Pseudocholinesterase levels in patients under electroconvulsive therapy

Objectives: In this study, we aimed to retrospectively assess the correlation of pseudocholinesterase (PChE) levels with age, gender, body weight and diagnosed psychiatric diseases in electroconvulsive therapy (ECT) cases. Methods: This retrospective study was conducted at Bülent Ecevit University Hospital, Zonguldak, Turkey, between 2007 and 2011. In the study, 193 ECT case files were retrospectively scanned to evaluate PChE values before ECT and other file information. Results: There was no difference between gender in terms of PChE levels. Correlation analysis determined a weakly positive correlation between age (p=0.013; correlation coefficient [cc]: 0.178) and body weight (p<0.001; cc: 0.273) and PChE levels. No correlation was found between age, gender, weight or psychiatric diagnosis, and PChE levels. Conclusion: Neuromuscular blockage is a significant factor that increases patient safety, while increasing the efficacy of ECT. In choosing muscle relaxant agents, both patient factors and the pharmacological properties of the neuromuscular blocker should be considered. We think that in situations with delayed recovery of ECT cases without identified PChE levels, low PChE levels must be considered. © 2018, Saudi Arabian Armed Forces Hospital. All rights reserved

Effect of sevoflurane–nitrous oxide induction on the incidence of rocuronium injection pain in adults

Objective: This randomized, prospective study was designed to investigate the effect of sevoflurane–nitrous oxide application on the incidence of the hand/arm withdrawal movement caused by rocuronium injection. Materials and Methods: There were 90 individuals undergoing elective surgery included in the study. After preoxygen-ation, Group T was given intravenous (i.v.) 5 mg/kg thiopental, Group S was given 7% sevoflurane and 40%/60% air/ O2, and Group N was given 7% sevoflurane and 40%/60% N2O/O2 for induction. After the eyelash reflex was lost, 0.6 mg/kg rocuronium was applied intravenously over 5 seconds, and then 2 ml saline was administered. Patients’ response to rocuronium injection was graded by using a 4-point scale (0–3). Hemodynamic data were recorded. Results: After the rocuronium injection, the mean arterial pressure (MAP) and heart rate (HR) values were different between the groups (p<0.05). The incidence of withdrawal movements associated with the injection of rocuronium was observed to be 96.7% in Group T (29/30), 73.3% in Group S (22/30), and 13.3% in Group N (4/30). There were significant differences between the groups (p<0.05). There were differences between Group T and Group S in terms of MAP and 4-point scale, and between Group N and Group S in terms of MAP, HR, and 4-point scale (p<0.05). Conclusions: Adding nitrous oxide to sevoflurane induction in adults reduces the incidence of withdrawal movements associated with rocuronium injection compared to thiopental induction. © 2017 by Erciyes University Faculty of Medicine

The effects of different doses of remifentanil on sedation, haemodynamy and respiratory parameters in spinal anaesthesia

Amaç: Çalışmamızda, spinal anestezide remifentanilin farklı dozlarının sedasyon, hemodinami ve solunum parametreleri üzerine etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve yöntem: Hastane Etik Kurulu izniyle ASA 1-11 grubundan, ürolojik operasyon geçirecek 46 olgu çalışmaya alındı. Olgulara operasyondan 1 saat önce 1000 cc Ringer laktat verildi, 0.02 mg.kg-1 midazolamla premedikasyon uygulandı. Standart spinal anestezi sonrası, sensorial blok TIO seviyesine ulaşınca cerrahinin başlamasına izin verildi. Olgular 0.5 microg.kg-1 remifentanil uygulandıktan sonra rasgele üç gruba ayrıldılar. Remifentanil infüzyonu Grup I'de 0.015 mikrog.kg-1 .dk-1, Grup IV de 0.03 mikrog.kg-1.dk-1, Grup lif de 0.05 mikro kg-1 .dk-1 hızıyla gerçekleştirildi. Sistolik, diastolik arter basınçları, kalp atım hızı, solunum sayısı, sensorial blok seviyesi, sedasyon seviyesi 5 dk aralıklarla kaydedildi. Yan etkiler ve derlenme değerlendirildi. Bulgular: Sistolik, diastolik arter basınçları Grup III'de Grup I ve Il'ye göre düşüktü. Anlamlı fark I5.dkda mevcuttu. Sedasyon skoru Grup III'de 20-45.âklarda Grup I ve Il'ye göre anlamlı olarak yüksekti. Diğer parametreler gruplar arasında benzer olarak değerlendirildi. Sonuç: Remifentanil çalışmamızda her üç dozda uygulanımmda spinal anestezi sırasında yumuşak bir hemodinamik profil ve uygun sedasyon seviyesi oluşturmuştur. Bununla birlikte remifentanilin yüksek dozda uygulamalarında solunum depresyonu açısından takibi uygun olacaktır.Objective: In our study, we aimed to assess the effects of different doses of remifentanil on sedation, haemodynamic and respiration parameters in spinal anaesthesia. Study design: After the approval by the Medical Ethics Committee 46 patiens in ASA I-II, undergoing urological operation were enrolled the study. All patients received 1000 cc lactated ringer solution 1 hour before operation and premeditated with 0.02 mg.kg-1 midazolam. After standard spinal anaesthesia surgery was allowed when sensorial block was reached to thlO. All patients received 0.5 microg.kg-1 remifentanil at the beginning of the operation and randomised into three groups. Remifentanil was infused in a rate of 0.015 microg.kg-1.min-1 in Group I or 0.03 microg.kg-1.min-1 in Group II or 0.05 microg.kg-1 .min-1 in Group III, Systolic, diastolic arterial pressures, heart rate, respiration rate, sensorial block level, sedation score were recorded every 5 minutes. Side .effects were observed and recovery was evaluated. Results: Systolic and diastolic arterial pressure values were lower in Group III than Group I and 11. The difference was significant at 15.min. Sedation score values were significantly higher in Group III than Group I and II at 20.-45. min. Other study parameters were comparable between the groups. Conclusion: Remifentanil provided a smooth haemodynamic profile and an adequate sedation level during spinal anaesthesia, thus appears to be an appropriate sedative agent in our study. Remifentanil induced respiratory depression requires cautious administration of this agent when used in higher doses