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Purpose: This study aimed to investigate the effects of different general anesthesia procedures on postoperative olfactory functions and olfactory memory. Materials and Methods: This prospective study was conducted with 97 patients. Patients were divided into three groups based on anesthesia induction and maintenance technique: Group P (induction and maintenance with propofol), Group PS (induction with propofol, maintenance with sevoflurane), and Group S (induction with sevoflurane, maintenance with sevoflurane). Butanol threshold and olfactory identification tests were administered 30 minutes (min) before the operation (T1) and 30 min (T2), 8 hours (h) (T3) and 24 h (T4) after the operation. Results: Butanol threshold values were increased at the T2 time point compared to baseline in all groups, which returned to baseline values at T3 only in Group P. There was a significant difference between Group P and Group S in terms of butanol threshold values at all time points except T1. When olfactory identification increased at T3 and T4 compared to baseline in Group P, there was a significant difference between T2, T3, and T4 time points in Group S, and between T2 and T3 time points in Group PS as compared to Group P. Conclusion: Propofol only causes a temporary impairment in olfactory functions in the early period and does not alter olfactory memory.

Purpose: Infraclavicular block (ICB) and interscalene block (ISB) accompanied by ultrasonography imaging (USI) are the most frequently used brachial plexus block techniques in upper extremity surgeries. It is already known that sympathetic blockage occurs after the application of these blocks, and blood flow increases with vasodilatation caused by the blockage. This study aimed to compare the effect of ICB and ISB, which are applied together with USI, on forearm tissue oxygenation. Materials and Methods: A hundred-four patients were included in this study belonging to ASA I-III risk groups, aged 18–65 years, who were scheduled for elective or emergency arm, elbow, or forearm surgery. The patients were divided into two groups: Group ICB and Group ISB. In addition to the baseline hemodynamic measurements, PI, time average velocity (TAV), brachial artery diameter (BAD), brachial arterial area (BAA), brachial artery beat flow (BF), and tissue oxygen saturation (rSO2) data were recorded before block and at the 10th, 20th, and 30th min after the block was completed. Results: The demographic data of the patients in the Group ICB and Group ISB were compared, no significant differences were detected between the groups. When the distribution of the percentage increase in PI and rSO2 values according to time was examined, significant differences were found between the groups. There were no significant differences in the percentage increases in BF, TAV, BAA, and BAD values between the 0th minute and at 10th, 20th, and 30th min (p>0.05). Horner syndrome was observed in 8 patients (15%) and sudden hoarseness was observed in 3 patients (5%) in Group ISB. No complications developed in the Group ICB. Conclusion: This study shows that the effects of ICB and ISB on forearm tissue oxygenation were compared and it was found that ICB increased rSO2 and PI values.

Amaç: Bu çalışmada preemptif ve intraoperatif analjezi amaçlı tramadol ve fentanil uygulamalarının hemodinami, analjezik ve nöromüsküler bloke edici ajan tüketimi, uyanma süresi ve postoperatif ağrı üzerine etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Genel anestezi altında laparoskopik kolesistektomi planlanan 120 hasta dört gruba ayrıldı. Fentanil bolus (Grup FB) ve fentanil infüzyon (Grup Fİ) gruplarına; 2 μgkg-1 fentanil, tramadol bolus (Grup TB) ve tramadol infüzyon (Grup Tİ) gruplarına; 2 mgkg-1 tramadol intravenöz (iv) uygulanmasını takiben, tüm gruplarda propofol ve rokuronium indüksiyonu yapıldı. Entübasyon sonrası, Grup Fİ’ye 0.5μgkg-1saat-1 fentanil, Grup Tİ’ye 0.5 mgkg-1saat-1 tramadol uygulandı. İntraoperatif ek analjezi ihtiyacında Grup FB ve Grup Fİ’ye; 0.5μgkg-1 fentanil, Grup Tİ ve Grup TB’ye 0.5 mg kg-1 tramadol yapıldı. Postoperatif vizüel analog skala (VAS) >5 olduğunda meperidin ve gerektiğinde diklofenak uygulandı. Hemodinamik veriler, fentanil, tramadol tüketimleri, uyanma süresi, VAS değerleri, analjezik ihtiyaçlar kaydedildi. Bulgular: İndüksiyondan sonra ortalama arter basıncı (OAB) fentanil gruplarında daha düşük bulundu (p

Amaç: Bu çalışmada, nazal cerrahi geçiren hastalarda uygulanan kontrollü hipotansiyonun serebral oksijen satürasyonu ve postoperatif kognitif disfonksiyon (POKD) üzerindeki etkisinin değerlendirmesi amaçlandı.Gereç ve Yöntem: Kırk hasta kapalı zarf yöntemi ile esmolol (Grup E, n=20) ve nitrogliserin (Grup N, n=20) olmak üzere iki gruba ayrıldı. Hastaların kognitif fonksiyonları operasyondan 1 gün önce ve 1 gün sonra Mini Mental Durum Testi ile değerlendirildi. Serebral desatürasyonu saptamak için rejyonel serebral oksijen satürasyonu yakın kızılötesi spektroskopi ile izlendi.Bulgular: Tüm gruplarda istenilen ortalama arteriyel kan basıncına (50-65 mmHg) ulaşıldı. Postoperatif 24. saatte 16 hastada (%40) kognitif fonksiyonlarda azalma meydana geldi. Postoperatif kognitif disfonksiyon açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu. Postoperatif kognitif disfonksiyon ile serebral desatürasyon arasında anlamlı bir ilişki olduğu görüldü.Sonuç: Hipotansif anestezi sırasında görülen serebral desatürasyon erken POKD gelişimine neden olabilmektedir, bu nedenle hipotansif anestezi sırasında yakın serebral ve hemodinamik monitorizasyon ile kognitif fonksiyonların korunabileceğini düşünmekteyiz., Purpose: This study aimed to evaluate the effect of controlled hypotension on cerebral oxygen saturation and postoperative cognitive dysfunction (POCD) in patients undergoing nasal surgery.Materials and Methods: Forty patients were randomized by a sealed envelope method into two drug groups: esmolol (Group E, n=20) or nitroglycerin (Group N, n=20) administration prior to surgical incision. The cognitive functions of the patients were evaluated by the Mini-Mental State Examination Test 1 day before and 1 day after the operation. Regional oxygen saturation was monitored with near-infrared spectroscopy to detect cerebral desaturation.Results: The desired mean arterial blood pressure (50-65 mmHg) could be achieved in all groups. A decline in cognitive function occured in 16 patients (40%) at the 24th postoperative hour. There was no statistically significant difference between the groups in terms of POCD. There was a significant relationship between POCD and cerebral desaturation status. Conclusion: Cerebral desaturation seen during hypotensive anesthesia may cause early POCD development, therefore we think that close cerebral and hemodynamic monitoring during hypotensive anesthesia may preserve cognitive functions.

Objectives : This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC video-laryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation. Methods : This prospective randomized study was conducted in Zonguldak Bulent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation. Results : The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p greater than 0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p greater than 0.05). Conclusions : In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® video-laryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure. Saudi Med J 2020; Vol. 41 (9): 930-937 doi: 10.15537/smj.2020.9.25349 How to cite this article: Kucukosman G, Aydin BG, Gulcek N, Okyay RD, Piskin O, Ayoglu H. The effect of laryngoscope types on hemodynamic response and optic nerve sheath diameter. McCoy, Macintosh, and C-MAC video-laryngoscope. Saudi Med J. 2020 Sep;41(9):930-937. doi: 10.15537/smj.2020.9.25349.

WOS: 000461743400003, Aim: The aim of our study was to evaluate specific factors in predicting difficult mask ventilation (DMV) in obese patients undergoing elective surgery. Methods: This prospective and observational study was performed in 90 obese patients. We assessed age, height, weight, sex, body mass index (BMI), dental structure, presence of facial hair, modified Mallampati test result, mouth opening, thyromental distance (TMD), sternomental distance, mandibular protrusion, mandibular length, neck circumference (NC), neck length, upper lip bite test result, height to TMD ratio, NC to TMD ratio (NC/TMD), and history of snoring and Obstructive Sleep Apnea syndrome for estimation of DMV. Results: The mean age of the patients was 40.9 +/- 9.4 years and the mean BMI was 44.7 +/- 6.2 kg/m(2). Of all patients 38.9% were determined to have DMV. Clinical variables associated with DMV were male gender, mandibular length, snoring, NC, and NC/TMD. Multiple logistic regression analysis showed that male gender (p=0.047) and snoring (p=0.02) were independent factors. Conclusion: We believe that NC/TMD and ML are predictive tests for DMV in obese patients. Tests and measurements at the bedside are not sufficient alone and we believe that they will be more reliable when considered together

The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of ultrasonography (USG) guided continuous erector spinae plane block (ESPB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS). Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged 18–75 and who were to undergo VATS were included in this study. Randomization was performed in 2 groups, continuous ESPB (ESPB Group) and no intervention (Control Group). 20 mL of 0.25% bupivacaine was administered for the block. Immediately after surgery, the patient received continuous infusion of 0.125% bupivacaine at 4 mL h−1 via the catheter inserted for the block. Patients in both groups received tramadol via an intravenous patient-controlled analgesia device. Tramadol and meperidine consumption, visual analog scale pain scores and opioid-related side effects were recorded at 0, 1, 4, 8, 12, 24, 36, and 48 h postoperatively. The use of continuous ESPB in VATS significantly decreased the amount of tramadol used in the first 48 h postoperatively (P < 0.001). There was a statistically significant difference in the number of meperidine rescue analgesia administered between the ESPB and Control Groups (P < 0.001). While the incidences of nausea and itching were higher in Control Group, there were no differences in terms of the other side effects between the groups. This study shows that USG-guided continuous ESPB provides adequate analgesia following VATS as part of multimodal analgesia. Continuous ESPB significantly reduced opioid consumption and opioid-related side effects compared to those in the Control Group.

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

Postoperative pain is an important factor that can affect morbidity and mortality in postoperative period. Although information about pain is increasing day by day in children, there are still insufficiencies in pain treatment. There are many intraoperative and postoperative methods to reduce postoperative pain. In this review, it is aimed to present updated information about postoperative pain management in children under the guidance of "Postoerative Pain Treatment Guide"., Postoperatifağrı, ameliyat sonrası dönemde morbidite ve mortaliteyi etkileyebilen önemlibir etkendir. Çocuklarda ağrıyla ilgili bilgiler gün geçtikçe artıyor olmasınarağmen ağrı tedavisinde hala yetersizlikler mevcuttur. Postoperatif ağrıyıazaltmak için intraoperatif ve postoperatif birçok yöntem bulunmaktadır. Buderlemede “Postoeratif Ağrı Tedavisi Kılavuzu” eşliğinde çocuklardapostoperatif ağrı yönetimi hakkında güncel bilgilerin anlatılmasıamaçlanmıştır.

BACKGROUND: It has been reported that noninvasive, objective tests are needed for determining the success of peripheral nerve blocks because conventional methods necessitate the cooperation of the patient. It is also known that the brachial plexus block causes vasodilatation and an increase in blood flow due to its sympathectomy effect. Our study aimed to determine whether Perfusion Index (PI) and measured regional hemodynamic changes using ultrasound were reliable parameters in evaluating the early success of an infraclavicular block. METHODS: Forty ASA I-III patients who were administered a successful infraclavicular block were included in this study. In addition to the baseline hemodynamic measurements, PI and regional hemodynamic parameters, such as brachial artery diameter (BAD), brachial arterial area (BAA), blood flow (BF), end-diastolic velocity (EDV), Resistance Index (RI), peak systolic velocity (PSV), and time average velocity (TAV) were measured. After completing the block procedure, all values were rerecorded at the 10th, 20th, and 30th minute. Patients with a successful block during the first 10 minutes were assigned to Group A, while patients with a successful block after the 10th minute were assigned to Group B. RESULTS: Statistically significant differences were observed for all regional hemodynamic variables and PI after 10 minutes. When the regional hemodynamic data and PI were compared between the groups, differences were identified for PI, BF, PSV, EDV, and TAV. Within the measured parameters, EDV was the parameter showing the greatest proportional change. CONCLUSIONS: Changes in EDV, especially RI and PI, provide more effective and objective results for the assessment of early regional block success. © 2018 EDIZIONI MINERVA MEDICA

WOS: 000395632900012, PubMed: 28042634, Objectives: To examine the anesthesiologist's choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

WOS: 000380843400008, PubMed: 27157202, Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was >= 9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine. (C) 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.

ResumoJustificativa e objetivoSugamadex é o primeiro agente de ligação relaxante seletivo. Após a administração de sugamadex, os tempos de despertar e de recuperação dos pacientes são menores, em comparação com neostigmina. Neste estudo, a hipótese foi que um despertar mais rápido e claro dos pacientes submetidos à anestesia geral tem efeitos positivos sobre as funções cognitivas no pós‐operatório imediato.MétodosApós a aprovação do Comitê de Ética local, 128 pacientes foram incluídos neste estudo prospectivo, randômico, controlado e duplo‐cego. Os pacientes foram designados para o grupo sugamadex (Grupo S) ou grupo neostigmina (Grupo N). O desfecho primário do estudo foi a recuperação cognitiva no pós‐operatório imediato, de acordo com a mensuração da Avaliação de Montreal da Função Cognitiva (MoCA) e com o Mini Exame do Estado Mental (MMSE), após a avaliação inicial 12‐24h antes da operação. Após a operação, quando o escore de recuperação de Aldrete modificado era ≥ 9, o teste MMSE e, uma hora depois, o teste MoCA foram repetidos.ResultadosEmbora tenha havido uma redução nos escores de MoCA e MMSE tanto no Grupo S quanto no Grupo N, entre os escores pré‐ e pós‐operatório não houve diferença estatisticamente significativa nas reduções (p>0,05). O tempo para atingir TOF 0,9 foi de 2,19min no Grupo S e de 6,47min no Grupo N (p0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p

Objectives: In this study, we aimed to retrospectively assess the correlation of pseudocholinesterase (PChE) levels with age, gender, body weight and diagnosed psychiatric diseases in electroconvulsive therapy (ECT) cases. Methods : This retrospective study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between 2007 and 2011. In the study, 193 ECT case files were retrospectively scanned to evaluate PChE values before ECT and other file information. Results : There was no difference between gender in terms of PChE levels. Correlation analysis determined a weakly positive correlation between age ( p =0.013; correlation coefficient [cc]: 0.178) and body weight ( p less than 0.001; cc: 0.273) and PChE levels. No correlation was found between age, gender, weight or psychiatric diagnosis, and PChE levels. Conclusion : Neuromuscular blockage is a significant factor that increases patient safety, while increasing the efficacy of ECT. In choosing muscle relaxant agents, both patient factors and the pharmacological properties of the neuromuscular blocker should be considered. We think that in situations with delayed recovery of ECT cases without identified PChE levels, low PChE levels must be considered. Saudi Med J 2018; Vol. 39 (1): 103-106 doi: 10.15537/smj.2018.1.21307 How to cite this article: Kucukosman G, Piskin O, Hanci V, Okyay RD, Ayoglu H, Yurtlu BS, et al. Pseudocholinesterase levels in patients under electroconvulsive therapy. Saudi Med J . 2018 Jan;39(1):103-106. doi: 10.15537/smj.2018.1.21307.

Resumen Justificacion y objetivo el objetivo de este estudio fue comparar la eficacia de la levobupivacaina en la induccion de la raquianestesia continua (RAC) versus dosis unica (RADU) en pacientes programados para la reseccion transuretral de prostata. Metodos cincuenta pacientes, ≥ 60 anos de edad, ASA I-II o III, fueron incluidos en el estudio. La levobupivacaina al 0,5% (12,5 mg) se administro via intratecal en el grupo RADU. En el grupo RAC, la levobupivacaina al 0,25% (2 mL) fue inicialmente administrada a traves de un cateter espinal. Para que el nivel de bloqueo sensorial alcanzase el dermatoma T10, se administro 1 mL adicional de levobupivacaina al 0,25% a traves del cateter cada 10 min. Los parametros hemodinamicos y las caracteristicas del bloqueo fueron registrados. Las muestras de sangre de los pacientes fueron extraidas en los periodos pre y postoperatorios para determinar los niveles plasmaticos de cortisona y adrenalina. Resultados la tecnica RAC proporciono una mejor estabilidad hemodinamica en comparacion con la tecnica RADU, particularmente a los 90 min despues de la administracion intratecal. El aumento del nivel de bloqueo sensorial fue rapido y el tiempo para alcanzar la anestesia quirurgica fue menor en el grupo RADU. El desarrollo del bloqueo motor fue mas rapido en el grupo RADU. En el grupo RAC, un nivel parecido de anestesia se obtuvo con una dosis mas baja de levobupivacaina que fue relacionada con la recuperacion mas rapida. Aunque ambas tecnicas hayan sido eficaces en la prevencion de la respuesta al estres quirurgico, los niveles de cortisona en el postoperatorio fueron mejor suprimidos en el grupo RADU. Conclusion la tecnica RAC con levobupivacaina al 0,25% puede ser usada como un metodo de anestesia regional en pacientes ancianos programados para la cirugia de reseccion transuretral de prostata.

Ischemia reperfusion injury causes the release of free oxygen radicals. Free oxygen radicals initiate the production of toxic metabolites, such as malondialdehyde (MDA), through the lipid peroxidation of cellular membranes. Following lipid peroxidation, the antioxidant enzyme system is activated against reactive oxygen species (ROS) and attempts to protect cells from oxidative damage. There is a balance between the scavenging capacity of antioxidant enzymes and ROS. Because of this balance, the total antioxidant capacity (TAC) measurement is a sensitive indicator of the overall protective effects of the antioxidants. Alpha2 receptor agonists are effective in preventing hemodynamic reactions during extremity surgeries by preventing the release of catecholamines secondary to tourniquet application. They have also been shown to possess preventive effects in various ischemia-reperfusion injury models. In our study, we examined the effects of dexmedetomidine on tourniquet-induced ischemia-reperfusion injury in lower extremity surgeries performed under general anesthesia. The effects of dexmedetomidine were measured with serum MDA and TAC levels. We studied 60 adult American Society of Anesthesiologists (ASA) physical status I or II patients undergoing one-sided lower extremity surgery with tourniquet. The patients were randomly divided into two groups. Group D was administered a dexmedetomidine infusion at a rate of 0.1 µg/kg/minute -1 for 10 minutes prior to induction and then at 0.7 µg/kg/hour-1 until 10 minutes before the end of the operation. The control group (Group C) received a saline infusion of the same amount and for the same period of time. General anesthesia was induced with thiopental, fentanyl, and rocuronium and maintained with nitrous oxide and sevoflurane in both groups. Venous blood samples were obtained before the administration of the study drugs (basal) at 1 minute before tourniquet release and at 5 and 20 minutes after tourniquet release (ATR). In both groups, MDA levels decreased at 5 and 20 minutes ATR when compared with the basal values (p < 0.05). TAC levels decreased at 1 and 5 minutes ATR and then returned to basal values at 20 minutes ATR (p < 0.05). In reference to the prevention of lipid peroxidation in tourniquet-induced ischemia-reperfusion injury, the results from the two groups in our study showed that dexmedetomidine did not have an additional protective role during routine general anesthesia. Copyright © 2012, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.

WOS: 000305320400015, Objective: In this study, we aimed to examine the effects of a subhypnotic dose of ketamine on the neuromuscular block characteristics of rocuronium and intubation quality. Material and Methods: Sixty patients in ASA I-II risk group were included in the study. Group S received 5 mL of 0.9% saline and Group K received 0.5 mg.kg(-1) ketamine in 5 mL volume, one minute before induction. Both groups had anesthesia induction with a propofol dose of 2.5 mg.kg(-1) (Propofol 1%, Fresenius Kabi). This was considered as anesthesia start time. After 1 min, a control single twitch stimulus (0.1 Hz) was applied and recorded. All patients were given 0.6 mg.kg(-1) rocuronium (Esmeron (R) 50 mg.5 ml(-1) N.V. Organon, Oss, Holland) in 5 sec. When the single twitch response was depressed 100%, the patient was intubated and the full depression time (onset time) was noted. Anesthesia maintenance was achieved with O-2/N2O and sevoflurane. Following the intubation, the application of train-of - four (TOF) stimulation was started. When the TOF ratio reached to 20%, rocuronium was repeated at a dose of 0.2 mg.kg(-1). Clinical duration (T25), recovery index (T25-75) and spontaneous recovery time to TOF > 0.9 were recorded. Intubation conditions were assessed by using the scale of Fuchs-Buder. The additional drugs used during the operation and neuromuscular blocker amounts were recorded. The hemodynamic values of both groups were recorded throughout the study. Postoperative recovery times, visual analogue pain scores (VAS) and Ramsay sedation scores were also recorded. Results: The time for 100% depression of single twitch in Group K was shorter than that of Group S (p0.05), recovery times (p>0.05), VAS scores, Ramsay sedation scores or mean arterial pressure values. When the mean heart rate values of the groups were compared, all values of Group K were higher than those of Group S except control and 60th min values (p

WOS: 000280478400019, PubMed: 20584874, We designed this study to determine the effect of the menstrual cycle on the hemodynamic response to tracheal intubation (TI). Sixty-two ASA I women who were either in the follicular phase (group F, n = 31) or luteal phase (group L, n = 31) of their menstrual cycle were included in the study. Patients received propofol and rocuronium for intubation. Hemodynamic variables were recorded before administration of the IV anesthetic, as well as after TI. Rate pressure products were calculated. Groups were similar in terms of demographic data. Rate pressure products values at the first minute after TI were significantly increased in group L than were those in group F (P < 0.001). We conclude that the phase of the menstrual cycle is an important factor in the hemodynamic response to TI. (Anesth Analg 2010;111:362-5)

WOS: 000277766100003, PubMed: 20466334, The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mu g/kg dexmedetomidine (Group D, n = 30) or 2 mu g/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine lidocaine propofol combination than with the fentanyl lidocaine propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

Objectives: The aim of the present randomized, placebo-controlled study was to compare postoperative analgesic effects of peroperative paracetamol and lornoxicam administration. Methods: Sixty adult patients with American Society of Anesthesiologists (ASA) risk classification I-II, who would undergo single-level lumbar discectomy under general anesthesia, were enrolled. Patients were administered either 1000 mg paracetamol (Group P), 8 mg lornoxicam (Group L), or saline (Group C) prior to induction of anesthesia (n=20 for all groups). All patients were administered the same anesthesia induction and maintainance. Postoperative analgesia was maintained with the same analgesic drug in each group. Rescue analgesia was supplied with intravenous meperidine delivered by a patient-controlled analgesia device. Numeric rating score (NRS) results, first analgesic demand time, and cumulative meperidine consumption were recorded postoperatively. Primary outcome was NRS at first postoperative hour. Secondary outcome was measure of opioid consumption during first 24 postoperative hours. Results: At first postoperative hour, NRS of Group L [4 (0-8)] was lower than NRSs of Groups P and C [6(0-7); 6(0-9), respectively; p

WOS: 000337101400004, PubMed: 24794450, Background: The aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. Methods: Sixty years or older, ASA I-II or III, 50 patients were included in the study. 12.5 mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2 mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at 110 dermatome, additional 1 mL of 0.25% levobupivacaine were administered through the catheter in every 10 min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. Results: CSA technique provided better hemodynamic stability compared to SDSA technique particularly 90 min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. Conclusion: CSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

WOS: 000321023200004, PubMed: 23731042, Background: We aimed to investigate the effects of nitrous oxide on plasma total homocysteine and vitamin B12 levels in patients with or without methyltetrahydrofolate reductase (MTHRF) gene mutation. Methods: After obtaining the ethics committee approval and written informed consents of patients, 93 patients between 18-70 years of age scheduled for surgery anticipated to last 1-4 hours were enrolled in the study. Patients with contraindications for nitrous oxide use were excluded. Preoperatively, blood samples were obtained from all patients for the determination of MTHFR gene mutation. Anesthesia induction was achieved with 3 mg.kg(-1) of propofol and 1 mu g.kg(-1) of fentanyl. Anesthesia maintenance was performed with sevoflurane and with a carrier gas composed of 40 % O-2 and 60 % N2O. Venous blood samples were obtained after venous canulation, and 24 hours after extubation for the analysis of plasma total homocysteine, vitamin B12 levels. Results: Eighty-one patients were included in the study. Postoperative vitamin B12 levels were found to be significantly lower when compared with their preoperative levels (p0.05). Postoperative plasma total homocysteine levels were found to be significantly different between patients with operation times under and over 3 hours (p=0.028). Conclusions: We conclude that MTHRF gene polymorphism had no significant effects on postoperative plasma total homocysteine levels. However, we found that homocysteine levels might rise in patients who received general anesthesia with nitrous oxide for longer than 3 hours (Tab. 7, Ref. 26). Full Text in PDF www.elis.sk., Karaelmas University Scientific Research Projects UnitBulent Ecevit University, This work was supported by Karaelmas University Scientific Research Projects Unit.

Aim: To determine if hypotension frequency changes when hyperbaric or isobaric formulations of bupivacaine, or their sequential administrations, are used for cesarean section. Hypotension after spinal anesthesia for cesarean section is common.

WOS: 000297532400037, PubMed: 22117995, This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements.

We evaluated P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion, and corrected QT dispersion (QTcd) intervals in patients with metabolic syndrome (MetS). Patients scheduled to undergo elective noncardiac surgery were included in the study. The main diagnoses, anthropometric measurements, waist circumferences, body mass index, electrocardiograms, serum levels of electrolytes, glucose, and lipids were recorded for all patients. QTc, QTcd intervals were determined with the Bazett formula. MetS (group M, n = 36) was diagnosed using the Adult Treatment Panel III. Controls (group C, n = 40) were chosen on the basis of patients with no MetS and matched for age and gender. There were no differences between groups in terms of age, sex, or serum electrolyte levels (P > 0.05). Waist circumferences, body mass index, serum glucose, and triglyceride values in group M were significantly higher than those in group C (P < 0.001). In group M, Pwd, QTc, QT dispersion and QTcd intervals were significantly longer than those in group C (P < 0.001). This finding and our retrospective analysis suggest that these patients may be at greater risk of perioperative arrhythmias. Copyright © 2011 International Anesthesia Research Society.

WOS: 000282141300002, PubMed: 20837343, The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(St) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. in the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p

PubMed ID: 20216071 Background This prospective, double-blind and randomized study is designed to determine the effect of menstrual cycle on the injection pain of propofol. Methods Seventy-two patients scheduled for elective surgery under general anaesthesia were divided into two groups according to the phase of the menstrual cycle. Patients were at follicular phase (Pd 8-12) in Group F (n=36) and luteal phase (Pd 20-24) in Group L (n=36). Injection pain was evaluated with 10-point numeric rating scale after 25% of the total propofol dose was injected over 20 s. Results There were no significant differences in terms of patient characteristics (P

The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition. A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index. No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P >0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.

Background and Objective: We evaluated the effects of dexmedetomidine pretreatment on bupivacaine cardiotoxicity in anesthetized rats. Methods: Sixteen Wistar-Albino male rats (300-400 g) were anesthetized with ketamine. Electrocardiographic and invasive blood pressure monitoring were performed, and the results were continuously recorded. The rats were randomized into 2 groups. In group D, rats were pretreated with intravenous dexmedetomidine at a dose of 10 µg/kg (n = 8), whereas in group S, rats were pretreated with intravenous saline (n = 8). Fifteen minutes later, bupivacaine was infused at a rate of 3 mg/kg per minute until cardiac asystole occurred. The timing of specific cardiotoxic events (a 25%, 50%, and 75% reductions of mean arterial pressure and heart rate as well as occurrence of the first arrhythmia and asystole) was recorded. Results: Dexmedetomidine pretreatment reduced the heart rates and mean arterial pressures of the rats who received it (P < 0.05). Dexmedetomidine pretreatment before bupivacaine administration also significantly increased the time to the 25%, 50%, and 75% reductions in mean arterial pressure and the time to the 25% and 50% reductions in heart rate (P < 0.05). In addition, dexmedetomidine significantly increased the time to first arrhythmia and time to asystole (P < 0.05) in the rats who received it before receiving bupivacaine. Conclusions: Dexmedetomidine pretreatment delays the effects of bupivacaine cardiotoxicity. Copyright © 2009 by American Society of Regional Anesthesia and Pain Medicine.

[No abstract available]

The aim of this study was to evaluate the effect of education on the knowledge, attitude and behavior of anesthesiology staff and residents towards low-flow anesthesia. The staff and residents in the Department of Anesthesia and Reanimation, Zonguldak Karaelmas University were given theoretical and practical training in delivering low-flow anesthesia. To evaluate their attitudes and behaviors toward low-flow anesthesia, we collected data during the 6 months before training, during the first 3 months after training, and at 4-6 months after training. Anesthesia follow-up records, operation time, volatile anesthetic agent used, and the amount (in liters) of fresh gas low mid-anesthesia were recorded in all three stages. A total of 3,158 patients received general anesthesia and inhalation anesthesia was used in 3,115 of these patients. Our study group consisted of 2,752 patients who had no absolute or relative contraindications to low-flow anesthesia. While the mean fresh gas flow was 4.00 ± 0.00 L/min before training, this level dropped to 2.98 L/min in the first 3 months after training, and to 3.26 L/min in the following 3 months. The mean fresh gas flow was significantly lower at the two post-training assessments than before training (p < 0.05). In conclusion, low-flow anesthesia may be used more frequently if educational seminars are provided to anesthetists. The use of low-flow anesthesia may increase further by allocating more time to this technique in anesthesia training programs provided at regular intervals. © 2010 Elsevier. All rights reserved.