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Objective The primary aim of the present study was to compare the ‘cross-legged foetal sitting position’ (CFSP) with the ‘sitting foetal position’ (SFP) sonographically. The secondary aim was to compare their comfort. Methods A randomised, consecutive controlled, single-blinded trial was performed in Yeditepe University. A total of 50 healthy volunteers were included in the study. Exclusion criteria were body mass index (BMI) >40 kg m-2, lumbar hernia, scoliosis, history of spine surgery, lower back pain or trauma, especially pelvic or knee problems related to arthropathy and not able to do one/both of the two position techniques. The two positioning techniques were evaluated by ultrasonography (USG) and 5-point Numerical Rating Scale (5-NRS) patient satisfaction of comfort questionnaire. Seven outcomes via USG were evaluated, subcutaneous tissue (ST), skin to spinous process (S–SP), transverse diameters of right and left paraspinal muscles (RPM and LPM), interspinous gap opening (ISGO), mean of bilateral paraspinal muscle (MPM) and CFSP–SFP change (CFSP–SFP). Stretcher comfort, position comfort, lumbar comfort (LC) and abdominal comfort (AC) were evaluated by participants with the 5-NRS. Results In the CFSP, the mean ST and S–SP were significantly (p

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

Objective: Diffuse brain injury is one of the most common issues encountered in, patients with trauma and it leads to morbidity and mortality via increased intracranial pressure. The aim of the study was to compare the effects of magnesium sulfate and hypertonic saline on diffuse brain injury in rats. Materials and Methods: In this study 18 male Sprague-Dawley rats weighing 250-300 g were used. The rats were randomly divided into trauma (control), trauma+magnesium, and trauma+hypertonic saline groups. Traumatic brain injury was induced by modified Feeney head trauma model. A single dose of 10 µL isotonic saline, magnesium sulphate and hypertonic saline were applied intraventricularly to the control, magnesium, and hypertonic saline groups, respectively. Rats were decapitated 24 hours after the head trauma. Their brains were dissected immediately and stored with dry ice at -80 °C for histopathological experiments. Results: The number of damaged neurons were significantly higher in both control and hypertonic saline groups (p=0.001, p=0.008). However, the number of damaged neurons did not show significant difference between hypertonic saline and control groups, it was significantly lower in magnesium group (p

Objective: Postoperative nausea and vomiting (PONV) is a common problem associated with general anaesthesia. The incidence can be as high as 80% in high-risk patients. Our primary objective was to compare the efficacy of the combination of dexamethasone-ondansetron and dexamethasone-aprepitant in patients undergoing laparoscopic surgery.Methods: Seventy 18 to 60 years old patients scheduled for laparoscopic surgery were included in the study. Sixty-seven patients completed the study. Patients in the dexamethasone-aprepitant group (group DA, n35) received 40 mg of aprepitant orally 1-2 hours before the induction of anaesthesia and 2 mL saline intravenously (iv) within the last 30 minutes of surgery; patients in the dexamethasone-ondansetron group (group DO, n35) received oral placebo identical to aprepitant 1-2 hours before the induction of anaesthesia and 4 mg ondansetron iv within the last 30 minutes of surgery. All patients received 8 mg dexamethasone iv after the induction of anaesthesia. The primary outcome was a complete response (no postoperative nausea, retching and vomiting and no need for rescue antiemetic); the secondary outcomes were the incidence of nausea, retching, vomiting, the need of rescue antiemetic and opioid consumption within 24 hours after surgery.Results: A complete response was not significantly different between the groups (group DO: 67%, DA: 69%) at 24 hours (p0.93). The incidence of PONV and postoperative opioid consumption was similar between the groups.Conclusion: The study was designed to evaluate whether the combination of dexamethasone-aprepitant is better than the combination of dexamethasone-ondansetron regarding the complete response for PONV in patients undergoing laparoscopic surgery. The results however showed that dexamethasone-aprepitant has not improved the complete response for PONV compared to dexamethasone-ondansetron. Amaç: Postoperatif bulantı ve kusma (POBK) genel anestezi sonrası sık karşılaşılan bir sorundur. Yüksek riskli hastalarda insidans yüzde 80 kadar yüksek olabilir. Çalışmamızın amacı laparoskopik ameliyat geçiren hastalarda deksametazon-ondansetron ve deksametazon-aprepitant kombinasyonunun etkililiğini karşılaştırmaktı.Yöntemler: Bu çalışmaya laparoskopik ameliyat planlanan 18-60 yaş arası 70 hasta alındı. 67 hasta çalışmayı tamamladı. Deksametazon aprepitant grubundaki (grup DA, n35) hastalara anestezi indüksiyonundan 1-2 saat önce 40 mg aprepitant ve cerrahinin son 30 dakikasında intravenöz 2 mL serum fizyolojik (iv) uygulandı. Deksametazon-ondansetron grubundaki (grup DO, n35) hastalara anestezi indüksiyonundan 1-2 saat önce aprepitanta benzer oral plasebo ve cerrahinin son 30 dakikasında 4 mg ondansetron iv olarak verildi. Tüm hastalara anestezi indüksiyonundan sonra iv 8 mg deksametazon uygulandı. Birincil sonuç ölçütü tam yanıt idi (postoperatif bulantı, öğürme, kusma ve ek antiemetik ihtiyacı yok); ikincil sonuç ölçütü ise bulantı, öğürme ve kusma insidansı, operasyondan sonraki 24 saat içerisinde ek antiemetik ve opioid tüketimi ihtiyacı idi.Bulgular: Tam yanıt gruplar arasında (grup DO: %67, DA: %69) 24 saatte anlamlı şekilde farklı değildi (p0,93). POBK insidansı ve postoperatif opioid tüketimi gruplar arasında benzerdi.Sonuç: Bu çalışma, laparoskopik cerrahi geçiren hastalarda POBK için tam yanıt elde etmede deksametazon-aprepitant kombinasyonunun deksametazon-ondansetron kombinasyonundan daha iyi olup olmadığını değerlendirmek üzere tasarlanmıştır. Ancak sonuç, deksametazon ve aprepitantın, laparoskopik cerrahiyi takiben deksametazon ve ondansetron ile karşılaştırıldığında POBK'da tam yanıtı iyileştirmediğini gösterdi.

Introduction: Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone–dimenhydrinate and dexamethasone–ondansetron combinations in prevention of nausea and vomiting in postoperative patients. Method: Sixty 18–65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone–dimenhydrinate group (group DD) and dexamethasone–ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air–oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated. Observations: Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups. Result: Our study revealed that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron in prevention of nausea and vomiting after rhinoplasty operations. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2016, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

Background: Propofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain. Methods: The patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 µg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Student’s t-tests and Fisher’s exact tests; P < 0.05 was considered to indicate statistical significance. Results: The demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001). Conclusions: This study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain. © The Korean Society of Anesthesiologists.

The purpose of our study is to compare two different ventilation modes-pressure support ventilation (PSV) and volume support ventilation (VSV)-as the means of weaning.Sixty patients were enrolled in our study. Patients were randomized in to two groups. For the PSV group, FiO2 and airway pressure values were adjusted in order to sustain PaCO2: 35-45 mm Hg, pH7.32, 6-8 mL kg(-1) TV (tidal volume), and saturation92%. For the VSV group, FiO2, TV, respiration frequency (f), and peak pressure were adjusted to obtain PaCO2: 35-45 mm Hg, pH7.32, 6-8 mL kg(-1) TV, saturation92%, and PO260 mm Hg. Every morning, spontaneous breathing was tried in those patients. The patients were extubated after 2 hours of T-piece breathing. The patients who failed spontaneous respiration with the T-piece were returned to mechanical ventilation. Assisted ventilation time (ART), mechanical ventilation time (MRT), total T-piece time (TTT), total weaning time (TWT), and sedation need (SN) values were recorded. "T-test" and "Chi-square" methods were used for statistical analysis.In our study, the mean ART was 82.60 hours for the PSV group and 56.03 hours for the VSV group (p0.041). TWT was 93.30 hours for the PSV group and 56.03 hours for the VSV group (p0.035). The mean TTT was 7.67 hours for the PSV group and 3.83 hours for the VSV group (p0.007). Nineteen patients in the PSV group and 9 patients in the VSV group required sedation during the weaning process (p0.01).In the weaning period, VSV seems to be more advantageous than PSV.