Search

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov).

Introduction: The noise levels in the ICUs exceed the levels suggested by the World Health Organization, because of the noises caused by devices and human noises. The aim of this study is to retrospectively examine the changes in audiometry results of nurses working in ICU. Methods: The audiometry results of nurses who worked for an uninterrupted period of 1 year in ICU in the last 3 years were examined retrospectively based on the results recorded at the time of employment and in the last year of working. Age, gender, years of work, assessments of hearing level and high frequency hearing losses were recorded. The normal level of hearing was accepted as 0-25dB. Results: Totally 10 male (25.6%), 29 female (74.4%) were included in the study. The mean age was 26.97 ± 4.69 years and the mean time of employment was 1.82 ± 0.91 years. The mean values of pure tone levels during the years of working were within the normal limits but a significant increase was observed. Two subjects (5.1 %) were confirmed to have high frequency hearing loss. Discussion and Conclusion: We believe that safety of the staff might be improved by reducing the level of noise in the ICUs and identifying the people at risk with yearly audiometry follow-ups.

One of the most common complications of anesthesia is postoperative nausea and vomiting (PONV). It is known that, in addition to the use of inhalational anesthetics and opioids, flank pain due to stones and the procedure also plays a role in the development of PONV in patients who undergo ureteroscopy. The purpose of this study was to retrospectively investigate PONV incidence and postoperative pain in patients who were administered hyoscine-N-butyl bromide (HBB) during ureteroscopy. Data from 40 patients who underwent ureteroscopy and were intravenously administered HBB for analgesia were retrospectively evaluated. Demographic data of the patients, PONV incidence and severity of pain at postoperative 15th and 30th min and postoperative 3rd, 6th, 12th, and 24th h were investigated. Additional analgesic requirements were recorded. Ten females (25%) and 30 males (75%) were included in the study. The mean age of the patients was 47.9 ± 14.9 years. Fourteen patients (35%) had comorbidities. Six patients (15.8%) had PONV at postoperative 15th min, two patients (5.3%) had PONV at postoperative 30th min, and one patient (2.5%) had PONV at postoperative 3, 6, 12, and 24th h. The mean VAS scores during the follow-up period were 0.67 ± 1.03, 0.41 ± 0.70, 0.65 ± 1.27, 0.63 ± 1.51, 0.60 ± 1.83, and 0.16 ± 0.60, respectively. Even though PONV is an important problem after ureteroscopy procedures, HBB that is an anticholinergic drug seems to exhibit effective antiemetic properties in addition to providing postoperative analgesic properties in patients who underwent ureteroscopy. [Med-Science 2020; 9(2.000): 482-4]

Background/aim: The aim of this study was to evaluate the effects of general anesthesia and ultrasonography-guided interscalene block on pain and oxidative stress evaluated by thiol–disulphide balance and C-reactive protein levels in patients undergoing shoulder arthroscopy. Materials and methods: A total of 42 patients aged 18–75 years who were scheduled to undergo shoulder arthroscopy were randomized into interscalene block group (Group-IB, n = 20) and general anesthesia group (Group-GA, n = 22). All patients received patient-controlled analgesia during the postoperative period. Additional analgesics were administered to patients with a visual analog scale score of > 4. Native -thiol, total -thiol, disulphide and C-reactive protein levels were measured. Patients’ visual analog scale scores, morphine and additional analgesic consumption were recorded. A shift in thiol–disulphide balance toward decreased thiol and increased disulphide levels was regarded as an indicator of oxidative stress. Results: Pain level, morphine and additional analgesic consumption were higher in Group-GA. Native-thiol and total-thiol levels were higher in Group-IB postoperatively and also disulphide levels were lower at postoperative 18 hours. C-reactive protein levels were similar in both the groups. Conclusion: Interscalene block induced less oxidative stress during the postoperative period, as evaluated by thiol–disulphide balance.

Objectives To compare analgesia nociception index (ANI) values, visual analog scale (VAS) values, and hemodynamic parameters in hysteroscopy patients who received remifentanil and dexmedetomidine during general anesthesia. Methods : In total, 30 patients who underwent hysteroscopy between March and September 2016 at the University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, Ankara, Turkey were included in this prospective study. Standard hemodynamic monitoring, ANI, and bispectral index (BIS) monitoring were applied to the patients. At 10 min prior to induction, 1 μg/kg of remifentanil was applied in Group R (n=15) and 1 μg/kg of dexmedetomidine was applied in Group D (n=15). After induction, sevoflurane was used for maintenance with dexmedetomidine at 0.2-0.7 μg/kg/hour in Group D and remifentanil at 0.05-0.5 μg/kg/minute in Group R. Perioperative and postoperative analgesia levels (ANI and VAS, respectively), hemodynamics, and complications were recorded. Results : Even though the ANI levels in Group D were lower at the perioperative 5th and 10th minutes, the ANI values were between the targeted limits, except for the measurement after I-gel insertion, in both groups. Hemodynamic parameters were within normal limits, but the mean arterial pressures in Group R after induction, following I-gel placement, and at the perioperative 5th, 10th, and 20th minutes and postoperative 30th minute were significantly higher. Conclusion : Dexmedetomidine and remifentanil are both efficacious agents for perioperative analgesia in hysteroscopy cases. Saudi Med J 2018; Vol. 39 (10): 1017-1022 doi: 10.15537/smj.2018.10.23098 How to cite this article: Gazi M, Abitagaoglu S, Turan G, Koksal C, Akgun FN, Ari DE. Evaluation of the effects of dexmedetomidine and remifentanil on pain with the analgesia nociception index in the perioperative period in hysteroscopies under general anesthesia. A randomized prospective study. Saudi Med J . 2018 Oct;39(10):1017-1022. doi: 10.15537/smj.2018.10.23098.

Resumo Justificativa e objetivo O uso do bloqueio do plano transverso abdominal com diferentes anestesicos locais e considerado como parte do regime de analgesia multimodal em pacientes submetidos a colecistectomia laparoscopica. No entanto, nenhum estudo comparando bupivacaina e levobupivacaina para bloqueio do plano transverso abdominal foi publicado. Nosso objetivo foi comparar bupivacaina e levobupivacaina em bloqueio do plano transverso abdominal guiado por ultrassom em pacientes submetidos a colecistectomia laparoscopica. Metodos Cinquenta pacientes (ASA I/II), submetidos a colecistectomia laparoscopica foram alocados aleatoriamente em dois grupos. Apos a inducao da anestesia, o bloqueio do plano transverso abdominal bilateral guiado por ultrassom foi realizado com 30 mL de bupivacaina a 0,25% no Grupo B (n = 25) e 30 mL de levobupivacaina a 0,25% no Grupo L (n = 25) para cada lado. O nivel de dor foi avaliado usando a escala visual analogica de 10 cm em repouso e durante a tosse em 1, 5, 15, 30 minutos e em 1, 2, 4, 6, 12 e 24 horas apos a operacao. Quando a escala visual analogica > 3, os pacientes receberam 10 mg de tenoxicam por via intravenosa (IV). Se a escala visual analogica permanecesse > 3, os pacientes recebiam tramadol IV (1 mg.kg−1). Em caso de analgesia inadequada, um analgesico de resgate foi administrado. A necessidade de analgesico e o tempo ate a primeira solicitacao de analgesico foram registrados. Resultados Os escores da escala visual analogica nao mostraram diferenca, exceto no primeiro e quinto minutos de pos‐operatorio, onde a escala visual analogica foi maior no Grupo L (p Conclusoes Bupivacaina e levobupivacaina apresentaram eficacia similar no bloqueio TAP em pacientes submetidos a colecistectomia laparoscopica.

Objectives: To investigate the analgesic effect of a subcostal-posterior transversus abdominis plane (TAP) block combination following laparoscopic sleeve gastrectomy. Methods : This study was conducted at Fatih Sultan Mehmet Educational and Research Hospital, Istanbul, Turkey, between March 2014 and June 2015. A total of 40 patients with a body mass index of 40-60 kg/m 2 scheduled for laparoscopic sleeve gastrectomy were randomly allocated into 2 groups. Patients in Group I (n=20) received a bilateral subcostal TAP block, and patients in Group II (n=20) received a bilateral subcostal and posterior TAP block. Pain intensity was assessed at rest and during coughing using the visual analog scale (VAS) prior to and at various time points after TAP block (0 min, 30 min, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours). Morphine consumption over 24 hours and time to first morphine requirement were recorded. Results : There was no difference in VAS scores between groups. Morphine consumption was 6.78±5.95 mg in Group I, and 7.28±5.95 mg in Group II ( p =0.795). Time to first morphine requirement was 267.22±303.84 min for Group I, and 207.80±209.81 min for Group II ( p =0.154). Conclusions : Subcostal-posterior TAP block provided equivalent analgesia to subcostal TAP block alone following laparoscopic sleeve gastrectomy. Saudi Med J 2017; Vol. 38 (12): 1224-1229 doi: 10.15537/smj.2017.12.21133 How to cite this article: Ari DE, Ar AY, Karip CS, Koksal C, Aydin MT, Gazi M, Akgun F. Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy. Saudi Med J . 2017 Dec;38(12):1224-1229. doi: 10.15537/smj.2017.12.21133.

Objectives : To compare the effects of sevoflurane, desflurane, and propofol on respiratory mechanics, and integrated pulmonary index (IPI) scores in patients undergoing laparoscopic sleeve gastrectomy. Methods : A total of 60 patients with a body mass index of ≥40 kg/m 2 , who underwent laparoscopic sleeve gastrectomy between September 2015 and September 2016 at Fatih Sultan Mehmet Health Application and Research Center, Istanbul, Turkey were included in this randomized prospective study. After induction, anesthesia was maintained by sevoflurane in group S, desflurane in group D, and propofol in group P. Peak inspiratory pressure (PIP), plateau pressure (Pplateau), compliance (Cdyn), respiratory resistance (Rrs), and IPI values were recorded. Mann-Whitney U, Kruskal- Wallis, Dunn’s, Friedman, and Fisher-Freeman- Halton tests were performed for statistical analysis. A p value of less than 0.05 was considered statistically significant. Results : A significant increase was found in PIP in group S (T 1 : 25; T 2 : 27 cmH 2 O), and group D (T 1 : 25; T 2 : 29,5 cmH 2 O) during pneumoperitoneum. Dynamic compliance decreased in all groups during pneumoperitoneum. In group S, the decrease in Cdyn was also statistically significant after pneumoperitoneum(T 1 :43.65;T 5 :41.25ml/cmH 2 O). Comparison between groups the values of PIP, P plateau , Cdyn, Rrs, and IPI were similar. Conclusion : In morbidly obese patients, sevoflurane, desflurane, and propofol are similar in terms of the intraoperative respiratory mechanics, and perioperative respiratory parameters provided with IPI. Saudi Med J 2019; Vol. 40 (12): 1235-1241 doi: 10.15537/smj.2019.12.24693 How to cite this article: Ozturk M, Demiroluk O, Abitagaoglu S, Ari D. The Effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial. Saudi Med J 2019; 40: 1235-1241. doi: 10.15537/smj.2019.12.24693

Background and objectives The risk of emergence agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA. Methods In this randomized study, a total of 102 ASA I–II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n = 52) and saline (Group-S, n = 50). After anesthesia induction, Group-K was intravenously administered 20 mL of saline containing 1 mg kg−1 ketamine, whereas Group-S was administered 20 mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30 minutes in the recovery unit. Results There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points. Conclusion Administration of 1 mg kg−1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.

We aimed to investigate that change of IPI values after sedation of patients undergoing cataract surgery under sedation. We included 50 patients (ASA I–III) undergoing cataract surgery under sedation by phacoemulsification method in this prospective observational study. IPI, SpO2, ETCO2, respiratory rate (RR), peripheral pulse rate (PR), hemodynamic data and BIS values and perioperative complications were recorded. Compared to baseline values, RR value at 5th min, RR, PR, IPI values at 10th min and RR, PR values at 15th min were significantly low and heart rate value at 15th min and arterial pressure, bispectral index (BIS) values at 5th min, 10th min, 15th min, 20th min, 25th min and 30th min were lower than baseline values. IPI monitoring will provide guidance during sedation of patients with comorbid diseases undergoing cataract surgery by phacoemulsification method.

Study objective To evaluate the effectiveness of 0.125% bupivacaine compared to 0.25% bupivacaine for ultrasound-guided transversus abdominis plane (TAP) block in patients undergoing open inguinal hernia repair. Design Randomized, double-blind study. Setting Educational and research hospital. Patients Forty adult patients of American Society of Anesthesiologists physical status I-III undergoing elective primary unilateral open inguinal hernia repair under spinal anesthesia. Interventions Patients in group I received 20 mL of 0.25% bupivacaine, whereas patients in group II received 20 mL of 0.125% bupivacaine for TAP block at the end of the surgery. Measurements Pain intensity was assessed at rest and during coughing using 10-cm visual analog scale score at 5, 15, 30, and 45 minutes and 1, 2, 4, 6, 12, and 24 hours after TAP block. Morphine consumption and time to first morphine requirement were recorded. Main results Visual analog scale scores at rest and during coughing were not significantly different between groups at all time points measured. Twenty-four hours of morphine consumption (7.72±7.33 mg in group I and 6.06±5.20 mg in group II; P =.437) and time to first morphine requirement (182.35±125.16 minutes in group I and 143.21±87.28 minutes in group II; P =.332) were not different between groups. Conclusions 0.125% Bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine for ultrasound-guided TAP block in patients undergoing open inguinal hernia repair.

Background and objective: The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Methods: Fifty patients (ASA I/II), undergoing laparoscopic cholecystectomy were randomly allocated into two groups. Following anesthesia induction, ultrasound-guided bilateral transversus abdominis plane block was performed with 30 mL of bupivacaine 0.25% in Group B (n = 25) and 30 mL of levobupivacaine 0.25% in Group L (n = 25) for each side. The level of pain was evaluated using 10 cm visual analog scale (VAS) at rest and during coughing 1, 5, 15, 30 min and 1, 2, 4, 6, 12 and 24 h after the operation. When visual analogue scale > 3, the patients received IV tenoxicam 20 mg. If visual analogue scale remained >3, they received IV. tramadol 1 mg.kg−1. In case of inadequate analgesia, a rescue analgesic was given. The analgesic requirement, time to first analgesic requirement was recorded. Results: Visual analogue scale levels showed no difference except first and fifth minutes postoperatively where VAS was higher in Group L (p 3, os pacientes receberam 10 mg de tenoxicam por via intravenosa (IV). Se a escala visual analógica permanecesse > 3, os pacientes recebiam tramadol IV (1 mg.kg−1). Em caso de analgesia inadequada, um analgésico de resgate foi administrado. A necessidade de analgésico e o tempo até a primeira solicitação de analgésico foram registrados. Resultados: Os escores da escala visual analógica não mostraram diferença, exceto no primeiro e quinto minutos de pós-operatório, onde a escala visual analógica foi maior no Grupo L (p < 0,05). A necessidade de analgésico foi semelhante em ambos os grupos. O tempo até a primeira solicitação de analgésico foi menor no Grupo L (4,35 ± 6,92 min vs. 34,91 ± 86,26 min, p = 0,013). Conclusões: Bupivacaína e levobupivacaína apresentaram eficácia similar no bloqueio TAP em pacientes submetidos à colecistectomia laparoscópica. Keywords: Bupivacaine, Cholecystectomy, Laparoscopic surgery, Levobupivacaine, Postoperative analgesia, Palavras-chave: Bupivacaína, Colecistectomia, Cirurgia laparoscópica, Levobupivacaína, Analgesia pós-operatória

OBJECTIVE I-gel is a new supraglottic airway device without an inflatable cuff. We aimed to compare I-gel and the classic laryngeal mask airway (LMA) regarding the ease of use and clinical performance in Turkish population. METHODS Fifty American Society of Anesthesiologists (ASA) I-II patients were randomly allocated into two groups: Group I-gel and Group LMA. Insertion time and success in first attempt were recorded. Peak, plato and mean airway pressures, EtCO2, airway compliance and leak volume were periodically recorded during the operation. The presence of blood on device removal and postoperative sore throat were also assessed. RESULTS The device insertion time in Group I-gel was shorter than that in Group LMA (21.00±4.15 vs. 30.40±12.17 s, p=0.001). The success rate in first attempt, peak, plato and mean airway pressures, EtCO2 and airway compliance did not differ between the groups. The leak volume was lower in Group I-gel 5 and 45 min after insertion (p=0.041 and p=0.027). The presence of blood on device removal and postoperative sore throat were similar in both groups. CONCLUSION I-gel may be a more advantageous supraglottic airway device compared with LMA.