Behavioural effects of chronic exposure to subanesthetic concentrations of halothane, sevoflurane and desflurane in rats.

BACKGROUND: A double-blind, randomized trial was conducted to determine the behavioural effects of chronic exposure to subanesthetic concentrations of halothane, sevoflurane and desflurane in rats. METHODS: Halothane, sevoflurane and desflurane group rats received 0.1%, 0.3%, and 0.6% concentrations in a flow rate of 3 L.min(-1) O(2) respectively. Control animals also received 3 L.min(-1) O(2) in another investigation room, which had the same properties as the study group rooms. Rats breathed inhaled agents or oxygen between 09:00-13:00 hr every day for 30 days. After 30 days of inhalation of subanesthetic doses of inhaled agents or oxygen, behavioural tests were applied. RESULTS: Tests of exploratory activity and curiosity (hole-board test), anxiety (elevated plus maze test) and learning and memory functions (multiple T maze test), demonstrated that chronic exposure to subanesthetic concentrations of all three anesthetics alters behavioural functions in rats. However, impairment of learning (P<0.05) and memory function (P<0.05) were greater in association with desflurane, in comparison to halothane and sevoflurane-treated rats. CONCLUSION: Chronic exposure to subanesthetic concentrations of halothane, sevoflurane and desflurane is associated with behavioural change in rats. Of the three drugs, desflurane was associated with the lowest learning and memory function test scores.

Effects of lidocaine and prednisolone on endoscopic rigid laryngoscopy.

OBJECTIVE/HYPOTHESIS: The aim of this study is to compare the effects of lidocaine and methylprednisolone on postoperative respiratory complications caused by short-term laryngeal surgery by way of rigid laryngoscope under general anesthesia. The effects of these drugs on recovery from anesthesia are also compared. STUDY DESIGN: One hundred American Society of Anesthesiologists physical status I to II patients over 20 years of age admitted for laryngeal mass, nodule, or polyp were included in this prospective, placebo-controlled, randomized, and double-blinded study. METHODS: Patients were randomly allocated to four groups; methylprednisolone 3 mg.kg-1 (group 1), 0.9% saline physiologic 5 mL (group 2), lidocaine 1.5 mg.kg-1 (group 3) intravenously, seven puffs of lidocaine aerosol 10% to oropharyngolaryngeal structures topically (group 4) sprayed. Anesthesia recovery time was calculated. Respiratory system was evaluated using a scoring table during early postoperative period. RESULTS: Ninety-two cases were suitable for analysis. Recovery time was longer in group 1 (9.8 3+/- 3.79 minutes) than in groups 3 and 4 (7.22 +/- 2.38, 7.50 +/- 2.30 minutes, respectively) (P < .05). Postoperative respiratory complications were lower in groups 3 and 4 than group 2 (P < .05). CONCLUSIONS: Lidocaine intravenous or topical administration was effective in reducing postoperative respiratory complications after short-term laryngeal surgery by way of rigid laryngoscope. Methylprednisolone prolonged recovery time from anesthesia.

[Comparison of effects of the administration of intraperitoneal local anesthetics for postoperative analgesia and prevention of shoulder pain]. / Laparoskopi sonrasi analjezi ve omuz agrisinin önlenmesinde intraperitoneal lokal anestezik uygulamasinin etkinliginin karsilastirilmasi.

Postoperative abdominal and shoulder pain are common complications after laparoscopy. The aim of this study is to compare the effects of intraperitoneal local anesthetics on postoperative abdominal and shoulder pain after laparoscopy. 55 women, physical status ASA I, who were undergoing diagnostic or minor gynecologic surgery, was enrolled to the study. In Group 1 (Bupivacaine, n: 17) and Group 2 (Ropivacaine, n: 18), 80 ml solution which contains one of the local anesthetics (60 ml saline and 20 ml %0.5 bupivacaine in Group 1, 60 ml saline and 20 ml %0.75 ropivacaine in Group 2), was injected into the right subdiaphragmatic (30 ml) and abdominopelvic space (50 ml) at the beginning of the surgical procedure. Patients in Group 3 (Control, n: 20) didn't received any solution intraperitoneally. Shoulder and abdominal pain was assessed with a visual analogue scale, and any other complications were noted during the first 24 hours after surgery. Shoulder and abdominal pain intensity and frequency were significantly less in the local anesthetic groups than control group, similar between ropivacaine and bupivacaine groups.

Effects of menstrual cycle on postoperative analgesic requirements, agitation, incidence of nausea and vomiting after gynecological laparoscopy.

BACKGROUND: Several studies have suggested that the menstrual cycle has an impact on postoperative nausea and vomiting (PONV). No previous study has evaluated the effect of the menstrual cycle on the incidence of postoperative agitation and analgesic/antiemetic requirements. METHODS: On the basis of the phase of the menstrual cycle [pre+/-menstrual (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15), and luteal phase (Pd 20-24)], 67 patients enrolled in this blinded, prospective study. Anesthesia was standardized. Fentanyl was given to the patients who had severe pain in the recovery room. The patients who had agitation were given midazolam. When pain intensity was >5 on the Visual Analog Scale, metamizol was administered in the Gynecology Department. A blinded anesthesiologist recorded episodes of PONV in the recovery room, and 2 and 24 h postoperatively. RESULTS: The opioid requirement and the frequency of agitation were similar in each group. Metamizol consumption was highest in the luteal phase (p < 0.05). The follicular and luteal phases were predictors for vomiting at recovery (p < 0.05 and p < 0.001, respectively). At the postoperative 2nd hour, nausea was higher in the follicular phase than in the other phases (p < 0.05) and the luteal phase was a predictor for retching (p < 0.001). At the postoperative 24th hour, nausea was the common symptom in the luteal phase (p < 0.05). The need for ondansetron was highest in the luteal phase (p < 0.01). CONCLUSIONS: In conclusion, we suggest that the scheduling of all surgical procedures according to the menstrual phase may serve to reduce the incidence of PONV and metamizol/ondansetron consumption and hospital costs.

Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain.

OBJECTIVE: The analgesic effect of bupivacaine/fentanyl with epinephrine given interpleurally after thoracotomy was investigated in a randomized placebo and intravenous controlled study. DESIGN: Prospective clinical study. SETTING: University teaching hospital. PARTICIPANTS: Sixty American Society of Anesthesiologists physical status II and III patients scheduled for posterolateral thoracotomy with general anesthesia. INTERVENTIONS: Patients were randomly divided into 4 groups to receive either 0.5% bupivacaine/1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine (n = 15, group IPBF), 0.5 % bupivacaine with 5 microg/mL of epinephrine (n = 15, group IPB), or saline (n = 15, group IPS) in a total volume of 15 to 20 mL in 60 seconds by an interpleural catheter placed at the end of surgery by direct vision. The same volume of bupivacaine 0.25% and 1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine to group IPBF, bupivacaine 0.25% with 5 microg/mL of epinephrine to group IPB or saline to group IPS was injected through the interpleural catheter every 6 hours for 48 hours postoperatively. Intravenous fentanyl (n = 15, group IVF) and interpleural saline groups received 1.5 microg/kg of fentanyl intravenously at the first complaint of pain. All patients also received patient-controlled analgesia (PCA) with fentanyl for 48 hours postoperatively. Metamizol sodium was used as a rescue analgesic. MEASUREMENTS AND MAIN RESULTS: Adequacy of pain relief was evaluated with the "Prince Henry Pain Scale" and visual analog pain scale. Fentanyl consumption via PCA and complications were evaluated for 48 hours. Visual analog scale scores were significantly higher in the interpleural saline group at 4 and 12 hours (6.6 +/- 1.2 and 5.0 +/- 2.1, respectively) postoperatively. Significantly more patients in the IPBF group had lower pain scores during coughing and deep breathing. Fentanyl consumption via PCA device was significantly higher in the intravenous fentanyl group (1,069 +/- 96.9 microg) than the interpleural groups (577.3 +/- 72.2 microg, 651.1 +/- 61.9 microg, and 601.0 +/- 22.6 microg in IPBF, IPB, and IPS groups, respectively). CONCLUSION: It is concluded that total fentanyl consumption via PCA decreased in all interpleural groups, but pain during coughing and deep breathing was significantly reduced in only the interpleural bupivacaine/fentanyl with epinephrine group.

Comparison of neonatal effects of epidural and general anesthesia for cesarean section.

We assessed the influence of anesthetic technique for cesarean section on neonatal outcome. Thirty parturient women (ASA I/II) were randomly allocated into two groups. In Group GA general anesthesia was induced with 4 mg.kg(-1) thiopental and 1.5 mg.kg(-1) succinylcholine. In group EA epidural anesthesia was performed with 20 ml 0.375% bupivacaine through L(3-4) inter-space. 1-min Apgar scores were significantly higher in group EA (p < 0.001). Neurologic and Adaptive Capacity scores at 2 and 24 h were higher in group EA (p < 0.001). In terms of blood gas values, umbilical arterial pH and pO(2) values were higher in group EA (p < 0.05 and p < 0.001, respectively). The first breast-feeding intervals were found to be shorter in group EA (p < 0.001). We conclude that in terms of better Apgar and NAC scores, acid-base status and earlier initiation of breast-feeding, the epidural anesthesia may be preferred to general anesthesia in cesarean section.

Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children.

BACKGROUND: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy. METHODS: Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated. RESULTS: The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups. CONCLUSIONS: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.

[Seroprevalence of hepatitis B and C infections in surgical personnel and evaluation of predisposing factors]. / Ameliyathane çalisanlarinda hepatit B ve C enfeksiyonu seroprevalansi ve etkileyen faktörlerin irdelenmesi.

The aim of this study was to investigate the seroprevalence of hepatitis B and C infections in the personnel of the operating room of Ondokuz Mayis University Hospital, to detect the carriers and actively infected individuals, to find out the health-workers' behaviours for the prevention from these infections, and to ascertain the risk factors of these diseases. HBsAg, anti-HBc, anti-HBs and anti-HCV antibodies were examined in the serum samples of 190 personnel, and their gender, education, working time (year), the daily working time in operating theatre (part/full time), the history of past hepatitis B infection, hepatitis B immunization, history of a past operation and blood transfusion, and the use of gloves during working (continuously-intermittent) were questioned. As a result, no carrier and/or actively infected personnel with hepatitis B and C were detected, while 36 (18.9%) of them had a history of past hepatitis B infection, and 132 (69.5%) of them had hepatitis B vaccine. The continuous glove use was more common in part-time workers than those of full-time workers, the history of past hepatitis B infection was increasing as the duration of working years increase, and the rates of being vaccinated against hepatitis B was decreasing as the duration of working years increase (p < 0.05).

Subdural hematoma as a late complication of spinal anesthesia.

Subdural hematoma is a rare complication of spinal anesthesia. This patient underwent bilateral inguinal herniorrhaphy under spinal anesthesia 40 days prior to admission. Two days after spinal anesthesia, the patient described a typical postdural puncture headache. Oral analgesics, fluid therapy, and lying flat were recommended. Because of prolonged headache, computed tomography scan was performed and demonstrated chronic subdural hematoma in the left fronto-temporo-parietal region. After surgical drainage, the patient fully recovered. Prolonged headache should be regarded as a warning sign of subdural hematoma.

Awake tracheal intubation through the intubating laryngeal mask airway in a patient with halo traction.

PURPOSE: To report a case of awake tracheal intubation through the intubating laryngeal mask airway (ILMA) in a patient with halo traction. CLINICAL FEATURES: A 16-yr-old, 40 kg, boy with atlanto-occipital instability and halo traction was scheduled for surgery under general anesthesia. The head of the patient was fixed in a position of flexion and extension was impossible. Cranial magnetic resonance imaging revealed that pharyngeal and laryngeal axes were aligned, but that the oral axis was in an extreme divergent plane. The tongue and oropharynx were anesthetized with 10% lidocaine spray and bilateral superior laryngeal nerve blockade was performed. Under sedation, awake orotracheal intubation via ILMA was successful. Fibreoptic bronchoscopy has been recommended for awake tracheal intubation in such patients. Other techniques, such as use of the Bullard laryngoscope have been described also but awake tracheal intubation through the ILMA in patients with a halo device in situ has seldom been reported in the medical literature. CONCLUSION: Airway management of patients with cervical spine instability includes adequate preoperative evaluation of the airway and choosing the appropriate intubation technique. We suggest that the ILMA may be an adequate alternative for awake tracheal intubation in patients with an unstable cervical spine and cervical immobilization with a halo device.