Laparoscopy-Assisted Percutaneous Cholangiography in Biliary Atresia Diagnosis: Comparison with Open Technique

Introduction. Biliary atresia is a surgical cause of prolonged jaundice, which needs to be diagnosed with cholangiography that has traditionally been performed via laparotomy. Laparoscopic assistance has lately been introduced to avoid unnecessary laparotomy. We aim to evaluate the benefits of the laparoscopy-assisted cholangiography and compare it to the traditional procedure via laparotomy. Patients and Method. The medical records of the cases who had undergone cholangiography for prolonged jaundice between 2007 and 2014 were analyzed. The patients were grouped according to cholangiography technique (laparotomy/laparoscopy). The laparoscopy and laparotomy groups with patent bile ducts were focused and compared in terms of operation duration, postoperative initiation time of enteral feeding, and full enteral feeding achievement time. Results. Sixty-one infants with prolonged jaundice were evaluated between 2007 and 2014. Among the patients with patent bile ducts, operation duration, postoperative enteral feeding initiation time, and the time to achieve full enteral feeding were shorter in laparoscopy group. Conclusion. Laparoscopic cholangiography is safe and less time-consuming compared to laparotomy, with less postoperative burden. As early age of operation is a very important prognostic factor, laparoscopic evaluation should be an early option in work-up of the infants with prolonged jaundice with direct hyperbilirubinemia, for diagnosis/exclusion of biliary atresia

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

Anesthesia for rigid bronchoscopy in children: single center experience

WOS: 000437950900022Purpose: Rigid bronchoscopy is performed by general anesthesia because of inspection, taking sample and extraction of foreign body in airway. In this study, anesthesia methods, perioperative complication and hospitalization time of children performed rigid bronchoscopy was retrospectively noted. Materials and Methods: Seventy-four children performed rigid bronchoscopy were included to the study in between Jan/2015-Mar/2017. The data of patients were acquired from Nucleus Medical Information System and anesthesia registration forms. Major complaint, perioperative features, anesthesia managements, and hospitalization time were evaluated. Results: Median age was 24 (3-156) months. Forty-one (55.4%) were male and 33 (44.6%) were female. The patients were received for complaint of foreign body aspiration suspicion (40.5%) and cough (31.1%). 52.7% of patients' lung auscultation and 67.6% of their lung x-ray were found to be normal. Intravenous agents (91.8%) and non-depolarizing neuromuscular blockers (100%) for anesthesia induction and manual controlled ventilation were used. Foreign bodies were found and extracted in 58.1% of the patients. Sugammadex was used for neuromuscular block antagonism in 46% of the patients. There was one pneumothorax, and 5 patients were received to intensive care unit by intubated and supported by mechanical ventilation. Conclusion: Rigid bronchoscopy is safely performed by good managed anesthesia. Meticulous evaluation of patients preoperatively and intense follow up of patients intra-and postoperatively are very important for the prevention of potential complications

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

The Comparison of Preemptive Oral Tramadol, Gabapentin Tramadol and Parasetamol Tramadol Combination on the Efficacy of Postoperative Pain Control in Breast Reduction Surgery

Purpose: Application of tramadol by intravenous patient controlled analgesia (PCA) is a routine method for controlling postoperative pain in the breast reduction operations. It was aimed to compare the efficacy of preemptive oral gabapentin/tramadol and parasetamol/tramadol combination usage on the postoperatif tramadol consumption in patients undergoing breast reduction operation. Material and Methods: Our study was held on 54 patients (ASA I-III, aged between 18-65 yr) undergoing breast reduction operation. Patients randomly divided into three groups. Group I were received 600mg tablet gabapentin and 35mg drop tramadol one hour before the operation. Group II were received 500mg tablet parasetamol and 35mg drop tramadol one hour before the operation. Group III (Control group) were received 35mg drop tramadol one hour before the operation. 30 minutes before the end of operation, 1mg/kg i.v. tramadol and 10mg metoklopramid HCL three groups were administred. After the end of operation, three groups were started to receive tramadol infusion and intravenous patient controlled analgesia (PCA) application (300 mg diluated with 0,09% 100cc SF, 0,2 mg/kg PCA, 15 min locked in time). Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects (nausea and vomiting, diplopia, dizziness) were recorded and evaluated. Results: Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects of groups were similar to each other. Peroperative second hour DKB values and postoperative twelfth hour additional analgesic need of second group was found higher compared to other groups. There were no significantly differences in the groups except diplopia. It was found higher in favour of the first group. Conclusion: Application of tramadol/gabapentin, tramadol/parasetamol and low dose tramadol (35mg) in patients undergoing breast reduction operation did not affect intraoperative hemodinami. The tramadol combined with postoperatif HKA also does not cause any differences among postoperative pain scores, 24 hours total tramadol consumption and additional analgesia need except twelfth hour. It was concluded that the side effects in group applied gabapentin were similar except diplopia. [Cukurova Med J 2013; 38(3.000): 417-425

Effect of Ultrasound Guided Rectus Sheath Block on Postoperative Analgesia after Laparotomy with Transverse Incision in Children

Purpose: Rectus sheath block have been used for postoperative pain control in adult patients undergoing abdominal surgery. To investigate the effect of the ultrasound guided rectus sheath block (RSB) with levobupivacaine on both intraoperative sevoflurane consumption and postoperative analgesia after laparotomy with transverse incision in children. Material and Methods: Forty patients with ASA I-II physical status, aged 3-7 years and undergoing laparotomy with transverse incision were randomly allocated into two groups. Patients were administered general anesthesia and before the beginning of surgery ultrasound guided RSB with 0.2 mL/kg, 0.25% of levobupivacaine and thirty minutes before the surgery the loading dose of morphine of 0.1 mg/kg intravenously were received in group RSB and group M, respectively. Analgesic drug pump with 0.01 mg/kg bolus doses of morphine and 30 minutes lockout interval was set up postoperatively in both groups. Concentrations (%) and consumed amounts (mL/h) of sevoflurane during the surgery and systolic and diastolic blood pressure, heart rate, and peripheral oxygen saturation values were recorded both intraoperative and postoperative period in each groups. Analgesic consumption with postoperative analgesic drug pump, FLACC pain scores, sedation level, nausea, vomiting, supplemental analgesic requirement and side effects were also recorded. Results: Demographic data and hemodynamic parameters were similar in both groups excepting that systolic arterial pressure values were reduced in group RSB than in group M. Inhaled concentration and consumed amounts of sevoflurane were decreased in group RSB compared with group M. Averages of consumptions of sevoflurane were 18.7+/-2.1 mL/h and 21.5 +/-2.9 mL/h in group RSB and group M, respectively (p<0.001). Postoperative FLACC scores, sedation scores, and morphine consumption for 24 hours were lower in group RSB than in group M (p<0.001). Three patients had nausea in group M, however no nausea and vomiting was observed in group RSB and any patients did not need supplemental analgesia postoperatively. Conclusions: Ultrasound guided RSB is superior to intravenous morphine according to intraoperative anesthetic gas consumption and postoperative pain control in children undergoing abdominal surgery using transverse incision. [Cukurova Med J 2015; 40(3.000): 534-541

Comparing the Laryngeal Mask Airway, Cobra Perilaryngeal Airway and Face Mask in Children Airway Management

WOS: 000382992900005PubMed ID: 27366563Objective: We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery. Methods: In this study, 90 cases of 1-14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%-50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively. Results: There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p<0.05). Conclusion: We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA

Comparison of neostigmine and sugammadex on postoperative nausea and vomiting in patients undergoing laparascopic cholecystectomy surgery

WOS: 000437950000008Purpose: The aim of this study is to compare the effects of neostigmine and sugammadex on the postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy surgery. Materials and Methods: Sixty patients (ASA I-III) and with a predicted operation time not exceeding 150 minutes were included to the study. Patients were divided into two groups. The first group received neostigmin, the second group received sugammadeks respectively. For anesthesia induction, all patients were applied thiopental (5-7 mg kg-1) and rocuronium (0.5 mg kg-1) intravenously and endotracheal entubation was provided. The lungs were ventilated with N2O (67%) and oxygen mixture (FiO2 33%) and anesthesia was maintained with desflurane. After completion of the surgery, cessation of desflurane and N2O while the last skin sutures were closured and neuromuscular blockade was reversed with atropine and neostigmine or sugammadeks. Extubation time and recovery time, postoperative hemodynamic variables and the other advers effects were recorded. Results: Extubation and recovery times were shorter in group sugammadex than in group neostigmine. Postoperative nausea and vomiting was lower in sugammadex group than neostigmine group at first twenty minutes, but this diffference was not significant. Conclusion: when neostigmine or sugammadex were applied for decurarization after general anesthesia with desflurane there is no superiority between sugammadeks or neostigmine for postoperative nausea and vomiting

Anesthetic Approach to a Child with Noonan's Syndrome

Noonan syndrome is characterized by fascial and physical features along with congenital heart disease. In these patients, fascial features include short webbed neck, micrognathia, limited mouth opening and high arched palate. Pulmonary stenosis and hypertrophic obstructive cardiomyopathy are highly prevalent in Noonan's syndrome. The anesthetic management is important because of difficult airway and severe cardiac abnormalities. We reported that anesthetic management of a child with Noonan's syndrome. [Cukurova Med J 2015; 40(Suppl 1): 47-50

The Effect of Sevoflurane and Dexmedetomidine on Pulmonary Mechanics in ICU Patients

WOS: 000468363500007PubMed ID: 31183467Objective: In intensive care unit (ICU) patients, intravenous (iv) and volatile agents are used for sedation. The aim of the present study was to investigate the effects of dexmedetomidine and sevoflurane on pulmonary mechanics in ICU patients with pulmonary disorders. Methods: After approval of the ethical committee and informed consent between the ages of 18-65 years were obtained, 30 patients with an American Society of Anesthesiologist status I-III. who Were mechanically ventilated, who had pulmonary disorders and who needed sedation were included in the study. Exclusion criteria were severe hepatic, pulmonary and renal failures; pregnancy; convulsion and/or seizure history; haemodynamic instability and no indication for sedation. Patients were divided into two groups by randomised numbers generated by a computer. For sedation 0.5%(-10/0) sevoflurane (4-10 mL h(-1)) was used by an Anaesthetic Conserving Device in Group S (n=15), and iv dexmedetomidine infusion (1 mu g(-1) kg(-1) 10 min(-1) loading and 0.2-0.7 mu g(-1) kg(-1) maintenance) was performed in Group D (n=15). Arterial blood gas analysis, airway resistance, positive end expiratory pressure (PEEP), frequency, tidal volume (TV), peak airway pressure (Ppeak), static pulmonary compliance and end-tidal CO2 values were recorded at baseline, 1, 3, 6, 9, 12 and 24 h. Results: Demographic data, airway resistance, PEEP frequency, TV, Ppcak and static pulmonary compliance values were similar between the groups. PaCO2 and end-tidal CO(2)values were higher in Group S than in Group D. Sedation and patient comfort scores were similar between the two groups. Conclusion: Both sevoflurane and dexmedetomidine arc suitable sedative agents in ICU patients with pulmonary diseases