Comparison of the Proseal, Supreme, and I-Gel SAD in Gynecological Laparoscopic Surgeries

We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp., P=0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel

Clinical Study Comparison of the Proseal, Supreme, and I-Gel SAD in Gynecological Laparoscopic Surgeries

We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp., = 0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel

Anesthetic Management of a Patient with Motor-sensory polyneuropathy [Motor-Duyu Polinoropatili Olguda Anestezi Yonetimi]

Polyneuropathy that characterized by diffuse axonal degeneration or multifocal segmental demyelination is neuropathy and usually influence peripheral nerves. It can lead to respiratory failure with muscle weakness, atrophy, fasciculations, the involvement of the respiratory muscles. Increased risk of malignant hyperthermia, potential airway problems that may develop after extubation with effected the respiratory muscles, prolonged duration of recovery from non-depolarizing neuromuscular blockade, the discussion of the used neuraxial anesthesia makes anesthesia management important in patient with polyneuropathy. In this presentation aimed to provide general anesthesia management without neuromuscular blockade a patient with motor-sensory polyneuropathy mainly demyelinating who underwent posterior instrumentation due to scoliosis. [Med-Science 2016; 5(3.000): 884-8

Our clinical experiences in ultra-sound guided peripheral nerve blocks: a retrospective evaluation

Peripheral nerve blocks are commonly used in extremity surgeries for anesthetic and/or postoperative analgesic purposes with general anesthesia. Ultra-sound (US) guided peripheral nerve blocks that have been used in recent years provide many superiorities in comparison with other conventional methods. The objective of this retrospective study was to carry out a retrospective evaluation of our experiences regarding 400 patients on whom US guided peripheral nerve was applied at the Inonu University Faculty of Medicine, Department of Anesthesiology and Reanimation during June 2012-March 2016. Demographic data of the patients, block type, purpose of block (for surgical or analgesic), type and volume of the local anesthetic, type of US probe, needle length, block success, toxicity finding and complications were all recorded. Blocks were performed for analgesia in 16% of the patients and for anesthesia in 84%. Lidocaine+bupivacaine combination, bupivacaine+prilocaine combination and bupivacaine were used on 82%, 13% and 5% of the patients as local anesthetic agent, respectively. Linear US probe (6-13 MHz) was used for all patients. In conclusion, US guided peripheral nerve blocks provide adequate depth of anesthesia and analgesia. It was found to be safe and useful and may be a good alternative to general anesthesia. [Med-Science 2017; 6(2.000): 195-8

The Effect of Dexamethasone in Tramadol Induced Nausea and Vomiting

We aimed to investigate the efficacy of a single dose bolus of dexamethasone on tramadol induced nausea and vomiting in our study. After approval was taken from ethics committee and patients, a total of 60 ASA I-II patients who were planned to undergo total abdominal hysterectomy (TAH) under general anesthesia were included in this study. A patient-controlled analgesia device was explained for the patients with preoperative visit. After the non-premedicated patients were taken in the operation room, the routine monitorization was performed. Induction was provided with 1μg/kg of fentanyl, 2 mg/kg propofol and 0.1 mg/kg vecuronium. 6-8% concentration of desflurane in a mixture of 50% air and 50% O2 was used for maintenance of anesthesia. When the incision was started to be closed, the patients were randomized into two groups by envelope method. 8 mg iv dexamethasone (2 mL) was given for Group D (n=30), iv Saline solution (2 mL) was given for Group K (n=30). After the incision was closed, a loading dose of intravenous tramadol 1 mg/kg was administered in both groups. The patients were taken in the postanesthesia care unit by extubating following the antagonism of muscle relaxant at the end of surgery. The patient-controlled analgesia device was scheduled to be as infusion: no, bolus: 12 mg, lock-out time: 10 min, 24 hour dosing limit: 400 mg. The pain and nausea and vomiting scores, additional analgesic and antiemetic requirements, the total amount of tramadol consumption were recorded at post-operative recovery and postoperative 2, 4, 6, 12 and 24 hours. Although the incidence of nausea and vomiting, and pain scores at 2 and 4 hours were not statistically significant, they were lower in Gorup D compared to Group K (p>0.05). 14 patients in Group K required additional antiemetics and 12 patients in Group D required additional antiemetics (p>0.05). Six patients in Group K required additional analgesics and 4 patients in Group D required additional analgesics. Although the total amount of tramadol consumption was not statistically significant, it was lower in Group D compared to Group K. It was concluded that a single bolus dose of dexamethasone 8 mg has not reduced tramadol induced nausea and vomiting in patients who were planned to undergo TAH. [Med-Science 2016; 5(1.000): 94-101

Anesthetic Management on a Patient with Friedreichs Ataxia

Friedreichs ataxia is a rare (1:50 000) autosomal recessively inherited neurodegenerative disorder. Findings such as weakness in skeletal muscles, progressive difficulty in walking and extremity ataxia are prominent. Problems such as cardiac, endocrine, pulmonary and neuromuscular dysfunction may affect the anesthesia method of patients with Friedreichs ataxia. In this case, we wanted to present our anesthetic management to a patient with Friedreichs ataxia who underwent posterior spinal fusion operation due to kyphoscoliosis. [Med-Science 2013; 2(4.000): 928-34

Protective effects of melatonin and Β-D-Glucan against acetaminophen toxicity in rats

The aim of this study was to investigate the possible protective effects of melatonin and β-D-glucan against AA-induced liver injury in rats. Forty (SpraqueDawley male) rats were randomly divided into 5 experimental groups: sham, acetaminophen only (AA, 900 mg/kg), melatonin (10 mg/kg) + AA (MLT), β-D-glucan (50 mg/kg) + AA (β), and melatonin + β-D-glucan + AA (MLT+β) groups. All of the rats were killed on day 11 of the experiment. Histopathological changes and biochemical parameters including levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and liver tissue malondialdehyde (MDA), activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were determined to assess the liver function. MDA levels were the highest in the AA group whereas activities of SOD, CAT, and GPx in the liver tissue were found as lowest in this group. MDA activities were significantly lower in the MLT+β group than in the AA group. Only GPx activities in the MLT+β group were significantly higher than those in the MLT and β groups. The serum AST and ALT levels were increased significantly following treatment with AA (p < 0.001). Pretreatment with the antioxidant compounds decreased AST levels significantly but again, the levels were still significantly higher than the sham levels (p < 0.001). There were no statistically significant differences in the microscopic damage between the S, MLT, β, and MLT+β groups (p > 0.05). This finding can be attributed to the higher efficacy of the combination of melatonin and β-D-glucan in scavenging free radicals and stimulating the antioxidant enzymes. [Med-Science 2016; 5(2.000): 539-43