60 research outputs found
The Effects of Glasgow Coma Scales and Bispectral Index on General Anaesthesia in Neurosurgery Patients
No full textObjective: Monitorisation under anaesthesia is important for objective evaluation in intracranial surgery. We investigated general anaesthesia management performed by bispectral index (BIS) monitoring in patients who underwent surgery due to intracranial pathology with different Glasgow Coma Scales (GCS). Methods: Forty-five patients who had been planned to undergo intracranial surgery under general anaesthesia were included in the study. Patients were divided into three groups according to GCS: Group I (n = 15) = 13-15 mildly injured; Group II (n = 15) = 9-12 moderately damaged; Group III (n = 15) = 3-8 severely damaged. Heart rate (HR), mean blood pressure, and use of anaesthetic agent were recorded. Results: It was found that the consumption of the inhalation agent in Group III was lower than Groups I and II at all time intervals measured, and it was lower in Group II than Group I during the intervals at intraoperative 15th minute and up to 150th minute thereafter. The inhalation agent consumption rates according to the duration of anaesthesia were different between groups. The HR was significantly higher in Group III compared with Group II during the post-operative period. The mean arterial pressure was significantly lower in Group I than Group II pre-operatively and at 5th, 10th, 15th, 20th, and 40th minute intra-operatively, whilst it was significantly lower in Group I than Group III preoperatively and 10th minute and 15th minute, intraoperatively. Conclusion: We found that in patients whose GCS was severely damaged and underwent intracranial surgery under general anaesthesia with BIS monitoring, the consumption of inhalation anaesthetic agent decreased, but opioid consumption did not change
Effects of General Anaesthesia on the Middle Ear Pressure
No full textObjective: Inhalation agents can have different effects on the middle ear pressure (MEP). We aimed to investigate the effect of sevoflurane and desflurane, the agents used in patients who do not have any car pathology and who undo go surgery under general anaesthesia, on MEP. Methods: Fifty adult patients who were scheduled to undergo inguinal hernia and lower extremity surgery were included in our study. All patients were aged between 20 and 60 years and belonged to the American Society of Anesthesiologists (ASA) I-III class. Patients were divided into two groups, according to the inhalation agent administered for the surgery: sevofluran, Group S (n=25); and desfluran, Group D (n=25). Anaesthetic agents, intraoperative end tidal carbon dioxide and airway pressures were recorded. The MEP was measured for both ears preoperatively, at the intraoperative 5th, 10th, 15th minutes, and at the postoperative 10th and 30th minutes. Results: The MEP at the intraoperative 10th minute was significantly higher in Group D compared to Group S. In Group D, the MEP increased significantly at the intraoperative 10th and 15th minutes, and postoperative 30th minute, compared to preoperative values. In Group S, the MEP increased significantly at the postoperative 10th minute, compared to preoperative values. Conclusion: We found that desflurane increases the MEP during the intraoperative and postoperative period, compared to sevoflurane.Trakya University Research Centre, Edirne, Turkey [TUBAB 2013-129]This study was supported as Project TUBAB 2013-129 by Trakya University Research Centre, Edirne, Turkey
Fat embolism associated with anesthesia induction with propofol-lidocaine combination
No full textFat embolism syndrome has been described following traumatic, surgical, and atraumatic conditions. Long-bone fractures are probably the most common cause of this syndrome. Fat embolic events are often clinically insignificant and difficult to recognize since clinical manifestations vary and there is no routine laboratory or radiographic means of diagnosis. Propofol is widely used for the induction and maintenance of anesthesia. Addition of lidocaine to propofol may result in a coalescence of oil droplets, forming a separate layer. The risk of propofol and lidocaine combination to cause fat embolism depends on the dose of lidocaine and the duration between its preparation and administration. We presented a patient who developed fat embolism following anesthesia induction during surgery for a lower extremity fracture due to a traffic accident. The occurrence of fat embolism was attributed to propofol-lidocaine use. The diagnosis of fat embolism was based on clinical manifestations, radiographic and laboratory findings, and elimination of other causes associated with arterial hypoxemia
Duodenal necrosis during nasogastric tube feeding: A case report
No full textA case of duodenal necrosis during nasogastric tube feeding in a 45-year-old male patient hospitalized in intensive care unit with a diagnosis of acute respiratory distress syndrome is reported with a review of literature. Abdominal distension developed after several days of uneventful nasogastric tube feeding. At laparotomy patchy necrosis of the duedonum was found without signs of bowel obstruction or impaired mesenteric perfusion. In this case, the large doses of fentanyl, midazolam and dopamine given for sedation, were suspected to be a major contributing factor to the development of the necrosis by impairing mucosal per-fusion
Is music the food of the anesthesia in children?
No full textBACKGROUND: The noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium. METHODS: One hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation. RESULTS: M-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups. CONCLUSIONS: The music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03544502)
Modified 30-Degree Head-Up Tilt Park Bench Position in Semielective Posterior Fossa Surgery in a Patient with Pheochromocytoma
No full textVon Hippel–Lindau (VHL) disease is a rare genetic disorder associated with the central nervous system and visceral organs. Pheochromocytomas occur in 10% of VHL patients, while cerebellar tumors are common tumors in VHL syndrome, with an incidence of 60%. The most common position for posterior fossa operations is the park bench or lateral decubitus position. These positions have primarily replaced the sitting position. However, the advantages of the supine position cannot be overlooked. The coexistence of pheochromocytoma and the cerebellar tumor may require modification in surgical position and anesthesia management in line with possible pathophysiological changes. We present the anesthesia management in posterior fossa surgery in patients with postponed pheochromocytoma surgery. The present case highlights the importance of a multidisciplinary team approach and anesthetic management
Postarthroscopy analgesia using intraarticular levobupivacaine and intravenous dexketoprofen trometamol
No full textThe aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia. Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively. The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p < 0.05). The average VAS score during the first 24 h post-operatively was significantly lower in group III than in group I and group II (p < 0.001). Total meperidine consumption was significantly lower in group III than in groups I and II (p < 0.001). Intraarticular levobupivacaine with adjuvant intravenous dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone. II
Comparación de diferentes test para determinar la intubación difícil en pacientes pediátricos
No full textResumenIntroducciónLas dificultades en el manejo de las vías aéreas son la principal causa de morbimortalidad relacionada con la anestesia pediátrica.ObjetivoEvaluar el valor del test modificado de Mallampati, test de la mordida del labio superior, distancia tiromentoniana y relación altura-distancia tiromentoniana para prever la intubación difícil en pacientes pediátricos.ProyectoAnálisis prospectivo.Medidas y resultadosDatos recopilados de 250 pacientes pediátricos con edades entre 5 y 11 años sometidos a la intubación traqueal. La clasificación de Cormack y Lehane fue usada para calcular laringoscopia difícil. Se registraron los valores de sensibilidad, especificidad, predictivo positivo y AUC para cada test.ResultadosLa sensibilidad y la especificidad del test modificado de Mallampati fueron del 76,92 y del 95,54%, mientras que para el ULBT fueron del 69,23 y del 97,32%. El punto de corte ideal para la relación altura-distancia tiromentoniana y distancia tiromentoniana para prever la laringoscopia difícil fue 23,5 (sensibilidad, 57,69%; especificidad, 86,61%) y 5,5cm (sensibilidad, 61,54%; especificidad, 99,11%). El test de Mallampati modificado fue el más sensible de los test. La relación entre altura-distancia tiromentoniana fue el test menos sensible.ConclusiónEsos resultados indican que los test de Mallampati modificado y de la mordida del labio superior pueden ser útiles en pacientes pediátricos para la previsión de la intubación difícil.AbstractBackgroundThe difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality.ObjectiveTo assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients.DesignProspective analysis.Measurements and resultsData were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured.ResultsThe sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test.ConclusionThese results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation
Default and prepayment options pricing and default probability valuation under VG model
No full textIn this paper, a new approach, the Variance Gamma (VG) model, which is used to capture unexpected shocks (e.g., Covid-19) in housing markets, is proposed to contribute to the standard option-based mortgage valuation methods. Based on the VG model, the closed-form solutions are performed for pricing mortgage default and prepayment options. It solves the options pricing equations explicitly and illustrates numerical results for both mortgage default and prepayment options' prices. Furthermore, the study enables researchers to monitor the default probability of mortgagors. Analyzing the effect of risks on default and prepayment options using simulations shows that the VG model captures the systematic and systemic (idiosyncratic) risks of default and prepayment options prices with closed-form solutions and computes the mortgage default probabilities. Therefore, it allows lenders a more advanced decision process compared to the standard option-based mortgage valuation method. (C) 2021 Elsevier B.V. All rights reserved
THE EFFECTS OF FRESH GAS FLOW ON CARBOXYHEMOGLOBIN LEVELS IN SMOKERS AND NON-SMOKERS DURING GENERAL ANESTHESIA
No full textTÜBAP- 2009/53Giriş: Sigara ve değişik şekillerde kullanılan tütün, sağlığa olan zararının bilinmesine karşın tüm dünyada oldukça yaygın bir şekilde kullanılmaktadır. Günümüzde birçok hastalık ile sigara kullanımı arasındaki ilişki gösterilmiştir. Postoperatif dönemde en önemli mortalite ve morbidite nedeni pulmoner komplikasyonlardır ve sigara kullanımı postoperatif pulmoner komplikasyonların gelişimi için en önemli risk faktörlerinden birisidir. Bu çalışmada elektif olarak operasyona alınan sigara içen ve içmeyen hastalardaki farklı taze gaz akımlarının (4 ve 6 lt/dk) karboksihemoglobin düzeylerine olan etkisinin araştırılması amaçlandı. Yöntemler: Genel anestezi altında elektif cerrahi planlanan Amerikan Anesteziyoloji Derneği risk skoru I-II risk grubunda, yaşları 18-80 arasında değişen 100 hasta çalışmaya dahil edildi. Operasyon öncesi olgular öncelikle, sigara içenler (Grup A, n=50) ve sigara içmeyenler (Grup B, n=50) şeklinde iki gruba ayrıldı. Tüm olguların indüksiyon öncesi, indüksiyon sonrası, entübasyon sonrası, intraoperatif her 30 dakikada bir, operasyon sonu, ekstübasyon sonrası, postoperatif 30. ve 60. dakikalarda kalp tepe atımı, sistolik arter basıncı (mmHg), diyastolik arter basıncı (mmHg), SpO2, end-tidal karbondioksit ve karboksihemoglobin değerleri ölçülerek kayıt edildi. Bulgular: Çalışmaya dahil edilen olgular arasında cinsiyet, yaş, kullanılan sigara miktarı, operasyon süresi ve ekstübasyon zamanı açısından fark yoktu. Farklı taze gaz akım hızlarına göre (n=25) karşılaştırıldıklarında operasyon öncesinde, sırasında ve sonrasında farklı zamanlarda ölçülen karboksihemoglobin değerleri açısından gruplar arasında istatistiksel anlamlı farklılık saptanmadı. Sonuç: Bu durum, elektif operasyon planlanan hastalarda preoperatif değerlendirme sonrasında operasyona kadar geçen sürede sigaraya ara verilmesi nedeniyle bu süre içerisinde karboksihemoglobinin kandan elimine edilmesine bağlanmaktadır.Introduction: Cigarettes and tobacco, which are used in different ways, are widely used all over the world, despite the known harm to health. Today, the relationship between many diseases and smoking has been shown. Pulmonary complications are the most important cause of mortality and morbidity in the postoperative period, and smoking is one of the most important risk factors for the development of postoperative pulmonary complications. In this study, we aimed to investigate the effect of different fresh gas flows (4 and 6 lt/min) on carboxyhemoglobin levels in smokers and non-smokers who were operated on electively. Methods: A total of 100 patients, aged between 18-80, in the American Society of Anesthesiology risk score I-II risk group, who were scheduled for elective surgery under general anesthesia, were included in the study. Preoperatively, cases were divided into two groups smokers (n = 50) and non-smokers (n = 50). Pre-induction, post-induction, postintubation, intraoperatively every 30 minutes, post-operative, postextubation, postoperative 30th and 60th minutes, peak heart rate, systolic arterial pressure (mmHg), diastolic arterial pressure (mmHg), SpO2, End-tidal carbon dioxide, and carboxyhemoglobin values were measured and recorded. Results: There was no difference between the cases included in the study in terms of gender, age, amount of cigarette smoked, operation time, and extubation time. When compared according to different fresh gas flow rates (n = 25), no statistically significant difference was found between the groups in terms of carboxyhemoglobin values measured at different times before, during, and after the operation. Conclusion: This situation is attributed to the elimination of carboxyhemoglobin from the blood during this period, due to the cessation of smoking in patients scheduled for elective surgery after the preoperative evaluation until the operation.Trakya Üniversitesi Bilimsel Araştırma Projeleri Birim
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