Effects of preoperative smoking cessation on HAM-A sedation scores and intraoperative consumption of anesthetics and fentanyl

Objective: Patients undergoing surgery, experience acute physiological distress in the preoperative period. Smoking addiction is a complex behavior in which environment and genetic effects play a part. In this study our aim was to compare the impact of cigarette smoking cessation verses continued smoking on preoperative HAM-A scores and anesthetic requirement

Methodology: After approval by the Ethic Committee, informed consent was obtained from patients, 18-65 years old, American Society of Anesthesiologists [ASA] physical status I-II, 120 patients scheduled for elective laparoscopic cholecystectomy were included in this prospective randomized, double-blind study. Groups were defined as Group N [n-.60, patients who continued smoking in the preoperative period] and Group NS [n:60, who stopped smoking 48 hours before the operation].Only the first patient on the list were included. All patients received intravenous midazolam 0.05-0.1 mg/kgas premedication. In the preoperative period HAM-A scores were recorded while the preoperative examination was performed in the outpatient clinic and after premedication. In addition, we monitored patients with Bispectral Index Monitor [BIS] and anesthetic requirements were recorded during surgical procedure

Results: HAM-A scores in the outpatient clinic and after receiving premedication were statistically significantly higher in Group N. Additional fentanyl requirement was also significantly higher in Group N

Conclusion: We conclude that to stop smoking 48 hours before surgery reduced anxiety as measured by HAM-A scores and anesthetic requirement and increased patient comfort

comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations

The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia [iv PCA]. Ramsey Sedation Score [RSS], Modified Aldrete's Score System[MASS] and Visual Analog Scale Pain Score [VAS] was used for postoperative evaluation. Postoperative opioid consumption was recorded. Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment

Anesthetic management for super-super morbidly obese patient

Obesity leads to several changes in both airway and drug metabolism. The problems are compounded in cases of super super morbid obesity. Gastric banding surgery for weight loss was planned for a 47 year old, super-super morbidly obese female patient [164 kg and 151 cm, BMI: 72 kg/m[2] On pre-operative examination, patient had a short thick neck and grade 4 Mallampatti class. Induction of anesthesia was done in the sitting / semi-sitting position Maintenance was provided with 6% desflurane and O[2]/air mixture. Remifentanil infusion of 0.05 [xg/kg was administered during surgery. Patient had an uneventful recovery. The use of short acting drugs and appropriate monitoring provided hemodynamic stability and a fast and smooth recovery