Procedural sedation protocols with or without ketamine in pediatric gastrointestinal endoscopy: A retrospective cohort study

Objective: A considerable difference exists in pediatric endoscopy sedation practices with the optimal sedation protocol for gastrointestinal (GI) endoscopy a subject of controversy and to investigate the safety and efficacy of sedation protocols with or without ketamine in procedural sedation for pediatric GI endoscopy. Materials and Methods: A total of 78 pediatric patients who received sedation anesthesia for GI endoscopy were included in this retrospective study. Anesthesia parameters include duration time, doses of anesthetic agents, Ramsay sedation score, respiratory and hemodynamic parameters, recovery time, modified Aldrete recovery scores, and side effects. Study parameters were evaluated with respect to ketamine dose (no ketamine group (NKG), low-dose ketamine group (LDKG, ≤0.75 mg/kg), and high-dose ketamine group (HDKG, ≥1 mg/kg). Results: The upper GI endoscopy rate (58.12% vs. 90.0%, p=0.001) was significantly lower in LDKG versus HDKG. No significant changes were observed in blood pressure levels, oxygen saturation, or heart rate compared to baseline levels. No significant difference was noted between study groups in terms of recovery time, modified Aldrete recovery scores, and nausea/vomiting. Final Ramsay sedation scores were significantly higher in NKG (p<0.05) and LDKG (p<0.01) than in HDKG. Conclusion: Our findings indicate a favorable safety and efficacy profile for ketamine as a useful adjunct to procedural sedation for pediatric GI endoscopy, enabling better quality of sedation with a low risk of cardiorespiratory suppression, or serious complications

The effect of anesthetic agents used in oocyte collection on intracytoplasmic sperm injection results in patients treated for infertility due to male factor

Aim: Different anesthetic methods and agents are used for transvaginal oocyte retrieval procedures (TORP) in assisted reproductive techniques (ART). In our study, we evaluated prospectively the effect of propofol and thiopental sodium during TORP on intracytoplasmic sperm injection (ICSI) results in the spouses of patients with male factor indication.Material and Methods: The study was approved by the ethics committee with Protocol No. 2019-21-07 on dated October 28, 2019. Sixty female patients who underwent TORP for intracytoplasmic sperm injection were included in the study. Anesthesia was randomized into two groups according to propofol (GP) or thiopental sodium (GT) used for induction and maintenance anesthesia. Patients' demographic data, effects of the anesthetic drug used on hemodynamics and nausea and vomiting, laboratory parameters including fertilization rate, cleavage rate, optimal embryo rate and implantation rate, and pregnancy outcomes were recorded.Results: Sixty patients, including the propofol group (n:30) and the thiopental sodium group (n:30), were evaluated. Mean age, body mass index and motile sperm count were similar in both groups. Mean arterial pressures and nausea and vomiting rates were lower in GP (p<0.05). Although intracytoplasmic sperm injection, pronucleus, MII oocyte values were statistically significantly higher in GP, B-HCG and clinical pregnancy outcomes were similar in both groups.Discussion: Our findings revealed that propofol and thiopental sodium, the anesthetic agents used in transvaginal oocyte collection procedure before ICSI treatment, had similar effects on clinical pregnancy. The results of our study are similar to many studies in the literature

Comparison of the Effect of Different Anesthesia Maintenance on Hemodynamics in Coronary Artery Bypass Grafting Surgery: A Retrospective Cohort Study

Objective:General anesthesia management in coronary artery bypass graft surgery (CABGC) should preserve myocardial function, prevent ischemic damage, and maintain stable hemodynamics. There is not a universally accepted technique for anesthetic management during CABGC. Drugs or drug combinations and maintenance of infusions are decided based on the pathophysiological condition of the patient and the individual preference and experience of the anesthesiologist (1). Although there are many studies about an anesthesia induction in CABGC, studies about anesthetic maintenance are very limited. In this study, we compared the hemodynamic effects of three different methods that were used in anesthetic maintenance in CABGC.Method:The retrospective records of 108 patients in ASA II-III group who underwent elective CABGC were divided into 3 groups according to their anesthetic maintenance methods. Group I was maintained with 1-3% sevoflurane and fentanyl 4 mcg/kg/hour infusion, group II with propofol 1.5-4 mg/kg/hour and fentanyl 4 mcg/kg/hour infusion, and group III with propofol 1.5-4 mg/kg/hour and remifentanil infusion of 0.03 mg/kg/hour. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and heart rate (HR) were measured and recorded after induction (T0), after sternotomy (T1), after pericardiotomy (T2), 5 minutes after cardiopulmonary bypass (CPB) (T3), after thorax closure (T4), at the end of the operation (T5). The vasodilator requirements in the time period before CBP and the inotropic agent requirements after CPB were noted.Results:Data of 108 patients (88 men/20 women) were analyzed. Demographic characteristics of the patients were similar in all the groups. Statistical analysis was made among the groups depending on coronary artery bypass graft number, cross-clamp time, total fluid administration, total blood transfusion, total urine volume, inotropic agent requirement after CPB, postoperative central venous pressure, and pre- and postoperative lactate levels; however, there was no statistical difference. There was not change more than 20-25% in MAP and HR in group I than the others.Conclusion:Better hemodynamic results were achived with sevoflurane and fentanyl in the anesthetic maintenance of CABGC