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Amaç: Supraglottik havayolu araçları havayolunun kontrolü ve mekanik ventilasyon için yaygın olarak kullanılmaktadır. Bu çalışmada 1 saatten kısa süreli pediatrik cerrahi olgularında 2 farklı supraglottik havayolu aygıtının (Klasik LMA, İ-gel LMA) yerleştirme koşulları ve ventilasyondaki etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ankara Eğitim ve Araştırma Hastanesi Eğitim Planlama Koordinasyon Kurulu onayı alındıktan sonra, Klasik LMA ve İ-gel LMA yerleştirilecek 2-7 yaş arası ASA I-II grubu 60 pediatrik olgu, ailelerinden onam alınarak çalışmaya dahil edilmiştir. Anestezi indüksiyonu 2,5 mgkgˉ¹ propofol, 1mcgkgˉ¹ fentanyl, 1 mgkgˉ¹ lidokain ve 0,2 mgkgˉ¹ rocuronyum uygulanmıştır. Anestezi idamesinde 2ltdkˉ¹ %50 N2O – O2 karışımı %2 Sevofluran ile sağlanmıştır. Klasik LMA uygulanan olgular grup K-LMA (n=30), İ-gel LMA uygulanan olgular ise Grup İ-gel (n=30) dahil edilmiştir. Olguların demografik verileri, kullanılan LMA tipi, LMA boyutu, LMA’nın kaçıncı denemede yerleştirildiği, LMA yerleştirme süresi, LMA kaçak basıncı kaydedilmiştir. Uygulayıcı tarafından LMA’nın yerleştirme kolaylığı 3 puan üzerinden (1: Çok kolay, 2: Kolay 3: Zor) değerlendirilmiştir. Vokal kordların görünümü ise Fiberoptik Bronkoskop (FOB) ile kontrol edilerek 4 puan üzerinden değerlendirilmiştir. İstatistiksel analiz için SPSS paket veri 23 programı kullanılmıştır. Bulgular: Grupların demografik verilerinde istatistiksel olarak anlamlı fark bulunamamıştır. LMA deneme sayısı, yerleştirme süresi, uygulama kolaylığı, kaçak basıncı ve FOB ile glottik görünüm için istatistiksel olarak anlamlı fark bulunamamıştır. İlk denemede yerleştirme için gruplar arasında anlamlı fark bulunamamıştır. Sonuç: Bu çalışmada 2-7 yaş arası pediatrik olgularda Klasik LMA ile İ-gel LMA’nın aynı etkinlikte kullanılabildiği sonucuna ulaşılmıştır. Fiberoptik görünümde İ-gel LMA’nın Klasik LMA’ya üstünlüğü saptanamamıştır.

BACKGROUND This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients. METHODS This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, ≥18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale. RESULTS Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of

Background/aim Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient’s airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP. Material and methods Sixty-one patients underwent ERCP (Group I: propofol, n = 31; Group II, sevoflurane, n = 30), with sedation controlled by the Ramsay sedation scale (RSS). The patients’ demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated. Results The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II’s saturation levels increased during sedation. Conclusion In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients.

The aim of this study was to compare insertion parameters of four different types of supraglottic airway devices (SGAD) (Classic LMA, I-gel LMA, Proseal LMA, Cobra PLA) in children undergoing ophthalmic surgery and to determine the effect on intra-ocular pressure (IOP) and haemodynamic responses during insertion.Sixty American society of Anesthesiologists (ASA) I-II children aged 1-10 years undergoing extra-ocular ophthalmic surgery were randomly divided into four groups (Group LMA, Group I-gel LMA, Group PLMA and Group CPLA) in this prospective, randomised study. Anaesthesia was induced with decreasing sevoflurane concentrations (8%-2%) in a mixture of 50% N2O-O2. All SGADs were inserted under deep anaesthesia. The characteristics of insertion (number of attempts, ease and time), oropharyngeal leak pressure (OLP) and complications were recorded. IOP in both eyes, heart rate (HR), mean arterial pressure (MAP) and EtCO2 were measured before and 2 and 5 min after insertion of the SGADs.There was no difference between the groups in terms of the characteristics of insertion. The mean IOP did not increase significantly in all groups. MAP and HR changes were similar among the groups during follow-up. In all groups, HR increased 2 min after insertion (statistically insignificant) and returned to the baseline value 5 min after insertion. A statistically significant correlation was seen between HR increase and IOP values before and after insertion of the SGADs (p=0.006, correlation coefficient=0.352). Desaturation was seen in one patient in Groups LMA, PLMA and CPLA, and laryngospasm was seen in two patients in Group CPLA and in one patient in Group LMA.It was seen that during insertion of Classic LMA, I-gel LMA, Proseal LMA and Cobra PLA, IOP did not increase and haemodynamic stability was maintained in children undergoing extra-ocular ophthalmic surgery.

Objectives/Hypothesis The aim of this study was to investigate the use of glass ionomer cement (GIC) as an injection material for vocal fold augmentation and to evaluate the biocompatibility of the material. Study Design Ten adult New Zealand rabbits were used. Methods Under general anesthesia, 0.1-cc GIC was injected to one vocal fold and the augmentation of vocal fold was observed. No injection was applied to the opposite side, which was accepted as the control group. The animals were sacrificed after 3 months and the laryngeal specimens were histopathologically evaluated. Results The injected and the noninjected control vocal folds were analyzed. The GIC particles were observed in histological sections on the injected side, and no foreign body giant cells, granulomatous inflammation, necrosis, or marked chronic inflammation were detected around the glass ionomer particles. Mild inflammatory reactions were noticed in only two specimens. The noninjected sides of vocal folds were completely normal. Conclusion The findings of this study suggest that GIC is biocompatible and may be further investigated as an alternative injection material for augmentation of the vocal fold. Further studies are required to examine the viscoelastic properties of GIC and the long-term effects in experimental studies. Level of Evidence NA. Laryngoscope, 2015

ResumoJustificativa e objetivoÉ óbvia a importância de minimizar as respostas simpatoadrenérgicas exageradas e o intervalo QT e a dispersão do intervalo QT que podem ocorrer por causa de laringoscopia e intubação traqueal durante a indução da anestesia em pacientes hipertensos. Esmolol diminui a resposta hemodinâmica à laringoscopia e à intubação. Porém, o efeito de esmolol sobre a redução do intervalo QT prolongado e a dispersão do intervalo QT induzida pela laringoscopia e intubação é controverso. Pesquisamos o efeito de esmolol sobre a hemodinâmica e o intervalo QT corrigido e as alterações da dispersão do intervalo QT observadas durante a indução da anestesia em pacientes hipertensos que receberam inibidores da enzima conversora de angiotensina (IECA).MétodosForam incluídos no estudo 60 pacientes, estado físico ASA I‐II, com hipertensão arterial essencial e que receberam IECA. O grupo esmolol recebeu uma dose em bolus de 500mcgkg−1, seguida por infusão contínua de 100mcgkg−1min−1 até o quarto minuto após a intubação. O grupo controle recebeu solução salina a 0,9%, semelhantemente ao grupo esmolol. Os valores da pressão arterial média e da frequência cardíaca e os registros do eletrocardiograma foram obtidos durante a fase inicial pré‐anestesia, cincominutos após a administração de esmolol e solução salina, trêsminutos após a indução e 30segundos, doisminutos e quatrominutos após a intubação.ResultadosO intervalo QT corrigido foi menor no grupo esmolol (p=0,012), o intervalo de dispersão do intervalo QT corrigido foi maior no grupo controle (p=0,034) e a frequência cardíaca média foi maior no grupo controle (p=0,022) 30segundos após a intubação. O risco da frequência de arritmia foi maior no grupo controle no quarto minuto após a intubação (p=0,038).ConclusãoDescobrimos que a intubação traqueal prolonga o intervalo e a dispersão do intervalo QT corrigido e aumenta a frequência cardíaca durante a indução da anestesia com propofol em pacientes hipertensos que receberam IECA. Esses efeitos foram prevenidos com esmolol (bolus de 500mcgkg−1, seguido de 100mcgkg−1min−1 de infusão). Durante a indução, a pressão tende a diminuir com esmolol. Portanto, cuidados são necessários.AbstractBackground and objectivesThe importance of minimizing the exaggerated sympatho‐adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected‐QT interval and corrected‐QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors.Methods60 ASA I–II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500mcg/kg followed by a 100mcg/kg/min infusion which continued until the 4th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5min after esmolol and saline administration, 3min after the induction and 30s, 2min and 4min after intubation.ResultsThe corrected‐QT interval was shorter in the esmolol group (p=0.012), the corrected‐QT interval dispersion interval was longer in the control group (p=0.034) and the mean heart rate was higher in the control group (p=0.022) 30s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4‐min period following intubation (p=0.038).ConclusionEndotracheal intubation was found to prolong corrected‐QT interval and corrected‐QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500mcg/kg bolus, followed by 100mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed.

Study Objective To evaluate the efficacy and the quality of recovery with intravenous (IV) paracetamol versus tramadol for postoperative analgesia after adenotonsillectomy in children. Design Prospective, randomized, double-blinded clinical trial. Setting Operating room and Postanesthesia Care Unit (PACU) of a university-affiliated hospital. Patients 64 ASA physical status I and II children, aged 6 to 16 years, scheduled for adenotonsillectomy. Interventions All patients were premedicated with oral midazolam 0.5 mg/kg 30 minutes before surgery. Patients were randomized to two groups following induction of general anesthesia. The paracetamol group (n = 32) received 15 mg/kg of IV paracetamol and the tramadol group (n = 32) received 1.0 mg/kg of IV tramadol. Measurements Modified Hannallah pain scores, emergence agitation, Aldrete scores, sedation scores, time to first administration of analgesic, heart rate, and mean arterial blood pressure were recorded for each patient. Data were recorded every 5 minutes for the first 30 minutes and every 10 minutes for the remaining 30 minutes in the PACU, then at 2, 3, 4, 5, 6, 8, 12, and 24 hours in the ward. The frequency of postoperative nausea and vomiting also was noted. Satisfaction of parents and nurses was determined on a 4-point scale at the end of the study. Main Results No significant demographic differences between groups were noted. No statistically significant difference was found in postoperative pain scores in either group. Agitation scores, Aldrete scores, sedation scores, and number of patients who received rescue analgesia and time to administration of rescue analgesia were similar in both groups. Conclusions The IV formulation of paracetamol was associated with similar analgesic properties and early recovery to that of IV tramadol after adenotonsillectomy in children.

The objective of this study was to evaluate the effectiveness of bilateral extraoral infraorbital nerve block with 0.25% bupivacaine administered at the end of surgery in postoperative pain relief after cleft lip repair. Forty ASA I-II children were randomly divided into 2 groups. Group I received 1.5 mL 0.25% bupivacaine and group II received 1.5 mL saline. FLACC scores of the patients in the recovery room in group I were 4 times less than in group II (P = 0.001) and in the first 4 hours postoperatively were apparently less in group I (P = 0.001). Mean time to first paracetamol requirement was longer in group I (P = 0.001). Total paracetamol consumption was lower in group I (P = 0.001). None of the patients required rescue tramadol in group I, whereas all patients in group II needed. In group I, parent satisfaction scores were higher (P = 0.001). Vomiting incidence was higher in group II (P = 0.028). Bilateral extraoral, infraorbital nerve block administered at the end of surgery provides satisfactory analgesia with high parental satisfaction and lower complication rates and reduces rescue analgesic consumption in patients undergoing repair of cleft lip.

Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia. Justificativa e objetivos: A incidência de agitação é um problema pós-anestésico comum em crianças após a anestesia com sevoflurano. Nosso objetivo foi comparar os efeitos de cetamina e midazolam administrados por via intravenosa, antes do término da cirurgia, para prevenir a incidência de agitação em crianças submetidas ao bloqueio caudal para alívio da dor sob anestesia com sevoflurano. Métodos: Foram inscritos no estudo 62 pacientes pediátricos, entre 2-7 anos, estado físico classificado de acordo com a Sociedade Americana de Anestesiologistas (ASA: I), programados para correção de hérnia inguinal, circuncisão ou orquidopexia. A anestesia foi induzida com sevoflurano a 8% em uma mistura de oxigênio (50%) e óxido nitroso (50%). Depois de atingir a profundidade adequada da anestesia, uma máscara laríngea foi colocada e, em seguida, o bloqueio caudal foi feito com bupivacaína a 0,25% (0,75 mL kg−1). No fim da cirurgia, cetamina (0,25 mg kg−1), midazolam (0,03 mg kg−1) e solução salina foram administrados aos grupos cetamina, midazolam e controle, respectivamente. A incidência de agitaçio foi avaliada com a escala Paediatric Anaesthesia Emergence Delirium (PAED) e a dor no período pós-operatório avaliada com a escala modificada Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Resultados e conclusões: Os escores de dor da escala modificada mCHEOPS foram maiores no grupo controle do que nos grupos cetamina e midazolam. Os escores PAED foram semelhantes entre os grupos. Os escores dessas duas escalas mostraram uma diminuição significativa do tempo em todos os grupos durante o acompanhamento em sala de recuperação pós-anestesia. O presente estudo resultou em escores satisfatórios da escala PAED, que ficaram abaixo de 10 em todos os grupos. Como conclusão, tanto cetamina quanto midazolam, adicionados ao bloqueio caudal sob anestesia com sevoflurano, não mostraram efeitos adicionais sobre a incidência de agitação. Além disso, o alívio da dor ainda parece ser o principal fator na prevenção da incidência de agitação após anestesia com sevoflurano. Introducción y objetivos La incidencia de agitación es un problema postanestésico frecuente en niños después de la anestesia con sevoflurano. Nuestro objetivo fue comparar los efectos de la ketamina y del midazolam administrados por vía intravenosa antes del término de la cirugía para prevenir la incidencia de agitación en niños sometidos al bloqueo caudal para alivio del dolor bajo anestesia con sevoflurano. Métodos 62 pacientes pediátricos, con edades entre 2 y 7 años, estado físico clasificado de acuerdo con la Sociedad Norteamericana de Anestesiólogos (ASA I), programados para la corrección de hernia inguinal, circuncisión o orquidopexia fueron inscritos en el estudio. La anestesia se indujo con sevoflurano al 8% en una mezcla de oxígeno al 50% y óxido nitroso al 50%. Después de alcanzar la profundidad adecuada de la anestesia, una mascarilla laríngea se colocó y enseguida el bloqueo caudal se realizó con bupivacaína al 0,25% (0,75 ml kg−1). Al final de la cirugía, la ketamina (0,25 mg kg−1), el midazolam (0,03 mg kg−1) y la solución salina fueron administrados a los grupos ketamina, midazolam y control, respectivamente. La incidencia de agitación se evaluó usando la escala Paediatric Anaesthesia Emergence Delirium y el dolor en el período postoperatorio se calculó con la escala modificada Children's Hospital of Eastern Ontario Pain Scale. Resultados y conclusiones Las puntuaciones de dolor de la escala modificada Children's Hospital of Eastern Ontario Pain Scale fueron más elevadas en el grupo control que en los grupos ketamina y midazolam. Las puntuaciones de la Paediatric Anaesthesia Emergence Delirium fueron parecidas entre los grupos. Las puntuaciones de esas 2 escalas arrojaron una reducción significativa del tiempo en todos los grupos durante el seguimiento en la sala de recuperación postanestesia. El presente estudio trajo puntuaciones satisfactorias de la escala Paediatric Anaesthesia Emergence Delirium, que quedaron por debajo de 10 en todos los grupos. Como conclusión, tanto la ketamina como el midazolam, adicionados al bloqueo caudal bajo anestesia con sevoflurano, no mostraron efectos adicionales sobre la incidencia de agitación. Además de eso, el alivio del dolor todavía parece ser el principal factor en la prevención de la incidencia de agitación posterior a la anestesia con sevoflurano.

Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage is still a leading cause of morbidity and death. This 50-year-old man underwent surgery for aneurysm clipping. After the aneurysm was clipped, papaverine was instilled into the surgical area. Bradycardia, hypotension, and sinus arrest developed in the first minute after applying the papaverine. Thus, the authors concluded that the application of papaverine to the surgical area can result in fatal bradycardia and hypotension.

In this prospective, randomized study, we evaluate the postoperative analgesic effect of lornoxicam after myomectomy operations.Forty ASA I-II patients scheduled for myomectomy operation were enrolled to this study. Patients were randomly divided into two groups and epidural block was performed with 0,75 % ropivacaine. After the operation, morphine Patient Controlled Epidural Analgesia (PCEA) combined with placebo (saline 2 ml iv) and morphine PCEA combined with lornoxicam 8 mg iv were administered to patients in Group I and Group II, respectively. Pain was assessed at the 0,1st, 2nd, 4th, 6th, 8th, 12th and 24th hours postoperatively. Chi-square and student's t tests were used for statistical analysis.VAS( Visual Analog Scale) scores were higher in Group I than Group II at 2nd, 4th, 6th and 24th hours. Total morphine consumption was 10.45+/- 4.03 in Group I and 4.25 +/- 1.74 in Group II.Single dose iv lornoxicam is a safe and an effective treatment option of post-myomectomy pain as it produces effective analgesia, reduces morphine consumption and does not increase the side effects.

Psychological status of patients during epidural and intravenous (i.v.) morphine administration are not known enough. It's known that after administration of morphine epidurally and intravenously plasma concentrations are similar but the concentrations in cerebrospinal fluide are different. The effects of two postoperative analgesia treatment regimens on the psychological and mental functions of the elderly after major orthopedic surgery were investigated in this randomized, blinded study. Morphine was used epidurally in Group E and intravenously in Group IV with patient controlled analgesia method for postoperative analgesia treatment. All patients were assessed for psychological status the day before surgery and 2 days after surgery using the Brief Symptom Inventory (BSI). The results of the BSI were assessed with the Global Severity Index (GSI). Nine subscales were also derived: depression, somatization, obsessive-compulsive, anxiety, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychoticism. There was not significant difference between the groups for preoperative and postoperative GSI results (p0.05). Only interpersonal sensitivity subscale results in Group i.v. were decreased compared to the baseline (p0.001). Preoperative BSI and submeasurement test scores revealed no correlation with total morphine consumption in both groups (p0.05). Mental changes like agitation, time and place disorientation were seen equally in both groups. This study showed that after epidural and intravenouse morphine administration, no psychologycal changes were observed in the postoperative period compared with baseline. Patients who received morphine intravenously were showed less interpersonal sensitivity in the postoperative period.

In total knee replacement operation, patients have a severe pain in the postoperative period. Because of side effects of opioids, multiple postoperative pain treatment regimens are more suitable in these elderly patients. In this double-blind, randomized, placebo controlled study, the effect of lornoxicam administration (32 mg/48 hour) on morphine consumption and drug-related side effects were investigated in elderly patients undergoing total knee replacement. Group M (n=23) and Group L (n=23) received morphine with patient controlled analgesia (PCA) device postoperatively. Additionally Group L received lornoxicam 16 mg intravenously 15 minutes before surgery and 8 mg at postoperative 12th and 24th hours. Morphine consumption in Group L were significantly lower than in Group M at 2, 3, 6, 8, 24, 36 and 48th postoperative hours (p0.05). At the end of 48th hour mean total morphine consumptions (mean+/-SD) for Group M and Group L were 63.70+/-15.70 mg and 34.60+/-16.32 mg, respectively. AUC (area under the curve) Morphine 0-48h in Group M was 59+/-13 and in Group L it was 30+/-13 (p0.001). Incidence of side effects in Group M were 60% and 25% in Group L (p0.05). In Group M, 8 patients (40%) experienced nausea and 3 (15%) patients experienced itching where as in Group L, 3 patients (15%) experienced nausea, 1 patient (5%) itching, 1 patient (5%) dry mouth. Lornoxicam administration in total knee replacement is associated with decreased morphine consumption for postoperative analgesia and fewer side effects.

Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375% ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 mll of ropivacaine 0.375%. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and postoperatively had a PCA pump programmed to deliver morphine. VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0, 1, 2, 3, 4, 6, 8 postoperative hours were significantly lower in group R in resting position (p0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ? 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine 0.375% provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.

ResumoJustificativa e objetivosA incidência de agitação é um problema pós‐anestésico comum em crianças após a anestesia com sevoflurano. Nosso objetivo foi comparar os efeitos de cetamina e midazolam administrados por via intravenosa, antes do término da cirurgia, para prevenir a incidência de agitação em crianças submetidas ao bloqueio caudal para alívio da dor sob anestesia com sevoflurano.MétodosForam inscritos no estudo 62 pacientes pediátricos, entre 2‐7 anos, estado físico classificado de acordo com a Sociedade Americana de Anestesiologistas (ASA: I), programados para correção de hérnia inguinal, circuncisão ou orquidopexia. A anestesia foi induzida com sevoflurano a 8% em uma mistura de oxigênio (50%) e óxido nitroso (50%). Depois de atingir a profundidade adequada da anestesia, uma máscara laríngea foi colocada e, em seguida, o bloqueio caudal foi feito com bupivacaína a 0,25% (0,75mLkg−1). No fim da cirurgia, cetamina (0,25mgkg−1), midazolam (0,03mgkg−1) e solução salina foram administrados aos grupos cetamina, midazolam e controle, respectivamente. A incidência de agitação foi avaliada com a escala Paediatric Anaesthesia Emergence Delirium (PAED) e a dor no período pós‐operatório avaliada com a escala modificada Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS).Resultados e conclusõesOs escores de dor da escala modificada mCHEOPS foram maiores no grupo controle do que nos grupos cetamina e midazolam. Os escores PAED foram semelhantes entre os grupos. Os escores dessas duas escalas mostraram uma diminuição significativa do tempo em todos os grupos durante o acompanhamento em sala de recuperação pós‐anestesia. O presente estudo resultou em escores satisfatórios da escala PAED, que ficaram abaixo de 10 em todos os grupos. Como conclusão, tanto cetamina quanto midazolam, adicionados ao bloqueio caudal sob anestesia com sevoflurano, não mostraram efeitos adicionais sobre a incidência de agitação. Além disso, o alívio da dor ainda parece ser o principal fator na prevenção da incidência de agitação após anestesia com sevoflurano.AbstractBackground and objectivesEmergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.Methods62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75mLkg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25mgkg−1, midazolam 0.03mgkg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.Results and conclusionsModified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow‐up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.

ResumenJustificación y objetivoEs evidente la importancia que tiene minimizar las respuestas simpatoadrenérgicas exageradas y el intervalo QT y la dispersión del intervalo QT que pueden ocurrir a causa de la laringoscopia e intubación traqueal durante la inducción de la anestesia en pacientes hipertensos. El esmolol disminuye la respuesta hemodinámica a la laringoscopia y a la intubación. Sin embargo, su efecto sobre la reducción del intervalo QT prolongado y la dispersión del intervalo QT inducida por la laringoscopia e intubación es controvertido. Investigamos el efecto del esmolol sobre la hemodinámica y el intervalo QT corregido, y las alteraciones de la dispersión del intervalo QT observadas durante la inducción de la anestesia en pacientes hipertensos que recibieron inhibidores de la enzima convertidora de la angiotensina.MétodosFueron incluidos en el estudio 60 pacientes, estado físico ASA I-II, con hipertensión arterial esencial y que recibieron inhibidores de la enzima convertidora de la angiotensina. El grupo esmolol recibió una dosis en bolos de 500mcg/kg, seguida de infusión continua de 100mcg/kg/min hasta el cuarto minuto después de la intubación. El grupo control recibió una solución salina al 0,9%, de forma similar al grupo esmolol. Los valores de la presión arterial media y de la frecuencia cardíaca y los registros del electrocardiograma fueron obtenidos durante la fase inicial preanestésica, 5min después de la administración del esmolol y la solución salina, 3min después de la inducción, y 30s, 2min y 4min después de la intubación.ResultadosEl intervalo QT corregido fue menor en el grupo esmolol (p=0,012), el intervalo de dispersión del intervalo QT corregido fue mayor en el grupo control (p=0,034) y la frecuencia cardíaca media fue mayor en el grupo control (p=0,022) 30s después de la intubación. El riesgo de la frecuencia de arritmia fue mayor en el grupo control en el cuarto minuto después de la intubación (p=0,038).ConclusiónDescubrimos que la intubación traqueal prolonga el intervalo y la dispersión del intervalo QT corregido y aumenta la frecuencia cardíaca durante la inducción de la anestesia con propofol en pacientes hipertensos que recibieron inhibidores de la enzima convertidora de angiotensina. Esos efectos fueron prevenidos con el esmolol (bolo de 500mcg/kg, seguido de 100mcg/kg/min de infusión). Durante la inducción, la presión tiende a disminuir con el esmolol. Por tanto, los cuidados se hacen necesarios.AbstractBackground and objectivesThe importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors.MethodsSixty ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500mcg/kg followed by a 100mcg/kg/min infusion which continued until the fourth minute after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5min after esmolol and saline administration, 3min after the induction, and 30s, 2min and 4min after intubation.ResultsThe corrected-QT interval was shorter in the esmolol group (P=.012), the corrected-QT interval dispersion interval was longer in the control group (P=.034) and the mean heart rate was higher in the control group (P=.022) 30s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (P=.038).ConclusionEndotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500mcg/kg bolus, followed by 100mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed.