[Show abstract][Hide abstract] ABSTRACT: Paroxetine is a selective serotonin reuptake inhibitor and one of the most frequently prescribed antidepressants. The serotonin syndrome is a potentially fatal complication of serotonin modifying drugs which is described with clinical triad of mental-status changes, autonomic instability, and neuromuscular abnormalities. Cases determined with therapeutic doses of paroxetine are rare. We present a case of serotonin syndrome presenting with confusion, high fever, rhabdomyolysis, autonomic nervous system dysfunction, acute renal failure and abnormal neuromuscular activity who has needed hospitalization at the intensive care unit after receiving only one tablet [20 mg] of paroxetine and chlorpheniramine 4 mg. We could not find any other serotonin syndrome case report associated with low dose paroxetine and chlorpheniramine use. Physicians need to remain aware of these potential medical complications and integrate this information into their clinical decision-making, informed-consent process, baseline assessment, and follow-up monitoring.
Full-text · Article · Nov 2009 · Anatolian Journal of Clinical Investigation
[Show abstract][Hide abstract] ABSTRACT: The purpose of this prospective randomized study was to evaluate the effects of intraarticular combinations of tramadol and ropivacaine with ketamine in postoperative pain control of patients undergoing arthroscopic meniscectomy.
We randomly divided 80 patients into four groups to receive intraarticular 50 mg tramadol (Group T), 50 mg tramadol with 0.5 mg kg(-1) ketamine (Group TK), 75 mg ropivacaine (Group R), 75 mg ropivacaine with 0.5 mg kg(-1) ketamine (Group RK) in 20 ml normal saline at the end of surgery. Postoperative analgesia was provided with patient-controlled analgesia with morphine. Postoperative pain scores, total morphine consumption amount and side effects were recorded at intervals of 0, 1, 2, 4, 8, 12 and 24 h after the operation.
Pain scores were higher in Group T when compared with Group R and Group RK at second and fourth hours, also compared with Group RK at zeroth, first, second, fourth and eighth hours. Total morphine consumption amount was found to be higher in Group T when compared to Group TK at eighth and twelfth hours and Group RK at eighth hours (P < 0.05). Total morphine consumption was lowest in Group TK (P < 0.05). There were no significant differences among the study groups regarding side effects.
Administration of intraarticular tramadol-ketamine combination was found to be more effective in decreasing postoperative daily analgesic consumption.
No preview · Article · Nov 2008 · Archives of Orthopaedic and Trauma Surgery
[Show abstract][Hide abstract] ABSTRACT: This double-blind pilot study compared the local anaesthetic effects of tramadol plus adrenaline with lidocaine plus adrenaline during surgery to repair hand tendons. Twenty patients were randomly allocated to receive either 5% tramadol plus adrenaline (n = 10) or 2% lidocaine plus adrenaline (n = 10). Injection site pain and local skin reactions were recorded. At 1-min intervals after injection of the anaesthetic agent, the degree of sensory blockade was assessed by the patient reporting the extent to which they felt a pinprick, light touch and a cold sensation. Pain felt during surgical incision was also recorded. There was no difference in the quality of sensory blockade or the incidence of side effects between the two groups. Only patients treated with tramadol did not require additional post-operative analgesia. A combination of tramadol plus adrenaline provided a local anaesthetic effect similar to that of lidocaine plus adrenaline.
Full-text · Article · Oct 2008 · The Journal of international medical research
[Show abstract][Hide abstract] ABSTRACT: To determine the effect of dexmedetomidine on intraoperative bleeding during septoplasty and tympanoplasty operations.
Randomized, placebo-controlled study.
Univesity medical center.
80 ASA physical status I and II patients, aged 18 to 65 years, 40 of whom were scheduled for septoplasty and 40 to undergo tympanoplasty operations.
Patients undergoing septoplasty (S) and tympanoplasty (T) operations were randomly divided into 4 groups. Dexmedetomidine (D) was administered to Group SD and Group TD first as a bolus dose of one microg kg(-1), then intraoperative maintenance was supplied with dexmedetomidine 0.7 microg kg(-1) hour(-1). Groups S and T (controls) were given identical amounts of saline. If systolic blood pressure measurements are greater than 20% preoperative values, then fentanyl one microg kg(-1) was given.
Intraoperative blood loss was determined with suction volumes and gauze counting. Bleeding was rated according to a 6-point scale. Hemodynamic parameters and fentanyl administration were recorded.
Group SD had less bleeding and lower bleeding scores (P < 0.05). In addition, this group received less intraoperative fentanyl (P < 0.05). The only significant difference between Groups TD and T was the amount of intraoperative fentanyl given (35.4 +/- 58.8 vs 110.0 +/- 81.0 microg) (P < 0.05).
Dexmedetomidine reduces bleeding, bleeding scores, and intraoperative fentanyl consumption during general anesthesia in septoplasty operations.
No preview · Article · Sep 2008 · Journal of Clinical Anesthesia
[Show abstract][Hide abstract] ABSTRACT: Preoperative and postoperative psychological factors, postoperative pain, analgesic consumption, treatment satisfaction were compared in patients treated with intravenous patient-controlled analgesia (IV-PCA) or intramuscular analgesics after laparoscopic ovarian cystectomy. Thirty-one women with laparoscopically operated benign ovarian cysts were recruited in Zonguldak Karaelmas University Faculty of Medicine, Department of Obstetrics and Gynecology. Postoperatively sixteen women received morphine delivered by IV-PCA pump system and 15 women were prescribed another opioid (meperidine) intramuscularly. Two weeks before and one day after the surgery, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were self-administered. Afterwards, the operation visual analog scale (VAS) and satisfaction with pain control scale were recorded. Preoperative BDI and BAI scores of both groups were comparable. Postoperative BDI (7.9 +/- 7.2 versus 13.8 +/- 6.9, P = 0.03) and BAI (11.4 +/- 9.1 versus 17.4 +/- 6.2, P = 0.045) scores were significantly lower in the IV-PCA group. Morphine usage with PCA resulted in significantly higher pain scores than equivalent doses of meperidine administered intramuscularly (2.94 +/- 1.0 versus 1.67 +/- 0.7, P = 0.001). Although higher pain scores were obtained from IV-PCA group, self-reported satisfaction rates were higher in this group (8.3 +/- 1.1 versus 7.4 +/- 1.1, P = 0.04). Involvement of patients in their pain management might increase the awareness of pain but their satisfaction about the control of postoperative pain was significantly improved.
No preview · Article · Jul 2008 · Journal of Psychosomatic Obstetrics & Gynecology
[Show abstract][Hide abstract] ABSTRACT: Our objective was to investigate the efficacy of intramuscular injection and peritonsillar infiltration of tramadol to prevent pain in children undergoing tonsillectomy.
In a double-blinded trial, 45 children were randomized into three groups: infiltration anesthesia with tramadol (2 mgkg(-1)) to the peritonsillar area (INF group, n=15), intramuscular analgesia with tramadol (2 mgkg(-1)) (IM group, n=15), and the placebo controls (PL group, n=15). Visual analog scale (VAS) scores for pain assessment, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia were recorded.
Mean HR values were higher in INF than PL group at 10th, 20th, and 30th minutes of operation (P<0.05). Nine children required analgesics within the first hour after surgery in PL compared to 1 child in INF group (P=0.036). VAS scores on awakening were significantly better in INF than PL group (P=0.015). The difference between IM and PL groups was not significant for any of the parameters.
Peritonsillar infiltration with tramadol provided good intraoperative analgesia, less postoperative pain on awakening and lower analgesic requirement within the first hour after surgery.
Full-text · Article · Mar 2008 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Objective: The effects of midazolam and dexmedetomidine on anxiety are compared during premedication for spinal anesthesia. Methods: State Trait Anxiety Inventory questionnaire is applied one night before to 60 patients in ASA risk group I-II planned for minor elective surgery. Hemodynamic values are recorded at five minutes intervals before and after premedication. After randomly divided into two groups, Group D received dexmedetomidine 1μg kg-1, Group M received midazolam 0.03 mg kg-1 iv. STAI test is repeated after 15 minutes. VAS scores are recorded during spinal anesthesia. Ramsey sedation scores were evaluated after surgery started. Results: The state anxiety scores of STAI test reduced in both groups (p<0.05). There was no difference between the STAI scores of the groups. VAS scores of Group D were lower (p<0.05). Ramsey sedation scores were similar in both groups. Mean arterial pressure values were compared before and after premedication and found to be lower in both groups (p<0.05). This reduction was more significant after spinal anesthesia in Group D (p<0.05). Heart rate values were compared before and after premedication and found to be reduced in Group D (p<0.05), the reduction in Group M was 10 min after drug application. The heart rate reduction after spinal anesthesia was more significant in Group D (p<0.05). Mouth dryness is determined in 10 patients in Group D (p<0.05). Conclusion: Premedication with dexmedetomidine during spinal anesthesia may provide similar sedation and anxiolysis as midazolam application but careful hemodynamic follow-up is thought to be appropriate.
No preview · Article · Jan 2008 · Anestezi Dergisi
[Show abstract][Hide abstract] ABSTRACT: This prospective, double-blind, randomized, placebo-controlled study was designed to determine the efficacy of dexmedetomidine compared with lidocaine in reducing the pain of propofol and rocuronium injection pain.
One hundred and fifty patients, scheduled for elective surgery with general anaesthesia, were divided into five groups: saline (Group 1), dexmedetomidine 0.25 microg kg(-1) (Group 2), lidocaine 0.5 mg kg(-1) (Group 3), dexmedetomidine 0.25 microg kg(-1) plus lidocaine 0.25 mg kg(-1) (Group 4) or dexmedetomidine 0.25 microg kg(-1) plus lidocaine 0.5 mg kg(-1) (Group 5) were administered at a rate of 0.5 mL s(-1) after tourniquet application. The occlusion was released after 1 min and 5 mL of propofol was injected over 20 s. Pain was evaluated by use of a 10-point verbal analogue scale. Then, the rest of the induction dose of propofol, 3 mL of saline bolus and 0.6 mg kg(-1) of rocuronium, was injected. The response to injection of rocuronium was assessed with a four-point scale (0-3).
Groups 1 and 2 were found to have higher propofol injection pain scores than Groups 3, 4 and 5 (P < 0.05). When the study groups were compared according to the overall incidence of withdrawal movements due to rocuronium (1 response) in Groups 1, 2, 3, 4 and 5, they were different (86.7%, 60%, 36.7%, 50% and 40%, respectively) (P < 0.05). Except Group 1, there was no significant difference between the groups according to incidence of withdrawal movement after rocuronium injection (P = 0.325).
Pretreatment with dexmedetomidine is not effective in reducing injection pain of propofol, but may attenuate the hand withdrawal associated to rocuronium, as lidocaine does.
No preview · Article · Jul 2007 · European Journal of Anaesthesiology
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION The aim of the study was to demonstrate the possible effects of preoperative intra-articular, intravenous, or intrathecal administration of morphine on postoperative pain management.
Sixty patients undergoing arthroscopic menisectomy were included. Spinal anesthesia was performed in the lateral decubitus position with 3 ml of 0.5% hyperbaric bupivacaine, and the patients were randomized into 4 groups. The IVM (intravenous, i.v., morphine) group received 3 mg of i.v. morphine after completion of spinal anesthesia, the ITM (intrathecal morphine) group received 0.3 mg of morphine together with bupivacaine during spinal anesthesia, the IAM (intra-articular morphine) group received 3 mg intra-articular morphine diluted in 10 ml of saline after spinal anesthesia had been induced but 15 min before surgery, while the C (control) group did not receive any drugs in addition to spinal anesthesia. The sensory block level was determined 15 min after spinal anesthesia. Pain at rest (by visual analogue scale, VAS) and pain at 30 degrees of flexion (by verbal rating scale, VRS) were evaluated during each of the first 2 h of the postoperative period and once every 4 h thereafter until 24 h. In each group; the number of patients in need of analgesics, the timing of the first analgesic intake (duration of analgesia), and the cumulative dose of analgesics were recorded.
The mean duration of analgesia in the IAM group was significantly longer and the mean analgesic intake was significantly lower when compared with the other groups (p < 0.05). The mean VAS value of the ITM group at the 4th postoperative hour was significantly lower than that of the other groups. Mean VAS values at 8 and 12 h and mean VRS values at 4 and 8 h were significantly lower in the ITM and IAM groups (p < 0.05). The ITM group had the highest rates of nausea, vomiting, pruritus, and headache (p < 0.05).
It was concluded that the preoperative administration of morphine, either intrathecally or intra-articularly, provides postoperative pain relief. Of these two, the intra-articular route seems to be superior in terms of fewer side-effects (nausea, vomiting, and pruritus), longer duration of analgesia, and reduction of total need for analgesics.
No preview · Article · Nov 2005 · Archives of Orthopaedic and Trauma Surgery
[Show abstract][Hide abstract] ABSTRACT: We present a case of severe postpartum HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome associated with central nervous system symptoms. Cerebral manifestations of HELLP syndrome and relevant radiological findings were discussed. Microvascular endothelial damage causes hemolysis of red blood cell and subsequent thrombosis occurs in the pathophysiology of syndrome. Diffuse symmetric hyperintensities in bilaterally basal ganglions, fronto-parieto-occipital cortical and subcortical white matter were illustrated on T2 weighted magnetic resonance imaging (MRI) of our case. Diffusion weighted images showed that these abnormalities are areas of vasogenic edema accompanied by focal cytotoxic edema with diffusion restriction. Plasma exchange was resulted in a steady improvement. This case illustrates the potential importance of early diagnosis with diffusion weighted imaging and management of pregnancy-related thrombotic microangiopathy for better neurological outcome.
[Show abstract][Hide abstract] ABSTRACT: Lumbar puncture or identification of the epidural space is technically more difficult in children. Prior obtained information regarding the distance from skin to the dura mater may be useful as leading to an increase in success. We studied the anatomy of the posterior lumbar spine at the L4-5 intervertebral space in 137 children, using ultrasonography. Children aged between 7 and 12 years in whom weight and height are in 3-97 percentiles (recommended for healthy Turkish boys and girls) were investigated. The measured distance from skin to dura mater was found significantly higher in girls (2.59+/-0.44 cm) than boys (2.43+/-0.46 cm) (p<0.05). Prediction of the posterior dural depth at L4-5 level was obtained using single linear regression equation. All demographic variables correlated significantly with the dural depth in both sexes. In girls the skin-duramater distance achieved highest correlation ranks with weight and body surface area (BSA): 'dural depth' (cm)=1.094+[0.048 x weight (kg)], r=0.79, p<0.01 and 'dural depth' (cm)=0.337+[2.119xBSA m2], r=0.76, p<0.01). We concluded that the distance between the skin and the dura mater at the level of L4-5 interspace could be predicted using a statistical model based on the age, weight, height or BSA of children aged between 7-12 years old.
Full-text · Article · Jul 2005 · Agri: Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology
[Show abstract][Hide abstract] ABSTRACT: The purpose of intraperitoneal local anaesthetic administration is to block visceral nociceptive conduction and to provide an additional route of analgesia. The present study evaluates the effects of sequential injections of bupivacaine on postoperative pain through a subphrenic catheter.
In this double-blinded controlled study, patients scheduled for gynaecological laparoscopy were randomly divided into two groups. One group received 20 mL of saline with 1:200000 epinephrine through a subphrenic catheter before the incision closure and at 4-hourly intervals for the first postoperative 20 h. The second group received 20 mL of bupivacaine 0.125% with 1:200000 epinephrine at the same injection times. Postoperative pain scores and consumption of analgesics were compared.
There were no statistical differences in pain scores at rest or incidence of shoulder pain between the two groups, but the patients of the bupivacaine group reported lower pain scores on coughing only in the first hour postoperatively (P = 0.007). Although the patients consumed comparable amounts of metamizole and ondansetron, the number of patients requiring supplemental meperidine and flurbiprofen in the bupivacaine group were significantly lower than in the saline group (P < 0.05).
This study demonstrates that intraperitoneal bupivacaine may reduce pain on coughing in the early postoperative period and the consumption of analgesics postoperatively. The subphrenic catheter technique had no impact upon pain at rest and shoulder-tip pain after gynaecological laparoscopy.
Full-text · Article · Jun 2005 · European Journal of Anaesthesiology
[Show abstract][Hide abstract] ABSTRACT: This study was designed to investigate the possible participation of morphine in pulmonary oedema induced by alpha-naphthylthiourea (ANTU), which is a well-known noxious chemical agent in the lung. Injection of ANTU (15 mg/kg i.p.) produced pulmonary oedema as indicated by an increase in lung weight/body weight ratio and pleural effusion reaching a maximum within 4 h in rat. Administration of morphine prior to ANTU significantly inhibited to pulmonary oedema with a dose-dependent manner. The protective effect of morphine is prevented by peripheral opioid receptor antagonist, naloxone methiodide. ANTU-treated rats were shown positive by inducible nitric oxide synthase immunohistochemical staining. There was no staining in the control group. On the other hand, the degree of staining was markedly reduced in tissue sections by morphine. These results suggest that previous administration of subcutaneous morphine has preventive effect on ANTU-induced pulmonary inflammatory reaction and its effect mediated via peripheral opioid receptors. Application of naloxone with ANTU has no effect on the lung parameters indicating that endogenous opioids do not modulate ANTU-induced damage.
Full-text · Article · Apr 2005 · European Journal of Pharmacology
[Show abstract][Hide abstract] ABSTRACT: A prospective study was carried out to find the exact site of obstruction in sleep model and to quantitatively evaluate the effect of Jaw-thrust maneuver (JTM) in opening the obstructed airway using flexible fiberoptic endoscope.
Twenty-eight ASA physical status I or II patients with snoring symptom undergoing elective surgery were included. The patients were held in supine position without hyperextension of the neck. Having induced anesthesia, the base of the tongue and laryngeal inlet and/or epiglottis were visualized using endoscope. The patients' epiglottides were classified as leaf-shaped, curved (concaved or omega-shaped) and floppy types. We graded the airway opening at the level of epiglottis into six grades and obstruction at the tongue base level into four grades. The grades during inspiration (GrIns), expiration (GrExp) and after JTM (GrJTM) were recorded and compared with Pearson chi-square test.
The strictly curved (Omega-shaped or concaved) epiglottis supplied a salvage pathway for airflow that resisted collapsing with the posterior movement of the tongue base in 2 patients. When we compared GrIns with GrExp for epiglottis the difference was statistically significant (chi(2) = 0.001), but the difference for tongue base was not (chi(2) = 0.152). After JTM, GrJTM for both epiglottis and tongue base were significantly better than GrIns and GrExp (chi(2) < 0.001).
Tongue base was the principal site of obstruction although during the respiratory cycle the position of epiglottis changed prominently and increased the obstruction in inspiration. JTM alone significantly relieved the obstruction at the tongue base and epiglottis levels and increased the retroglossal airway.
[Show abstract][Hide abstract] ABSTRACT: This prospective, double-blind, randomized, placebo-controlled study compares the effects of ephedrine and ketamine on injection pain, and hypotension from propofol.
After obtaining the approval of the Ethics Committee, 75 patients (ASA I-II) scheduled for elective operations with general anaesthesia were divided into three groups. Saline 2 mL (Group S, n = 25), ketamine 0.5 mg kg(-1) (Group K, n = 25) or ephedrine 70 microg kg(-1) (Group E, n = 25) were administered over 5 s after tourniquet application. After releasing the tourniquet, propofol 2 mg kg(-1) was injected in 30 s. Pain was evaluated on a numerical scale (0-10) where 0 represented no pain and 10 the most severe pain possible. Systolic, diastolic blood pressures and heart rates were recorded preoperatively, 1 min after propofol injection, before intubation and 1, 2 and 3 min after intubation in all patients.
The incidences of pain in Groups S, E and K were similar (84%, 80% and 72%, respectively). The mean pain score in Group K (2.1, SD 3.1) was significantly lower than those of Groups S and E (4.9, SD 2.6 and 4.6, SD, 3.3, respectively) (P < 0.05). The systolic and diastolic blood pressure values in Group K (120 +/- 27 mmHg) and Group E (123 +/- 21 mmHg) before intubation were significantly higher than that of Group S (104 +/- 25 mmHg) (P < 0.05). There was no significant difference between the mean heart rate values of the groups.
Low dose ketamine or ephedrine pretreatment may prevent hypotension due to propofol induction. Despite the reduction in injection pain intensity after ketamine, the study drugs were found to be ineffective in lowering the injection pain incidence.
No preview · Article · Feb 2005 · European Journal of Anaesthesiology
[Show abstract][Hide abstract] ABSTRACT: Pseudocholinesterase (PChE) is a significant drug metabolizing enzyme of succinylcholine, mivacurium, choloroprocain and diamorphine, which is used as a diagnostic and therapeutic parameter in organophosphate toxicity. PChE activity may decrease following hepatic and renal failure, malnutrition, malignancy, burns and toxic inhibition or due to inherited enzyme variants. Most studies which have examined the relationship between ageing and oxidative enzymes of drug metabolism have been consistent in finding no effect of ageing. In our study, we planned to investigate age and gender related influences on PChE activity in a surgical population. We measured the level of PChE preoperatively in 492 patients excluding those who were pregnant, had solid organ failure or malignancies or who were taking drugs known to induce or inhibit enzyme activity. The mean enzyme level was found to be significantly higher in males than in their female counterparts. While the enzyme levels of males decreased significantly in those over 60 years of age, the minimum mean enzyme levels in females was in the 18-44 age group. The PChE activity decreased to a minimum level in the elderly men and the mature prolific women of the surgical population. Our findings suggest that the risk of 'prolonged apnea' is likely to increase in these age groups when anesthetic drugs which are metabolized by PChE are used.
No preview · Article · Jan 2005 · Anestezi Dergisi
[Show abstract][Hide abstract] ABSTRACT: Various malpositions can be seen during subclavian vein catheterisation. Serious problems and clinical complaints can occur during these malpositions. There are reports pain in the chest, shoulder, arm and midthoracic back pain, sensation of ear gurgling, headaches and earache related to malposition of a central venous catheter. Although there are various imaging systems and pressure monitors to demonstrate these malpositions, clinical complaints must be considered in a conscious patient. We present a case of earache caused by subclavian catheterization of ipsilateral internal jugular vein which subsided after pulling back the catheter.
No preview · Article · Jan 2005 · Anestezi Dergisi