Comparison of the Effects of Pharyngeal Packing and Gastric Aspiration with an Orogastric Tube on Postoperative Nausea, Vomiting and Sore Throat in Septorhinoplasty

Introduction:We compared the effects of pharyngeal packing and gastric decompression with orogastric tube application on the incidence of nausea/vomiting, sore throat, and dysphagia. As a secondary objective, we assessed the effect of the selected method on the postoperative pain score and patient satisfaction.Methods:In this randomized, prospective study were 60 patients aged 18-50 years who underwent elective septorhinoplasty. Nasopharyngeal packing was performed in group 1 and gastric decompression with an orogastric tube in group 2, and both procedures were terminated by the practitioner before extubation. Between-group demographic data, duration of operation/anesthesia, hemodynamic parameters, nausea, vomiting, additional antiemetic requirement, pain/dysphagia during swallowing, visual analogue scale (VAS), and patient satisfaction were measured at 24 h, and the group findings were compared.Results:The demographic findings and durations of anesthesia/operation were not statistically different between the groups, and there was no difference in postoperative nausea and vomiting, VAS, and satisfaction scores. In contrast, sore throat was twice as common in the nasopharyngeal pack group but decreased over time.Conclusion:The routine packing approach should be abandoned by anesthesiologists. Because pharyngeal packing is not a completely risk-free procedure, we do not recommend intraoperative packing during nasal surgery. If indicated for surgical reasons, however, protocols, checklists, and observation forms pre-prepared with the participation of the surgical and anesthesia teams should be used. All materials should be included in the surgical (scrub) count, and it should be ensured that all materials are removed before extubation with a matching count. Regardless of the method used, it should not be forgotten that the anesthesiologist is responsible for the examination of the oral cavity and throat via direct laryngoscopy and, if necessary, aspiration before extubation

Rainier hemoglobinopatisi olan bir hastada azalmış oksijen satürasyonuna rağmen genel anestezi ile septoplasti ameliyatının tamamlanması

Rainier hemoglobinopathy is an extremely rare hematologic disorder characterizedwith increased oxygen affinity of hemoglobin leading to decreased blood oxygensaturation. Up to date literature includes only 1 case who had been operated undergeneral anesthesia. In this report, we present a 27-year-old male patient with Rainierhemoglobinopathy who underwent nasal septoplasty under general anesthesia.Rainier hemoglobinopati, hemoglobinin düşük kan oksijen satürasyonuna yol açanarmış oksijen afinitesi ile karakterize, oldukça ender görülen hematolojik bir hastalıktır.Güncel literatür, genel anestezi ile ameliyat edilen yalnızca 1 olguyu kapsamaktadır. Bu makalede, genel anestezi ile nazal septoplasti yapılan, Rainier hemoglobinopatisi olan 27 yaşında bir erkek hastayı sunduk

A case report of a pericapsular nerve group block for transcatheter aortic valve implantation

A pericapsular nerve group (PENG) block is an interfascial plane block that targets the articular branches of the femoral and obturator nerves. PENG blocks may be used for hip, vein, and groin surgeries. Transcatheter aortic valve implantation (TAVI) is a common treatment for aortic valve stenosis (AVS). Patients who undergo TAVI tend to be at high risk due to their older age and comorbidities. A PENG block using a high volume of local anesthetics may be as effective as a lumbar plexus block. In this case report, we describe successful anesthesia management using PENG blocks in 2 patients who underwent TAVI

Comparison Between the Effects of Preoperative (Preemptive) and Intraoperative use of Tramadol on Post-Operative Pain

Aim: The aim of this study was to investigate the efficiency of tramadol treatment in prevention of postoperative pain in two different groups in which tramadol applied before skin incision (group 1/preemptive), and intraoperatively (group 2/preventive) at the same dose. Methods: The study was designed as a randomized prospective study. The patients in group 1 (n=25) received 1.5 mg/kg tramadol IV 15 minutes before induction of anesthesia. The patients in group 2 (n=25) received the same dose of tramadol after the incision. Postoperative pain was assessed with 10 cm visual analogue scale (VAS) after extubation, before the first analgesic request and at the 6th, 12th, 18th and 24th hours, postoperatively. Paracetamole (15 mg/kg) and, if it was not sufficient, pethidine (1 mg/kg) were used for postoperative analgesia. Total doses of analgesics and side effects were recorded. Results: This study showed no significant differences in pain scores and total doses of analgesics except for time to first analgesic requirement [(tanalgezia) 24.21±8.2 min. in group 1 and 42.18±9.8 min. in group 2]. Conclusion: In this study, any difference between preemptive and preventive properties of iv tramadol could not be demonstrated. Applying route of tramadol and the possibility that anesthetic drugs can suppress central sensitization are thought to be reasons. (The Medical Bulletin of Haseki 2015; 53:220-4

İstanbul İli Sınırları İçindeki Bir Devlet Hastanesi Çalışanlarının Kızamık Seronegatifliğinin Belirlenmesi

Amaç: Bu çalışmanın amacı, tanımlayıcı tasarımda Sağlık Bakanlığı’na bağlı bir devlet hastanesinde çalışanların kızamık seronegatiflik durumlarını sosyo-demografik özellikler açısından belirlemektir. Gereç ve Yöntem: İlk olarak, araştırmaya alınan 717 çalışanın yaşı, cinsiyeti, mesleği gibi sosyo-demografik nitelikler hazırlanan Kişisel Personel Sağlık Kartlarına kaydedilmiştir. Daha sonra tüm vakaların serum örneklerinde kızamık virüsüne spesifik IgG tipi antikor düzeylerine bakıldı. Son olarak, verilerin analizinde Mann-Whitney U Testi kullanılmıştır. Bulgular: Elde edilen bulgulara göre; çalışanların %44,8’i sağlık çalışanı iken %55,2’si sağlık dışı çalışandır. Çalışanların %54,4’ü kadın iken, %45.6’sı erkektir. Çalışanların %17,4’ü 17-25 yaş aralığında iken %82,6’sı ise 26-60 yaş aralığındadır. Çalışanların kızamık seronegatiflik durumları ile seronegatiflik durumları- nın sosyo-demografik özellikleri ile ilişkisi incelendiğinde; sağlık çalışanlarının %11,8’inin kızamık antikoru seronegatif iken, sağlık dışı çalışanların %10,1’inin kızamık antikoru seronegatiftir. Kadın çalışanların %14,4’ünün kızamık antikoru seronegatif iken, erkek çalışanlarında %6,7’sinin kızamık antikoru seronegatiftir. 17-25 yaş grubu çalışanların %17,16’sının kızamık antikoru seronegatif iken 26-60 yaş grubu çalışanların ise %9,5’nin kızamık antikoru seronegatiftir. Ayrıca, araştırmada kızamık antikoru seropozitif olan 639 kişinin oranı %89,1 iken, kızamık antikoru seronegatif olan 78 kişinin oranı ise %10.9 olarak belirlenmiştir. Sonuç: Araştırma kapsamına alınan hastane çalışanları %10,9 oranında kızamığa duyarlı bulunmuştur. Hastanedeki riskli bölümlerde görev alan sağlık çalışanları başta olmak üzere tüm çalışanlara serolojik tarama ile aşı yapılmasının, kızamık hastalığının nazokomiyal yayılımının önlenmesi için yararlı olabileceği sonucuna varılmıştır

Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females) were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years). There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc.) and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM) and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9%) and individuals of young age (median age: 27.45 years). Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7

Prediction of Hemodynamic Reactivity during Sevoflurane Remifentanyl Anesthesia for Laparoscopic Cholecystectomy Using Analgesia Nociception Index

Aim: Pneumoperitoneum may cause serious side effects in high-risk patients during laparoscopic cholecystectomy. Perioperative analgesic sufficiency has been measured by the Analgesia Nociception index (ANI) in recent years. We examine the possibility of predicting hemodynamic reactivity by observing sudden changes in ANI during operation. Methods: In this retrospective study, recorded hemodynamic parameters (including heart rate, systolic/ diastolic blood pressure values) and ANI values, before and after intubation, nasogastric tube application, intraperitoneal gas insufflation, and surgical incision in 31 patients who were applied laparoscopic cholecystectomy were compared by paired t-test. Additionally, an increment or decrement of 20% in ANI and 15% in hemodynamic parameters with respect to basal observation values were called “sudden changes”. Correlation of these parameters with sudden changes in ANI values was examined either. Results: There was a statistically significant difference in parameters after premedication and intubation. After induction, a statistically significant decrement was detected only in heart rate and systolic/diastolic blood pressure values. There was no significant change after nasogastric tube insertion. During pneumoperitoneum and surgical incision, there was no change in heart rate and systolic/diastolic blood pressure values, but a statistically significant decrement was observed in ANI. No correlation was detected between sudden changes in ANI values and hemodynamic parameters. Conclusion: We assume that use of ANI in analgesia evaluation under general anesthesia at perioperative period is suitable, however, it is not reliable in predicting hemodynamic interaction

Evaluation of Patients Hospitalized in Intensive Care Unit Due to Drug-Related Suicide Attempt and Access to Drugs: A Single Center Prospective Study

Aim: We aimed to evaluate patients who were hospitalized in our intensive care unit due to drug-related suicide attempt (medical or insecticides) and their access to these drugs. Methods: We prospectively recorded the demographic characteristics and medical data of 50 patients (32 females and 18 males) who were hospitalized in our intensive care unit due to drug-related suicide attempt. Results: 66% of subjects were between the ages of 15 and 24 years with a mean age of 25.4±8.8 years. Multiple drug overdose was observed in 28% of patients. The unemployment rate was higher for women than men (p<0.001). Men obtained drugs from pharmacy more often than women (27.8% vs 6.2%, p=0,03). Of the patients, 86% got the drugs from home medicine cabinet while this rate was 93% among women (n=30). The level of toxicity was higher among patients who got the drugs from pharmacy than in those who used drugs at home (p=0.06). The length of stay in the intensive care unit was longer among patients with toxic level of medication (p=0.001). Conclusion: Patients usually use drugs or insecticides available at home to commit suicide. We believe that in patients with risk of suicide attempt, access to drugs should be limited and state regulations should be applied. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:111-5

Profile of Patients with Acute Poisoning and Factors Effecting Prognosis: A Retrospective Analysis in the Intensive Care

Aim: The aim of this study was to retrospectively analyse demographic and epidemiologic characteristics, clinical course, laboratory results and prognosis of patients who were admitted to Haseki Training and Research Hospital Intensive Care Unit due to intoxication between 24.11 2007 and 21.02.2013. Methods: We evaluated age, gender, types of intoxication (accident, suicide), etiology, length of stay, mortality rate, duration of mechanical ventilation, and blood pressure, heart rate and symptoms at the time of admission. Patients who took multiple drugs were recorded. Liver and kidney function tests, blood glucose, complete blood count parameters, electrolytes and arterial blood gas values at the time of admission were evaluated. Results: A total of 59 cases of intoxication were studied. 59.7% of patients were male, 42.4% were female. The mean age was 32±13 years. 86.4% of cases occurred due to suicide attempts and 13.6%, accidentally. In our study, it was found that the most common intoxication agents were paracetamol and amitriptyline, and the most common cause of death was methyl alcohol intoxication. Conclusion: Our results showed that a significant portion of the intoxication cases admitted to the intensive care unit were young adults who attempted suicide by overdosing on drugs. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 29-33

The comparison of percutaneous central venous catheter insertion methods with the aid of anatomical description and ultrasonographic guidance - Single center experience

Amaç: Pediyatrik kardiyak anestezist tarafından ultrasonun yaygın olarak kullanılması ile zaman ve malzeme tasarrufu ile birlikte başarılı girişim sayısı artmış, komplikasyonlarda da azalma olmuştur. Bu çalışmada, çocuklara 2 farklı yöntem olan anatomik tarif (AT) ve Ultrasonografi (US) eşliğinde perkutan santral venöz kateter (SVK) takılması yöntemlerini karşılaştırdık. Yöntem: On kilogramın altında, toplam 293 olgu, rastgele, retrospektif olarak; AT (n=151) ve US (n=142) eşliğinde kateterizasyon yapılanlar olarak 2 gruba ayrıldı. SVK sağ/sol internal juguler ven (İJ), sağ/sol femoral ven (FV) ve sağ/sol subklaviyen venden (SKV) takıldı. Karşılaştırılan parametreler: demografik veriler, kateterin takıldığı yer, girişim sayısı, işlemi bitirme süresi, cerrahi kateter takılma sayısı, komplikasyonlar idi. Bulgular: Grupların demografik verileri; yaş (1 gün- 4.5 yaş), ağırlık (560 g-10 kg), boy (23-103 cm) ve cinsiyetleri arasında fark yoktu (p>0,05). SVK takıldığı yerler sırası ile % olarak: sağ İJ/sol İJ/sağ FV/ sol FV/ sağ SKV / cerrahi femoral ven/sağ atriyum; AT de 82/6/6/2/2/2, US’de 89/9/1/0/0/0 (p<0.05). SVK girişim sayısı: AT grubunda 1-26 (6.7±17.7) kez ve US grubunda ise 1-4 (1.23±0,5) kez idi (p<0,05). SVK takma süresi: AT grubunda 16-231 (45.2±47,5) dk. ve US grubunda ise 11-82 (16.1±13.8) dakika idi (p<0.05). Komplikasyonlar: kanama, hematom, dolaşım bozukluğu, sinir hasarı, uzamış yatış, mortalite sırası ile % olarak, AT’de 11/9/7/3/4/1, US’de %1/2/0/0/0/0 idi (p<0,05). Sonuç: Pediatrik kardiyak anestezide kateterizasyonlar anatomik tarif veya ultrason eşliğinde yapılabilir. Ultrason eşliğinde yapılması; zaman ve başarılı girişim sağlarken, komplikasyonlarda da azalmaya neden olacağı kanısındayız.Objective: With the widespread use of ultrasound by the pediatric cardiac anesthesiologist, the number of successful interventions with time and material saving increased and complications decreased. In this study, we compared the methods of percutaneous central venous catheter (CVC). Insertion using two different methods namely anatomic definition (AD) and ultrasonography (US). Method: A total of 293 cases, under 10 kg, randomly, and retrospectively divided into two groups as AD (n=151) and US (n=142). The CVC was inserted into the right/left internal jugular vein (IJ), the right/left femoral vein (FV), and the right/left subclavian vein (SCV). Parameters such as demographic characteristics of the patients, catheter insertion sites, procedures, and their durations, number of surgical catheter insertions and complications were compared between groups.. Results: Demographic data of the groups were compared:, and age (1 day-4.5 years), weight (560 gr-10 kg), height (23-103 cm) and gender of the patients did not differ between groups (p≥0.05). Rates (%) of CVC insertion into right/left IJ, right/left FV, right SCV, surgical femoral vein/right atrium were 82, 6, 6, 2, 2, and 2% in the AD, and 89, 9, 1, 0, 0, and 0% in the US groups, respectively (p<0,05). The number of CVC interventions ranged between 1-26 (6.7±17.7) times in the AD and 1-4 times (1.23±0.5) in the US groups (p<0.05). The duration (minute) of CVC insertion ranged between 16-231 (45.2±47.5) mins in the AD and 11-82 (16.1±13.8) mins in the US group (p<0.05). Rates of complications encountered were bleeding, hematoma, circulatory disorder, nerve damage, prolonged hospitalization,and mortality (AD 11, 9, 7, 3, 4, 1%, and US 1, 2, 0, 0, 0, 0%, respectively (p<0.05). Conclusion: Catheterization in pediatric cardiac anesthesia can be done by anatomical description or via ultrasonographic guidance. We believe that it causes a decrease in the complications while leading to an improvement in time and successful intervention