Effect of the Recruitment Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery

Purpose LSG surgery is used for surgical treatment of morbid obesity. Obesity, anesthesia, and pneumoperitoneum cause reduced pulmoner functions and a tendency for atelectasis. The alveolar recruitment maneuver (RM) keeps airway pressure high, opening alveoli, and increasing arterial oxygenation. The aim of our study is to research the effect on respiratory mechanics and arterial blood gases of performing the RM in LSG surgery. Materials and Methods Sixty patients undergoing LSG surgery were divided into two groups (n = 30) Patients in group R had the RM performed 5 min after desufflation with 100% oxygen, 40 cmH(2)O pressure for 40 s. Group C had standard mechanical ventilation. Assessments of respiratory mechanics and arterial blood gases were made in the 10th min after induction (T1), 10th min after insufflation (T2), 5th min after desufflation (T3), and 15th min after desufflation (T4). Arterial blood gases were assessed in the 30th min (T5) in the postoperative recovery unit. Results In group R, values at T5, PaO2 were significantly high, while PaCO2 were significantly low compared with group C. Compliance in both groups reduced with pneumoperitoneum. At T4, the compliance in the recruitment group was higher. In both groups, there was an increase in PIP with pneumoperitoneum and after desufflation this was identified to reduce to levels before pneumoperitoneum. Conclusion Adding the RM to PEEP administration for morbidly obese patients undergoing LSG surgery is considered to be effective in improving respiratory mechanics and arterial blood gas values and can be used safely

Traumatic Avulsion of Upper Eyelid Skin Following Surgery in a Patient With Multiple Myeloma and Amyloid Light-chain Amyloidosis

Multiple myeloma (MM) is a common hematologic malignancy. Primary systemic amyloidosis or amyloid light-chain (AL) amyloidosis is a rare disease. PURPOSE: This article presents the case of a patient with MM and AL amyloidosis who experienced a severe case of medical adhesive-related skin injury. CASE STUDY: A 64-year-old man with MM, AL amyloidosis, and diabetes presented with a necrotic wound on his left heel that required surgical debridement. The patient experienced a traumatic avulsion of the right upper eyelid skin during the removal of the corneal abrasion preventive tape as well as traumatic avulsion of the left upper eyelid skin while the patient's face was being cleansed. The avulsed right upper eyelid skin above the tarsus was repaired with a full-thickness skin graft. The partly avulsed left upper eyelid skin was repositioned, and an excisional biopsy was taken. Both upper eyelids healed uneventfully. The biopsy specimen revealed increased amyloid deposition in the dermis, subcutaneous tissue, and areas surrounding the veins and sweat glands. CONCLUSION: This case illustrates the increased risk of medical adhesive-related skin injury and other skin damage in patients with MM and AL amyloidosis. In these patients, the use of tape should be avoided to prevent intraoperative corneal abrasion

Laparotomi geçiren hastalarda preoperatif oral pregabalin ve peroperatif intravenöz lidokain infüzyonunun postoperatif morfin gereksimine etkisi

Çalışmamızın amacı; laparatomi geçiren hastalarda preoperatif oral pregabalin ve peroperatif iv lidokain infüzyonunun postoperatif morfin tüketimi, yan etkiler, hasta tatmini, mobilizasyon, barsak sesleri başlama, defekasyon ve taburculuk süresine etkilerini araştırmak ve karşılaştırmaktır.Çalışmamızda 18-65 yaş arası elektif laparatomi geçirecek 80 hasta plasebo kontrollü, randomize, çift kör olarak 4 gruba (n=20) ayrılmıştır. Grup K’ya (kontrol-plasebo) preop 12 saat önce ve operasyon sabahı plasebo kapsül içirildi ve peroperatif 6 cc/s 0.9 NaCl infüzyonu yapıldı. Grup L’ye operasyondan 12 saat önce ve operasyon sabahı plasebo kapsül içirildi ve peroperatif 1.0 mg/kg bolus ardından 2 mg/kg/s lidokain infüzyon uygulandı. Grup P’ye operasyondan 12 saat önce ve operasyon sabahı 150 mg pregabalin içirildi, operasyon sırasında % 0.9 NaCl infüzyonu yapıldı ve Grup PL’ye operasyondan 12 saat önce ve operasyon sabahı 150 mg pregabalin içirildi, peropeatif l.0 mg/kg bolus ve 2 mg/kg/s lidokain infüzyonu uygulandı. Tüm hastalarda anestezi indüksiyonu 5-7 mg/kg tiyopental sodyum ve 0.1 mg/kg vekuronyum bromid iv ile, anestezi idamesi 1 MAC desfIuran ve O2 içinde %7O N20 ile sağlandı. Peroperatif kalp atım hızı (KAH), ortalama arteriyel kan basıncı (OAB), periferik oksijen satürasyonu ve tidal-sonu karbondioksit basıncı 30 dk aralar ile kaydedildi. Postoperatif dönemde VAS<30 olacak şekilde iv morfin yüklemesi yapıldıktan sonra iv hasta kontrollü analjezi (HKA) başlandı. Tüm hastalarda postoperatif 48 saat boyunca VAS skorları, HKA dozları, uygulanan ek analjezik miktarları, yan etkiler, mobilizasyon, barsak hareketlerinin başlama, taburcu olma zamanı ve tatmin skorları kaydedildi. Elde edilen veriler iki yönlü varyans analizi, post hoc Tukey -Kramer test, non parametrik veriler Kruskal Walles testi ile istatistiksel olarak karşılaştırıldı.Pregabalin, pregabalin+lidokain ve lidokain gruplarının VAS değerleri kontrol grubundan belirgin düşük bulundu (p<0,05). Pregabalin ve pregabalin+lidokain grubunun total morfin tüketimi kontrol grubundan düşük bulundu (p<0,05). Kontrol47grubunda bulantı görülme oranı lidokain ve pregabalin+lidokain grubundan yüksekti. Lidokain ve pregabalin+lidokain gruplarının ilk defekasyon zamanı kontrol grubundan ve pregabalin grubundan kısaydı (p<0,05). Kontrol grubunun mobilizasyon zamanı lidokain ve pregabalin+lidokain grubundan uzundu (p<0,05).Sonuç olarak preemptif uygulanan oral pregabalin ve peroperatif intravenöz lidokain infüzyonunun postoperatif analjezik gereksinimini azalttığı ve postoperatif bulantı sıklığını azaltığı, ilk defekasyon ve mobilizasyon zamanını kısalttığı saptandı.The aim of our study was to evaluate and compare the effects of preoperative oral pregabalin and perioperative iv lidocaine infusion on postoperative morphine comsumption, adverse effects, patients’ satisfaction, mobilization time, first defecation time and discharge time in patients undergoing laparotomy.80 patients aged between 18-65 years, undergoing elective laparotomy were randomly divided into 4 groups (n=20). In Group K (Control-placebo), patients had placebo capsules 12 hours prior to operation and at the morning of operation and 6 cc/h NaCl 0,9% was infused during operation. In Group L patients had also plasebo capsules and lidocaine 1mg/kg iv bolus dose followed by 2mg/kg/h infusion was adminestered perioperatively. In Group P, patients had 150 mg oral pregabalin 12 h prior to operation and at the morning of operation and NaCl 0.9% was infused during operation. In Group PL, patients had 150 mg oral pregabalin 12 h before operation and at the morning of operation and lidocaine 1mg/kg iv bolus dose followed by 2mg/kg/h infusion was administered peroperatively. Anesthesia was induced with 5-7 mg/kg thiopental sodium and 0.1 mg/kg vecuronium bromide iv and maintained with 1 MAC desflurane with N2O 70% in oxygen in all patients. Heart rate, mean arterial blood pressure, peripheric oxygen saturation and end-tidal carbondioxide pressure were recorded with 30 minutes intervals during operation. Postoperatively morphine were administered iv until Visual Analogue Scale(VAS) < 30, and iv patient controlled analgesia (IVPCA) was started. During 48 hours postoperatively, VAS scores, IV PCA dose, additional analgesic dose, side effects, mobilization time, time of intestinal motility, time of hospital discharge and patients’ satisfaction were recorded.VAS scores of pregabalin, pregabalin+lidocaine and lidocaine groups were lower than control group (p<0.05). Morphine comsumption of pregabalin+lidocaine and pregabalin groups were found lower than control group (p< 0.05). Incidence of nausea in control group was higher than pregabalin and pregabalin+lidocaine groups. Time of49first defecation and mobilization were shorter in pregabalin and pregabalin+lidokain groups than control group (p<0.05).We concluded that preoperatif oral 2x150 mg pregabalin and perioperative iv lidocaine infusion decrease postoperatif VAS scores and morphine requirement, fastens gastrointestinal motility and decreases the incidence of nausea in patients undergoing laparotomy

Topical and systemic analgesia versus caudal epidural and dorsal penile nerve block in relieving pain after pediatric circumcision

Objective: There is no consensus on the use of optimal analgesic method after pediatric circumcision, although, caudal block (CB), dorsal penile nerve block (DPNB), topical local anesthetic application and systemic analgesic administration are frequently used methods. In this study, we aimed to compare the postoperative analgesic effects and side effects, as well as parental satisfaction concerning these methods. Patients and Methods: Eighty children, aged 3-12 years, undergoing circumcision were randomized into four groups (n=20). Group Caudal Anesthesia (CA), Group Dorsal Penile Blok (DP), Group Topical Analgesia (TA), Group Systemic Analgesics (SA). The severity of pain was measured with NRS or CHEOPS scores. Time to awakening, first analgesic requirement, hospital discharge, side effects and parental satisfaction were recorded. Results: In groups CA and DP, pain scores during the first postoperative hour were lower than the pain scores of other groups and in group CA, the first analgesic requirement time was significantly longer compared to other groups (p<0.05). In the early postoperative hour, parental satisfaction was higher in group CA compared to other groups. Conclusion: In the early postoperative period, CB and DPNB reduce pain more effectively and provide more parental satisfaction than other applications, (in children who underwent) circumcision

Relationship of Bradykinin B-2 Receptor Gene C-58T Variation with Total-Cholesterol and Glucose in Essential Hypertension

Objective: Hypertension, which affects 25% of the world's population, is a complex disease, with 30% genes affecting its pathogenesis. In this study, we aimed to examine the frequency of the bradykinin B-2 receptor gene C-58T genotypes in patients with essential hypertension and non-hypertensive controls. In addition, we evaluated the effects of C-58T genotypes on demographic characteristics, phenotypes related to obesity, and hypertension. Methods: Genotyping was performed in 63 hypertensive patients and 56 non-hypertensive subjects by PCR-RFLP. Results: The frequency of bradykinin B-2 receptor gene C-58T genotypes in hypertensive patients and control subjects was 25.4% and 28.6% for homozygous wild-type (T/T), 49.2% and 58.9% for heterozygous (T/C), and 25.4% and 12.5% for homozygous polymorphic (C/C) genotypes, respectively. Genotype frequencies did not differ significantly among study groups. The C allele was found to have an increasing effect on blood glucose levels (p=0.05) and decreasing effect on total cholesterol levels (p=0.008) in hypertensive patients, whereas it was found to have an increasing effect on waist circumference (p=0.041) in control subjects. Hypertensive patients with C allele were found to use sulfonylurea drugs (p=0.021) at a higher frequency than those with T allele. Further, hypertensive patients with T allele were found to use diuretic drugs (p=0.007) at a higher frequency than those with C allele. Conclusions: The C-58T polymorphism is found to have a positive association with total cholesterol levels, blood glucose levels, and waist circumference but no association with systolic/diastolic blood pressure

A Comparison of Pregabalin and Ketamine in Acute Pain Management After Laparoscopic Cholecystectomy

Objective: Pregabalin and ketamine are popular analgesic adjuvants for improving perioperative pain management. We designated this double-blind, placebo controlled study to test and compare the preventive effects of pregabalin and ketamine on postoperative pain management after elective laparoscopic cholecystectomy. Methods: Seventy five patients (18 to 65 years of age) undergoing laparoscopic cholecystectomy were randomly assigned to one of the following 3 groups: control group (group C) received oral placebo capsule 1 h before surgery and bolus plus intravenous (iv) infusion of saline during surgery; ketamine group (group K) received oral placebo capsule 1 h before surgery and 0.3 mg kg(-1) iv bolus plus 0.05 mg kg(-1) h(-1) iv infusion of ketamine during the surgery; pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery and bolus plus iv infusion of saline during surgery. The anesthetic technique was standardized, total tramadol consumption, visual analog scale (VAS), incidence of postoperative nausea and vomiting (PONV), sedation score and complications related to the drugs used in the study were assessed in the postoperative 24 h period. Results: Postoperative total tramadol consumption were significantly lower in the pregabalin and ketamine group compared to the group C (p=0.001). Tramadol requirement was similar between pregabalin and ketamine groups. At 30 min postoperatively, VAS values were lower in the pregabalin and ketamine groups compared with group C (p=0.001). There was no difference between the three groups in the need for supplemental analgesia, incidence of PONV and sedation score >2. Discussion: Pregabalin and ketamine improved postoperative pain control and decreased analgesic consumption after laparoscopic cholecystectomy with a good safety profile without any changes in sedation level or PONV