological laparoscopic surgery in TP. Patients included in the study were randomly divided into two groups as the saline (Group S, n=30) and air (Group A, n=30) groups. ETT cuff pressures and peak airway pressures were recorded immediately after intubation and at 10-minute intervals during the intraoperative period. Results: The cuff pressure and maximum cuff pressure values in the saline group were significantly lower than in the air group in the 50-minute (p

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Background Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. Methods This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. Results Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. Conclusion Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

Aim In this study, we aimed to compare the effects of standard verbal information in the preoperative period and the information by visual expression and physical applications in the development of agitation, edema and ecchymosis in the postoperative period. Materials and methods The study was carried out in 60 ASA I-II patients who were going to undergo open rhinoplasty by plastic surgery. In the Preoperative Anesthetic Assessment the patients were divided into two groups as the patients given standard verbal information (Group S; n = 30) and those informed with a catalog which contains visuals (Group V; n = 30) In the preoperative period, anxiety levels of the patients were evaluated. Standard anesthesia induction was performed in both groups after standard monitoring. Patients were monitored in the post-anesthesia care unit and ward. Patient's extubation quality, presence of postoperative agitation and periorbital edema and ecchymosis at the 6th, 12th, 18th, and 24th hours were evaluated. Results No significant difference was found between the groups in terms of intraoperative and postoperative MAP, HR, extubation quality, presence of recovery agitation, postoperative pain, development edema and ecchymosis (P > 0.05). Significant positive correlation was found between post-extubation MAP and edema scores at the 16th and 24th hours postoperatively and between the post-anesthesia care unit entry MAP and ecchymosis at the 24th postoperative hours independently of the groups (r = 0.27; P = 0.038, r = 0.302; P = 0.019, r = 0.345; P = 0.007, respectively). Result In our study, it was concluded that detailed visual information and physical application in the preoperative period among rhinoplasty patients had no effect on the incidence of postoperative agitation, development of edema and ecchymosis.

In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations.Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kgEdema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p 0.017).We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.

Objective: The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cut-off value for TT or TP. Materials and Methods: Patients who underwent elective orthopedic lower-extremity surgery under general anesthesia were randomized into 2 groups: group A (inflation with a pneumatic TP of systolic blood pressure + 100 mm Hg; n = 30) and group B (inflation using the arterial occlusion pressure formula; n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic-nerve sheath diameter (ONSD) and end-tidal CO2 values were taken at specific time points (15 min before the induction of anesthesia, just before, and 5, 10, and 15 min after the tourniquet was deflated). Results: The initial and maximum TPs were found to be significantly higher in group A than in group B. At 5 min after the tourniquet deflation, there was a significant positive correlation between TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥5 mm was taken as a standard criterion, the safe cut-off value for the optimal TT was found to be < 67.5 min (sensitivity 87% and specificity 59.5%). Conclusion: The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. TT of ≥67.5 min was found to be the cut-off value and is considered the starting point of the increase in ICP after tourniquet deflation.

Objectives: Vitamin D has potent immunomodulatory effects with the capability of acting as an autocrine and paracrine agent,and inhibits inflammatory signaling. In this study, our aim was to evaluate the relationship between vitamin D levels in systemicinflammatory response syndrome (SIRS), sepsis and, septic shock patients and outcomes.Patients and Methods: A total of 45 patients whose vitamin D levels were measured within the first 48 hours of Intensive Care Unit(ICU) admission and 20 healthy controls were studied prospectively. The patients were grouped as, SIRS (Group-I,n=10), sepsis(Group-II,n=25), septic shock (Group-III,n=10) and healthy subjects (Group-IV,n=20). Serum vitamin D levels were categorized asa deficiency (≤15ng/mL), insufficiency (16-29ng/mL) and sufficiency (≥30ng/mL). Demographic characteristics, Acute Physiologyand Chronic Health Assessment II (APACHE-II) scores, and biochemical parameters were noted.Results: Vitamin D levels were significantly lower in all study groups compared to the control group (p

Background/aim: The aim of this study was to evaluate changes in intracranial pressure following tourniquet deflation using noninvasiveultrasonographic optic nerve sheath diameter (ONSD) measurements.Materials and methods: Our study included 59 adult patients between the ages of 18 and 65 years from the American Society ofAnesthesiologists (ASA) I/II risk groups who were scheduled to undergo elective orthopedic surgery of the lower extremities usinga tourniquet under general anesthesia. ONSD and end-tidal CO2 (ETCO2) were measured 5 times: 15 min prior to the anesthesiainduction; just prior to the deflation of the tourniquet; and at 5, 10, and 15 min after the deflation. Additionally, age, sex, weight, height,ASA score, and duration of operation and tourniquet usage were recorded.Results: The ONSD value measured 5 min after the deflation was significantly higher than all of the remaining measurements. Therewas a significant correlation between the ONSD and ETCO2 measurements at 5 and 10 min after deflation (r = 0.61, 95% CI 0.42-0.75,P < 0.0001 and r = 0.30, 95% CI 0.04-0.51, P < 0.05, respectively).Conclusion: The ultrasonographic ONSD measurements, which were obtained using a simple and noninvasive approach, increasedsignificantly following tourniquet deflation, and this increase was correlated with an increase in ETCO2.

Amac: Entube hastalarda nitrik oksitli (N2 O) dusuk akimli genel anestezide (DAA) inspire edilen nitroz oksit fraksiyonundaki (Fi N2 O) artisa bagli olarak N2 O’nun endotrakel tup (ETT) kafi icine diffuzyonu kaf basinclarinda artisa neden olur. Biz calismamizda N2 O’lu DAA’de hava ve salin ile sisirilen ETT kaf basinclarini ve bunun ameliyat sonrasi donemdeki bogaz agrisina olan etkisini karsilastirdik. Yontemler: Calismaya ASA I/II toplam altmis eriskin hasta dahil ettik. Anestezi induksiyonu sonrasi endotrakeal entubasyon yapilan hastalarin ETT kaflari hava (Grup A, n=30) ve salin (Grup S, n=30) ile 25 cmH2 O olacak sekilde sisirilerek rastgele iki gruba ayrildi. Anestezi N2 O’li DAA ile surduruldu. ETT kaf basinclari bir basinc manometresi ile surekli olarak olculdu ve inspire edilen oksijen ve N2 O seviyeleri operasyon boyunca her 10 dakikada bir kaydedildi. Hastalarin cerrahi sonrasi 2. ve 24. saatlerde yutkunurken ve yutkunma olmaksizin bogaz agrilari numerical rating scala (NRS) ile degerlendirildi. Bulgular: Gruplar arasinda demografik ve intraoperatif acisindan anlamli bir fark yoktu. Tum takip donemlerindeki kaf basinclari Grup S ile kiyaslandi- ginda Grup A’da maksimum olarak yuksekti (p10.dk=0,02, deger donemlerde p

Background: Breast reduction surgery is a common cosmetic surgery with a high incidence of blood loss and transfusion. In this surgery, the reduction of blood loss related to surgical manipulation and the volume of resected tissue is a target. In the present study, we compared the effects of esmolol-induced controlled hypotension on surgical visibility, surgical bleeding, and the duration of surgery in patients anesthetized with propofol/remifentanil (PR) or sevoflurane/remifentanil (SR). Methods: Patients in the American Society of Anesthesiologists I/II risk group undergoing breast reduction surgery were prospectively randomized into PR (n = 25) and SR (n = 25) groups. Controlled hypotension was induced with esmolol in both groups. During the intraoperative period, the heart rate (HR), mean arterial pressure (MAP), operation duration, volume of intraoperative blood loss, volume of blood received through postoperative drains, volume of resected tissues, and surgical area bleeding score were recorded. Results: The duration of operation in the incisional period was shorter in group PR compared to group SR (P = 0.04). The change in HR was lower in incision and hemostasis periods in the group PR compared to the group SR (P

Aim: Local anesthetics are commonly used in surgical interventions and anesthesia applications. The aim of this study was to increase the sensitivity of local anesthetic toxicity to the presence of symptoms, precautions to be taken and the use of 20% lipid infusion for treatment. Material and Methods: The questionnaire was applied on 160 of 205 physicians who were prescribed local anesthetics.Results: Of the 160 participants included in the study, 108 (67.5%) were research assistants, 47 (29.4%) were faculty members and the remaining 5 (3.1%) were expert medical practitioners. 63 of the participants (39.4%) had been working in the medical profession for more than 5 years. While 42.5% of the participants administered local anesthetics every day, 33.1% had not received any training in the area. On the basis of their training status, it was the anesthetists among specialist doctors who were the most trained in anesthetics with a statistically high rate of 86.3%. Thirty-three of the surveyed physicians (20.6%) who responded stated that they had experienced a case of local anesthetic toxicity previously. The most frequent answer to the question in early findings concerning local anesthetic toxicity was anaphylaxis (74.4%). 38.1% of the participants had not heard the use of 20% lipid solution in local anesthetic toxicity. Although there was 20% lipid solution in the university hospital where the research was conducted, 31.9% of the participants knew this.Conclusion: Although local anesthetic toxicity is rare, it frequently occurs in clinical practice. Therefore, physicians should have general knowledge regarding local anesthetic drugs, maximum doses, side effects, toxicity symptoms and the required treatment in the case of toxicity. We also think local anesthetic toxicity should be included in annual training programs and practical applications by other clinical branches that apply local anesthetic drugs as we currently do at our Clinic and physicians should be given appropriate guidance.

Resumen Durante la anestesia general pueden lesionarse los nervios en la region faringola-ringea. Los nervios mas a menudo lesionados son el hipogloso, lingual y laringeo recurrente.Las lesiones puedensurgir como resultado de varios factores que ser, durante la larin-goscopia, intubacion endotraqueal e insercion deltubo y por presion balon, ventilacion conmascarilla, maniobra aereatriple, via orofaringea, modo de insercion del tubo, posicionde la cabeza ydel cuello, aspiracion.Las lesiones nerviosas en esa region pueden comprometer un solo nervio aislado o causar laparalisis de 2 nervios en conjunto, como la del nervio laringeo recurrente hipogloso (sindromede Tapia). Sin embargo, la lesion combinada de los nervios lingual e hipogloso, despues de laintubacion para la anestesia, es una condicion mucho mas rara. El riesgo de una lesion se puedereducir con medidas preventivas. A continuacion describimos un caso de paresia unilateralcombinada de los nervios hipogloso y lingual despues de la intubacion para la anestesia.© 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. Todos losderechos reservados.

BACKGROUND This randomized, double-blind study was designed to assess the effect of perioperative remifentanil with controlled hypotension on intraoperative bleeding, postoperative edema, and ecchymosis. METHODS Fifty-two patients undergoing rhinoplasty were divided into 2 groups. The remifentanil group received 1 µg · kg(-1) intravenously as a bolus before induction of anesthesia, 0.5 to 1 µg · kg(-1) · h(-1) by continuous intravenous infusion during the operation. After anesthesia induction with propofol (2-3 mg · kg(-1)) and fentanyl (1-15 µg · kg(-1)), muscle relaxation was achieved with rocuronium (0.45-0.90 mg · kg(-1)). Mean arterial pressure was maintained at 50 to 60 mm Hg in controlled hypotensive anesthesia achieved using remifentanil infusion. Perioperative hemodynamics and bleeding; early postoperative pain and agitation scale; postoperative first, third, and seventh day edema; and ecchymosis were evaluated. Edema and ecchymosis were evaluated using graded scale from 0 to 4. RESULTS Remifentanil reduced mean arterial pressure during the entire operative period and the first 30 minutes postoperatively (P < 0.05 for these comparisons). Intraoperative bleeding also decreased (P < 0.001). There was a significant decrease in edema in both upper and lower eyelid edema on the first and third days in the remifentanil group, although this difference was not detected on the seventh day (P(1upper) = 0.000, P(1lower) = 0.000, P(3upper) = 0.008, and P(3lower) = 0.002). Ecchymosis decreased significantly in both upper and lower eyelids on the first, third, and seventh days in the remifentanil group (P(1upper) = 0.000, P(3upper) = 0.000, P(3upper) = 0.002, P(3lower) = 0.002, P(7upper) = 0.049, and P(7lower) = 0.038). There were no differences in postoperative pain and agitation between 2 groups. CONCLUSIONS Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

The aim of this study was to compare the effects of wound infiltration with levobupivacaine and tramadol in reducing postoperative pain in children undergoing unilateral inguinal hernia and undescended testis surgery. Under general anesthesia for elective unilateral inguinal hernia and undescended testis underwent surgery, ASA I-II, 80 children between the ages of 1-6 records in the patient's file was reviewed. The patients who were given 2mg.kg-1 tramadol in saline solution as prepared 0,2 ml.kg-1 into the surgical incision area by the surgeon at the end of the operation were accepted as Group T, who were given 0.25% levobupivacaine as 0.2 ml.kg-1 were accepted as Group L. Hemodynamic parameters, CHEOPS pain scores, additional analgesic consumption, adverse effects were recorded from the files. Patients\' CHEOPS were significantly higher in Group L compared to Group T at 4 and 6 hours (p, Biz çalışmamızda inguinal herni ve inmemiş testis operasyonu geçiren çocuklarda levobupivakain ile tramadolun yara yeri infiltrasyon yöntemiyle postoperatif ağrıyı azaltmadaki etkinliklerini karşılaştırmayı amaçladık. Genel anestezi altında elektif inguinal herni ve inmemiş testis operasyonu geçiren, ASA I-II risk grubunda, 1-6 yaş arası 80 çocuk hastanın dosya kayıtları retrospektif olarak incelendi. Cerrahi bitiminde, cilt kapanmadan önce yara dudaklarına 2 mg/kg tramadol içeren solusyondan 0.2 ml/kg olacak şekilde yapılanlar T Grubu, %0.25’ lik levobupivakain solusyondan 0.2 ml/kg olacak şekilde yapılanlar L Grubu olarak kabul edildi. Hemodinamik parametreler, CHEOPS ağrı skoru, ek analjezik tüketimi ve yan etkiler dosyalardan incelenerek kaydedildi.Hastaların CHEOPS skoru L grubunda T grubu ile kıyaslandığında 4. ve 6. saatte daha yüksek saptandı (p

Purpose: The purpose of this study is to evaluate the contribution, efficacy and safety of preemptive intravenous lornoxicam 8 mg on postoperative analgesia in patients who shall undergo spinal surgery and instrumentation. Materials and Methods: 50 adult (18-65) patients from ASA I-II risk group, scheduled for elective spinal surgery were included in clinical prospective, randomized, double blind, placebo controlled study. Lornoxicam 8 mg (in 100 ml physiological serum iv) was administered to the first group (Group L; n=25) and 100 ml physiological serum iv was administered by perfusor to the second group (Group P; n=25) 30 minutes before surgical incision. General anesthesia was applied after standard monitorization. Postoperative analgesia was performed with tramadol (iv) in 2 mg/ml concentration via patient controlled analgesia (PCA); bolus: 20 mg, lock time: 60 minutes and application time: 24 hours. Numerical Rating Scale (NRS) (0-10 points), tramadol used by PCA, frequency of drug request, additional analgesic amount consumed and effective analgesia times were recorded at the end of operation, 2nd, 4th, 6th, 12th and 24th hours. Results: Total PCA tramadol consumption during 24 hours period and frequency of PCA drug request at the end of operation, 2nd and 12th hours was significantly lower than the values for placebo (p

Aim: The aim of this study was to investigate the effects of extravasated fluid on the airway pressure of the patients in different surgical positions.Material and Methods: This prospective observational study included 50 arthroscopic shoulder surgery patients (18-65 years) placed in lateral decubitus (Group L) and beach chair (Group B) positions under general anesthesia. Peak airway pressure (Ppeak) and internal PEEP (iPEEP) measurements were recorded after intubation. The neck, chest, and shoulder circumferences were measured before induction and after operation.Results: The increases in Ppeak and iPEEP values were not statistically significant between the groups (p> 0.05). The total amount of irrigation fluid was significantly higher in Group L (p=0.042), not significantly correlated with Ppeak but positively correlated with the surgery time (r=0.51099; p=0.001 0.05). The neck circumference measurements were statistically significant between the groups. No respiratory complications were observed during the follow-up period.Conclusion: The lateral decubitus and beach chair positions do not cause a clinically significant compromise on the airway pressure in arthroscopic shoulder surgery but a longer operation duration will cause a higher amount of irrigation fluid to be used, leading to an increased circumference of the neck in the postoperative period.Keywords: Shoulder arthroscopy; airway pressure; lateral decubitus position; beach chair position

WOS: 000384952700119 PubMed: 27687454 Study objective: To investigate the effects of dexmedetomidine on oxidative injury caused by ionizing radiation. Design: Randomized controlled experimental study. Setting: Department of radiation oncology and research laboratory of an academic hospital. Interventions: Twenty-eight rats were randomized to 4 groups (n = 7 per group). Group S rats were administered physiologic serum; group SR rats were administered physiologic serum and 10 Gy external ionizing radiation. Groups D100 and D200 were administered 100 and 200 mu g/kg dexmedetomidine intraperitoneally, respectively, 45 minutes before ionizing radiation. Measurements: Liver, kidney, lung, and thyroid tissue and serum levels of antioxidant enzymes (glutathione peroxidase [GPX], superoxide dismutase, and catalase) and oxidative metabolites (advanced oxidation protein products, malondialdehyde, and nitrate/nitrite, and serum ischemia-modified albumin) were measured 6 hours postprocedure. Main results: In group SR, IR decreased antioxidant enzyme levels and increased oxidative metabolite levels (P < .05). In plasma, antioxidant enzyme levels were higher and oxidative metabolite levels were lower in groups D100 and D200 than in group SR (P < .01). In tissues, hepatic and lung GPX levels were higher in groups D100 and D200 than in group SR (P < .001). Renal and thyroid GPX levels were higher in D200 than in group SR (P < .01). Thyroid superoxide dismutase levels were higher in groups D100 and D200 than in group SR (P < .01). Renal, lung, and thyroid catalase levels were higher in group D200 than in group SR (P < .01). Hepatic, renal, and lung advanced oxidation protein products and malondialdehyde levels were lower in groups D100 and D200 than in group SR (P < .01). Hepatic, renal, and lung nitrate/nitrite levels were lower in group D200 than in group SR (P < .05). Conclusions: Dexmedetomidine preserves the antioxidant enzyme levels and reduces toxic oxidant metabolites. Therefore, it can provide protection from oxidative injury caused by ionizing radiation. (C) 2016 Elsevier Inc. All rights reserved.

To investigate the effects of propofol and caffeic acid phenethyl ester (CAPE) on prevention of lung injury as a remote organ after performing hindlimb ischaemia-reperfusion (IR) in a rat model.The animals were divided randomly into one of four groups: sham, no IR (n = 8), control, IR, (n = 8), CAPE group, IR with CAPE, (n = 8), propofol group, IR with P, (n = 8). After the rats were anaesthetised, the animals in the CAPE group received CAPE of 10 micromol, in the propofol group received propofol 50 mg/kg, in the control group received a similar volume of saline solution by means of intraperitoneal injection 1 h before reperfusion. After 4 h of ischaemia the tourniquet was removed and the animals were released for reperfusion for 4 h thereafter. At the end of the reperfusion period, a median sternotomy was performed. A blood sample was obtained for plasma malondialdehyde (MDA). The lung tissues were also removed for MDA assays, myeloperoxidase (MPO) activity, and histopathological examination.Plasma and lung MDA levels, and lung MPO activity were significantly higher in the control group compared to the other groups (p0.0005). In the CAPE group, these were significantly lower compared to the control group (p0.0005). Also, propofol caused a marked reduction in the MDA levels and MPO activity compared with control group (p0.0005), with no significant difference compared to that of the sham group. Histopathologically, the scores resulted in a grade zero (8/8) in the sham group, 3 (3/8) or 4 (5/8) in the control group, 1 (2/8) or 2 (6/8) in the CAPE group, and 1 (3/8) or 2 (5/8) in the propofol group.Propofol and CAPE seem to be effective in protecting against lung injury caused by increased oxidative stress and neutrophil accumulation after hindlimb IR in a rat model.

Pulmonary artery sling (PAS) is a rare congenital anomaly frequently accompanied by focal or long-segment tracheal stenosis. We presented a 34-year-old female patient with severe long-segment tracheal stenosis associated with PAS which was assessed with Multi Slice Computed Tomography (MSCT) consisting of axial, three dimensional and virtual bronchoscopic images of the airway. This case report discussed the management of her difficult airway condition during surgical cholecystectomy and thyroidectomy by using proseal- LMA and I-gel, respectively (Fig. 4, Ref. 10).

Purpose. This study was intended to investigate the effect of dexmedetomidine on oxidative stress response in pneumoperitoneum established in rats.Methods. Animals were randomized into three groups, group S: with no pneumoperitoneum, group P: with pneumoperitoneum established, and group D: given 100 mcg intraperitoneal dexmedetomidine 30 min before establishment of pneumoperitoneum. Plasma total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) activity were measured 30 min after conclusion of pneumoperitoneum.Results. The mean TOS level was significantly higher in group P than in the other two groups, and the TOS level was significantly higher in group D than in group S (P<0.05). Plasma TAS level was found to be lower in group P than in the other two groups, and the TAS level was lower in group D than in group S (P<0.05). Consequently, the OSI was significantly higher in group P than in groups D and S (P<0.05).Conclusions. Ischemia-reperfusion phenomenon that occurs during pneumoperitoneum causes oxidative stress and consumption of plasma antioxidants. Dexmedetomidine decreases oxidative stress caused by pneumoperitoneum and strengthens the antioxidant defense system.

ObjectiveTo compare the anaesthetic and convulsive effects of sevoflurane/remifentanil versus propofol/remifentanil combination in electroconvulsive therapy (ECT).MethodsIn this prospective, randomized double-blind study, patients diagnosed with treatment-resistant depression were included for ECT. Prior to treatment, 1 µg/kg remifentanil was intravenously administered to all patients, followed by anaesthetic induction with either 0.5 mg/kg propofol or 8% sevoflurane. Following muscular paralysis with succinylcholine and hypnosis, bitemporal ECT was applied. Vital signs, depth of sedation, recovery parameters, motor and electroencephalography (EEG) convulsion activity and postictal suppression index scores were recorded.ResultsA total of 120 sessions of ECT were administered to 12 patients. Heart rate was higher in the sevoflurane group than the propofol group. Compared with the sevoflurane group, bispectral index level was lower in the propofol group during the induction period and higher during the recovery period. Anaesthetic induction and recovery times were lower, and average motor and EEG convulsion activity was longer, in the propofol group than in the sevoflurane group.ConclusionPropofol/remifentanil is more successful compared with sevoflurane/remifentanil in anaesthesia management during ECT since it provides quick induction and recovery, longer seizure activity and stable haemodynamics.

Background. The aim of this study is to compare the effects of sevoflurane and propofol on one lung ventilation (OLV) induced ischemia-reperfusion injury (IRI) by determining the blood gas, ischemia-modified albumin (IMA), and malonyldialdehyde (MDA).Material and Methods. Forty-four patients undergoing thoracic surgery with OLV were randomized in two groups (sevoflurane Group S, propofol Group P). Anesthesia was inducted with thiopental and was maintained with 1–2.5% of sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil. Hemodynamic records and blood samples were obtained before anesthesia induction (t1), 1 min before two lung ventilation (t2), 30 min after two lung ventilation (t3), and postoperative sixth hours (t4).Results. Heart rate att2andt3in Group P was significantly lower than that in Group S. While there were no significant differences in terms of pH and pCO2, pO2att2andt3in Group S was significantly lower than that in Group P. IMA levels att4in Group S were significantly lower than those in Group P.Conclusion. Sevoflurane may offer protection against IRI after OLV in thoracic surgery.

Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy.Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient’s analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient’s demands from the pump, pump’s delivery, and additional analgesic requirement were also recorded.Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient’s demand and pump’s delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C.Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration.Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia. Keywords: Hypoglossal paralysis, Lingual paralysis, Intubation anesthesia

WOS: 000323912900041 PubMed: 23601417 Objectives: To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia-reperfusion (I/R) injury in rat ovarian tissue. Study design: Animals were randomized into three groups: Group S (n = 8), no pneumoperitoneum; Group C (n = 8), pneumoperitoneum; and Group D (n = 8), 100 mu g intraperitoneal dexmedetomidine 30 min before pneumoperitoneum. Ovarian tissue was collected from all rats 30 min after desufflation, and fresh frozen for histological and biochemical evaluation. Results: Body weight was similar in all three groups (202.62 +/- 28.86, 211.00 +/- 14.45 and 212.87 +/- 15.71 g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p < 0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p < 0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p < 0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p > 0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p < 0.05). Conclusion: Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Peripheral nerve blocks can provide a number of advantages in high-risk patients and may sometimes be preferred despite relative contraindication. Our first case had relative contraindication due to being confused, with a

ResumoLesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração.As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia). No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.