Experiences of Duzce University Department of Anesthesiology and Reanimation in COVID-19 Pandemic

Working in extraordinary conditions as healthcare professionals is a situation where your standard rules and working order disappear. In this process, the transfer of experiences facilitates adaptation to these extraordinary conditions. In the ongoing pandemic process, we, as Duzce University Department of Anesthesiology and Reanimation, have benefited from the experiences of clinicians who have experienced COVID-19 outbreak before us. In this article, we aimed to share a presentation about our working plan, the resources we took advantage of and the difficulties we experienced, with other clinicians. In our initial evaluations, when there is no official case in the region yet, based on the data of countries with similar region abroad, we encountered how many cases we have the capacity to support and how much we can increase this capacity in the worst conditions. During this discussions, we have planned material, equipment and our possible work order.We tried to provide protective equipment procurement, equipment use training in terms of employee health, we talked through case scenarios to create a safe working environment and for safe anesthesia practices. Our scenarios contained the questions like how many people and at what level of seniority should be and how the task should be done. We followed the Turkish Anesthesiology and Reanimation Association (TARD), the Turkish Intensive Care Association(TYBD), European Society of Anesthesiology (ESA) , European Society of Intensive Medicine (ESICM) guidelines for safe anesthesia and intensive care practices. In this process, the guides we used the most for Novel Coronavirus Disease follow-up and treatment were the Guide of Scientific Advisory Board of Turkish Ministry of Health , besides the Zhejiang University School of Medicine (FAHZU) COVID-19 Prevention and Treatment Handbook and Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19. While planning a pandemic ICU physically, it was decided to create a new area, it was seen that this area reduced the risk of transmission, but brought about the adaptation and placement problems to the working area. It should be taken into consideration that multidisciplinary approach may lead to problems in followup and orientation, although it has a positive contribution to the treatment process.WOS:00058856330000

The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study

The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similiar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P>0.05), and high satisfaction levels (90.1±3.0 for dexmedetomidine versus 84.9±4.5 for midazolam; P>0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8±6.5 versus 73.5±16.4, P<0.05; and 20.6±4.4 versus 45.2±6.0; P<0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P<0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy

Comparison of effects on the oxidant/antioxidant system of sevoflurane, desflurane and propofol infusion during general anesthesia

BACKGROUND AND OBJECTIVES: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. METHODS: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 mg/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. RESULTS AND CONCLUSIONS: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation

Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Ankarali, Handan Camdeviren/0000-0002-3613-0523; Ersoy Karka, Ozlem/0000-0001-7309-427X; Yorulmaz, Ilknur Suidiye/0000-0002-1441-6360WOS: 000346935200001PubMed: 25550680Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients. Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive-midazolam). Dexmedetomidine was administered at a concentration of 0.5 mu g.kg(-1), and midazolam was administered at a concentration of 0.025 mu g.kg(-1) via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T-beginning, T-preop5 min, T-preop 10 min, T-induction, T-intubation, T-intubation 5 min, T-initial surgery, T-surgery 15 min, T-surgery 30 min, T-extubation, T-extubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately. Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T-preop 5 min, T-preop 10 min, T-induction, T-intubation, T-intubation 5 min and T-initial surgery. MBP was significantly different in the hypertensive groups at T-induction, T-intubation, T-intubation 5 min, T-initial surgery, T-surgery 15 min, T-surgery 30 min, T-extubation and T-extubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM. Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.Duzce University's Projects Support Fund for Scientific ResearchDuzce UniversityThis study was financed by Duzce University's Projects Support Fund for Scientific Research