Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery

Abstract Background: Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. Methods: A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n ¼ 30, tidal volume ¼ 10 mL/kg, rate ¼ 12/minute, PEEP ¼ 0 cm H 2 O) or the low tidal group with PEEP group (n ¼ 30, tidal volume ¼ 6 mL/kg, rate ¼ 18/minute, PEEP ¼ 5 cm H 2 O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. Results: There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO 2 ) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg; p ¼ 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO 2 values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H 2 O, p ¼ 0.041, low tidal; 23.67 cm H 2 O, p ¼ 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. Conclusion: The application of low tidal volume þ PEEP þ high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases

Developing intracranial hypotension after spinal anesthesia

ntrakraniyal hipotansiyon, ortostatik baş ağrısı ile ortaya çıkan beyin omurilik sıvısı (BOS) basıncı düşüklüğü ile karakterize bir tablodur. 30 yaşında, 165cm boyunda ve 64kg ağırlığında olan kadın hastanın spinal anestezi sonrası postoperatif 1. günde enseden başlayıp tüm başına yayılan, ayağa kalkınca artış gösteren baş ağrısı şikayeti olmuş. Olgunun postoperatif 12. günde bu şikayetine çift görme yakınması, bulantı ve kusma şikayetleri eklenmiş. Hasta intrakraniyal hipotansiyon olarak değerlendirildi. Dirençli olmayan intrakraniyal hipotansiyon tedavisinde yatak istirahati, hidrasyon, kafein ve teofilinin etkili bir tedavi yöntemi olduğu kanaatindeyiz.Intracranial hypotension is an entity, which occurs with orthostotic headache and characterized with low cerebrospinal fluid (CSF) pressure. The patient was 30 years old and 165cm height, 64kg weight female patient. She had complaints of headache that began from neck to the all of head, increased by standing up and developed at the first day postoperatively following spinal anesthesia. Diplopia, nausea and vomiting were also noted by the twelfth postoperative day. The patient was evaluated as intracranial hypotension. We believe that bed rest, hydration, caffeine and theophylline administration are effective medical treatment for non resistant intracranial hypotension

Awake fi beroptic intubation of a patient with amyotrophic lateral sclerosis: case report

Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis is<br />dependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected death<br />due to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroid<br />cancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2) and a mixture of oxygen and air<br />under volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after ten<br />hours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation

Meperidine, As An Effective Adjuvant Agentin Unilateral Spinal Anaesthesia For Knee Arthroscopy

Aim: Unilateral spinal anaesthesia permits early recovery and short ambulatory stay. Our study aimed to search if meperidine may prolong sensory block time when added to hyperbaric bupivacaine. Methods: This is a prospective, double blinded study: Ambulatory, 46 consenting patients aged 18-60 years, undergoing unilateral knee arthroscopy were randomized in two groups. saline group (n=20): 1.3 ml of hyperbaric bupivacaine and 0.2 ml of serum physiologic was used. Meperidine group (n=20): 1.3 ml of hyperbaric bupivacaine and 0.2 ml of 5% meperidine was used. Sensory block times, duration of spinal anaesthesia, intraoperative adverse effects and patient satisfaction were recorded. Results: Mean duration of sensory block was greater in the meperidine group compared with the saline group. Strict unilateral block and hypotension were comparable among groups. Conclusion: Addition of meperidine to hyperbaric bupivacaine in unilateral spinal anaesthesia prolonged analgesia without effecting total anesthesia time with minimal adverse effects

Developing intracranial hypotension after spinal anesthesia

ntrakraniyal hipotansiyon, ortostatik baş ağrısı ile ortaya çıkan beyin omurilik sıvısı (BOS) basıncı düşüklüğü ile karakterize bir tablodur. 30 yaşında, 165cm boyunda ve 64kg ağırlığında olan kadın hastanın spinal anestezi sonrası postoperatif 1. günde enseden başlayıp tüm başına yayılan, ayağa kalkınca artış gösteren baş ağrısı şikayeti olmuş. Olgunun postoperatif 12. günde bu şikayetine çift görme yakınması, bulantı ve kusma şikayetleri eklenmiş. Hasta intrakraniyal hipotansiyon olarak değerlendirildi. Dirençli olmayan intrakraniyal hipotansiyon tedavisinde yatak istirahati, hidrasyon, kafein ve teofilinin etkili bir tedavi yöntemi olduğu kanaatindeyiz.Intracranial hypotension is an entity, which occurs with orthostotic headache and characterized with low cerebrospinal fluid (CSF) pressure. The patient was 30 years old and 165cm height, 64kg weight female patient. She had complaints of headache that began from neck to the all of head, increased by standing up and developed at the first day postoperatively following spinal anesthesia. Diplopia, nausea and vomiting were also noted by the twelfth postoperative day. The patient was evaluated as intracranial hypotension. We believe that bed rest, hydration, caffeine and theophylline administration are effective medical treatment for non resistant intracranial hypotension

Retrospective assesing of spinal anesthesia applications in our hospital

Amaç: Spinal anestezi uygulanan hastaların retrospektif bulguları tarayıp, komplikasyon nedenlerini ortaya koymayı amaçladık. Gereç ve Yöntem: Afyon Kocatepe Üniversitesi Tıp Fakültesi hastanesinde spinal anestezi uygulanarak opere edilmiş ASA I,II,III grubuna giren 16 ile 91 yaşları arasında 247 si bayan 365 i erkek olan toplam 612 hasta retrospektif olarak incelendi. Hastalara ait veriler hasta dosyalarından anestezi gözlem formlarından ve kendilerinden toplandı. Spinal anesteziye bağlı gelişebilecek komplikasyonları ve buna olumlu, olumsuz etkisi olabilecek faktörleri değerlendirmek için tüm veriler istatistiksel olarak T-testi, Chi square, spearman korelasyon testleri ile değerlendirilmiştir. Bulgular: Komplikasyonlar cinsiyet, boy, kilo, yaş, ASA, lokal anestezikler, fentanil kullanımı ve cerrahi klinikler ile ilişkili bulunmaz iken uygulama sonrası bütün hastaların sistolik, diyastolik tansiyonlarında ve kalp atım hızlarında anlamlı düşüş görüldü. Ayak bileği operasyonu, anal fissür operasyonu ve 35-45 yaş grubu ve iğne çapı ile komplikasyonlar arasında anlamlı bir ilişki saptanmadı (p<0,05). Komplikasyonlardan sadece bradikardinin iğne çapının büyümesiyle arttığı bulgusuna varıldı. Komplikasyon gelişen hastalarda anesteziden memnuniyet anlamlı olarak düşük bulundu. Sonuç: Komplikasyon gelişiminin; genç-orta yaş grubu ve spinal iğne seçimi ile ilişkili olduğu görüldü. Komplikasyonlara sebep olan faktörlerin belirlenmesi ve tedavilerinin başarısını değerlendirebilmek için hasta gözlem formlarının ayrıntılı hazırlanması, muntazam ve dikkatlice doldurulması, sonrasında düzenli olarak dosyalanması gerektiği görüldü.Aim: To scan retrospective findings in patients undergoing spinal anesthesia and putting forth the reasons for complications. Materials and Methods: We recruited patients have had surgery with spinal anesthesia, in ASA I, II, III groups between the ages of 16 and 91, 365 male and 247 female, retrospectively. During the application 22, 25,26 gauge spinal needle, bupivacaine and levobupivacaine was used. Standart monitorization was performed to all patients and sistolic, diastolic and mean arteryal pressure; heart rate, peripheral oxygen saturation were recorded by deterimined intervals. The data of the patients were collected from patients file, from forms of anesthesia monitoring. Complications related to spinal anesthesia, and the positive and negative factors that may influence it were assessed with T-test, Chi-Square, spearman’s correlation tests. Results: Complications was not associated with the use of fentanyl, sex, height, weight, age, ASA, local anesthetics, and surgical clinics. Systolic and diastolic blood pressure and heart rate showed a significant reduction in rates after application. No significant correlation between needle diameter, 35-45 age group, anal fissure surgery, ankle surgery and the complications was found (p<0,05). No evidence of complications increased with the growth of the diameter of the needle was reached except bradycardia. Anesthesia had significantly lower satisfaction for patients who develop complications. Conclusion: The development of complications was associated with young-middle age group, and selection of the spinal needle. It was concluded that detailed preparation of uniform and carefully filled patient monitoring forms seems essential