Effect of Low-flow Anesthesia Education on Knowledge, Attitude and Behavior of the Anesthesia Team

AbstractThe aim of this study was to evaluate the effect of education on the knowledge, attitude and behavior of anesthesiology staff and residents towards low-flow anesthesia. The staff and residents in the Department of Anesthesia and Reanimation, Zonguldak Karaelmas University were given theoretical and practical training in delivering low-flow anesthesia. To evaluate their attitudes and behaviors toward low-flow anesthesia, we collected data during the 6 months before training, during the first 3 months after training, and at 4–6 months after training. Anesthesia follow-up records, operation time, volatile anesthetic agent used, and the amount (in liters) of fresh gas low mid-anesthesia were recorded in all three stages. A total of 3,158 patients received general anesthesia and inhalation anesthesia was used in 3,115 of these patients. Our study group consisted of 2,752 patients who had no absolute or relative contraindications to low-flow anesthesia. While the mean fresh gas flow was 4.00 ± 0.00 L/min before training, this level dropped to 2.98 L/min in the first 3 months after training, and to 3.26 L/min in the following 3 months. The mean fresh gas flow was significantly lower at the two post-training assessments than before training (p < 0.05). In conclusion, low-flow anesthesia may be used more frequently if educational seminars are provided to anesthetists. The use of low-flow anesthesia may increase further by allocating more time to this technique in anesthesia training programs provided at regular intervals

Difficult Mask Ventilation in Obese Patients: New Predictive Tests?

Aim:The aim of our study was to evaluate specific factors in predicting difficult mask ventilation (DMV) in obese patients undergoing elective surgery.Methods:This prospective and observational study was performed in 90 obese patients. We assessed age, height, weight, sex, body mass index (BMI), dental structure, presence of facial hair, modified Mallampati test result, mouth opening, thyromental distance (TMD), sternomental distance, mandibular protrusion, mandibular length, neck circumference (NC), neck length, upper lip bite test result, height to TMD ratio, NC to TMD ratio (NC/TMD), and history of snoring and Obstructive Sleep Apnea syndrome for estimation of DMV.Results:The mean age of the patients was 40.9±9.4 years and the mean BMI was 44.7±6.2 kg/m2. Of all patients 38.9% were determined to have DMV. Clinical variables associated with DMV were male gender, mandibular length, snoring, NC, and NC/TMD. Multiple logistic regression analysis showed that male gender (p=0.047) and snoring (p=0.02) were independent factors.Conclusion:We believe that NC/TMD and ML are predictive tests for DMV in obese patients. Tests and measurements at the bedside are not sufficient alone and we believe that they will be more reliable when considered together

Efectos del mantenimiento de varias anestesias sobre los niveles séricos de selenio, cobre, cinc y hierro y la capacidad antioxidante

ResumenJustificación y objetivosInvestigar los efectos del mantenimiento de sevoflurano, desflurano y propofol sobre los niveles séricos de selenio, cobre, cinc, hierro y malondialdehído, las medidas de glutatión peroxidasa y la capacidad antioxidante.MétodosFueron ubicados en 3 grupos 60 pacientes programados para cirugía unilateral de miembros inferiores, realizada con torniquete bajo anestesia general. Fueron recogidas muestras de sangre para determinar los niveles séricos basales de selenio, cobre, cinc, hierro, malondialdehído y glutatión peroxidasa. La anestesia fue inducida con 2-2,5mg/kg−1 de propofol, 1mg/kg−1 de lidocaína y 0,6mg/kg−1 de rocuronio. En el mantenimiento de la anestesia, bajo gas portador de 50% de O2 y 50% de N2O (4L/min−1), sevoflurano a 1CAM fue administrado al grupo S; y desflurano a 1CAM al grupo D y bajo gas portador en mezcla de 50% O2 y 50% aire (4L/min−1), 6mg/kg/h−1 de propofol y 1μg/kg/h−1 de fentanilo fueron administrados al grupo P. En el postoperatorio se recogieron de nuevo muestras de sangre.ResultadosSolamente en los grupos S y P los niveles de malondialdehído disminuyeron en las 48h del postoperatorio; los niveles de glutatión peroxidasa aumentaron en comparación con los valores basales. Los niveles de selenio disminuyeron en el grupo S y en el grupo P, los niveles de cinc disminuyeron en el grupo P, los de hierro disminuyeron en todos los grupos y no hubo alteración en los niveles de cobre en ningún grupo en el período postoperatorio.ConclusiónDe acuerdo con los marcadores de malondialdehído y glutatión peroxidasa, llegamos a la conclusión de que el mantenimiento de la anestesia general con propofol y sevoflurano activó el sistema antioxidante contra el estrés oxidativo y el uso de desflurano no tuvo efectos sobre el estrés oxidativo y el sistema antioxidante.AbstractBackground and objectivesIn this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity.Methods60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mg/kg−1 propofol, 1mg/kg−1 lidocaine and 0.6mg/kg−1 rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4L/min−1, 1MAC sevoflorane was administered to group S and 1MAC desflurane to group D; and under carrier gas of 50:50% O2:air 4L/min−1 6mg/kg/h−1 propofol and 1μg/kg/h−1 fentanyl infusion were administered to group P. At postoperative blood specimens were collected again.ResultsIt was observed that only in group S and P, levels of malondialdehyde decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in group S and group P, zinc levels decreased in group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period.ConclusionAccording to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system

Effects of Preoperative Anxiety and General Anesthetic Administration on Intraoperative Awareness in Patients Undergoing Cesarean Section

Aim:The aim was to investigate the effects of preoperative anxiety and general anesthetic administrations on intraoperative awareness among patients undergoing cesarean section.Methods:This prospective randomized study included 90 pregnant subjects. Preoperative anxiety was assessed using the Beck Anxiety Inventory. The patients were divided into three groups: group P received propofol 2.5 mg/kg, group T thiopental 5 mg/kg and group K received ketamine 1 mg/kg. Data on intraoperative hemodynamics, isolated forearm (IFA) responses and time to first pain and to first analgesic requirement evaluated using postoperative numerical rating scale were recorded. The Modified Brice Scale (MBS) was used to assess awareness.Results:The preoperative anxiety levels in the groups were low and demographic data were similar (p>0.05). There was no statistically significant difference in IFA response between the groups (p>0.05). Group T had higher MAP at all times and NRS values at hour 0 compared to the other groups (p<0.05), and had shorter time to first analgesic requirement (p<0.05). MBS responses were evaluated as recall in 12 cases in group K, four in group P and three in group T.Conclusion:As the anxiety levels in pregnants were low, the superiority of agents used in induction over each other regarding awareness could not be shown

DEVELOPMENT AND CHARACTERIZATION OF HEMP-CONTAINING HYBRID YARNS FOR CLOTHING

Known for its sustainable properties, the usability of hemp instead of conventional cotton hybrid yarns for clothing wasinvestigated by spinning hybrid ring yarns using conventional cotton, viscose-hemp, and organic cotton-viscose-hempblends for the sheath and elastane and polyester (Lycra and T400) for the core in the yarn structure. Unevenness, yarnimperfections, hairiness, tenacity, and breaking elongation properties of the spun hybrid yarns were examinedcomparatively by statistical analysis methods. The findings revealed that sheath fiber type, number of components inthe yarn structure, and blend ratio were influential factors on yarn quality. Using hemp fiber in the yarn structureslightly decreased the yarn properties, except for tenacity, in general. This situation was more visible in hybrid yarns,which have three different fibers in the sheath. Blending viscose and hemp fibers in the yarn sheath structure provided asynergetic effect, improving the weak properties of both fibers. These yarns had nearly the same tenacity values (from12.98 to 15.47) as conventional cotton yarns (from 15.24 to 16.8), which could be explained by the fact that hemp fiberhas a higher tenacity value (45 cN/tex) than other fibers. Moreover, these yarns had the highest elongation values (from15.88 to 10.79) due to the good elongation properties of the viscose fibers (20%), compared to other sheath fibers. As aresult, when the produced yarns were evaluated in terms of sustainability and performance, viscose-hemp-blendedyarns had the optimum yarn properties.&nbsp;&nbsp;</p

The effects of ıntrathecal levobupivacaine and opioid combinations in caesarean operations

Amaç: Çalışmamızda, spinal anestezi ile elektif sezaryen operasyonu planlanan gebelerde; levobupivakain, fentanil ve morfin kullanılarak hazırlanan farklı intratekal kombinasyonların anne ve yeni doğan üzerine etkilerinin araştırılması amaçlandı. Gereç ve Yöntem: Sezaryen operasyonu planlanan, ASA I-II grubundan 120 gebe çalışmaya alındı. Randomize, dört gruba ayrılan olgulardan Grup L’ye (n=30) 12 mg % 0,5 levobupivakain, Grup LF’ye (n=30) 10 mg % 0,5 levobupivakain + 12,5 µg fentanil, Grup LM’ye (n=30) 11 mg % 0,5 levobupivakain + 100 µg morfin, Grup LFM’ye (n=30) 11 mg % 0,5 levobupivakain + 5 µg fentanil + 50 µg morfin intratekal uygulandı. Bulgular: Fentanil eklenen gruplarda hemodinami daha fazla etkilendi ve duyusal blok düzeyi daha hızlı yükseldi (p<0.05). Morfin eklenen gruplarda duyusal blok düzeyi daha uzun sürede yükseldi, cerrahi başlama süresi uzadı, ayrıca duyusal ve motor blok daha geç sonlandı (p<0.05). Postoperatif analjezi kalitesi morfin eklenen gruplarda daha iyi sağlandı (p<0.05). Yalnızca levobupivakain kullanımı intraoperatif bulantı insidansını, morfin eklenmesi postoperatif kaşıntıyı artırdı (p<0.05). Her dört uygulama da yeni doğanda yan etkiye neden olmadı. Sonuç: Levobupivakaine, morfin ve fentanil eklenerek oluşturulan kombinasyonun duyusal blok düzeyini hızla yükseltip analjezi kalitesini artırdığı, özellikle preoperatif dönemde iyi hidrasyon sağlanarak, yakın hemodinamik monitörizasyon ile spinal anestezi altında gerçekleştirilecek sezaryen operasyonlarında iyi bir alternatif olacağı kanısına varıldı.Aim: We aimed to investigate the effects of levobupivacaine, fentanyl and morphine&amp;#8217;s different intrathecal combinations on parturients planned to have elective caesarean operation with spinal anesthesia. We have also investigated the effects of these combinations on newborns. Material and Methods: One hundred and twenty parturients of ASA physical status I-II planned to have Caesarean operation enrolled in the study. Parturients randomized into four groups and Group L received 12 mg 0.5% levobupivacaine, Group LF received 10 mg 0.5% + 12.5 &micro;g fentanyl, Group LM received 11 mg 0.5% levobupivacaine + 100 &micro;g morphine and Group LFM received 11 mg 0.5 % levobupivacaine + 5 &micro;g fentanyl + 50 &micro;g morphine intrathecally. Results: Haemodynamics were affected much more in groups which included fentanyl and sensorial block level raised up faster (p<0.05). In groups where morphine was added sensorial block level increased slowly, time to start surgery get longer and in addition sensorial and motor block ceased later (p<0.05). Postoperative analgesia quality was better in morphine added groups (p<0.05). Levobupivacaine use by itself increased intraoperative nausea incidence whereas morphine addition increased postoperative itching (p<0.05). We did not observe any side effects in infants of four groups. Conclusions: We conclude that combination composed by fentanyl and morphine addition to levobupivacaine rises sensorial block time faster, improves analgesia quality, can be a good alternative for caesarean operations that will be performed under spinal anesthesia with close monitorization and provided by preoperative sufficient hydration

Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain

Comparison of the effects of oral midazolam, ketamine and tramadol on postoperative agitation related to sevoflurane in children

Amaç: Çalışmamızda, coçuk hastalara premedikasyon amacıyla verilen oral midazolam, ketamin ve tramadolün, sedasyon kalitesi, postoperatif ajitasyon ve ağrı üzerine etkilerini araştırmayı amaçladık. Yöntemler: 2-12 yaş arası, Amerikan Anestezistler Derneği (ASA) I-II risk grubunda, 60 olgu çalışmaya dahil edildi. Operasyondan 30 dk. önce; Grup M’ye (n=20) 0,5 mg kg-1 midazolam, Grup K’ya (n=20) 6 mg kg-1 ketamin ve Grup T’ye (n=20) 2 mg kg-1 tramadol damla; 0,4 ml kg-1 vişne suyu içinde, toplam 10 ml volümü geçmeyecek şekilde oral olarak verildi. Tüm hastalarda ortalama arteriyel kan basınçları (OAB), kalp atım hızı (KAH), Ramsey sedasyon skoru (Rss) ve Sedasyon ajitasyon skoru (Sas), ilaç öncesi ve ilaç sonrası 10 ve 30. dakikalarda, indüksiyon öncesi, operasyon sonrası 5, 10, 15, 30, 45, 60, ve 90. dakikalarda kaydedildi. Anestezi indüksiyonu lidokain, propofol ve rokuronyum ile yapıldı. Anestezi idamesi sevofluran, N2O ve O2 ile sağlandı. Ekstübasyon zamanı, yeterli spontan solunum zamanı, Alderete skorları ve derlenme süresi kayıt edildi. Postoperatif ağrının değerlendirilmesinde, fasiyal ağrı skoru (FPS) kullanıldı. Bulgular: Gruplar arasında demografik veriler açısından fark yoktu. KAH Grup T’de, anlamlı olarak düşük bulundu. Operasyon sonrası 30 ve 45. dakikalarda Grup M’nin daha ajite olduğu saptandı. Grup K’da Aldrete skorları daha düşüktü. Grup T’de FPS değeri daha düşüktü (p<0,05). Gruplar arasında postoperatif izlem sırasında ajitasyon sıklığı açısından fark bulunamadı. Sonuç: Ketamin pediatrik hastalarda postoperatif sedasyon ajitasyon skorlarını düşürebilmekle birlikte, derlenme skorlarını da düşürebilir. Tramadol premedikasyonunda yeterli sedasyon sağlamamakla birlikte postoperatif ağrı skorlarını düşürmektedir. Ancak her üç ajan arasında ajitasyon-deliryum sıklığı açısından fark bulunmamaktadır. (Haseki Tıp Bülteni 2010; 48: 146-52)Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain. Methods: Sixty pediatric patients (aged 2-12 years) with American Society of Anesthesiology (ASA) classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP), heart rates (HR), Ramsey sedation scores (Rss) and sedation agitation scores (Sas) were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2. Recovery times, Alderete scores and facial pain scores (FPS) were recorded. Results: There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05). There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium. Conclusion: Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents. (The Medical Bulletin of Haseki 2010; 48: 146-52

The effect of gender on reversal of non-depolarizing block with Sugammadex

Sugammadex is a rapid and selective aminosteroid agent that has entered use recently. We aimed to research the effect of gender on reversal of non-depolarizing block with sugammadex. We designed a prospective study. The research included a total of 100 cases who underwent rhinoplasty operation administered general anaesthesia. Cases were divided according to gender as male (Group M) and female (Group F). At the end of the operation for patients with TOF value 25%, patients were given 2 mg kg-1 iv sugammadex. Duration from the rocuronium administration until the TOF value was zero(TOF0), the time from sugammadex administration until TOF reached from 25% to 90% was recorded (TOF25-90). The time from TOF90 to extubation was named the extubation duration. From the time the patients entered the PCU until Aldrete score was &#8805;9 was named the recovery duration and recorded. The time for the groups to TOF25-90 was 123.84 ± 38.03 s in Group M and 122.06 ± 30.461 s in Group F (p &gt; 0.05). The extubation duration was 189.68 ± 41.37 s in Group M and 206.50 ± 45.99 in Group F (p = 0.316). The recovery time was 8.26 ± 14 min in Group M and 8.48 ± 14.23 min in Group F (p = 0.328). After the administration of sugammadex, there was no difference observed between the groups in terms of the TOF25-90 duration, recovery and extubation duration. As a result, conclusion was reached that gender did not affect rocuronium reversal with sugammadex. [Med-Science 2018; 7(2.000): 306-11

The Effect of Levobupivacaine and Bupivacaine on QT, Corrected QT (Qtc), and P Wave Dispersions in Cesarean Section

Background and Objectives: In our study we aimed to investigate the effect of bupivacaine and levobupivacaine on QT, corrected QT (QTc), and P wave dispersion durations during spinal anesthesia in cesarean section. Methods: Sixty parturients scheduled for elective cesarean section in ASA I-II risk groups were included in the study. Baseline electrocardiographic (ECG) records of the patients were obtained in the operation room. Heart rate (HR), non-invasive blood pressure (NIBP), peripheral oxygen saturation (SpO2) and respiration rates (RR) were recorded. Venous cannulation was performed with 18G cannula and fluid preload made with 10 mL.kg-1. Lactated Ringer solution. After fluid preload, second ECG recordings were taken and the patients were randomly separated into two groups. Group B (n = 30) received 10 mg of bupivacaine and Group L (n = 30) received 10 mg of levobupivacaine for spinal anesthesia. ECG recordings were repeated at 1, 5 and 10 minutes after spinal block. HR, NIBP, SpO2, RR and sensory block levels were also recorded at the same time intervals. At predetermined time intervals of spinal anesthesia, P wave dispersion (Pwd), QT dispersion (QTd), and QTc dispersion (QTcd) durations were measured from ECG records. QT and QTc durations are calculated with Bazzett formula. Results: There was no difference between two groups according to block levels, hemodynamic parameters, Pwd, QTd, QTc and QTcd durations. Conclusion: Bupivacaine and levobupivacaine may be preferred in spinal anesthesia in pregnant patients who have extended Pwd and QTcd preoperatively. Keywords: Anesthesia, Spinal, Cesarean Section, Bupivacaine/levobupivacaine, Electrocardiograph