Anesthetic Management of Patient for Case with Apert Syndrome

Apert syndrome is an autosomal dominant inherited mandibulofacial dysostosis characterized by craniosynostosis, syndactyly, high forehead, broad nose, maxillary hypoplasia, synostosis of cervical vertebrae, organ malformations, and mental retardation. It is rarely encountered and as there is little knowledge of the anesthesia practice for this syndrome in the literature, we present our anesthesia experience of a case undergoing bilateral syndactyly surgery

Difficult Mask Ventilation in Obese Patients: New Predictive Tests?

Aim:The aim of our study was to evaluate specific factors in predicting difficult mask ventilation (DMV) in obese patients undergoing elective surgery.Methods:This prospective and observational study was performed in 90 obese patients. We assessed age, height, weight, sex, body mass index (BMI), dental structure, presence of facial hair, modified Mallampati test result, mouth opening, thyromental distance (TMD), sternomental distance, mandibular protrusion, mandibular length, neck circumference (NC), neck length, upper lip bite test result, height to TMD ratio, NC to TMD ratio (NC/TMD), and history of snoring and Obstructive Sleep Apnea syndrome for estimation of DMV.Results:The mean age of the patients was 40.9±9.4 years and the mean BMI was 44.7±6.2 kg/m2. Of all patients 38.9% were determined to have DMV. Clinical variables associated with DMV were male gender, mandibular length, snoring, NC, and NC/TMD. Multiple logistic regression analysis showed that male gender (p=0.047) and snoring (p=0.02) were independent factors.Conclusion:We believe that NC/TMD and ML are predictive tests for DMV in obese patients. Tests and measurements at the bedside are not sufficient alone and we believe that they will be more reliable when considered together

Efectos del mantenimiento de varias anestesias sobre los niveles séricos de selenio, cobre, cinc y hierro y la capacidad antioxidante

ResumenJustificación y objetivosInvestigar los efectos del mantenimiento de sevoflurano, desflurano y propofol sobre los niveles séricos de selenio, cobre, cinc, hierro y malondialdehído, las medidas de glutatión peroxidasa y la capacidad antioxidante.MétodosFueron ubicados en 3 grupos 60 pacientes programados para cirugía unilateral de miembros inferiores, realizada con torniquete bajo anestesia general. Fueron recogidas muestras de sangre para determinar los niveles séricos basales de selenio, cobre, cinc, hierro, malondialdehído y glutatión peroxidasa. La anestesia fue inducida con 2-2,5mg/kg−1 de propofol, 1mg/kg−1 de lidocaína y 0,6mg/kg−1 de rocuronio. En el mantenimiento de la anestesia, bajo gas portador de 50% de O2 y 50% de N2O (4L/min−1), sevoflurano a 1CAM fue administrado al grupo S; y desflurano a 1CAM al grupo D y bajo gas portador en mezcla de 50% O2 y 50% aire (4L/min−1), 6mg/kg/h−1 de propofol y 1μg/kg/h−1 de fentanilo fueron administrados al grupo P. En el postoperatorio se recogieron de nuevo muestras de sangre.ResultadosSolamente en los grupos S y P los niveles de malondialdehído disminuyeron en las 48h del postoperatorio; los niveles de glutatión peroxidasa aumentaron en comparación con los valores basales. Los niveles de selenio disminuyeron en el grupo S y en el grupo P, los niveles de cinc disminuyeron en el grupo P, los de hierro disminuyeron en todos los grupos y no hubo alteración en los niveles de cobre en ningún grupo en el período postoperatorio.ConclusiónDe acuerdo con los marcadores de malondialdehído y glutatión peroxidasa, llegamos a la conclusión de que el mantenimiento de la anestesia general con propofol y sevoflurano activó el sistema antioxidante contra el estrés oxidativo y el uso de desflurano no tuvo efectos sobre el estrés oxidativo y el sistema antioxidante.AbstractBackground and objectivesIn this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity.Methods60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mg/kg−1 propofol, 1mg/kg−1 lidocaine and 0.6mg/kg−1 rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4L/min−1, 1MAC sevoflorane was administered to group S and 1MAC desflurane to group D; and under carrier gas of 50:50% O2:air 4L/min−1 6mg/kg/h−1 propofol and 1μg/kg/h−1 fentanyl infusion were administered to group P. At postoperative blood specimens were collected again.ResultsIt was observed that only in group S and P, levels of malondialdehyde decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in group S and group P, zinc levels decreased in group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period.ConclusionAccording to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system

Effects of Preoperative Anxiety and General Anesthetic Administration on Intraoperative Awareness in Patients Undergoing Cesarean Section

Aim:The aim was to investigate the effects of preoperative anxiety and general anesthetic administrations on intraoperative awareness among patients undergoing cesarean section.Methods:This prospective randomized study included 90 pregnant subjects. Preoperative anxiety was assessed using the Beck Anxiety Inventory. The patients were divided into three groups: group P received propofol 2.5 mg/kg, group T thiopental 5 mg/kg and group K received ketamine 1 mg/kg. Data on intraoperative hemodynamics, isolated forearm (IFA) responses and time to first pain and to first analgesic requirement evaluated using postoperative numerical rating scale were recorded. The Modified Brice Scale (MBS) was used to assess awareness.Results:The preoperative anxiety levels in the groups were low and demographic data were similar (p>0.05). There was no statistically significant difference in IFA response between the groups (p>0.05). Group T had higher MAP at all times and NRS values at hour 0 compared to the other groups (p<0.05), and had shorter time to first analgesic requirement (p<0.05). MBS responses were evaluated as recall in 12 cases in group K, four in group P and three in group T.Conclusion:As the anxiety levels in pregnants were low, the superiority of agents used in induction over each other regarding awareness could not be shown

Cerebral oxygenation during electroconvulsive therapy

Amaç: Elektrokonvülzif tedavi (EKT), etkin ve yaşam kurtarıcı bir tedavi yöntemi olmakla beraber, etkisi ve yan etkileri hala tartışılmaktadır. Çalışmamızda EKT’nin apne döneminde oksijen (O2) uygulamasının Near Infrared Spektroskopi ile serebral oksijenizayon üzerine ve EKT sonrası komplikasyonlar üzerine etkisini değerlendirmeyi amaçladık. Yöntem: Bu ileriye dönük, gözlemsel çalışmaya ilk kez EKT planlanan 40 hasta katılmıştır. Tüm hasta-lara serebral oksimetre ve bispektral indeks sensörleri (BİS) uygulandı. Hastalar nazal kanül ile 6 L/dk O2 uygula-ması yapılan hastalar Grup O (s=20), O2 uygulanmayan hastalar Grup K (s=20) olarak rastgele ikiye ayrıldı. Nöbet sırasında ve nöbetten 10 dakika sonra hemodinamik veriler, end-tidal karbondioksit (EtCO2), bölgesel serebral doku oksijen satürasyonu (rSO2 ) ve BİS değerleri ile EKT sonrası komplikasyonlar kaydedildi. Sonuçlar: Nöbet sırasında ölçülen rSO2’deki değişim ve demografik özellikler açısından gruplar arasında anlamlı bir fark saptanmadı (p>0.05). EKT sırasında desatürasyon (SpO2<%90) hastalarımızın %12.5'inde gözlendi. Bu beş hastanın dördü Grup K'de, biri Grup O'da idi. Nöbet sonrası EtCO2 değerleri Grup C'de anlamlı olarak yüksek bulundu. EKT sonrası görülen komplikasyon oranı Grup K’de daha yüksek bulundu. Tartışma: EKT gibi serebral oksijen tüketiminin arttığı pro-sedürlerde anestezi süresinin kısa olması nedeniyle serebral oksijen monitorizasyonunun klinik olarak yararı görüle-memiştir. Bunun yanında apne döneminde O2 uygulanmasının EKT sırasında ve sonrasında oluşabilecek solunum komplikasyonlarını azaltabileceği kanısına varılmıştır. (Anadolu Psikiyatri Derg 2018; 19(5):472-477)Objective: Electroconvulsive therapy (ECT) is an effective and life-saving treatment modality, while its effects and side effects are still being discussed. In our study, we aimed to demonstrate the effect of O2 administration on the cerebral oxygenation measured by Near Infrared Spectroscopy and the complications after ECT in the apnea period of ECT. Methods: This prospective, observational study was carried out with 40 patients whom ECT had been planned and who were undergoing ECT for the first time. Cerebral oximeter sensors and Bispectral index (BIS) monitoring were applied in all patients as well as routine monitoring. The participants were randomly divided into two groups. The patients who received administration of 6 L/min O2 through nasal cannula were included in Group O (n=20), and the patients who were not administered O2 were included in Group C (n=20). Hemodynamic data after induction, during the seizures and at the 10th min after the seizures, EtCO2, regional cerebral tissue oxygen saturation (rSO2), BIS values and complications after ECT were recorded in both groups. Results: No significant difference was determined between the groups with regard to rSO2 alteration values measured during the seizures and demographic characteristics. Desaturation (SpO2<90%) was observed in 12.5% of our patients. Of these five patients, four were in Group C, and one was in Group O. The EtCO2 values after the seizures was found to be significantly higher in Group C. The complication rate after ECT was also high in Group K. Discussion: Cerebral oxygen monitoring does not seem clinically useful in procedures with increased cerebral oxygen consumption, such as that in ECT in which the anesthesia time is short. In addition, it has been concluded that administration of oxygen during apnea may reduce respiratory complications that may occur during and after ECT. (Anatolian Journal of Psychiatry 2018; 19(5):472-477

Apert Sendromlu Olguda Anestezi Yönetimi

Apert syndrome is an autosomal dominant inherited mandibulofacial dysostosis characterized by craniosynostosis, syndactyly, high forehead, broad nose, maxillary hypoplasia, synostosis of cervical vertebrae, organ malformations, and mental retardation. It is rarely encountered and as there is little knowledge of the anesthesia practice for this syndrome in the literature, we present our anesthesia experience of a case undergoing bilateral syndactyly surgery.Apert sendromu, kraniyosinostoz, sindaktili, yüksek alın, düz kemer burun, maksiller hipoplazi, servikal vertebralarda sinostoz, organ malformasyonları, konjenital kalp hastalıkları ve mental retardasyon ile karakterize ve sıklıkla otozomal dominant geçiş gösteren bir mandibulofasiyal dizostozdur. Nadir karşılaşılması ve literatürde bu sendroma ait anestezi pratiğinin az olması nedeniyle bilateral sindaktili ameliyatı yapılan olgudaki anestezi deneyimimiz sunulmuştur

Atan kalpte koroner arter bypass cerrahisi yapılan Moyamoya hastalığında serebral oksimetre monitörizasyonunun yeri

Moyamoya disease is a chronic cerebrovascular disease characterized by the development of compensatory collateral vessels due to progressive narrowing or obstruction of the intracranial arteries. Neurological complications after coronary bypass in patients with Moyamoya disease may be prevented by recent technical developments, surgical modifications, and cerebral monitorization. The objective of perioperative anesthetic management is to provide balance between oxygen supply and consumption of the brain. In this case report, we aim to share our anesthetic experience in a patient with Moyamoya disease who underwent off-pump coronary artery bypass surgery and cerebral oximetry monitoring.Moyamoya hastalığı, intrakraniyal arterlerin daralması ve tıkanması sonucu kompansatuvar kollateral damarların gelişmesi ile kendini gösteren kronik serebrovasküler bir hastalıktır. Moyamoya hastalarının koroner arter bypass cerrahisi sonrası nörolojik komplikasyonları son yıllardaki teknik gelişmeler, cerrahi modifikasyonlar ve serebral monitörizasyon ile önlenebilir. Perioperatif anestezi yönetimindeki hedef beyin oksijen sunumu ve kullanımı arasındaki dengenin sağlanmasıdır. Bu olgu sunumunda serebral oksimetre monitörizasyonu uyguladığımız, atan kalpte koroner arter bypass cerrahisi yapılan Moyamoya hastasındaki anestezi deneyimimizi paylaşmayı amaçladık

Anesthetic Management of a Patient With JarchoLevin Syndrome

Jarcho Levin sendromu (JLS) kostavertabral anomalilerin ve bunlara hidrosefali, nöral tüp defekti, kardiyak, renal ve gastrointestinal problemlerin eşlik ettiği nadir görülen bir hastalıktır. Solunum sistemi patolojileri nedeniyle erken yaşta mortalite oranı yüksektir. Nadir karşılaşılması ve literatürde JLS'ye dair anestezi pratiğinin az olması nedeniyle inguinal herni ameliyatı yapılan hastadaki anestezi deneyimimiz sunulmuştur.Jarcho-Levin syndrome (JLS) is a rare disease involving costovertebral anomalies and is accompanied by hydrocephalus, neural tube defect, and cardiac, renal and gastrointestinal problems. Due to respiratory system pathologies, there is a high mortality rate at young ages. Due to its rarity and little information in the literature related to anesthetic practice for this syndrome, we present our anesthetic experience of inguinal hernia surgery in a patient with JLS

Entübasyon sırasında oluşan dental travmaya yaklaşım: olgu sunumu

The incidence of dental trauma reported during general anesthesia is 0.06-12.3%. The majority of perioperative dental trauma occurs during laryngoscopy and intubation, it may be observed when excessive force is applied to remove the airway, endotracheal tube or laryngeal mask. Dental injury may vary from simple fracture to restoration loss or avulsion (removal of tooth from the socket). Dental injury generally occurs in the upper front region and the left central incisor is most frequently affected due to the position of the laryngoscope. We aim to share an approach to dental trauma that may be encountered during general anesthesia administration in this case report.Genel anestezi sırasında bildirilen diş travması insidansı % 0.06-12.3’dir. Perioperatif dental travmaların çoğu laringoskopi ile entübasyon sırasında ortaya çıkarken, airway, endotrakeal tüp ya da larengeal maske çıkarılması için aşırı kuvvet uygulandığında da görülmektedir. Dental yaralanmalar basit kırıktan restorasyon kaybı veya avulsiyona (dişin soketinden çıkması) kadar değişebilir. Dental yaralanma genellikle üst ön bölgede meydana gelir ve laringoskopun konumu nedeniyle sol orta kesici diş en sık etkilenir. Genel anestezi uygulamalarında karşılaşılabilecek dental travmalara yaklaşımımızı olgu üzerinden aktarmayı amaçladık

Approach to dental trauma occurring during intubation: case report

Genel anestezi sırasında bildirilen diş travması insidansı % 0.06-12.3'dir. Perioperatif dental travmaların çoğu laringoskopi ile entübasyon sırasında ortaya çıkarken, airway, endotrakeal tüp ya da larengeal maske çıkarılması için aşırı kuvvet uygulandığında da görülmektedir. Dental yaralanmalar basit kırıktan restorasyon kaybı veya avulsiyona (dişin soketinden çıkması) kadar değişebilir. Dental yaralanma genellikle üst ön bölgede meydana gelir ve laringoskopun konumu nedeniyle sol orta kesici diş en sık karşılaşılabilecek dental travmalara yaklaşımımızı olgu üzerinden aktarmayı amaçladık.The incidence of dental trauma reported during general anesthesia is 0.06-12.3%. The majority of perioperative dental trauma occurs during laryngoscopy and intubation, it may be observed when excessive force is applied to remove the airway, endotracheal tube or laryngeal mask. Dental injury may vary from simple fracture to restoration loss or avulsion (removal of tooth from the socket). Dental injury generally occurs in the upper front region and the left central incisor is most frequently affected due to the position of the laryngoscope. We aim to share an approach to dental trauma that may be encountered during general anesthesia administration in this case report