ABSTRACT
Adequate and effective pain management and prevention of depression are essential in burn patients. This study aims to explore the effects of ketamine sedation in burn patients in terms of mood disorders, depression, anxiety, and suicidality during postoperative follow-up in the intensive care unit. This study targeted subjects aged 18 to 65 years, in the ASA I-II class, with basic communication skills, no history of diagnosed mental illness, and no history of neuropsychiatric or cognitive disorders or related treatment. The study was conducted on 67 patients. After preoxygenation, anesthesia induction was practiced with 2 mg/kg IV propofol and 1 mcg/kg IV fentanyl in the general anesthesia group. Anesthesia was continued with a mixture of 0.3-0.5 mcg/kg/min remifentanil, 2% sevoflurane, 50% air, 50% oxygen. In the sedation group, 1 mcg/kg IV fentanyl and 1 mg/kg IV ketamine were administered at induction; anesthesia was maintained by adding 30-50 mg IV propofol if necessary. The Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Beck Scale for Suicidal Ideation (BSSI) have been administered via way of means of a psychiatrist preoperatively and on the primary postoperative day. In intragroup evaluations, MADRS values for the sedation anesthesia group decreased statistically significantly after the anesthesia (11.63±5.49) compared to the pre-anesthesia period (14.44±7.22) (p < 0.001). HAM-A scores of both anesthesia groups decreased statistically significantly after anesthesia. No patient was found to have suicidal ideation in all evaluations in which BSSI was used. Burn patients may have a high potential for depression, anxiety disorders, and suicidal tendencies due to the trauma they have experienced. In these patients, sedation anesthesia with ketamine may reduce negative mood, depression, anxiety, and suicidal tendencies in the postoperative period.
ABSTRACT
AIM: Both LigaSure (LS) and Harmonic Scalpel (HS) are new surgical technologies that have been used to secure hemostasis in various fields of surgery. There is little information in the literature about the use of LS and HS in thyroid surgery. The aim of this study was to report our experience with LS and HS in thyroid surgery. MATERIALS AND METHODS: In this nonrandomized retrospective study 326 consecutive patients who underwent primary thyroid surgery were reviewed. HS was used in 136 patients and LS was used in 126 patients. A conventional technique was used in 64 patients. The were 42 male patients (12.9%) and 284 female patients (87.1%); their ages varied between 19 and 72 years (mean 42.8 + 12.4). Data regarding each patient's demographics, thyroid pathology, operation time, and complications were collected throughout the study. RESULTS: The 3 study groups-had similar demographics (age, female/male ratio) and thyroid pathology. Permanent hypocalcemia developed in 2 (1.6%) patients in the patient group operated on through LS, of which 1 was male and the other was female. In the HS group, postoperative hematoma developed in 2 (1.5%) patients. CONCLUSION: The results of this retrospective clinical study showed that LS and HS thyroidectomy can be a useful and fast alternative for conventional thyroidectomy. The main advantage of these devices is that they simplify the procedure and eliminate the need for clips and suture ligations while achieving efficient hemostasis.
