Uzamış postoperatif ağrının tedavisinde ultrason yardımıyla TAP blok - alternatif bir yaklaşım

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery

Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial

Background/Aims: To assess the effect of propofol supplemented with alfentanil or fentanyl on cognitive functions for sedation during elective colonoscopy. Materials and Methods: Patients (n=150, 18-65 years old, American Society of Anesthesiologists risk group I-III) scheduled undergo elective colonoscopy were included. They were randomized into three groups using the closed envelope methodpropofol-alfentanil (Group A), propofol-fentanyl (Group F), and propofol only (Group P).Group A patients were given an alfentanil (10 mcg/kg)-supplemented propofol bolus infusion and 5 mcg/ kg alfentanil when necessary. Group F patients were given fentanyl (1 mcg/kg)-supplemented propofol and 0.5 mcg/kg fentanyl when necessary. Group P patients were given 1 mg/kg propofol and 0.5 mg/kg propofol when necessary. Vital signs, depth of sedation, recovery parameters, and patient and endoscopist satisfaction were recorded. Trieger dot test (TDT) and Digit Symbol Substitution Test (DSST) were performed post procedure. Results: Demographic data were similar among all patients in the groups. Bispectral index values were lower in Group P (p<0.001). DSST scores were higher in Group A (p=0.004). TDT scores and Facial Pain Scale scores were higher in Group P (p<0.005). Apnea incidence (p=0.009) and Observer’s Assessment of Alertness/Sedation Scale scores (p=0.002) were also higher in Group P. Patient satisfaction and endoscopist satisfaction were similar among all patients. Conclusions: Compared with propofol-alfentanil and propofol-fentanyl, propofol alone is associated with an increased incidence of apnea, drug consumption, and reported pain. Propofol-alfentanil has a less negative effect on cognitive functions than propofol alone or propofol-fentanyl

Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial

Purpose: To compare hemodynamic effects of two different modes of ventilation (volume controlled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic gynecology surgeries with exaggerated Trendelenburg position. Methods: Thirty patients undergoing laparoscopic gynecology operations were ventilated using either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording Analytical Method by radial artery cannulation in addition to peak and mean airway pressures and expired tidal volume. Results: The only remarkable finding was a more stable cardiac index in Group PCVG, where other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while peak airway pressure was lower in Group PCVG. Conclusion: PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated Trendelenburg position in laparoscopic surgery

The effects of repeated sevoflurane anesthesia on renal tubular enzymes in rabbits

Yeni inhalasyon ajanlarından birisi olan sevofluran, organik ve inorganik florür metabolitlerine metabolize olmaktadır. Açığa çıkan serbest florid iyonu, nefrotoksisiteden sorumlu tutulmaktadır. Bu çalışmada; deneysel olarak tekrarlayan uygulamalarda farklı konsantrasyonlarda sevofluran kullanımının renal etkileri, önemli üriner indikatörlerden n-asetil-d- glukozaminidaz (NAG), alkalen fosfataz (ALP), ve gamma glutamil transferaz (GGT) atılımı incelenerek araştırıldı. Çalışmada 14 adet Yeni Zellanda tipi erkek tavşan kullanıldı. Tavşanlar rastgele 2 gruba ayrıldı (n=7). Grup I'deki tavşanlara % l, Grup H'deki tavşanlara % 3 sevofluran, 4 Ldk-1 O2+N2O karışımı içinde 3 gün ardarda, 3 saat süreyle uygulandı. Her iki grubun 24 saatlik idrarları özel bir düzenek ile preoperatif dönemde ve her anestezi uygulamasından sonra toplandı. Son anesteziden 5 gün sonra 24 saatlik idrarları toplandı. İdrar örneklerinden NAG, ALP ve GGT çalışıldı. Ayrıca, preoperatif dönemde ve anestezi uygulamalarını takiben tavşanların kulak yenlerinden kan örnekleri alınarak, kan üre azotu (BUN) ve kreatinin (Kr) çalışıldı. Sonuçlarda, üriner NAG seviyesinde Grup II de 3. günde preoperatif değerlere göre belirgin artış, üriner GGT seviyesinde de, 2. ve 3. günlerde anlamlı artış izlendi. Her iki grupta da, BUN, kreatinin ve idrar ALP değerlerinde fark saptanmadı. NAG ve GGT düzeyleri 9. günde preoperatif değerlere döndü. Sonuç olarak, tekrarlayan sevofluran uygulamalarının, renal sistem üzerinde oluşturduğu değişikliklerin geçici olduğu kanaatine varıldı.Sevoflurane, one of new inhalation agents, is metabolized to organic and inorganic fluoride metabolites. Nephrotoxicity is due to free fluoride. In this study; we investigated the renal effects of repeated and different concentrations of sevoflurane anesthesia, experimentally. Sensitive urinary indicators n-asetil-d- glukozaminidaz (NAG), alkalen phosfatase (ALP), and gamma glutamil transferase (GGT) were assessed. This study was performed in 14, male New Zelland rabbits. Rabbits were divided into two groups (n=7). Group I (n=7) received sevoflurane 1 % and Group II (n=7) 3 % sevoflurane with O2+N2O ( 4 Lmin') 3 hours a day for 3 days Urine samples were collected via a special apparatus for 24 hours preoperative and after anesthesia. Urine samples were taken five days after the last administration of anesthesia and NAG, ALP and GGT levels in urine were determined. Blood samples taken from ear veins were obtained to determine BUN and Creatine. In Group II, urinary NAG levels increased significantly on the third day and a significant increase in GGT was observed on second and third days. There was no significant change in BUN, Cre and urinary ALP. NAG and GGT levels returned to normal on the 9th day. We concluded that, the effects of repeated sevoflurane administration on renal system are temporary

Anesteziyologların İdrar Sondasına Bağlı Mesane Rahatsızlığının Tedavisine Yaklaşımı: Bir Anket Çalışması

Objective: Urinary catheterization causes catheter related bladder discomfort (CRBD) in the early postoperative period following all surgeries. CRBD mostly develops after urological interventions and has two independent predictors: Male gender and urinary catheters ?18F. We aimed to investigate the awareness of Anesthesiology and Reanimation specialists to CRBD and its treatment. Methods: After ethics committee approval, a questionnaire with informed consent of 20 multiplechoice and open-ended questions was transferred to docs.google.com. and Turkish Society of Anesthesiology and Reanimation Specialists were contacted for contribution. Results: 144 anesthesiologists, 26-66 years old (39.5±8.02 years), 54.5% males, 45.5% females, 66.4% with a teaching position and 55.5% with >10 years of experience participated. 54.4% reported encountering >1 CRBD per week and mostly following urology (70.9%), obstetrics and gynecology (52.5%) and general surgery (51.1%) cases. The frequency and severity (66% and 69.5%) of CRBD was reported higher in male patients. 94.4% agreed that CRBD should be treated. 37.8% believed the surgeon should manage CRBD, 60.1% believed it should be planned together. All male participants stated treatment was necessary (p=0.008). Participants chose preemptive (19.9%, n=28), symptomatic (80.1%, n=113) or both (4.3%, n=6) treatments. The choices for preemptive and symptomatic treatment were similar; non-steroidal anti-inflammatory drugs (70.8%, 59%), paracetamol (43.4%, 50.7%) and tramadol (18.9%, 21.6%). Participants’ knowledge on factors effecting CRBD was lacking. Conclusion: Anesthesiologists do not utilize preemptive and effective treatment for CRBD; one thirds of them do not consider it their responsibility. Anesthesiologists should be aware of CRBD and participate in the treatment using multimodal approaches.Amaç: Üriner kateterizasyon, tüm ameliyatları takiben erken postoperatif dönemde idrar sondasına bağlı mesane rahatsızlığına (İSBMR) neden olur. İSBMR çoğunlukla ürolojik girişimlerden sonra gelişir ve iki bağımsız prediktöre sahiptir: Erkek cinsiyet ve 18F üriner kateter. Bu çalışmada Anesteziyoloji ve Reanimasyon uzmanlarının İSBMR ve tedavisi konusundaki farkındalıklarını araştırmayı amaçladık. Yöntem: Etik kurul onayından sonra, 20 çoktan seçmeli ve açık uçlu sorudan oluşan bilgilendirilmiş onam içeren bir anket docs.google.com’a aktarıldı. Türk Anesteziyoloji ve Reanimasyon Derneği ile katkıları için iletişime geçildi. Bulgular: Çalışmaya 26-66 yaşlarındaki (39.5±8.02 yaş), %54.5 erkek, %45.5 kadın, %66.4 eğitim kadrosunda ve %55.5> 10 yıl deneyimli 144 anestezist katılmıştır. Katılımcıların %54.4’ü haftada 1’den fazla İSBMR ile karşılaştığını ve bunların çoğunlukla üroloji (%70.9), obstetrik ve jinekoloji (%52.5) ve genel cerrahi (%51.1) vakalarını takip ettiğini belirtti. Erkek hastalarda İSBMR’nin sıklığı ve şiddeti (%66 ve %69.5) daha yüksek bildirildi. Anesteziyoloji ve Reanimasyon uzmanlarının %94.4’ü İSBMR’nin tedavi edilmesi gerektiğini onaylarken. %37.8’i cerrahın İSBMR’yi yönetmesi gerektiğine, %60.1’i ise cerrahla birlikte planlanması gerektiğine inanıyordu. Tüm erkek katılımcılar tedavinin gerekli olduğunu belirttiler (p=0.008). Katılımcılar tedavide önleyici (%19.9, n=28), semptomatik (%80.1, n=113) yaklaşımları veya her ikisini (%4.3, n=6) seçtiler. Tercih edilen önleyici ve semptomatik tedavi seçenekleri benzerdi; non-steroid anti-inflamatuar ilaçlar (%70.8, %59), parasetamol (%43.4, %50.7) ve tramadol (%18.9, %21.6). Katılımcıların İSBMR’yi etkileyen faktörler hakkındaki bilgileri eksikti. Sonuç: Anesteziyoloji ve Reanimasyon uzmanları, İSBMR için önleyici ve etkili tedavileri kullanmamakta ve üçte biri bu rahatsızlığı kendi sorumlulukları olarak görmemektedir. Anesteziyologlar, İSBMR’nin farkında olmalı ve multimodal yaklaşımlar kullanarak tedavisine katılmalıdır

Ultrasound Guided TAP Block For The Treatment of Postoperative Prolonged Pain - An Alternative Approach

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery