A Comparison of the Effects of Lung Protective Ventilation and Conventional Ventilation on Thermoregulation During Anaesthesia.

OBJECTIVE: During prolonged surgery, hypothermia is an unwanted condition that frequently develops and increases complication rates. It has been shown that positive end-expiratory pressure (PEEP) during mechanical ventilation reduces hypothermia development by providing earlier peripheral vasoconstriction. In the present study, an investigation was made of the effect of two different ventilation models on perioperative hypothermia development. METHODS: A total of 40 patients undergoing elective lumbar disc surgery were randomised to either the conventional group (Group C, n=20, tidal volume=10 mL kg-1, PEEP=0 cm H2O) or the lung protective ventilation group (Group P, n=20, tidal volume=6 mL kg-1, PEEP=5 cm H2O). Demographic data on gender, age, weight, height, preoperative-postoperative temperatures and haemodynamic values were recorded. The point where the forearm to fingertip skin temperature difference reached 0°C was determined as the peripheral vasoconstriction development. At this point, the core temperature was recorded as the thermoregulatory vasoconstriction threshold. RESULTS: Demographic characteristics of the patients and haemodynamic variables were similar between the groups. Preoperative and postoperative temperature gradients were not significantly different between the two groups (p=0.827). There was also no significant difference between the two groups in respect of the vasoconstriction threshold of the patients (p=0.432). CONCLUSION: The study results showed that lung protective ventilation has no advantage in preserving the perioperative core temperature compared to conventional ventilation.

Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

OBJECTIVE: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. MATERIALS AND METHODS: Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant. RESULTS: Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C. CONCLUSION: In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers.

The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation.

Comparison of Transcutaneous Electrical Nerve Stimulation and Paravertebral Block for Postthoracotomy Pain Relief.

BACKGROUND: Inadequate relief of postthoracotomy pain is a major reason of increased occurrence of postoperative complications. We aimed to investigate and compare the effects of transcutaneous electrical nerve stimulation (TENS) and paravertebral block (PVB) to relieve pain after thoracotomy procedures. MATERIALS AND METHODS: We studied 40 patients who underwent thoracotomy. Patients were randomly allocated to receive either PVB (group P, n = 20) or TENS (group T, n = 20) for postoperative pain. The electrodes of TENS were placed 2 cm under and 2 cm over the thoracotomy cut on both posterior and anterior sides. The surgeon inserted paravertebral catheters using direct vision at the end of the surgery. A patient-controlled analgesia (PCA) device was connected to all patients. Visual analog scales, patient demand, and consumption of tramadol were evaluated postoperatively. RESULTS: Mean visual analog scale (VAS) values were significantly lower in group P for all time points. The patients in group P needed lower amounts of opioid (tramadol) and the difference was statistically significant (258.4 ± 13.52 mg vs. 314.4 ± 8.65 mg, p = 0.005). In addition, the number of demand attempts recorded from the PCA device was significantly lower in group P (14.95 ± 13.64 vs. 26.7 ± 17.34, respectively and p < 0.001). CONCLUSION: TENS has beneficial effects for pain relief after thoracotomy, without any side effects; however, it cannot provide sufficient pain relief when compared with PVB.

Impact of a lung-protective ventilatory strategy on systemic and pulmonary inflammatory responses during laparoscopic surgery: is it really helpful?

Laparoscopic surgery is performed by carbon dioxide (CO2) insufflation, but this may induce stress responses. The aim of this study is to compare the level of inflammatory mediators in patients receiving low tidal volume (VT) versus traditional VT during gynecological laparoscopic surgery. Forty American Society of Anesthesiologists (ASA) physical status 1 and 2 subjects older than 18 years old undergoing laparoscopic gynecological surgery were included. Systemic inflammatory response was assessed with serum IL-6, TNF-alpha, IL-8, and IL-1ß in patients receiving intraoperative low VT and traditional VT during laparoscopic surgery [within the first 5 min after endotracheal intubation (T1), 60 min after the initiation of mechanical ventilation (T2), and in the postanesthesia care unit 30 min after tracheal extubation (T3)]. Additionally, inflammatory response was assessed with bronchoalveolar lavage (BAL) at T1 and T3 periods. An increase in the serum levels of IL-6, TNF-alpha, IL-8, and IL-1ß was observed in both groups during the time periods of T1, T2, and T3. No significant differences were found in the serum and BAL levels of inflammatory mediators during time periods between groups. The results of the present study suggested that the lung-protective ventilation and traditional strategies are not different in terms of lung injury and inflammatory response during conventional laparoscopic gynecological surgery.

Effect of transversus abdominis plane block on cost of laparoscopic cholecystectomy anesthesia.

BACKGROUND: Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. MATERIAL AND METHODS: Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. RESULTS: There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. CONCLUSIONS: Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy.

Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery.

BACKGROUND: Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. METHODS: A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n = 30, tidal volume = 10 mL/kg, rate = 12/minute, PEEP = 0 cm H(2)O) or the low tidal group with PEEP group (n = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H(2)O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. RESULTS: There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO(2)) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg;p = 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO(2) values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H(2)O, p = 0.041, low tidal; 23.67 cm H(2)O, p = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. CONCLUSION: The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases.

Exploring for the safer ventilation method in laparoscopic urologic patients? Conventional or low tidal?

BACKGROUND: To study the effects of low tidal volume with positive end-expiratory pressure (PEEP) on arterial blood gases of patients undergoing laparoscopic urologic surgeries. SUBJECTS AND METHODS: Eighty-six laparoscopic urologic patients were enrolled in this study. Patients were randomized into two groups according to the ventilatory settings. In the conventional group (Group C) (n=43), the tidal volume was 10 mL/kg, and the PEEP was set at 0 cm of H2O. In the low tidal volume with PEEP group (Group LP), the tidal volume was 6 mL/kg, with PEEP of 5 cm of H2O. In both groups total minute volume was 6 L/kg. Peak and plateau airway pressure (PPEAK and PPLAT, respectively) and arterial blood gases were recorded before pneumoperitoneum (PNP) (T1) and the first and third hour (T3) after PNP induction and also after extubation in the intensive care unit. Additionally, heart rate, mean arterial pressure, and peripheral O2 saturation of hemoglobin were recorded. RESULTS: Heart rate, PPEAK, and PPLAT values were similar in both groups. Partial arterial O2 pressure values measured postoperatively were significantly higher in Group LP, whereas those measured before PNP induction were similar (P=.014 and P=.056, respectively). Compared with the baseline, partial arterial CO2 pressure values measured at T1 and at T3 after PNP induction were significantly higher in Group C than in Group LP (P<.001). The pH values of Group C at T1 and at T3 postoperatively were significantly lower than the values of Group LP (P<.001). Extubation times were significantly lower in Group LP. CONCLUSIONS: The results of the present study suggest that low tidal volume with PEEP application may be a good alternative for preventing high CO2 levels and yielding better oxygenation and lower extubation times in patients undergoing prolonged laparoscopic urology.

Comparison of the effects of desflurane and propofol anesthesia on the inflammatory response and s100ß protein during coronary artery bypass grafting.

Cardiopulmonary bypass (CPB) contributes to the secretion of anti-inflammatory cytokines that mediate the inflammatory response observed during open heart surgery. In addition to many factors, type of anesthesia management affects immune response and central nervous system in cardiac surgery. The aim of this study was to assess the effect of propofol versus desflurane anesthesia on systemic immune modulation and central nervous system on patients undergoing coronary artery bypass grafting. Forty patients undergoing elective coronary artery bypass graft surgery with CPB were included in this prospective randomized study. Patients were allocated to receive propofol (n = 20) or desflurane (n = 20) for maintenance of anesthesia. The blood samples for IL-6, IL-8, TNF-α, and S100ß were drawn just prior to the operation before the induction of anesthesia, second before cardiopulmonary bypass, third after CPB, fourth 4 h postoperatively at the ICU. Major finding in our study is that S100ß levels were lower in propofol group when compared to desflurane anesthesia. And also immune reaction was less in patients exposed to desflurane anesthesia when compared to propofol anesthesia as indicated by lower plasma concentrations of IL-8 and IL-6. Propofol is more preferable in terms of S100ß for anesthetic management for CABG.

Pleomorphic adenoma of the trachea.

Pleomorphic adenoma in the trachea is very rare. We report the case of a 46-year-old woman who had been treated for asthma for 12 months before the diagnosis of pleomorphic adenoma of the trachea was made. The tumour was defined by fiberoptic bronchoscopy in the mid 1/3 of the trachea obstructing nearly 90 % of the lumen. Through a collar incision and partial sternotomy, 3 cm segment of the trachea was resected and end-to-end anastomosis was performed.

Determining entropy values equivalent to the bispectral index values during sevoflurane anaesthesia.

INTRODUCTION: We aimed to identify the entropy levels that would be equivalent to the bispectral index (BIS) levels in sevoflurane anaesthesia in patients who are to undergo elective lumbar disc surgery. MATERIAL AND METHODS: Thirty cases in ASA groups I-II who underwent lumbar disc surgery under general anaesthesia were included in our study after obtaining the consent of the patients and Ethics Committee of our medical school between January 1, 2005 and October 30, 2006. BIS and entropy electrodes were applied at the same time in 30 cases in the study group. The depth of the anaesthesia was regulated so that 10 min after beginning the general anaesthesia the BIS values were between 40 and 60. At the same time equivalent entropy values corresponding to BIS values were obtained. RESULTS: At the end of the study, entropy values corresponding to general anaesthesia BIS values were identified. General anaesthesia BIS and RE/SE values at 10 min were lower than the values of the control, which was statistically significant (p < 0.05). Equivalent entropy values were obtained lower than the BIS values during general anaesthesia and these values were found to be statistically significant (p < 0.05). The blood pressure (BP) values obtained were very low at equivalent BIS values and when these BP values were compared with the initial BP values they were found to be statistically significant (p < 0.05). CONCLUSIONS: Based on this observation, we think that general anaesthetic agents that might cause severe hypotension could be more safely administered under entropy monitoring.

Advantages of autologous blood transfusion in off-pump coronary artery bypass.

BACKGROUND: In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery. METHODS: Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit. RESULTS: Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group. CONCLUSION: Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.

Gastrointestinal ischemia related mortality in patients undergoing off- or on-pump coronary artery bypass grafting.

OBJECTIVE: Gastrointestinal ischemia (GII) after heart surgery is a rare but devastating condition. The aim of this study was to compare the occurrence of GII after coronary artery bypass grafting (CABG) performed off-pump (OPCAB) vs on-pump (ONCAB). METHODS: We retrospectively evaluated 2625 adult patients who underwent isolated coronary artery surgery during a 6-year period. The OPCAB group included 658 patients and the ONCAB group 1967 patients. Patients were evaluated, and GII, morbidity, and mortality in the 2 groups were compared. RESULTS: GII developed in 0.4% (7 of 1967) patients in the ONCAB group and in 0.2% (1 of 658) patients in the OPCAB group (P = .28). Mortality rates due to GII were 0.2% (4 of 1967) in the ONCAB group, and no deaths occurred in the OPCAB group (P < .04). Postoperative atrial fibrillation incidence with GII was 100% (7 of 7) in ONCAB group and 0% (0 of 1) in the OPCAB group (P < .01). CONCLUSIONS: Compared to ONCAB, the OPCAB procedure has lower GII related mortality rates, which is an important cause of morbidity and mortality in the postoperative period of CABG surgery.

Recurrent hepatic hydatid cyst in a pregnant woman.

BACKGROUND: Hydatid cyst in pregnancy is a very rare pathology and its diagnosis and treatment is still a complex problem. This report describes the clinical features and evolution of a pregnant woman operated for a recurrent hepatic hydatid cyst. CASE REPORT: A 26-year-old multigravida was admitted to our hospital in her 16th week of pregnancy because of dyspeptic complaints. She had had previous operations for hydatid cyst. A 7x5x6 cm recurrent hepatic hydatid cyst and cholelithiasis were diagnosed on sonographic evaluation. Partial cystectomy, external drainage, and cholecystectomy were performed in the second trimester of her pregnancy. No complication occurred and she gave birth to a healthy baby five months later. CONCLUSIONS: Every physician working in endemic areas should be aware of this potential healthy problems because a hydatid cyst can cause severe complications and be fatal to both mother and baby.