Laparoscopic Cholecystectomy in Elderly Patients

Laparoscopic surgery can be safely applied in the elderly. Complications can be minimized by carefully selecting patients aged 80 years or older and operating on these patients with experienced teams with good technical capabilities

Sedación y Analgesia en Colonoscopia Electiva: Propofol-fentanilo versus Propofol-Alfentanilo

ResumenJustificativa y objetivoLa sedación y la analgesia están recomendadas en la colonoscopia para propiciar la comodidad, porque son procedimientos invasivos y pueden ser dolorosos. Este estudio tuvo el objetivo de comparar las combinaciones de propofol-alfentanilo y propofol-fentanilo para la sedación y la analgesia en pacientes sometidos a la colonoscopia electiva.MétodosEstudio prospectivo y aleatorio. Participaron en el estudio 80 pacientes, ASA I-II, entre 18 y 65 años. La inducción de sedación y la analgesia fue hecha con propofol (1 mg.kg-1) y fentanilo (1 μg.kg-1) en el grupo propofol-fentanilo (PF) y con propofol (1 mg.kg-1) y alfentanilo (10 μg.kg-1) en el grupo propofol-alfentanilo (PA). Para el mantenimiento, dosis adicionales de propofol se administraron en bolos de 0,5 mg.kg-1 para obtener las puntuaciones de 3-4 en la Escala de Sedación de Ramsey (ESR). Se registraron los datos demográficos, la frecuencia cardíaca, la presión arterial promedio (PAP), la saturación de oxígeno de la hemoglobina (SpO2), los valores de la ESR, el tiempo de colonoscopia, la dosis total de propofol, las complicaciones, el tiempo de recuperación y el tiempo para el alta, como también las puntuaciones de satisfacción del colonoscopista y del paciente.ResultadosLa PAP a los 15 minutos en el Grupo PA fue significativamente mayor que en el Grupo PF (p = 0,037). La frecuencia cardíaca promedio del grupo PA fue mayor al inicio que en las mensuraciones posteriores (p = 0,012, p = 0,002). El promedio de la dosis total de propofol del Grupo PA fue significativamente mayor que la del Grupo PF (p = 0,028). El tiempo promedio de recuperación del grupo PA fue significativamente mayor que el del grupo PF (p = 0,032).ConclusionesEl Fentanilo proporciona mejores condiciones de operación y reduce la necesidad de dosis adicionales de propofol. Esas ventajas reducen el tiempo de recuperación. Por tanto, el propofol-fentanilo es superior al propofol-alfentanilo para la sedación y la analgesia en la colonoscopia

Sedation-Analgesia in Elective Colonoscopy: Propofol-Fentanyl Versus Propofol-Alfentanil

AbstractBackground and objectivesSedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients.MethodsThis prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1μg.kg-1 fentanyl, 1mg.kg-1 propofol in the propofol-fentanyl group (Group PF) and 10μg.kg-1 alfentanil, 1mg.kg-1 propofol in the propofol-alfentanil group (Group PA). Patients’ scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5mg.kg-1 bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores.ResultsMAP at the 15th minute in Group PA was significantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was significantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was significantly longer than that of Group PF (p = 0.032).ConclusionFentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy

A case report of multiple anesthesia for pediatric surgery: 80 anesthesia applications in a period of 6 years

Abstract Background The side and adverse effects of anesthesia and its neurotoxicity to children have become major concerns of anesthesiologists in recent years. Currently, no clinical trials have provided clear evidence indicating the suitable minimum age for a patient’s first anesthetic application, importance of anesthesia duration, number of anesthetic applications or interval between two consecutive anesthesia applications. A very rare case concerning the side, adverse and neurotoxic effects of multiple anesthesia in a child is presented. Case presentation A case of a 9-year-old child who received 80 applications of anesthesia in 6 years because of corrosive esophagitis is presented. The commonly used anesthetic agents were propofol, fentanyl, rocuronium and sevoflurane. Conclusion In our case, there were no permanent side or adverse effects due to multiple anesthesia. The minimal psychological and scholastic problems of our case were tied to frequent hospitalization by the pediatric psychiatry consultation

The Comparison of efficacy of lornoxicam and paracetamol for preemptive analgesia in mice

Objectives: Preemptive analgesia means that block the peripheral and central nociception as an analgesic regime apply before the painful stimulus. We aimed compared preemptive analgesic properties of lornoxicam with paracetamol on mice in this experimental study.Materials and methods: Experimental mice were divided into three groups. Before the formalin injection in the right front foot of mice, saline administered in first group, lornoxicam administered in second group and paracetamol in third group intraperitoneally. Responses to pain of mice were recorded after the procedure during the 60 min.Results: While appears to be lornoxicam more effective than the control group in the first 10 minutes, paracetamol provided more effective analgesia lornoxicam and control group within 11-60th min. and 0-60th min.Conclusion: Although lornoxicam provided significant benefit in acute phase, paracetamol was found more effective in tonic phase and total time in this study

Knowledge and experience regarding perioperative anaphylaxis among anesthesiologists in Istanbul

Anesthesiologists are among the physicians with the highest probability of encountering cases with anaphylaxis. Therefore, they should be familiar with recent developments in anaphylaxis diagnosis and treatment. This study assessed the personal experiences and knowledge of the current diagnostic criteria and management of anaphylaxis among anesthesiologists. Anesthesiologists working in Istanbul were randomly selected and requested to complete a 16-item questionnaire related to their experiences with perioperative anaphylaxis and knowledge about current anaphylaxis guidelines. The study group consisted of 203 physicians; 10.8% of them reported having experienced any case with perioperative anaphylaxis during their own practice. The leading responsible agents were penicillins and other antibiotics (36.3%), followed by neuromuscular blocking agents (32%). Most of the physicians reported hypotension as the most important sign of anaphylaxis under general anesthesia and preferred epinephrine as the first-line medication during anaphylaxis. Antibiotics and neuromuscular blocking agents were the most common causative agents identified in the cases of perioperative anaphylaxis experienced by our study group. Like other health care providers, anesthesiologists should be aware of recent advances in anaphylaxis diagnosis and treatment

Can supreme™ laryngeal mask airway be an alternative to endotracheal intubation in laparoscopic surgery?

Background and objectives: In laparoscopic surgical procedures, experts recommend tracheal intubation for airway management. Laryngeal mask airway (LMA) can be a good alternative to intubation. In this case series, we aimed to examine the use of the Supreme™ LMA (SLMA) in laparoscopic surgical practice. Methods: We planned the study for sixty patients between the ages of 18 and 60, who would undergo laparoscopic surgery. We recorded one, 15, 30, 45, and 60-minute peripheral O2 saturation (SpO2) and end-tidal carbon dioxide (EtCO2) values, heart rate and mean arterial blood pressure (MAP). We observed the duration of SLMA insertion, the rate of gastric tube applicability, whether nausea, vomiting, and coughing developed, and whether there was postoperative 1-hour sore throat. Results: The initial EtCO2 mean was lower than the EtCO2 means of 15, 30, 45, and 60 minutes (p < 0.0001) and the 15-minute EtCO2 mean was lower than other measured EtCO2 means. We observed the initial heart rate mean to be higher than the ones following the SLMA insertion, prior to the SLMA removal, and after the SLMA removal. The heart rate mean after the SLMA insertion was remarkably lower than the heart rate mean prior to the SLMA removal (p = 0.013). The MAP after the SLMA insertion was lower than the initial MAP means, as well as the MAP averages prior to after the removal of SLMA (p = 0.0001). Conclusion: SLMA can be a suitable alternative to intubation in laparoscopic surgical procedures in a group of selected patients. Keywords: Intubation, Intratracheal, Laryngeal Masks, Laparoscop