Sugammadex use in a patient with myastenia gravis

Myastenia gravis nöromüsküler kavşağı tutan otoimmün bir hastalıktır ve bu tanıyı alan hastalarda operasyon sonrası solunum yetmezliği gelişme riski vardır. Aynı şekilde kronik obstrüktif akciğer hastalığı varlığında da postoperatif solunum yetmezliğinin gelişebileceği bilinmektedir. Ancak steroid yapılı nondepolarizan kas gevşeticiler ve bu kas gevşeticilerin etkilerini geri döndürmek için kullanılacak sugammadeks olası postoperatif solunum yetmezliği riskini en aza indirmektedir. Bu olgu sunumunda, acil laparotomi için roküronyum ile genel anestezi uygulanan myastenia gravis ve kronik obstrüktif akciğer hastalığı tanıları olan hastada sugammadeks ile postoperatif solunum yetmezliğinin önlenebildiği başarılı bir genel anestezi uygulamasını sunmak istedik.Myastenia gravis is an autoimmune disease involving the neuromuscular junction and patients receiving this diagnosis have a risk of developing postoperative respiratory failure. Similarly, the presence of chronic obstructive lung disease is known to be associated with postoperative respiratory failure. However, steroidal non-depolarising muscle relaxants and sugammadex to reverse their muscle-relaxing effects minimize the risk of postoperative respiratory failure. In this case report, we wanted to present a successful application of general anesthesia with rocuronium for emergency laparotomy in a patient with myasthenia gravis and chronic obstructive pulmonary disease in whom postoperative respiratory failure could be prevented by using sugammadex

Cochlear Implant Surgery and Anesthesia

Cochlear implant, converting mechanical sound energy into electrical signal, is a device that can enables to detection of sounds from cochlea. Cochlear implantation is the name of cochlear implants to be placed in the cochlea. This procedure brings up some difficulties in terms of anesthesia and surgery. Both range of patients population and surgical complications make different implantation applications. Besides age group of children who underwent surgery, this procedure can be applied to all age groups. During surgery, anesthesia technics which allow the immobil bloodness field and fascial nerve neuromonitorisation must be performed. During recovery period from surgery, it is important that patient's head movement must be kept slow and controlled for preventing implant replacement. Also in this period, neuromuscular blocking must be fully reversed for fascial nerve examination. In this article, preoperative preparation, anesthetic management and surgical aspects of cochlear implantation surgery were reviewed. [Archives Medical Review Journal 2015; 24(2.000): 159-170

Vitamin D and Anaesthesia

Vitamin D; vücutta sadece kalsiyum, fosfor metabolizmasını de- ğil aynı zamanda birçok organ sistemini etkileyen bir vitamindir ve son yıllarda özellikle immün sistem üzerine etkilerinden dolayı daha çok dikkat çekmeye başlamıştır. Vitamin D eksikliği ise hala yaygın olarak toplumda gözlenebilen bir klinik durumdur. Dolayı- sıyla da anestezi uygulamalarında sıklıkla vitamin D eksikliği olan hasta ile karşılaşılabilmektedir. Eksikliğinde yoğun bakımda kalış sürelerinin uzaması, mortalite ve morbiditenin artışının yanı sıra kronik hastalıklarla sıklıkla birlikte olabilmesi vitamin D eksikli- ğinin önemini bir kat daha artırmaktadır. Yapılan çalışmalardan elde edilen sonuçlar vitamin D eksikliğinin kötü cerrahi prognozla ilgisinin olup olmadığının sorgulanmasına neden olmuştur. Biz de vitamin D eksikliğini ve buna bağlı ortaya çıkabilecek olumsuz sonuçları anestezistler açısından değerlendirdik.Vitamin D is a vitamin not only associated with calcium-phosphorus metabolism but also affects many organ systems. Because of its effect on the immune system in recent years, it has attracted much attention. Vitamin D deficiency is a clinical condition that can be widely observed in the society. Thus, patients with vitamin D deficiency are often seen in anaesthesia practice. In the absence of vitamin D, prolongation of intensive care unit stay, increase in mortality and morbidity and also association of chronic diseases further increase the importance of vitamin D deficiency. The results obtained from studies have led to the question of whether poor surgical outcome is associated with vitamin D deficiency. We assessed the vitamin D deficiency and its negative consequences for the anaesthesiologist

Vitamin D and Anaesthesia

Vitamin D is a vitamin not only associated with calcium-phosphorus metabolism but also affects many organ systems. Because of its effect on the immune system in recent years, it has attracted much attention. Vitamin D deficiency is a clinical condition that can be widely observed in the society. Thus, patients with vitamin D deficiency are often seen in anaesthesia practice. In the absence of vitamin D, prolongation of intensive care unit stay, increase in mortality and morbidity and also association of chronic diseases further increase the importance of vitamin D deficiency. The results obtained from studies have led to the question of whether poor surgical outcome is associated with vitamin D deficiency. We assessed the vitamin D deficiency and its negative consequences for the anaesthesiologist

Anesthetic Management of Pediatric Craniofacial Surgery and Methods of Reducing Blood Loss

One of the most common craniofacial congenital abnormalities requiring surgery is craniosynostosis where there is premature fusion of one or more cranial sutures. A thorough assessment of the airway is necessary to enable careful planning of the anesthetic technique for craniofacial surgery. Pediatric craniofacial reconstruction procedures, has been associated with significant morbidity including cardiac arrest, massive transfusion, coagulopathy, severe hypotension, air embolism, largely related to blood loss. Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. In children undergoing surgical correction of craniosynostosis, pre-treated with erythropoietin, intraoperative tranexamic acid reduces transfusion requirement

Sugammadex in a Patient with Brugada Syndrome

WOS: 000382992900009PubMed ID: 27366567Brugada Syndrome was first described in 1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhythmias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right precordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complications. Many anaesthetics have been administered during the operation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study

Sugammadex in a Patient with Brugada Syndrome

Brugada Sendromu ilk kez 1992 yılında Pedro Brugada tarafından tanımlanan, ani kalp durması ile sonuçlanabilen ventrikül aritmi- leri ile karakterize genetik bir sendromdur. Bu sendromda özel- likle sağ dal bloğu ve sağ prekordiyal derivasyonlarda ST segment elevasyonu gözlenmektedir. Perioperatif birçok farmakolojik ve fizyolojik faktör bu malign aritmileri tetikleyebilir. Nadir görülen bir durum olmasına rağmen ölümcül komplikasyonlarla seyrede- bildiğinden Brugada Sendromunda anestezi uygulaması önem arz etmektedir. Brugada sendromlu hastaların ameliyatlarında birçok anestezi ilacı uygulanmıştır. Bu makalede sugammadeks kullanı- mının genel anestezi uygulanan Brugada sendromlu hastadaki yeri tartışıldı.Brugada Syndrome was first described in1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhyth- mias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right pre- cordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complica- tions. Many anaesthetics have been administered during the oper- ation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study

Sugammadex in a Patient with Brugada Syndrome

WOS: 000382992900009PubMed ID: 27366567Brugada Syndrome was first described in 1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhythmias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right precordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complications. Many anaesthetics have been administered during the operation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study

EVALUATION OF SYMPTOMS AND CLINICAL FEATURES ASSOCIATED WITH ŞBROMYALGIA SYNDROME

Amaç: Şbromiyalji sendromu yaygın görülen, yaşam kalitesini etkileyebilen semptom ve bulgularla seyredebilen bir klinik tablodur. Bu çalışmada Şbromiyalji sendromuna eşlik eden semptom ve bulguları incelemeyi amaçladık. Yöntem: Ağrı kliniğine 2003-2004 tarihleri arasında başvuran ve daha önce Şbromiyalji tanısı almış hastalar prospektif olarak Şzik muayene, anksiyete, depresyon ve klinik şikayetler açısından değerlendirilmiştir. Hamilton depresyon ölçeği depresyonun, durumluk kaygı ölçeği de anksiyetenin değerlendirilmesinde kullanılmıştır. Bulgular: Toplam 86 hasta Ağrı kliniğimize başvurmuş ancak 8 hasta çalışma dışı kalarak çalışma 80 hastayla tamamlanmıştır. Hastaların 77’si kadın (%96.3), 3’ü erkek (%3.7) idi. Hastaların 1’i hariç tamamı yaygın ağrı şikayetinin olduğu ve 63’ünün düzenli analjezik kullandığı (%78.7) gözlenmiştir. Hastaların 14’ünün antidepresan kullandığı gözlenmiştir. Antidepresan kullanan hastalarda anksiyete skoru 50.07±10.19, antidepresan kullanmayanlarda 52.79±12.1 olarak ölçülmüştür. Analjezik kullanan hastalarda anksiyete skoru 55.8±12.7, kullanmayanlarda 51.35±11.4 olarak ölçülmüştür. En yüksek anksiyete skorlarının 60-69 yaş grubunda ölçüldüğü gözlenmiştir. Yaygın ağrının şiddeti arttıkça anksiyete skorlarının da arttığı gözlenmiştir. Hastaların 42’sinde (% 42.5) Hamilton depresyon ölçeğine göre depresyon yoktu. 29 hastada (%36.2) haŞf depresyon, 8 hastada (%10) orta, 1 hastada (%1.2) ağır depresyon olduğu tespit edildi. Sonuç: Şbromiyalji anksiyete ve depresyonun da eşlik edebileceği ağrı ile diğer Şziksel yakınmaların birlikte gözlendiği yaygın bir sendromdur.Objective: Şbromyalgia syndrome is clinical state that is common with symptoms and signs may affect quality of life. In this study, we aimed to investigate symptoms and Şndings associated with Şbromyalgia. Method: Patients who admitted to Pain Clinic between 2003-2004 previously diagnosed Şbromyalgia were evaluated prospectively for physical examination, anxiety, depression and clinical complaints. The Hamilton depression scale and state anxiety scale were used. Results: A total of 86 patients admitted to clinic, but 8 patients were out and study was completed with 80 patients. Seventy-seven patients were female (96.3%), 3 were male (3.7%). All but one of patients had generalized pain complaints, 63% had regular analgesics (78.7%). Fourteen patients had antidepressant use. Anxiety score was measured 50.07±10.19 in patients using antidepressants, 52.79±12.1 in not taking. The anxiety score was measured 55.8±12.7 in patients using analgesics, 51.35±11.4 in patients without analgesics. The highest anxiety scores were observed in 60-69 age. The severity of common pain increased with anxiety scores. There was no depression was observed in 42 patients (42.5%). Mild depression was found in 29 patients (36.2%), moderate in 8 (10%), severe in 1 (1.2%). Conclusion: Şbromyalgia is a common syndrome characterized by pain and associated with anxiety and depression

Effect of single dose of esmolol on response to endotracheal intubation and bispectral index during sevoflurane and desflurane anesthesia in patients over 65 years

Amaç: Bu prospektif ve randomize çalışma, elektif cerrahi geçirecek 65 yaş ve üzeri ASA II-III hastalarda, sevofluran ve desfluran anestezisinde tek doz uygulanacak esmololün hemodinamik değişiklikler, entübasyona bağlı Bispektral indeks (BIS) değişiklikleri ve derlenme üzerine etkilerini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: 65 yaş üzeri ASA II-III elektif cerrahi geçirecek 80 hasta 4 gruba ayrıldı. Tüm hastalara standart monitörizasyon ve BIS monitörizasyonu uygulandıktan sonra Grup I deki hastalara sevofluran ve intravenöz(IV) salin, Grup II deki hastalara desfluran ve IV salin, Grup III deki hastalara sevofluran ve tek doz esmolol (1 mg kg1), Grup IV deki hastalara desfluran ve tek doz esmolol (1 mg kg-1) uygulandı. Hastaların indüksiyon ajan uygulanması sonrası, esmolol uygulanması sonrası, kas gevşetici uygulanması sonrası, entübasyon esnasında, entübasyon sonrası oksijen saturasyonu, sistolik kan basıncı, diyastolik kan basıncı, kalp atım hızı ve bispektral indeks değerleri kaydedildi. Bulgular: Tek doz esmolol uygulamasının sevofluran ve desfluran anestezisinde endotrakeal entübasyona bağlı BIS değerlerindeki karşılaştırıldığında ekstübasyon, göz açma ve derlenme süreleri daha kısa bulundu. Sonuç: İleri yaş grubu hastalarda desfluran ve sevofluran anestezisinde tek doz uygulanan esmolol trakeal entübasyona yanıt olarak gelişen sempatik deşarjı ve BİS değerlerindeki artışı baskılamaktadır.Purpose: In this prospective, randomized study, we aimed to compare the effects of single dose of esmolol on haemodynamic, bispectral index (BIS) changes related to intubation and recovery at sevoflurane and desflurane anaesthesia in 65 years and older patients who scheduled for elective surgery Material and Methods: Eighty ASA II-III patients who undergo elective surgery were divided 4 groups. After standart and Bispectral monitoring to all patients, the first group received sevoflurane and salin,e second group received desflurane and salin. The patients in Group III received sevoflurane and single dose of esmolol(1 mg kg1) and group IV received desflurane and single dose of esmolol(1 mg kg-1). While given induction drugs, neuromuscular blockers, during intubation and at 30 second, first minute and 5. minutes of intubation, oxygen saturation, systolic and diastolic blood pressure, heart rate, BIS values were recorded. Results: Single dose of esmolol administration during sevoflurane and desflurane anaesthesia was found to inhibit the increase of BIS values due to endotracheal intubation. When the groups compared, extubation, eyeopening and recovery time were significantly shorter in the groups which applied esmolol. Conclusion: In elderly patients, single dose esmolol administration in desflurane and sevoflurane anesthesia significantly inhibits sympathetic decharge and BIS value increases due to tracheal intubation