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Aim: Human pseudocholinesterase (PChE) is an enzyme responsible for hydrolysis of the muscle relaxant drugs like succinylcholine and mivacurium. PChE deficiency, which may lead to prolonged apnea, may occur due to hereditary or acquired causes. In our study, we aimed to investigate the prevalence of human pseudocholinesterase (PChE) enzyme deficiency around the central Anatolia region and present our results in light of the literature. Methods: This cross-sectional study included 936 patients (age 18-70 years) who underwent any elective surgery under general anesthesia between August 2015 and September 2019. Human PChE level, plasma PChE activity, the human PChE activity/albumin, serum liver and kidney function tests were analyzed from blood samples. Human PChE enzyme deficiency and possible association of the PChE deficiency with other values was also investigated. The normal value of PChE was considered to range from 4650 U/L to 10,440 U/L. Results: PChE activity was decreased in 19 (1.9%) of the 936 patients (442 males and 494 females). There was no statistically significant difference between the PChE levels in terms of gender (P=0.236). The mean human PChE activity of all patients was 7.490 (0.980). The PChE activity of 22 (2.35%) and 58 patients (6.4%) were below 5.000 U/ml and 6.000 U/, respectively. A statistically significant difference was found between serum urea, creatinine and human PChE levels (P=0.034, P=0.236, respectively). However, PChE deficiency had no correlation with liver function tests such as AST and ALT (P=0.432, P=0.022, respectively). Conclusion: PChE deficiency can be observed in preoperatively evaluated patients and may cause serious life-threatening conditions, including respiratory failure and prolonged apnea. Amaç: Human psödokolinesteraz (PChE), süksinilkolin ve mivakuryum gibi kas gevşeticilerin yıkımından sorumlu bir enzimdir. PChE eksikliği genetik kökenle veya edinilmiş sebeplerle ortaya çıkabilir ve bu durum uzamış apneye yol açabilir. Biz çalışmamızda, orta Anadolu bölgesinde Human psödokolinesteraz (PChE) enzim eksikliğinin sıklığını araştırmayı ve literatür ışığında sunmayı amaçladık. Yöntemler: Bu enine-kesitsel çalışmada, Ağustos 2015 ve Eylül 2019 arasında genel anestezi altında herhangi bir elektif cerrahi geçiren 18-70 yaş arasındaki toplam 936 hasta çalışmaya dahil edildi. Hastaların kan örneğinde human PChE düzeyi, plazma PChE aktivitesi, human PChE aktivitesi / serum albümin düzeyi, serum karaciğer ve böbrek fonksiyon testleri analiz edildi. Human PChE enzim eksikliği ve serumda ölçülen diğer değerler ile muhtemel ilişkisi de ayrıca araştırıldı. PChE normal değeri 4650 U/L-10440 U/L olarak kabul edildi. Bulgular: PChE enzim aktivitesi, toplam 936 hastanın (442 erkek, 494 bayan) 19’unda (%1,9) normalin altındaydı. Cinsiyet açısından PChE düzeyleri arasında anlamlı fark yoktu (P=0,236). Hastaların 22’sinde (%2,35) PChE aktivitesi 5,000 U/ml’ in altındaydı. 58 (%6,4) hastada ise PChE aktivitesi 6,000 U/L’ in altında ölçüldü. Human PChE seviyesi ile serum üre ve kreatinin arasında istatistiki olarak önemli fark saptandı (sırasıyla, P=0,034, P=0,236). Ancak PChE enzim eksikliğinin AST ve ALT gibi karaciğer fonksiyon testleri ile ilişkisi saptanmadı (sırasıyla, P=0,432, P=0,022). Sonuç: Psödokolinesteraz enzim eksikliği preoperatif hastalarda gözlenebilir ve uzamış apne ve solunum desteği dahil yaşamı tehdit eden ciddi sonuçlara sebep olabilir.

The diagnosis of neuroacanthocytosis (NA) is made by the presence of acanthocytes via peripheral smear and by the accompanying clinical picture. Laboratory tests for diagnosis include blood smears to detect acanthocytosis, creatine kinase, genetic analysis and / or chorein level examination with western blot technique. This paper describes the case of a 34 year-old male patient who presented to the emergency department with acute respiratory failure and loss of consciousness. He was intubated and received mechanical ventilatory support after admission to the intensive care unit, and was diagnosed with Chorea akanthozytose (ChAc). We aim to emphasize the need to consider NA among the differential diagnoses for patients presenting with complex clinic such as acute respiratory failure and altered consciousness.

Background/Aim: Carotid body tumors (CBTs) are very rare. There is no uniform agreement on the method of anesthesia according to the Shamblin classification. The aim of this study was to report and compare outcomes and complications of different anesthesia methods according to the Shamblin classification in patients operated for CBTs. Methods: The data of 52 patients (40 males, 12 females) diagnosed with CBT Shamblin Type 1 or Type 2 and surgically treated were enrolled. General anesthesia (Group G) and sedoanalgesia (Group S) were administered in 35 and 17 patients, respectively. We retrospectively compared the surgical outcomes and complications between the groups to evaluate which anesthetic approach was more appropriate for early recognition of complications, hemodynamic stability, and surgical satisfaction in CBT surgeries. Results Group S patients were more stable hemodynamically. Hypertension, tachycardia, hypotension were significantly more frequent in Group G (P

Background: In this study, the μ-Opioid receptor activity was examined before the septoplasty. We assessed preoperative μ-Opioid receptor activity association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty.Methods: In our prospective study, 120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into preop 2 groups. The first group (n=60) was patients given tramadol (1-2 mgr/kg) for postop analgesia, and the second group (control group) (n=60) was initially performed only fentanyl (1 µg/ kg-i.v.) in the induction. The μ-Opioid receptors activities were investigated in preoperative blood samples and compared post-op pain level and requiring time for second analgesic agent. The visual analogue score(VAS) was used to evaluate the postoperative pain degree (0 no pain,10 worst pain). Patients' post op VAS scores were evaluated upon arrival to recovery room, and at 1st, 3rd, 7th, 10th, and 24th hours in postoperative period.Results: Demographic data and perioperative variables was similar in both study group (pConclusions: In this study, we revealed that postoperative pain level and second analgesic requirement decreased as μ-Opioid receptor levels increased in tramadol group.Trial registration: This trial was registered retrospectively (The ACTRN: ACTRN12619001652167, registration date: 26/11/2019).

Introduction: Dressing changes and wound care-debridement procedures often cause fear and anxiety in burn patients, as these processes are quite painful. In order to determine the best method for alleviating pain during these procedures, the current study compared the efficacy and safety of intravenous dexmedetomidine and midazolam for premedication prior to these painful burn care procedures. Methods: This comparative and randomized study included patients who had a burn size of 1563%, were aged 1870 years, were diagnosed with the American Society of Anesthesiologists physical status (ASA I–II), and who underwent painful burn care procedures. Patients were intravenously administered either 1 mcg/kg dexmedetomidine (Group 1) or 0.03 mg/kg midazolam (Group 2) prior to the burn care procedure. Recorded at predetermined time points for each patient were heart rhythm (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), standard bispectral index (BIS), and Ramsay Sedation Scale (RSS). Results: In the dexmedetomidine group, HR and MAP measurements of patients ​​at the 3rd, 5th, and 10th mins during sedation were significantly lower than the baseline values (p < 0.05). A significant decrease in SpO2 was observed in both groups at the 10th min during sedation, but the decline was higher in the midazolam group (p < 0.05). BIS measurements of the patients in both groups were significantly lower at 10 min. during sedation and at 15th and 60th mins during the procedure (p < 0.05). However, there was no significant difference between the group (p > 0.05). The RSS scales of both groups in during the sedation were higher in the 3rd, 5th and 10th mins than the baseline values (p < 0.05), but there was no significant difference between the groups (p > 0.05). The RSS scales of groups in during the burn procedure were significantly higher at 15 th min than the 0 th values, while the RSS scales of both groups were significantly lower in the 45th and 60th mins (p < 0.05). Conclusion: Results of this study indicate that dexmedetomidine causes hemodynamic alterations while midazolam causes respiratory depression. However, these effects are not severe, and we conclude that both agents are safe and effective to ensure sedation prior to painful burn-care procedures. WOS:000608468400011 33277091 Q2

Background: The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. Methods: In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. Results: Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. Conclusion: In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments. J Clin Med Res. 2015;7(6):460-463 doi: http://dx.doi.org/10.14740/jocmr2141w

WOS: 000493730200005 Objectives: We aimed to look into potential associations between specific biomarkers and trauma to Cranial Nerve VII (CNVII) in a rabbit model, focusing on whether endocrine studies have potential as biomarkers in this context. Methods: 30 adult New Zealand rabbits with intact facial muscles were used for the research. Each animal underwent identical surgery by the same surgeon. The facial nerve divisions were exposed by incising below the level of the mandible. After dissection of the skin and subcutaneous layers, the buccal division of CNVII was located with the nerve stimulator and microscopic dissection and a section of nerve 10mm long was excised in each case from the buccal branch of CNVII. Blood samples were drawn 8 weeks and 12 weeks after nerve injury had been surgically induced. The samples from day 1, week 4 and week 8 were tested for the following levels: Testosterone, oestrogen, progesterone, free T3 and T4, Cancer antigen 19-9 (Ca19-9), folate, TPSA, FPSA, FSH, LH, CA15.3, CAE, AFP and prolactin. Results: The levels of free T3 and T4 as well as testosterone, were down at 4th week, but at 8 weeks each had increased. Ca19-9 levels were also above the baseline. At 4 weeks, whilst oestrogen had markedly risen, progesterone had fallen. The statistical significance of the change in levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA was evaluated. For the group of animals with induced paralysis, the association between the lesion and testosterone, oestrogen, progesterone, free T3 and T4, Ca19-9, and folate levels were strong and at the level of statistical significance. Conclusion: There were statistically significant alterations in the serum levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA at the 4 and 8 week intervals post surgically-induced CNVII injury. It is likely that rabbit pathophysiology resembles human pathophysiology in nervous injury, hence these six biomarkers may be of value in managing trauma or idiopathic degeneration of CNVII in humans. The authors hope this study will pave the way for future research in this area.

Aim: In this study, we measured the arterial blood gas and pulmonary function tests of the patients in whom nasal packs containing an airway were placed and on whom trans-septal suturing procedure was performed. Methods: The first patient population underwent a trans-septal suturing process, while the second patient population received nasal packs with airway. During the preoperative period and the postoperative 24th hour, arterial blood gases were received from the patients in both groups, and their pulmonary function tests were measured, as well. Results: Following septoplasty, a trans-septal suturing was performed on 18 patients, whereas nasal packs with airway were applied on 23 patients. It was found that the PO2 (partial oxygen pressure) in the preoperative and postoperative arterial blood gas levels between the groups had declined less in the group with trans-septal suture than in the group to whom nasal packs with airway were applied (p

Background This study investigates the effects of local anesthetics application on pain and hemorrhage caused by nasal pack removal. Methods The study included 140 patients. Of these, 72 were women and 68 were men. The mean age and weight of the patients were 33.67 ± 10.2 years (range, 21–63 years) and 69.6 ± 13.6 kg. The patients were divided randomly into four groups. Three of the four groups received one of the local anesthetics studied in our trial (lidocaine + adrenaline, 0.25% bupivacaine, or 2% prilocaine) before removal of the nasal packing material and the control group received saline solution. Local anesthetics and 0.9% saline solution were applied to Merocel nasal packs 15 minutes before removal. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. Results The mean pain score was 3.5 ± 1.2 (median, 4; range, 3–5) in the lidocaine group, 4.5 ± 1.2 (median, 4; range 3–5) in the prilocaine group, 4.7 ± 1.3 (median, 6; range, 3–5) in the bupivacaine group, and 6.35 ± 1.2 (median, 6; range, 5–7) in the saline group during nasal packing removal. The lidocaine group had significantly better pain scores versus other groups (p < 0.05). Bupivacaine and prilocaine had significantly better pain scores versus the control group, respectively. Analysis of bleeding scores after pack removal showed that all three study groups had significantly better bleeding scores versus the control saline group (p < 0.05). The lidocaine group had significantly less bleeding score than bupivacaine and prilocaine groups (p < 0.05). Conclusion Topical lidocaine application before removal of nasal packs in patients who undergo nasal septal surgery can decrease discomfort and bleeding and improve patient tolerance.

Objectives: Sleeve gastrectomy is one of the most popular bariatric procedures today. Following laparoscopic interventions, common complications such as bleeding, organ damage, respiratory problems and emboli development are observed. The objective of this study was to evaluate our experiences with anesthesia and postoperative complications in sleeve gastrectomy operations performed in morbid obesity surgery. Design: Prospective study Setting: Operation room Subjects: Sixty adult patients who provided informed consent and who underwent laparoscopic sleeve gastrectomy from November 2015 to January 2019 (N=60). Intervention: Data collection, sleeve gastrectomy operation Main outcome measures: Postoperative complications were evaluated under headings: bleeding, respiratory problems, prolonged mechanical ventilation, prolonged hospital stay, emboli development and mortality. Results: None of the patients had mortality. Mean age was 36.2 (range: 18-59) years. Of the 60 morbid obese patients, 86.6% were female. Mean preoperative body mass index was 48.7 (range: 37-60) kg/m(2). The integrity of the anastomosis was controlled with a 36 French orogastric tube. The mean operating time was 43 minutes (range: 34-72) Two patients (3.3%) were re-intubated due to hypercarbia. Only two patients had bleeding on the postoperative 1st day. Mean length of hospital stay was 4.8 days. Conclusions: We believe there are fewer risks in the laparoscopic sleeve gastrectemy technique if there is careful preoperative patient preparation and evaluation with a multidisciplinary approach, appropriate perioperative anesthesia management, successful coordination with the surgical team and postoperative care. WOS:000701389600013 Q4

Amaç: Çalışmamızda ultrason rehberliğinde interskalen brakial pleksus blok uygulamasının solunum fonksiyonları ve arteriyel kan gazı analizi üzerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışma, omuz bölgesi ve üst kol cerrahisi planlanan, ASA I-II, cerrahi süresi 2 saati geçmeyen, pulmoner disfonksiyonu olmayan, toplam 64 hasta ile yapıldı. Cerrahi sırasında anestezi sağlamak amaçlı USG-rehberliğinde interskalen brakial pleksus blok işlemi öncesi baseline (T0) ve blok sonrası 20. dk’ da (T20) kalp hızı, non-invaziv sistolik, diyastolik ve ortalama arter basıncı ölçülerek kaydedildi. Spirometri ve arteriyel kan gazı analizi yapılarak interskalen brakial pleksus blok uygulamasının solunum fonksiyonlarına ve arteriyel kan gazı üzerine etkisi değerlendirildi. Ayrıca blok uygulaması ile ilgili veriler kaydedildi. Bulgular: Blok sonrası 20.dk’ da kalp hızında daha belirgin olmak üzere (p =0,003), sistolik (p =0,375), diyastolik (p =0,608) ve ortalama arteriyel basınçta (p =0,496) baseline (T0) değerlere göre düşme gözlendi. Blok işlemi sonrası 20.dk’ da yapılan ikinci (T20) spirometrik ölçümde, baseline (T0) ile karşılaştırıldığında, vital kapasite (VC) (4,86-3,68, p