[Show abstract][Hide abstract] ABSTRACT: Objective: Transporting critically ill patients is very often associated with problems and complications. Previous reports studied incidence of complications with associated factors for different patients groups. The aim of our study is to investigate complications during an in-hospital transport of highly special group as postoperative cardiac surgical patients. Material and Methods: All patients undergoing elective open heart surgery between January-September 2013 were included in the study. The commencement of the patient transport was determined as transfer of the patients from inbuilt to portable ventilator and ventilator. The transport was terminated wheren patients were again attached to ventilator and monitor of ICU. Hemodynamic parameters (blood pressures, heart rate, oxygen saturation) were all noted with arterial gas analysis on admission into ICU. All complications during transport were also recorded. Results: During the study period 240 subjects, including 108 adults and 132 children were enrolled in the study. Most frequent complication was respiratory alkalosis due to hyperventilation (13,75%). Other problems were hypotension (2,5%), arterial decannulation (2,5%), difficult ventilation (1,66%), respiratory acidosis (0,82%), inadvertent removal of central venous catheter (0,4%). One patient had cardiac arrest and was successfully resuscitated. Conclusion: Postoperative cardiac surgery patients could be transported with minor complications. We think that reduced incidence of adverse events was related to short transport time as well as to experienced transport team.
[Show abstract][Hide abstract] ABSTRACT: Objective: The purpose of this study was to compare the anesthetic efficacy, durations of motor and sensorial blocks and of unilateral spinal anesthesia with 5 and 4 mg hyperbaric bupivacaine in patients undergoing arthroscopic knee surgery (AKS) and find out if there is a reduction in discharge times. Method: After obtaining ethics committee approval and informed consent 90 ASA physical status 1-2 outpatients undergoing AKS, aged between 18-65 years, were enrolled. The patients were randomized to two groups: spinal anesthesia was performed with hyperbaric bupivacaine in Group B5 5 mg (1 mL) and in Group B4 4 mg (0.8 mL) at the L3-4 level in lateral decubitus position and patients were kept in the same position for at least 15 minutes to make unilateral spread possible. Bilateral levels of motor and sensorial blocks were evaluated; onset time to surgical anesthesia was recorded. Induction of general anesthesia was accepted as a failure of spinal anesthesia. Results: Spinal anesthesia was unsuccessful in one patient in Group B5 (2.2%) and three patients in Group B4 (6.7%). Onset time to surgical anesthesia was 16 min (min.- max.: 9-25 min) in Group B5 and 17 min (min.- max.: 11-25 min) in Group B4. The median value of cephalad spread of sensory block on the operative side were T10 (min.- max.: T7-T10) and T11 (min.- max.: T7-T11) in Group B5 and Group B4 respectively. Complete unilateral motor block was seen in 38 cases (84.4%) in Group B5 and in 42 (93.3%) in Group B4. Duration of motor block was shorter in Group B4 (86±31 min vs. 110±40 min, p<0.05). Time to discharge home was shorter in Group B4 (127±42 min vs. 101±34 min, p<0.05). Conclusion: Both solutions produced reliable spinal anesthesia for AKS. It was shown that the 4 mg dose produced more selective blocks and allowed early home discharge.
No preview · Article · Jan 2012 · Anestezi Dergisi
[Show abstract][Hide abstract] ABSTRACT: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery.
Sixty patients were randomized to two groups: 1) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative subacromial infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5 mL bolus dose and a 20 min lockout time or; 2) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative interscalene infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5 mL bolus dose and a 20 min lockout time. Infusions were maintained for 48 hours.
The VAS scores in the postanesthesia care unit and at 4 h were not different. The VAS scores at 8, 12, 24, 36 and 48 h were lower than 4 in both groups; but they were significantly lower in the interscalene group. Additional analgesic requirements were lower in the interscalene group (16.6% vs 53.3%, p<0.05). Patients' satisfaction was higher in the interscalene group (9.4±0.8 vs 8±1.2, p<0.01). One patient had a toxicity related to interscalene block but; there was no complication related to subacromial catheters.
This study demonstrates that subacromial infusions, although provided good postoperative analgesia, are not as effective as interscalene infusions and additional analgesics should be prescribed when subacromial infusions are started. Subacromial infusions could be considered as an alternative in case of any contraindication to interscalene block.
Full-text · Article · Jan 2011 · Agri: Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology
[Show abstract][Hide abstract] ABSTRACT: Aim: Techniques allowing fast and safe discharge of patient's undergoing arthroscopic knee surgery are still evaluated. Regional techniques or general anesthesia are suitable for these operations. The purpose of this study was to compare the recovery and early discharge properties of two anesthesia techniques. Materials and Methods: After obtaining ethics committee approval and informed consent patients were divided to two groups. After standard monitorization bispectral index (BIS) monitor was also applied to patients in Group I (n=30). For anesthesia induction 0.5-1 μg kg-1 remifentanil, 2-3 mg kg-1 propofol and 0.1 mg kg-1 atracurium were given and a laringeal mask airway (LMA) was inserted. During maintenance of anesthesia desflurane was applied and was titrated to achieve BIS index values of 50-60. In Group II (n=30) spinal anesthesia in lateral decubitus position (ULSA) with 5mg hyperbaric bupivacaine 0.5 % was performed and patients were kept in the same position to achieve an anesthesia level at T12 (maximum 25 minutes). Development of motor and sensorial block on both sides, onset time to surgical anaesthesia was recorded. The time required for 14 points recovery score to be ≥12, the number was also recorded. Results: Time to be ready for surgery was significantly shorter in Group I. Recovery times after surgery was significantly longer in Group I. The overall anesthesia-related time was comparable between the groups. The recovery scores were significantly higher in Group II. The time for recovery score to be ≥12 was shorter in Group II. However, home readiness did not differ significantly between the groups. Conclusion: ULSA with 5mg hyperbaric bupivacaine in knee arthroscopy provided fast-tracking and was superior to desflurane anesthesia in this respect; but this did not affected home-readiness. However patients in the ULSA achieved faster and higher recovery scores during the immediate postoperative period which seems advantageous.
[Show abstract][Hide abstract] ABSTRACT: Background: Different approaches are utilized in order to overcome the excess total body icater after cardiopulmonary bypass (CPB). For this purpose various combinations of priming solutions are used. In our study we aimed to compare the effects of hypertonic saline (HS) on hemodynamic and respiratory variables as well as overall fluid balance und extravascular lung water (EVLW). Material and Method: Fourteen patients undergoing coronary artery surgery icere randomized into two groups. For priming; ringers' lactate, succinated gelatin and 20 % mannitol was used in the first group (G I), whereas ringers' lactate, succinated gelatin and 7.5 % HS was used in the second group (G II). In addition to ECG, invasive blood pressure, oxygen saturation and centred venous pressure monitoring, a pulse contour catheter (PICCO) was placed to the femoral artery in all patients. Patients were followed for 24 hours postoperatively. Hemodynamic and respiratory data, fluid balance, intrathoracic blood volume (ITBV), EVLW, blood transfusion requirement, colloid oncotic pressure (COP), mechanical ventilation time, length of intensive care slay were recorded and compared. Results: There was no significant difference between demographic and intraoperative data, length of intensive care stay and mechanical ventilation times in both groups. CPB times and 24 hour fluid balance were significantly lower in the G II group. Blood transfusion requirement, over a period of 24 hours was significantly higher in the G I group. EVLW and ITBV were significantly loicer in the G II group during postoperative follow-up. Conclusion: It is known that priming solution plays a role in post-CPB edema. Replacing priming solution with HS which has hyperosmotic effect reduced post-CPB and post-op fluid load and decreased EVLW and blood transfusion requirement.
[Show abstract][Hide abstract] ABSTRACT: Aim: Postoperative pain is a problem after shoulder surgery. The aim was to compare the postoperative analgesic efficacies of subacromial infusion after single shot interscalene block (ISB) to a continuous ISB. Material and Methods: After ethical committee approval and informed consent 36 ASA I-II patients were randomly divided into two groups. Preoperalively all patients received an ISB with 30 mL 0.5 % bupivacaine. Catheters were inserted to the interscalene sheath in Group I and to the subacromial space in Group II. In the postoperative period patients received an analgesia using patient controlled analgesia (PCA) device. The PCA parameters were 5 mL h-1 bupivacaine 0.125%, a bolus of 5 mL bupivacaine 0.125 % in GI and 2.5 mL h -1 bupivacaine 0.125%, a bolus of 2.5 mL bupivacaine 0.125 % in GII a with a lock out time of 20 minutes. Pain relief was assessed using a visual analog scale (VAS, 0-10 cm) at the postoperative at 0, 4 th, 8 th, 12 th and 24 th hours. Additional analgesics were noted and at the end of 24 h patients rated their satisfaction. Results: All patients had adequate analgesia (VAS< 4). GI had lower VAS scores during the study period accept for the 0 and 4 th hour compared to GII. Two patients (11 %) in GI and 8 patients (44 %) in GII had additional analgesics, which was not significant. Patient satisfaction: 9±0.8 in GI and 8±0.7 in GII with significant differences (p<0.001). Conclusion: Subacromial catheters can be applied without serious side-effects and complications. Although less effective than continuous ISB; it is a suitable method with adequate analgesia.
[Show abstract][Hide abstract] ABSTRACT: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare sensory neuropathy, which affects patients' pain sensation and thermoregulation. There are several issues to consider when planning anesthesia for those with this congenital disorder. Over a year period, two patients with CIPA underwent 4 surgical procedures under general anesthesia in our institution. In our cases, no excessive fluctuations in temperature were noted throughout the stay in theatre. In order to maintain hemodynamic stability anesthesia was required. We reviewed anesthesia records of the patients for anesthetic technique and incidence of side-effects. We conclude that patients with CIPA are able to undergo surgical procedures under general anesthesia without major problems.
[Show abstract][Hide abstract] ABSTRACT: Aim: The aim of this placebo controlled, randomized, double blind study was to evaluate the efficacy of 15 or 30 mg ephedrine, administered in 1000 mL crystalloid solution, for prevention of hypotension due to spinal anaesthesia for caesarean section. Materials and Methods: 63 pregnant patients in 38-40. gestational weeks undergoing caesarean section under spinal anaesthesia were enrolled in three randomized groups to the study. 1000 mL RL was applied to venous canula of all patients. 6 mL of saline (group RL) or 15 (group RL15) or 30 mg (group RL30) ephedrine diluted in the same volume of saline were added in the iv solution. No prehydration was given. Spinal anesthesia was induced using 20 μg fentanyl and 7-9 mg hyperbaric bupivacaine. Just after intrathecal injection iv solutions were started to infuse rapidly. Hypotension was defined as a decrease of systolic blood pressure of more than 20% lower from the baseline measurement. In case of hypotension, the rate of infusion was increased and if it continued in the following measurement iv 5 mg ephedrine bolus was injected. Results: The incidence of hypotension was significantly lower in group RL30 than in group RL (85.7 %, 62 % and 47.6 % in groups RL, RL15 and RL30 respectively; p=0.032). Number of hypotensive episodes was statistically significant lower in group RL30 than the other two groups (3.5±2.3, 2.1±2.3, 0.6±0.7 in groups RL, RL15 and RL30 respectively; p<0.001). Nausea and vomiting was less in group RL30 compared to RL (p=0.04). Conclusion: We conclude that prophylactic 30 mg ephedrine in 1000 mL Ringer's lactate given just after spinal anaesthesia although can not eliminate hypotension during caesarean section, but it decrease the incidence of hypotension, number of hypotensive episodes, and nausea-vomiting incidence.
[Show abstract][Hide abstract] ABSTRACT: The Efficacy of Ephedrine on the Prophylaxis of Spinal-induced Hypotension in Pregnant Patients
Aim: The aim of this placebo controlled, randomized, double blind study was to evaluate the efficacy of 15 or 30 mg ephedrine, administered in 1000 mL crystalloid solution, for prevention of hypotension due to spinal anaesthesia for caesarean section.
Materials and Methods: 63 pregnant patients in 38-40. gestational weeks undergoing caesarean section under spinal anaesthesia were enrolled in three randomized groups to the study. 1000 mL RL was applied to venous canula of all patients. 6 mL of saline (group RL) or 15 (group RL15) or 30 mg (group RL30) ephedrine diluted in the same volume of saline were added in the iv solution. No prehydration was given. Spinal anesthesia was induced using 20 µg fentanyl and 7-9 mg hyperbaric bupivacaine. Just after intrathecal injection iv solutions were started to infuse rapidly. Hypotension was defined as a decrease of systolic blood pressure of more than 20% lower from the baseline measurement. In case of hypotension, the rate of infusion was increased and if it continued in the following measurement iv 5 mg ephedrine bolus was injected.
Results: The incidence of hypotension was significantly lower in group RL30 than in group RL (85.7 %, 62 % and 47.6 % in groups RL, RL15 and RL30 respectively; p=0.032). Number of hypotensive episodes was statistically significant lower in group RL30 than the other two groups (3.5±2.3, 2.1±2.3, 0.6±0.7 in groups RL, RL15 and RL30 respectively; p<0.001). Nausea and vomiting was less in group RL30 compared to RL (p=0.04).
Conclusion: We conclude that prophylactic 30 mg ephedrine in 1000 mL Ringer's lactate given just after spinal anaesthesia although can not eliminate hypotension during caesarean section, but it decrease the incidence of hypotension, number of hypotensive episodes, and nausea-vomiting incidence.
[Show abstract][Hide abstract] ABSTRACT: The success rate of cardiopulmonary resuscitation (CPR) may differ from institution to institution, even within different sites in the same institution. A variety of factors may influence the outcome. In this study, we assessed the adequacy of CPR attempts guided by the current standards and aimed to define the factors influencing the outcome following in-hospital cardiac arrest. One hundred and thirty-four patients who required CPR were studied prospectively. Different variables for the CPR performance were recorded using forms designed for this study in the light of the guidelines. In these CPR forms various data including the demographics, history, monitoring, number, composition and experience of the anaesthesiologists, the site of CPR, time of day, the delay before onset of CPR, tracheal intubation, duration of arrest, initial rhythm in ECG monitored patients, management of CPR, drug administration and reversible causes of cardiac arrest were recorded. Our rates of immediate survival, survival at 24 h and survival to discharge 49.3%, 28.5% and 13.4%, respectively. The extent of monitoring prior to arrest, the attendance of one or more experienced anesthesiologists in the CPR team, CPR during office hours, CPR in ICU or operating room, early initiation of CPR and tracheal intubation prior to arrest were found as the factors increasing discharge survival. We conclude that early initiation of CPR with an experienced team in a well-equipped hospital sites increases the discharge survival rate following cardiac arrest.
[Show abstract][Hide abstract] ABSTRACT: In this double-blind, randomized, placebo-controlled study we compared the effects of three different dose regimens of magnesium on intraoperative propofol and atracurium requirements, and postoperative morphine consumption in patients undergoing gynaecological surgery.
Eighty women were allocated to four equal groups. The control group received normal saline; magnesium groups received 40 mg kg(-1) of magnesium before induction of anaesthesia, followed by i.v. infusion of normal saline, magnesium 10 mg kg(-1) h(-1) or magnesium 20 mg kg(-1) h(-1) for the next 4 h. Propofol infusion was targeted to keep bispectral index values between 45 and 55. Postoperative analgesia was achieved using PCA with morphine.
Magnesium groups required significantly less propofol [mean (sd) 121.5 (13.3), 102.2 (8.0) and 101.3 (9.7) microg kg(-1) min(-1) respectively] than the control group (140.7 (16.5) microg kg(-1) min(-1)). Atracurium use was significantly higher in the control group than magnesium groups [0.4 (0.06) vs 0.34 (0.06), 0.35 (0.04), 0.34 (0.06) mg kg(-1) h(-1) respectively]. Morphine consumption was significantly higher in control group than magnesium groups on the first postoperative day [0.88 (0.14) vs 0.73 (0.17), 0.59 (0.23), 0.53 (0.21) mg kg(-1) respectively]. The heart rate was lower in magnesium groups and 20 mg kg(-1) h(-1) infusion group demonstrated the lowest values.
Magnesium 40 mg kg(-1) bolus followed by 10 mg kg(-1) h(-1) infusion leads to significant reductions in intraoperative propofol, atracurium and postoperative morphine consumption. Increasing magnesium dosage did not offer any advantages, but induced haemodynamic consequences.
Full-text · Article · Mar 2006 · BJA British Journal of Anaesthesia
[Show abstract][Hide abstract] ABSTRACT: In this prospective, randomized study we compared the recovery profiles of bispectral index (BIS)-guided anesthesia regimens with desflurane or propofol in ambulatory arthroscopy. Fifty ASA I-II adult patients who underwent knee arthroscopy were randomized to receive desflurane (D) or propofol (P) infusion accompanied by remifentanil and nitrous oxide during maintenance, titrated to maintain a bispectral index value between 50 and 60. Initial awakening, fast-track eligibility, and home readiness as well as intraoperative hemodynamics, were compared. The groups did not differ with respect to demographics, duration of operation, or intraoperative vital signs. Although the times for initial awakening parameters were shorter in group D, the differences between the groups were not significant. The time needed for the White fast-track score to reach 12 was shorter in group P than group D (9 +/- 3.5 min vs 12.5 +/- 5.3 min). However, home readiness did not differ significantly between the groups. Desflurane is an alternative to propofol for BIS-guided ambulatory anesthesia. Using desflurane in combination with opioid analgesics blunted its rapid emergence characteristics, and the higher frequency of emetic symptoms with desflurane diminished the success of its fast-track eligibility.
No preview · Article · Feb 2006 · Journal of Anesthesia
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV.
Randomized, crossover, clinical study.
Twenty-five patients undergoing thoracotomy.
During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH2O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence.
At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4+/-4.2, 28.3+/-4.1, and 28.9+/-3.7 cmH2O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p<0.05 for PCV-ZEEP v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO2 (230.3+/-69.8 v 189.0+/-54.8 mmHg, p<0.05) and decreased Qs/Qt (33.4%+/-7.3% v 38.4%+/-5.7%, p<0.05) compared with PCV-ZEEP (mean+/-SD). Eighty-eight percent of the patients have benefited from PEEP.
During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.
No preview · Article · Mar 2005 · Journal of Cardiothoracic and Vascular Anesthesia
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between peripheral and central venous pressures in different patient positions (supine, prone, lithotomy, Trendelenburg, and Fowler), different catheter diameters (18 G and 20 G), and catheterization sites (dorsal hand and forearm) during surgical procedures.
Prospective clinical study.
Five hundred adult patients.
Peripheral over-the-needle intravenous catheters were placed in the dorsal hand or forearm. Central venous catheters were inserted via the internal jugular or subclavian vein after induction of anesthesia. MEASUREMENTS and
Simultaneous measurements of central and peripheral venous pressures were made during stable conditions at random time points in surgery; 1953 paired measurements were performed. Mean central venous pressure was 11 +/- 3.7 mmHg and peripheral venous pressure was 13 +/- 4 mmHg (p = 0.0001). The overall correlation between central venous and peripheral venous pressures was found to be statistically significant (r = 0.89, r(2) = 0.8, p = 0.0001). Mean difference between peripheral and central venous pressure was 2 +/- 1.8 mmHg. Ninety-five percent limits of agreement were 5.6 to -1.6 mmHg.
It has been assumed that replacing central venous pressure by peripheral venous pressure would cause problems in clinical interpretation. If the validity of this data is confirmed by further studies, the authors suggest that central venous pressure could be estimated by using regression equations to compare the 2 methods.
No preview · Article · Sep 2004 · Journal of Cardiothoracic and Vascular Anesthesia