Anesthetic Management of Patient for Case with Apert Syndrome

Apert syndrome is an autosomal dominant inherited mandibulofacial dysostosis characterized by craniosynostosis, syndactyly, high forehead, broad nose, maxillary hypoplasia, synostosis of cervical vertebrae, organ malformations, and mental retardation. It is rarely encountered and as there is little knowledge of the anesthesia practice for this syndrome in the literature, we present our anesthesia experience of a case undergoing bilateral syndactyly surgery

Effect of Low-flow Anesthesia Education on Knowledge, Attitude and Behavior of the Anesthesia Team

AbstractThe 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

Difficult Mask Ventilation in Obese Patients: New Predictive Tests?

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/m2. 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

Effects of Preoperative Anxiety and General Anesthetic Administration on Intraoperative Awareness in Patients Undergoing Cesarean Section

Aim:The aim was to investigate the effects of preoperative anxiety and general anesthetic administrations on intraoperative awareness among patients undergoing cesarean section.Methods:This prospective randomized study included 90 pregnant subjects. Preoperative anxiety was assessed using the Beck Anxiety Inventory. The patients were divided into three groups: group P received propofol 2.5 mg/kg, group T thiopental 5 mg/kg and group K received ketamine 1 mg/kg. Data on intraoperative hemodynamics, isolated forearm (IFA) responses and time to first pain and to first analgesic requirement evaluated using postoperative numerical rating scale were recorded. The Modified Brice Scale (MBS) was used to assess awareness.Results:The preoperative anxiety levels in the groups were low and demographic data were similar (p>0.05). There was no statistically significant difference in IFA response between the groups (p>0.05). Group T had higher MAP at all times and NRS values at hour 0 compared to the other groups (p<0.05), and had shorter time to first analgesic requirement (p<0.05). MBS responses were evaluated as recall in 12 cases in group K, four in group P and three in group T.Conclusion:As the anxiety levels in pregnants were low, the superiority of agents used in induction over each other regarding awareness could not be shown

Medical malpractices about anesthesia in forensic reports between years 1990 and 2001

Bu retrospektif çalışmada, anesteziye ait uygulamalar ve sonrasında oluşan tıbbi uygulama hatalarının araştırılması planlanmıştır. Nisan 1990- Temmuz 2001 yılları arasında Yüksek Sağlık Şurası'nca incelenen 1826 adli dosya taranmış ve 82 dosyada (%4.5) sorumluluğun direkt anestezi uygulaması ile ilişkisinin olduğu görülmüştür. Elli iki olguda (% 63.4) kusur bulunmuştur. Bu olgulardan 49'una genel anestezi uygulanmıştır. Anestezi ile ilgili 82 dosya incelendiğinde,- kusurlu bulunan 52 dosyadan 40''mm ölümle (%76.9) sonuçlandığı gözlenmiştir. Kusurlu bulunan anestezi uygulamalarındaki ölümlerin %25'inde, diğer kusurlu adli olayların ise %33.4'ünde yalnızca anestezistler sorumlu tutulmuştur. Kusurlu bulunan anestezi ile ilgili olaylarda ölümlerin %42.5'inin 0-10 yaş grubu arasında olduğu gözlenmiştir. Anestezi uygulamalarına bağlı tıbbi uygulama hatalarının en sık genel cerrahi, kadın doğum ve kulak burun boğaz ameliyatları sırası ve sonrasında oluştuğu saptanmıştır. Kusurlu anestezi uygulamalarında 27 ölüm ilk 24 saat içinde olurken, 7 ölüm postoperatif 30 gün içerisinde oluşmuştur. Kalıcı beyin hasan ve yanıklar da sık karşılaşılan diğer sorunlar olarak gözlenmiştir. Tıbbi uygulama hatalarının sebeplerinin başında ventilasyon problemleri yer alırken bunu preoperatif tetkik ve muayene eksikliği izlemektedir. Sonuç olarak, anestezi uygulamalarına bağlı tıbbi uygulama hatalarının düzenli olarak irdelenmesinin mortalite ve morbiditeyi azaltmada faydası olabileceği düşünüldü.In this retrospective study, we aimed to evaluate malpractices during anesthesia and postanesthetic period. We found out that 1826 forensic reports were examined at Medical Council between April 1990 and July 2001. Eightytwo cases (4.5%) were directly related with anesthesia. In 52 cases (63.4%) anesthetic management was found to be responsible. Forty nine patients were given general anesthesia and 40 (76.9%) patients died. Anesthetists were found to be responsible for 25% of death cases and 33.4% of other faulty cases. Deaths between 0-10 age group were 42.5% of deaths. Malpractices related to anesthesia occured mostly in general surgery, obstetrics and ear-nose-throat operations. 27 death occured within 24 hours and 7 of them within 30 days after the operation. Permenant brain damage and burns were other frequently seen problems. Ventilation problems were the major cause of malpractice and inadequate preoperative evaluation followed it. As a result, it is thought to be useful that periodical evaluation of medical malpractices about anesthesia can play important role in decreasing morbidity and mortality

The effects of ethylene oxide exposure on health

Etilen oksit, etilen glikol esaslı antifriz üretimi, deterjan yapımı, steril tarım ürünü yetiştirilmesi ve dezenfektan olarak farklı işkollarında yaygın biçimde kullanılan ve kanserojen özelliği tanımlanmış bir kimyasal maddedir. Tek kullanımlık tıbbi malzemenin yeniden kullanıma hazırlanması ve ısıya duyarlı malzemenin sterilizasyonundaki etkinliği etilen oksitin sağlık hizmetlerinde yaygın biçimde kullanılmasına neden olmaktadır. Günümüzde önemli bir kısmı kapalı ve otomatize sistemlerde kullanılmasına karşın, etilen oksit sağlık çalışanları için önemli bir kimyasal maruziyet kaynağıdır. Etilen oksite kronik maruziyet genotoksik etkinin yanı sıra üreme sistemi ve sinir sistemini de olumsuz etkiler. Etilen oksit maruziyetinin önlenmesinde mühendislik uygulamaları, özellikle kapalı sistem kullanımı ve sürecin insansızlaştırıtması, ve tıbbi sürveyans çalışmaları önemlidir.Ethylene oxide is well described cansinogenic chemical and is used in various work activities for manifacture of antifreeze based on ethylene glycol and detergent, sterilization of agricultural products and dezenfection. Ethylene oxide is widely employed in health services for sterilization of fieat sensitive and disposal medical equipment for reusing purpose. Although today's systems are closed and automatized, ethylene oxide is still an important source of chemical exposure to health workers. Chronic exposure to ethylene oxide may cause genotoxicity and also affect the reproductive and neural systems. Engineering practices, usage of closed system and delrumanization of process, and medical surveillance are important factors to prevent of ethylene oxide exposure

Akut zehirlenme olgularının geriye yönelik değerlendirmesi, Zonguldak, Türkiye

Amaç: Bu çalışmanın amacı Türkiye’nin kuzey batısında yer alan Zonguldak şehrinde Zonguldak Karaelmas Üniversite Hastanesi Acil Servisi’ne başvuran akut zehirlenme olgularını bireysel, nedensel ve klinik özelliklerine göre değerlendirmektir. Gereç ve Yöntemler: Zonguldak Karaelmas Üniversite Hastanesi Acil Servisi’ne başvuran (Mart 2003-Aralık 2006) 295 akut zehirlenme olgusu geriye yönelik değerlendirildi. Bulgular: Acil servise başvuran 4166 hastadan 295’i zehirlenme olgusu idi. Zehirlenme olgularının % 67,5’i kadındı. Yaş ortalaması 22,5±15,9 idi. Zehirlenen olguların mevsimsel dağılımında yaz mevsiminde yoğunluk olduğu gözlendi (% 29,8). İntihar amaçlı zehirlenme, olguların çoğunluğunda başlıca etiyoloji olarak gözlendi (% 59,7). Tıbbi ilaçlar zehirlenmelerin başlıca nedeni idi (% 63,7).Bunu korozivler (% 12,9), karbon monoksit (% 10,2), organofosfatlı insektisidler (% 5,8), mantar (% 3,4), alkol (% 1,36) ve fare zehiri (süpervarfarinler) (% 0,3) izledi. Olguların % 21,4’ü yalnızca sertralin ile zehirlenmişti. Zehirler başlıca gastrointestinal sistem yolu ile alınmış idi (% 87,8). Olguların % 59,7’si hastanede yatarak tedavi aldı. Hastanede ortalama yatış süresi 2,8 ± 5,0 gün idi. Yoğun bakıma alınma oranı % 58,6 idi. Mortalite oranı % 2,7 idi. Karbon monoksit en sık ölüm nedeniydi. 282 olgu sekelsiz taburcu edilirken 5 olgu sekel ile taburcu edildi. Sonuç: İntihar amaçlı ve kaza ile ortaya çıkan zehirlenmeler; etiyolojik, bireysel ve klinik farklılıklara sahiptir. Bu farklılıkların acil servis ve reanimasyon bölümlerinde çalışanların eğitiminde tartışılmasının gerektiği düşüncesindeyiz.Aim: The aim of this study was to evaluate etiological, demographical and clinical characteristics of cases with acute poisoning referred to the Emergency Medical Service (EMS) of Zonguldak Karaelmas University Hospital in Zonguldak, a City in the West Black Sea Region of Turkey. Materials and Methods: Two-hundred and ninety-five cases with acute intoxication referred to the Emergency Department of Zonguldak Karaelmas University Hospital between March 2003 and December 2006 were analyzed retrospectively. Result

Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain. Methods: Sixty pediatric patients (aged 2-12 years) with American Society of Anesthesiology (ASA) classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP), heart rates (HR), Ramsey sedation scores (Rss) and sedation agitation scores (Sas) were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2. Recovery times, Alderete scores and facial pain scores (FPS) were recorded. Results: There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05). There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium. Conclusion: Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents. (The Medical Bulletin of Haseki 2010; 48: 146-52

Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: A prospective randomized study

Background: Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally. Methods: Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26) or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26). At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded. Results: Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T. Conclusion: Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy. © 2014 Numanoğlu et al