23 research outputs found
Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery
Abstract Background: Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. Methods: A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n ¼ 30, tidal volume ¼ 10 mL/kg, rate ¼ 12/minute, PEEP ¼ 0 cm H 2 O) or the low tidal group with PEEP group (n ¼ 30, tidal volume ¼ 6 mL/kg, rate ¼ 18/minute, PEEP ¼ 5 cm H 2 O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. Results: There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO 2 ) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg; p ¼ 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO 2 values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H 2 O, p ¼ 0.041, low tidal; 23.67 cm H 2 O, p ¼ 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. Conclusion: The application of low tidal volume þ PEEP þ high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases
Developing intracranial hypotension after spinal anesthesia
ntrakraniyal hipotansiyon, ortostatik baş ağrısı ile ortaya
çıkan beyin omurilik sıvısı (BOS) basıncı düşüklüğü ile karakterize
bir tablodur. 30 yaşında, 165cm boyunda ve 64kg
ağırlığında olan kadın hastanın spinal anestezi sonrası
postoperatif 1. günde enseden başlayıp tüm başına yayılan,
ayağa kalkınca artış gösteren baş ağrısı şikayeti olmuş.
Olgunun postoperatif 12. günde bu şikayetine çift görme
yakınması, bulantı ve kusma şikayetleri eklenmiş. Hasta
intrakraniyal hipotansiyon olarak değerlendirildi. Dirençli
olmayan intrakraniyal hipotansiyon tedavisinde yatak
istirahati, hidrasyon, kafein ve teofilinin etkili bir tedavi
yöntemi olduğu kanaatindeyiz.Intracranial hypotension is an entity, which occurs with
orthostotic headache and characterized with low
cerebrospinal fluid (CSF) pressure. The patient was 30 years
old and 165cm height, 64kg weight female patient. She had
complaints of headache that began from neck to the all of
head, increased by standing up and developed at the first
day postoperatively following spinal anesthesia. Diplopia,
nausea and vomiting were also noted by the twelfth
postoperative day. The patient was evaluated as
intracranial hypotension. We believe that bed rest,
hydration, caffeine and theophylline administration are
effective medical treatment for non resistant intracranial
hypotension
Awake fi beroptic intubation of a patient with amyotrophic lateral sclerosis: case report
Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis is<br />dependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected death<br />due to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroid<br />cancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2) and a mixture of oxygen and air<br />under volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after ten<br />hours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation
Meperidine, As An Effective Adjuvant Agentin Unilateral Spinal Anaesthesia For Knee Arthroscopy
Aim: Unilateral spinal anaesthesia permits early recovery and short
ambulatory stay. Our study aimed to search if meperidine may prolong
sensory block time when added to hyperbaric bupivacaine. Methods:
This is a prospective, double blinded study: Ambulatory, 46 consenting
patients aged 18-60 years, undergoing unilateral knee arthroscopy were
randomized in two groups. saline group (n=20): 1.3 ml of hyperbaric
bupivacaine and 0.2 ml of serum physiologic was used. Meperidine group
(n=20): 1.3 ml of hyperbaric bupivacaine and 0.2 ml of 5% meperidine
was used. Sensory block times, duration of spinal anaesthesia,
intraoperative adverse effects and patient satisfaction were recorded.
Results: Mean duration of sensory block was greater in the meperidine
group compared with the saline group. Strict unilateral block and
hypotension were comparable among groups. Conclusion: Addition of
meperidine to hyperbaric bupivacaine in unilateral spinal anaesthesia
prolonged analgesia without effecting total anesthesia time with
minimal adverse effects
Anesthesia for intestinal obstruction in a six years old child with cerebro-oculo-facio-skeletal syndrome
Developing intracranial hypotension after spinal anesthesia
ntrakraniyal hipotansiyon, ortostatik baş ağrısı ile ortaya
çıkan beyin omurilik sıvısı (BOS) basıncı düşüklüğü ile karakterize
bir tablodur. 30 yaşında, 165cm boyunda ve 64kg
ağırlığında olan kadın hastanın spinal anestezi sonrası
postoperatif 1. günde enseden başlayıp tüm başına yayılan,
ayağa kalkınca artış gösteren baş ağrısı şikayeti olmuş.
Olgunun postoperatif 12. günde bu şikayetine çift görme
yakınması, bulantı ve kusma şikayetleri eklenmiş. Hasta
intrakraniyal hipotansiyon olarak değerlendirildi. Dirençli
olmayan intrakraniyal hipotansiyon tedavisinde yatak
istirahati, hidrasyon, kafein ve teofilinin etkili bir tedavi
yöntemi olduğu kanaatindeyiz.Intracranial hypotension is an entity, which occurs with
orthostotic headache and characterized with low
cerebrospinal fluid (CSF) pressure. The patient was 30 years
old and 165cm height, 64kg weight female patient. She had
complaints of headache that began from neck to the all of
head, increased by standing up and developed at the first
day postoperatively following spinal anesthesia. Diplopia,
nausea and vomiting were also noted by the twelfth
postoperative day. The patient was evaluated as
intracranial hypotension. We believe that bed rest,
hydration, caffeine and theophylline administration are
effective medical treatment for non resistant intracranial
hypotension
Retrospective assesing of spinal anesthesia applications in our hospital
Amaç: Spinal anestezi uygulanan hastaların retrospektif
bulguları tarayıp, komplikasyon nedenlerini ortaya koymayı
amaçladık.
Gereç ve Yöntem: Afyon Kocatepe Üniversitesi Tıp Fakültesi
hastanesinde spinal anestezi uygulanarak opere edilmiş ASA
I,II,III grubuna giren 16 ile 91 yaşları arasında 247 si bayan
365 i erkek olan toplam 612 hasta retrospektif olarak incelendi.
Hastalara ait veriler hasta dosyalarından anestezi
gözlem formlarından ve kendilerinden toplandı. Spinal
anesteziye bağlı gelişebilecek komplikasyonları ve buna
olumlu, olumsuz etkisi olabilecek faktörleri değerlendirmek
için tüm veriler istatistiksel olarak T-testi, Chi square,
spearman korelasyon testleri ile değerlendirilmiştir.
Bulgular: Komplikasyonlar cinsiyet, boy, kilo, yaş, ASA, lokal
anestezikler, fentanil kullanımı ve cerrahi klinikler ile ilişkili
bulunmaz iken uygulama sonrası bütün hastaların sistolik,
diyastolik tansiyonlarında ve kalp atım hızlarında anlamlı
düşüş görüldü. Ayak bileği operasyonu, anal fissür operasyonu
ve 35-45 yaş grubu ve iğne çapı ile komplikasyonlar
arasında anlamlı bir ilişki saptanmadı (p<0,05). Komplikasyonlardan
sadece bradikardinin iğne çapının büyümesiyle
arttığı bulgusuna varıldı. Komplikasyon gelişen hastalarda
anesteziden memnuniyet anlamlı olarak düşük bulundu.
Sonuç: Komplikasyon gelişiminin; genç-orta yaş grubu ve
spinal iğne seçimi ile ilişkili olduğu görüldü. Komplikasyonlara
sebep olan faktörlerin belirlenmesi ve tedavilerinin başarısını
değerlendirebilmek için hasta gözlem formlarının
ayrıntılı hazırlanması, muntazam ve dikkatlice doldurulması,
sonrasında düzenli olarak dosyalanması gerektiği görüldü.Aim: To scan retrospective findings in patients undergoing
spinal anesthesia and putting forth the reasons for
complications.
Materials and Methods: We recruited patients have had
surgery with spinal anesthesia, in ASA I, II, III groups
between the ages of 16 and 91, 365 male and 247 female,
retrospectively. During the application 22, 25,26 gauge
spinal needle, bupivacaine and levobupivacaine was used.
Standart monitorization was performed to all patients and
sistolic, diastolic and mean arteryal pressure; heart rate,
peripheral oxygen saturation were recorded by deterimined
intervals. The data of the patients were collected from
patients file, from forms of anesthesia monitoring.
Complications related to spinal anesthesia, and the positive
and negative factors that may influence it were assessed
with T-test, Chi-Square, spearman’s correlation tests.
Results: Complications was not associated with the use of
fentanyl, sex, height, weight, age, ASA, local anesthetics,
and surgical clinics. Systolic and diastolic blood pressure
and heart rate showed a significant reduction in rates after
application. No significant correlation between needle
diameter, 35-45 age group, anal fissure surgery, ankle
surgery and the complications was found (p<0,05). No
evidence of complications increased with the growth of the
diameter of the needle was reached except bradycardia.
Anesthesia had significantly lower satisfaction for patients
who develop complications.
Conclusion: The development of complications was
associated with young-middle age group, and selection of
the spinal needle. It was concluded that detailed
preparation of uniform and carefully filled patient
monitoring forms seems essential