Search

ABSTRACT BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid "codeine" to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. METHODS: Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. RESULTS: The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p < 0.05). The median time to the first demand of PCA was shorter in Group N compared with Group NC (p < 0.001). Meperidine consumption was higher in Group N compared with Group NC (p < 0.001). There was no difference between groups with respect to side effects (p > 0.05). CONCLUSIONS: The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy.

O manejo da dor pós-amigdelectomia pode ser feito com uma série de medicamentos. OBJETIVO: O presente estudo duplo-cego placebo controlado pretendeu avaliar a eficácia de paracetamol e dipirona administrados por via endovenosa na analgesia de pacientes pediátricos pós-amigdelectomia. MÉTODO: Cento e vinte crianças com idades entre três e seis anos submetidas à amigdelectomia com ou sem adenoidectomia e/ou entubação foram randomizadas para receber infusões de paracetamol (15 mg/kg), dipirona (15 mg/kg) ou placebo (0,9% NaCl) durante a cirurgia. As avaliações foram executadas com 0,25, 0,50, 1, 2, 4, 6h de pós-operatório. Petidina 0,25 mg/kg foi utilizada como analgésico de resgate. Dose acumulada de petidina foi o desfecho primário. Medições de intensidade da dor, alívio da dor, nível de sedação, náusea e vômitos, hemorragia no pós-operatório e outros efeitos adversos foram anotados. RESULTADOS: Nenhuma diferença significativa foi encontrada na dose acumulada de petidina entre os grupos paracetamol e dipirona. A dose acumulada de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação ao grupo placebo. Nenhuma diferença significativa foi observada entre os escores de dor no pós-operatório dos grupos durante o estudo. CONCLUSÃO: Paracetamol endovenoso tem eficácia analgésica semelhante à da dipirona endovenosa; ambos ajudam a reduzir a necessidade de opioides na analgesia pós-operatória de pacientes pediátricos submetidos à amigdelectomia em hospital-dia.Tonsillectomy is associated with severe postoperative pain for which, several drugs are employed for management. OBJECTIVE: In this double-blind, placebo-controlled study we aimed to evaluate the efficacy of intravenous paracetamol and dipyrone when used for post-tonsillectomy analgesia in children. METHOD: 120 children aged 3-6 yr, undergoing tonsillectomy with or without adenoidectomy and/or ventilation tube insertion were randomized to receive intraoperative infusions of paracetamol (15 mg/kg), dipyrone (15 mg/kg) or placebo (0.9% NaCl). Evaluation was carried out at 0.25, 0.50, 1, 2, 4, 6h postoperatively. Pethidine 0.25 mg/kg was utilized as rescue analgesic. Cumulative pethidine requirement was the primary outcome. Pain intensity measurement, pain relief, sedation level, nausea and vomiting, postoperative bleeding and any other adverse effects were noted. RESULTS: No significant difference was found in pethidine requirement between paracetamol and dipyrone groups. Cumulative pethidine requirement was significantly less in paracetamol and dipyrone groups vs. placebo. No significant difference was observed between groups in postoperative pain intensity scores throughout the study. CONCLUSION: Intravenous paracetamol is found to have a similar analgesic efficacy as intravenous dipyrone and they both help to reduce the opioid requirement for postoperative analgesia in pediatric day-case tonsillectomy.

Amaç: Bu retrospektif çalışmada hastanemizde intrakranial kitle cerrahisi uygulanan hastalardaki anestezi deneyimimizin değerlendirilmesi ve perioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntem: 2015-2016 tarihleri arasında intrakranial kitle cerrahisi geçiren yaşları 3 ile 78 arasında ASA risk sınıflaması I-III olan 112 hasta retrospektif olarak değerlendirildi. Veriler için anestezi kayıt formları, hasta dosyaları ve hastane bilgisayar sistemi kullanıldı. Hastaların demografik özellikleri, anestezi yönetimi ve postoperatif bilgileri kaydedildi.Bulgular: Hastaların yaş aralığı 3 ile 78 arasında değiştiği ve %57.1’nin erkek olduğu tespit edildi. 98 (%87.5) hastanın kitlesi supratentorial bölgede iken 14 (%12.5)’nin infratentorial bölgede lokalize olduğu saptandı. Ortalama operasyon süresi 184 dakika, ortalama yoğun bakımda kalış süresi 3 gün, hastanede kalış süresi 7 gündür. İntroperatif dönemde görülen komplikasyonlar arasında taşikardi (%5.4), bradikardi (%3.6), hipertansiyon (%3.6) ve hipotansiyon (%1.8) yer almaktadır. Takiplerde 13 (%11.6) hastanın tekrar operasyona alındı. Preoperatif ve postoperatif dönemde ölüm ile karşılaşılmadı Sonuç: İntrakranial kitle cerrahisi için nöroaanestezi uygulamalarında çeşitli anestezi teknikleri başarıyla kullanılabilir. İnvaziv monitorizasyon, sıkı hemodinami ve kan gazı takibi ile olası komplikasyonlar erken fark edilerek mortalite ve morbidite azaltılabilir.

Purpose: The aim of this study was to evaluate the effect of red blood cell transfusion and/or inotropic/vasopressor agent infusion during intraoperative and postoperative first 24-hour period on 30-day and one-year survival. Materials and Methods: In the final analysis, 133 patients who underwent radical cystectomy and urinary diversion surgery between November 2011 and January 2019 were included in this study. Perioperative anesthesia management early postoperative intensive care patient follow-ups were based on. Results: A statistically significant relationship was found between intraoperative red blood cell transfusion and one-year mortality rates. A statistically significant relationship was found between red blood cell transfusion in the intensive care unit and postoperative 30-day mortality rates. The relationship between vasopressor/inotrope agent infusion in intensive care unit and postoperative 30-day mortality was statistically significant. Conclusion: In radical cystectomy and urinary diversion, intraoperative red blood cell and/or inotrope/vasopressor drug administration, and red blood cell transfusion within first 24 postoperative hours in intensive care unit are associated with lower survival rates in both early and late periods. Future studies should focus on developing and implementing different strategies for perioperative blood management and maintenance of patient hemodynamics that may affect early and late outcomes.

Amaç: Bu retrospektif çalışmada hastanemizde laparaskopik bariatrik cerrahi uygulanan hastalardaki anestezi deneyimimizin aktarılması ve perioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntem: Obezite cerrahisi geçiren ASA risk sınıflaması II-III olan 62 hasta retrospektif olarak değerlendirilmiştir. Hastaların demografik özellikleri, cerrahinin süresi, peroperatif dönemde görülen komplikasyonlar, hastanede kalış süresi kaydedilmiştir.Bulgular: Hastaların yaş aralığı 19 ile 59 arasında değiştiği ve %72.6’sının kadın olduğu tespit edildi. Ortalama operasyon süresi 167 dakika, hastanede kalış süresi 5 gündür. İntroperatif dönemde görülen komplikasyonlar arasında taşikardi, hipertansiyon ve aritmi yer almaktadır. Takiplerde 6 (%9.7) hastanın tekrar operasyona alındığı, hastaların tamamının sağlıklı şekilde hastaneden taburcu edildiği tespit edildi. Sonuç: Laparaskopik obezite cerrahisinde oluşabilecek komplikasyonların önlenmesinde donanımlı bir ekip ve takım çalışması ile birlikte iyi bir preoperatif hazırlık, tromboemboli proflaksisi, sıkı hemodinami ve kan gazı takibi güvenli bir anestezi için gereklidir.

ABSTRACTBACKGROUND AND OBJECTIVE: Sedation in dialysis dependent end-stage renal disease patients requires caution as a result of performing high doses of sedatives and its complications. Multidrug sedation regimens might be superior and advantage on lesser drug consumption and by the way adverse events which occur easily in end-stage renal disease patients. We evaluated the effects of dexmedetomidine premedication on propofol consumption, sedation levels with Observer's Assessment of Alertness and Sedation scores and the bispectral index and the hemodynamic changes, potential side effects in geriatric patients with end-stage renal disease who underwent hip fracture surgery under spinal anesthesia.METHOD: In this randomized, controlled, double-blind study 60 elderly patients (age ≥ 65 years) with end-stage renal disease and hip fracture scheduled for anterograde femoral intramedullary nailing were assigned to groups that received either intravenous saline infusion (Group C) or dexmedetomidine 0.5 g/kg/10 min infusion for premedication (Group D). All the patients received propofol infusion after the induction of the spinal anesthesia.RESULTS: Total propofol consumption, propofol dose required for targeted sedation levels according to Observer's Assessment of Alertness and Sedation scores and bispectral index levels, recovery times were significantly lower in Group D (p < 0.001). The time to reach to Observer's Assessment of Alertness and Sedation score 4 and to achieve bispectral index ≤ 80 was significantly lower in Group C compared with Group D (p < 0.001). Adverse events were similar in both groups.CONCLUSION: Dexmedetomidine premedication lowers intraoperative propofol consumption to maintain targeted level of sedation. Therefore low dose dexmedetomidine premedication in addition to propofol infusion might be an alternative in geriatric patients with end-stage renal disease for sedation

Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Santral kor miyopati; konjenital miyopatiler grubunda yer alan, nadir görülen herediter bir nöromüsküler bozukluktur. Santral kor miyopati; kas güçsüzlüğü, iskelet sistemi deformiteleri ve artmış malign hipertermi duyarlılığı ile karakterize olup bu hastaların anestezi yönetimi ayrı bir önem taşımaktadır. Bu hastalarda perioperatif yönetimi güçleştirebilecek uzamış kas güçsüzlüğü ve malign hipertermi en hayati risklerdir. Bu olgu sunumunda santral kor miyopati hastalığı olduğu bilinen elektif sezaryen ameliyatı planlanan ancak acil cerrahiye alınan genç bir hastadaki anestezi yönetimi paylaşılacaktır.

Central core myopatyhy is a rarely seen hereditary neuromuscular disorder that is involved in congenitally myopathies group. The disease is characterized by muscular weakness, skeleton system deformities, increased malign hyperthermia sensitivity and anesthesia management is critically important. In these patients, prolonged muscular weakness and malign hyperthermia that can complicate the perioperative management are the most critical risks. In this case report, anesthesia management of an electively planned caesarean section patient, taken into emergency surgery that is also previously known to have central core myopathy diagnosis will be shared. [Cukurova Med J 2013; 38(4.000): 770-773]

Purpose:Renal transplantation significantly improves quality of life compared to hemodialysis in patients with end-stage renal failure. In end-stage renal failure anesthetic technique should be planned carefully, due to changes in volume distribution, drug metabolism, excretion. Results of total intravenous anesthesia, inhalation anesthesia, regional techniques are being investigated. Aim of this study was to present our experience in total intravenous anesthesia in 77 patients, who underwent live and cadaveric donor renal transplantation at Baskent University Faculty of Medicine Adana Teaching and Research Center. Material and Methods:Induction of anesthesia was performed with propofol(2mg/kg) and fentanyl(1μg/kg), and rocuronium bromide(0.4-0.5mg/kg) was given before intubation. Anesthesia was maintained with total intravenous anesthesia(propofol,50 mcg/kg/min; remifentanil,0.25 mcg/kg/min infusion). Intraoperative fluid, urine volumes were recorded. For preemptive multimodal analgesia, pre-incisional intravenous paracetamol(15mg/kg), intramuscular morphine(0.1mg/kg) were given. Postoperative analgesia was maintained with intravenous patient-controlled analgesia(meperidine 10 mg bolus, with a lockout time of 20 minutes). Postoperative pain was recorded using Visual Analogue Scale, level of sedation was assessed by Ramsey Sedation Scale. Results:Study included 64(83.1%) live donor transplantations and 13(16.9%) cadaveric donor transplantations. Mean total fluid administration was similar between live and cadaveric donor kidney transplantation patients however mean intraoperative urine output was significantly higher in live donor kidney transplantation patients(p