Anaesthetic Management in Obstructive Sleep Apnoea Syndrome for Adenotonsillectomy

Case Report 230 The anaesthetic management of adenotonsillectomy in children with obstructive sleep apnoea syndrome is characteristic due to respiratory and cardiac side effects. A detailed physical examination in the preoperative period should be performed, including children's respiratory and cardiac systems. If they have an active infection, surgery should be postponed until the end of medical treatment. Preparation for difficult airway management should be done in the preoperative period. In this case, we presented a report of two children who had obstructive sleep apnoea syndrome, with airway management performed at the right lateral position to prevent the pharyngeal collapse and rapid sequence intubation performed using a short-acting muscle relaxant

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Aim. The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results. A total of 102 patients, 38 females and 64 males, with a mean age of 10.9±8.1 months, body weight 7.1±3.7 kg, and height 67±15 cm, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were TVe20%, a larger uncuffed tube was used due to PIP 30 cmH2O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion. There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume

Hipotansiyon insidansı üzerine etkiler: Sezaryen için spinal anestezide hiperbarik, isobarik bupivakain ve kombinasyonları

Amaç: Sezaryen için spinal anestezide hipotansiyon yaygındır. Bu çalışma sezaryende hipotansiyon sıklığının hiperbarik, isobarik bupivakain veya bunların ardışık uygulanması ile değişip değişmediğini araştırmak üzere planlanmıştır. Yöntem ve gereç: Spinal anestezi ile sezaryen operasyonu geçirecek 144 hasta randomize olarak dört gruba ayrıldı. Spinal anestezi H10 grubunda 10 mg hiperbarik bupivakainle, Grup H5P5’de ardışık 5 mg hiperbarik ve isobarik bupivakain uygulanmasıyla, Grup P5H5’de ardışık 5 mg isobarik hiperbarik ve isobarik bupivakain uygulanmasıyla ve P10 grubunda 10 mg isobarik bupivakainle gerçekleştirildi. Hemodinamik parametreler, hipotansiyon, bradikardi insidansı ve hipotansiyonu tedavi etmek için gereken efedrin miktarı kaydedildi. Fetal Apgar, umblikal kord kan pH’sı ve yan etkiler de not edildi. Bulgular: ASA risk grubu, cerrahi süre ve demografik veriler gruplar arasında benzerdi. Hipotansiyon insidansı H10, H5P5, P10 ve P5H5 gruplarında sırasıyla % 69,4, % 66,7, % 75,0 ve % 83,3 olarak bulundu. Hipotansiyon insidansı istatistiksel olarak farklı değildi. Gruplar arasındaki bradikardi insidansı, efedrin tüketimi, kord kan pH’sı ve yan etkiler de farklı değildi. Sonuç: Lokal anestezik dozu aynı olduğunda, sezaryen operasyonu için spinal anestezide, spinale bağlı hipotansiyon insidansı bupivakainin hiperbarik, isobarik veya yarı dozda ardışık uygulanması ile düşürülemez.Aim: To determine if hypotension frequency changes when hyperbaric or isobaric formulations of bupivacaine, or their sequential administrations, are used for cesarean section. Hypotension after spinal anesthesia for cesarean section is common. Materials and methods: A total of 144 patients who were to undergo cesarean section with spinal anesthesia were allocated into 4 groups. Spinal anesthesia was achieved with 10 mg of hyperbaric bupivacaine in Group H10, sequential 5-mg administrations of hyperbaric and isobaric bupivacaine in Group H5P5, sequential 5-mg administrations of isobaric and hyperbaric bupivacaine in Group P5H5, and 10 mg of isobaric bupivacaine in Group P10. Hemodynamic parameters were determined and the incidence of hypotension, incidence of bradycardia, and amount of ephedrine required to treat hypotension were recorded. Fetal Apgar scores, the pH of the umbilical cord blood, and side effects were also noted. Results: American Society of Anesthesiologists risk group, surgical duration, and demographic values were similar among the groups. The incidence of hypotension was found to be 69.4%, 66.7%, 75.0%, and 83.3% in the H10, H5P5, P10, and P5H5 groups, respectively. The incidences of hypotension were not signifi cantly different. Bradycardia incidence, ephedrine consumption, the pH of cord blood, and side effects were not different among the groups. Conclusion: When the dose of local anesthetic is the same, the incidence of spinal-induced hypotension cannot be lowered using hyperbaric, isobaric, or sequential injections of a half dose of bupivacaine for spinal anesthesia during cesarean section