General anesthesia for acute appendicitis operation in a patient with kyphoscoliosis

While applying anesthesia, kyphosis and/or scoliosis can lead to difficulty in both during endotracheal intubation and also during performing regional interventional technics. In this case, we aimed to report our general anesthesia experience in a 22 year-old women with advanced kyphoscoliosis who underwent acute appendicitis operation. There was no complication during the peroperative period and successful general anesthesia was performed

Septoplasty: Under general or sedation anesthesia. Which is more efficacious?

WOS: 000339973800014PubMed ID: 24384631The objective of the study was to assess the more efficacious anesthesia method in septal surgery. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 60 patients, between the ages of 16 and 65, who underwent septal surgery under general (GA) or sedation (SDA) anesthesia during 1-year period was done. Mean age of the patients was 44.30 +/- A 13.29. Patients were divided into two groups according to the anesthesia method: general (group 1) or sedation (group 2). Intraoperative hemodynamic variables, surgery time, intraoperative blood loss volume, length of hospital stay, postoperative vomiting and nausea, postoperative pain score according to the visual analog scale (VAS) and cost analysis of each method were compared. Thirty-six males and 24 females with a mean age 44.30 +/- A 13.29 were included to the study. Total operation time, operation time, intraoperative and postoperative bleeding volume, postoperative nausea and vomiting, duration of hospital stay after surgery, were better in group 2. Postoperative pain scores and patient satisfaction about surgery were not statistically different. Cost of anesthesia in group 1 per patient was $44.35 +/- A 10.81 and in group 2,$16.29 +/- A 11.88 (p < 0.01). Hospital stay after surgery was much longer in group 1 than group 2 (p < 0.01). Using SDA is better in many ways including cost-effectiveness than using GA for septoplasty operation

Sedation in a Patient with Prader-Willi Syndrome: A Case Report

Prader-Willi syndrome (PWS) is a rare disorder characterized by hypotonia, growth retardation, characteristic face shape, hypogonadism, hyperphagia and related morbid obesity. Anesthesia application in these patients has increased risk of peroperative complication due the central hypotonia, abnormal teeth structure, and limited neck mobility. Therefore, clinicians should be prepared for the worst scenario before anesthesia application in patients with PWS during general or out-patient surgery. Here, in this case report, outpatient anesthesia performed in a patient with PWS for diagnostic electromyography is presented with the literature review

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi amaçlanmaktadır.Gereç-yöntem: Sedo-analjezi ile endoskopik ultrasonografi işlemi planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve 0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5 mg.kg-1 Propofol, 1 mg.kg-1 Ketamin, Propofol+fentanil grubuna (Grup F) da 1,5 mg.kg-1 Propofol, 1 mcg. kg-1 Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı, periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.Bulgular: Her iki grupta demografik veriler ve total operasyon süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha düşüktü (p&lt;0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa gözlendi (p&lt;0.001). Endoskopist memnuniyetinde herhangi bir fark gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.Sonuç: Endoskopik girişim yapılan hastaların büyük çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz

Comparison of the Effects of Laparoscopic and Open Repair Techniques on Postoperative Pain and Analgesic Consumption in Pediatric Unilateral Inguinal Hernia

Aim: Although laparoscopic inguinal hernia (IH) repair in adults is widely accepted, its advantages in pediatric age group are questionable. We aimed to compare the effects of open inguinal hernia repair and laparoscopic inguinal hernia repair on length of anaesthesia, postoperative pain and analgesic consumption in boys who underwent unilateral inguinal hernia repair. Methods: Forty patients aged between 7 and 14 years who underwent open and laparoscopic inguinal hernia repair were included in this study. The patients were randomly divided into two groups: unilateral open inguinal hernia repair group (OR) n=20 and unilateral laparoscopic inguinal hernia repair group (LR) n=20. All patients underwent general anesthesia. The duration of anaesthesia and the duration of surgery were recorded. The Patient Controlled Analgesia (PCA) device was set at a 0.01 mg/kg bolus dose, 10 minutes lockout interval and 4 hour limit of 4 mg morphine. The patients, who received morphine PCA for 24 hours postoperatively, were monitored with continuous oximetry. The Visual Analogue Scale (VAS) was used to measure pain (0 cm: no pain, 10 cm: worst possible pain). We recorded the side effects of morphine, such as respiratory depression, nausea, vomiting, urinary retention, pruritus. SpO2 level and Ramsay Sedation Scale (RSS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS) scores at intervals 1, 2, 4, 12, 24 hours as well as amount of analgesics consumed and number of requests within 24 hours postoperatively were recorded. Time to first walking was recorded. Results: In group OR, the mean duration of anaesthesia and surgery were 39.85 minutes and 28.85 minutes, respectively. In group LR, the mean duration of anaesthesia and surgery were 26.11 and 20.53 minutes, respectively. VAS scores and time to first walking were similar in both groups. There was no significant difference in amount of analgesics consumed and number of request between the two groups. In group OR, the number of unsuccessful requests was higher than in group LR. There was not any side effects except for a higher NRS score of higher than 2 in one patient. Peripheral oxygen saturation was never less than 95%. RSS scores were never higher than 2. Conclusion: Higher number of unsuccessful request implies that children who undergo an open inguinal hernia repair feel more pain, thus, it can be thought that laparoscopic hernia repair is an alternative technique although the duration of anaesthesia and surgery was significantly longer in unilateral laparoscopic inguinal hernia repair technique. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 84-8