The placement of four different supraglottic airway devices by medical students: a manikin study.

BACKGROUND AND OBJECTIVES: Although endotracheal intubation is the gold standard in airway management, this procedure requires both technical training and experience. Supraglottic airway devices are an alternative to endotracheal intubation and are simpler, less invazive, and require less time for placement compared with endotrakeal intubation. Aim of the study was to evaluate the success rates, ease of use, duration of application, and maneuver performance of different supraglottic airway devices (SADs) used by term-5 medical students on a manikin. MATERIALS AND METHODS: This cross-sectional study was conducted in Zonguldak Bülent Ecevit University Hospital, Turkey, between April and June 2022. Term 5 Medical students (n = 111) were asked to place four different SAD [classical laryngeal mask, suprema laryngeal mask, ProSeal laryngeal mask (pLMA), I-gel] on an adult airway manikin. After the students were trained in the use of the devices, the ease of use for each, duration of successful application, success of application and use of optimization maneuvers were recorded. The participants were asked to distinguish the device they felt most confident to place and the most difficult to implement. RESULTS: There was a significant difference between the groups in ease and duration of application (p < 0.001). The most difficult and longest application time was with pLMA and the easiest and shortest was with I-gel (p < 0.05). The number of application failure was also highest for pLMA (p < 0.001). It was found that the participants distinguished (41%) I-gel as the most confident device to use, (84%) pLMA as the most difficult device to use for airway control. CONCLUSIONS: I-gel was found to be superior to others in terms of ease of use, duration and success of application.

Evaluation of the relationship between the stop-bang score with oxygen reserve index and difficult airway: a prospective observational study.

BACKGROUND: Patients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire. METHODS: This prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0-2 points) and high risk (3-8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation. RESULTS: In the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer (p < 0.05). CONCLUSION: Using ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions.

Effects of Supraglottic Airway Devices on Hemodynamic Response and Optic Nerve Sheath Diameter: Proseal LMA, LMA Supreme, and I-gel LMA.

Background and Objectives: Supraglottic airway devices (SADs) are known to be useful in eliminating the drawbacks of laryngoscopy and tracheal intubation, especially ocular pressure and stress responses. The ultrasonographic measurement of optic nerve sheath diameter (ONSD) reflects increases in intracranial pressure (ICP). In our study, we aimed to compare the effects of SADs on hemodynamic response and ONSD. Materials and Methods: Our prospective study included 90 ASA I-II patients over the age of 18 who did not have a history of difficult intubation or ophthalmic pathology. The patients were randomly divided into three groups based on the laryngeal mask airway (LMA) devices used: ProSeal LMA (pLMA, n = 30), LMA Supreme (sLMA, n = 30), and I-gel (n = 30). The bilateral ONSD measurements and hemodynamic data of the patients who underwent standard anesthesia induction and monitoring were recorded before induction (T0) and 1 min (T1), 5 min (T5), and 10 min (T10) after SAD placement. Results: At all measurement times, the hemodynamic responses and ONSD values of the groups were similar. In all three groups, intergroup hemodynamic changes at T0 and T1 were similar and higher than those at other times of measurement (p < 0.001). The ONSD values of all groups increased at T1, and they tended to return to baseline values afterward (p < 0.001). Conclusions: We concluded that all three SADs could be used safely because they preserved both hemodynamic stability and ONSD changes in their placement processes, and they did not cause elevations in ONSD to an extent that would lead to increased ICP.

The effect of PECS-1 block on postoperative pain in total implantable venous access port catheter (TIVAP) insertion.

BACKGROUND: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of US-guided Pectoral (PECS) I blocks on postoperative analgesia after TIVAP insertion. METHODS: A hundred-twenty patients were included in this study. The patients were divided into two groups: Group PECS and Group INF (infiltration). A total 0.4 mL kg-1 0.25% bupivacaine was injected to below the middle of the clavicle in the interfascial space between the pectoralis major and minor muscles for PECS-1. The skin and deep tissue infiltration of the anterior chest wall was performed with 0.4 mL kg-1 0.25% bupivacaine for INF group. Tramadol and paracetamol consumption, visual analog scale pain scores were recorded at 0, 1, 4, 12, and 24 h postoperatively. RESULTS: The use of the PECS in TIVAP significantly decreased the amount of paracetamol used in the first 24 h postoperatively (p < 0.001). There was a statistically significant difference in the number of tramadol rescue analgesia administered between the groups (p < 0.001) There was no significant difference between the groups in terms of the VAS scores at 0 and 24 h. However, VAS scores at 1, 4, and 12 h were found to be significantly lower in patients who underwent PECS than in those who received infiltration anesthesia (p < 0.001). CONCLUSIONS: This study shows that US-guided PECS-1 provides adequate analgesia following TIVAP insertion as part of multimodal analgesia. The PECS-1 significantly reduced opioid consumption.

Comparison of the Effectiveness of the Miller Laryngoscope and the McGrath-MAC Video Laryngoscope in Direct Visualization of the Glottic Opening.

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.

Investigation of preoxygenation methods in cesarean surgeries with the oxygen reserve index.

OBJECTIVES: To investigate preoxygenation methods that were carried out for 3 minutes (min) at tidal volume and 30 seconds (s) with the 4 deep vital capacity technique using the Oxygen Reserve Index (ORI) among pregnant women. METHODS: This prospective study was carried out between December 2020 and 2021. The patients were randomly divided into 2 groups with the provision of preoxygenation using 100% O2 at a rate of 10 L.min-1 for 3 min at normal tidal volume (Group 1) and 30 s with the 4 deep vital capacity technique (Group 2). For the pregnant women who underwent routine anesthesia induction, hemodynamic parameters before preoxygenation, as well as their fraction of inspired O2 (FiO2), fraction of expired O2 (FeO2), and ORI values were recorded after preoxygenation and 0, 3 and 7 minutes after intubation (T1, T2, T3, and T4). RESULTS: The study was completed with 66 patients. FiO2 values were found to be low in T1 (p=0.012) in Group 1, and high in FeO2 values in T1 and T2 (p=0.025 and 0.009) in Group 2, while no significant differences were found at other times (p>0.05). Oxygen Reserve Index values did not show a significant difference in comparisons between groups, but ORI values of Group 1 after intubation were significantly lower than those measured after preoxygenation in in-group comparisons (p<0.001). According to the results of the correlation analyses between the mean ORI values and their mean FeO2 and FiO2 values, there were weak and positive statistically significant relationships at T3 and T4 (p<0.05). CONCLUSION: As we obtained greater FiO2 and FeO2 values in preoxygenation with the 30 s 4 deep vital capacity method, and because this method did not cause a significant decrease in the post-intubation ORI values, we believe that the usage of this method in cesarean section surgeries may be appropriate.

Effects of different fresh gas flows on carboxyhemoglobin levels: non-invasive carbon monoxide monitoring: A randomized clinical trial.

OBJECTIVES: To observe the effect of different fresh gas flows (FGF) on carboxyhemoglobin (COHb) levels non-invasively and continuously and to determine the contribution of the smoking status to intraoperative carbon monoxide (CO) accumulation and respiratory complications. METHODS: A total of 64 patients were included in the study. Carboxyhemoglobin level was monitored non-invasively from the fingertip. Patients were divided into 2 according to the FGF as low-flow anesthesia (LFA; Group L) and high flow anesthesia (Group H). Each group was divided again into 2 groups as smokers and non-smokers. Carboxyhemoglobin and and the respiratory complications that occurred in the post-anesthesia care unit were recorded. RESULTS: The mean COHb values were significantly higher in Group L between 30th and 210th minutes. Furthermore, in Group L, intraoperative COHb levels were significantly higher in smokers compared to non-smokers in all periods. In group H, no difference was observed between smokers and non-smokers in terms of COHb levels after 60 minutes and also preoperative COHb levels of the patients developed respiratory complication was higher. CONCLUSION: If the CO2 absorbent is properly preserved in patients who are administered LFA, there will be no risk of CO accumulation even in chronic smokers.ClinicalTrials.gov REG. No.: NCT04832256.

Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study.

BACKGROUND: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of ultrasonography (USG) guided continuous erector spinae plane block (ESPB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS). METHODS: Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged 18-75 and who were to undergo VATS were included in this study. Randomization was performed in 2 groups, continuous ESPB (ESPB Group) and no intervention (Control Group). 20 mL of 0.25% bupivacaine was administered for the block. Immediately after surgery, the patient received continuous infusion of 0.125% bupivacaine at 4 mL h-1 via the catheter inserted for the block. Patients in both groups received tramadol via an intravenous patient-controlled analgesia device. Tramadol and meperidine consumption, visual analog scale pain scores and opioid-related side effects were recorded at 0, 1, 4, 8, 12, 24, 36, and 48 h postoperatively. RESULTS: The use of continuous ESPB in VATS significantly decreased the amount of tramadol used in the first 48 h postoperatively (P < 0.001). There was a statistically significant difference in the number of meperidine rescue analgesia administered between the ESPB and Control Groups (P < 0.001). While the incidences of nausea and itching were higher in Control Group, there were no differences in terms of the other side effects between the groups. CONCLUSIONS: This study shows that USG-guided continuous ESPB provides adequate analgesia following VATS as part of multimodal analgesia. Continuous ESPB significantly reduced opioid consumption and opioid-related side effects compared to those in the Control Group.

Are there predictive tests that determine the difficulty in Laryngeal Mask Airway Insertion?

OBJECTIVE: To determine the predictive tests for difficulty in laryngeal mask airway insertion, and to observe the success rate of insertion in the first attempt. METHODS: The prospective, observational study was conducted at Bülent Ecevit University Hospital, Turkey, from September 2013 to 2014, and comprised patients of American Society of Anaesthesiologists grade I to IV adult patients who underwent elective surgery under general anaesthesia. The supraglottic airway device was randomly selected for each patient, and the laryngeal mask airway was used as per the decision of an anaesthesiologist who was not part of the study. Patients were divided into three groups according to laryngeal mask airway types as classic group A, i-gel group B and suprema group C. These were inserted by anaesthesia residents with the same seniority when bispectral index value reached 40-60. Data was noted and analysed using SPSS 24. RESULTS: Of the 120 patients, 40(33.33%) were in cLMA, 38(31.66%) in i-gel, and 42(35%) in sLMA. There was no significant difference among the groups in terms of demographics (p>0.05). Apart from the height/thyromental distance ratio (p=0.046), no predictive test was statistically significant in identifying the difficulty in laryngeal mask airway insertion (p>0.05). There was no significant difference involving number of attempts, difficulty in insertion, and patient response (p>0.05). Placement success rate at first attempt was similar among the groups (p>0.05). CONCLUSIONS: Higher height/thyromental distance ratio values were associated with difficulty in laryngeal mask airway insertion, and first-attempt success rate was similar in all the three laryngeal mask airway types.

The effect of laryngoscope types on hemodynamic response and optic nerve sheath diameter. McCoy, Macintosh, and C-MAC video-laryngoscope.

OBJECTIVES: This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC video-laryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation. METHODS: This prospective randomized study was conducted in Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation. RESULTS: The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p greater than 0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p greater than 0.05). CONCLUSIONS: In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® video-laryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure.

Non-ST elevation myocardial infarction induced by carbon monoxide poisoning.

Carbon monoxide (CO) poisoning is the most common cause of poisoning-related death in the world. Cardiovascular complications of CO intoxication includes myocardial damage, left ventricular dysfunction, pulmonary edema, and arrhythmias. The carboxyhemoglobin level does not correlate with the clinical severity of CO intoxication. This case report presents a patient with acute myocardial infarction secondary to carbon monoxide poisoning who was successfully treated with coronary bypass surgery.

Perfusion Index and ultrasonography in the evaluation of infraclavicular block.

BACKGROUND: It has been reported that noninvasive, objective tests are needed for determining the success of peripheral nerve blocks because conventional methods necessitate the cooperation of the patient. It is also known that the brachial plexus block causes vasodilatation and an increase in blood flow due to its sympathectomy effect. Our study aimed to determine whether Perfusion Index (PI) and measured regional hemodynamic changes using ultrasound were reliable parameters in evaluating the early success of an infraclavicular block. METHODS: Forty ASA I-III patients who were administered a successful infraclavicular block were included in this study. In addition to the baseline hemodynamic measurements, PI and regional hemodynamic parameters, such as brachial artery diameter (BAD), brachial arterial area (BAA), blood flow (BF), end-diastolic velocity (EDV), Resistance Index (RI), peak systolic velocity (PSV), and time average velocity (TAV) were measured. After completing the block procedure, all values were rerecorded at the 10th, 20th, and 30th minute. Patients with a successful block during the first 10 minutes were assigned to Group A, while patients with a successful block after the 10th minute were assigned to Group B. RESULTS: Statistically significant differences were observed for all regional hemodynamic variables and PI after 10 minutes. When the regional hemodynamic data and PI were compared between the groups, differences were identified for PI, BF, PSV, EDV, and TAV. Within the measured parameters, EDV was the parameter showing the greatest proportional change. CONCLUSIONS: Changes in EDV, especially RI and PI, provide more effective and objective results for the assessment of early regional block success.

Pseudocholinesterase levels in patients under electroconvulsive therapy.

OBJECTIVES: In this study, we aimed to retrospectively assess the correlation of pseudocholinesterase (PChE) levels with age, gender, body weight and diagnosed psychiatric diseases in electroconvulsive therapy (ECT) cases. Methods: This retrospective study was conducted at Bülent Ecevit University Hospital, Zonguldak, Turkey, between 2007 and 2011. In the study, 193 ECT case files were retrospectively scanned to evaluate PChE values before ECT and other file information.  Results: There was no difference between gender in terms of PChE levels. Correlation analysis determined a weakly positive correlation between age (p=0.013; correlation coefficient [cc]: 0.178) and body weight (p less than 0.001; cc: 0.273) and PChE levels. No correlation was found between age, gender, weight or psychiatric diagnosis, and PChE levels.  Conclusion: Neuromuscular blockage is a significant factor that increases patient safety, while increasing the efficacy of ECT. In choosing muscle relaxant agents, both patient factors and the pharmacological properties of the neuromuscular blocker should be considered. We think that in situations with delayed recovery of ECT cases without identified PChE levels, low PChE levels must be considered.

The role of cerebral oximetry monitoring in off-pump coronary artery bypass surgery of Moyamoya disease.

Moyamoya disease is a chronic cerebrovascular disease characterized by the development of compensatory collateral vessels due to progressive narrowing or obstruction of the intracranial arteries. Neurological complications after coronary bypass in patients with Moyamoya disease may be prevented by recent technical developments, surgical modifications, and cerebral monitorization. The objective of perioperative anesthetic management is to provide balance between oxygen supply and consumption of the brain. In this case report, we aim to share our anesthetic experience in a patient with Moyamoya disease who underwent off-pump coronary artery bypass surgery and cerebral oximetry monitoring.

The effect of bariatric anaesthesia on postoperative pulmonary functions.

OBJECTIVE: To evaluate respiratory function in the post-operative early period of patients undergoing bariatric surgery using the sleeve gastrectomy technique. METHODS: This prospective, observational study was conducted at Bülent Ecevit University Health Application and Research Centre, Zonguldak, Turkey from June to December 2014, and comprised patients with planned bariatric sleeve gastrectomy under general anaesthesia. Participants were visited 12-24 hours before the operation to record accompanying diseases and demographic data. Before the operations, respiratory function test, maximum expiratory pressure, maximum inspiratory pressure and arterial blood gas assessment tests were done and recorded as T0. After one hour of the operation, Aldrete scores >9 and the above-mentioned tests were repeated and recorded as T1. SPSS 18 and MedCalc 12.2.1.0 were used for statistical analysis. RESULTS: Of the 76 participants, 60(78%) were women and 16(21%) were men. The overall median age was 39 years (inter-quartile range: 32-47 years). The mean and median values for forced expiratory volume in 1 second, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure and the ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen at T0 were 101±17, 102±17, 66 (interquartile range: 59-74), 114 (interquartile range: 100-138) and 379±49, respectively, compared with 78±18, 76±18, 53 (interquartile range: 48-59), 85 (interquartile range: 73-95) and 331±49at T1 (p<0.001 each). Also, 38(50%) participants were given sugammadex and 38(50%) were given neostigmine. At the end of the test, sugammadex (odds ratio: 5.80; 95% confidence interval: 1.26-26.69; p=0.024) and pre-operative ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen (odds ratio: 1.04, 95% confidence interval: 1.02-1.06; p<0.0001) were found to correlate significantly. CONCLUSIONS: Impairment of respiratory function was found during the early post-operative period.

Anesthesia methods used by anesthetic specialists for circumcision cases. National survey study for Turkey.

OBJECTIVES: To examine the anesthesiologist's choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

The effect of sugammadex on postoperative cognitive function and recovery / O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório

Abstract Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

Resumo Justificativa e objetivo: Sugamadex é o primeiro agente de ligação relaxante seletivo. Após a administração de sugamadex, os tempos de despertar e de recuperação dos pacientes são menores, em comparação com neostigmina. Neste estudo, a hipótese foi que um despertar mais rápido e claro dos pacientes submetidos à anestesia geral tem efeitos positivos sobre as funções cognitivas no pós-operatório imediato. Métodos: Após a aprovação do Comitê de Ética local, 128 pacientes foram incluídos neste estudo prospectivo, randômico, controlado e duplo-cego. Os pacientes foram designados para o grupo sugamadex (Grupo S) ou grupo neostigmina (Grupo N). O desfecho primário do estudo foi a recuperação cognitiva no pós-operatório imediato, de acordo com a mensuração da Avaliação de Montreal da Função Cognitiva (MoCA) e com o Mini Exame do Estado Mental (MMSE), após a avaliação inicial 12-24 h antes da operação. Após a operação, quando o escore de recuperação de Aldrete modificado era ≥ 9, o teste MMSE e, uma hora depois, o teste MoCA foram repetidos. Resultados: Embora tenha havido uma redução nos escores de MoCA e MMSE tanto no Grupo S quanto no Grupo N, entre os escores pré- e pós-operatório não houve diferença estatisticamente significativa nas reduções (p > 0,05). O tempo para atingir TOF 0,9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001). O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001) Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina.

The effect of sugammadex on postoperative cognitive function and recovery.

BACKGROUND AND OBJECTIVE: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

[The effect of sugammadex on postoperative cognitive function and recovery]. / O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório.

BACKGROUND AND OBJECTIVE: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

Selenium, copper, zinc, iron levels and mortality in patients with sepsis and systemic inflammatory response syndrome in Western Black Sea Region, Turkey.

OBJECTIVE: To evaluate the changing levels of selenium, copper, zinc and iron in patients with sepsis and systemic inflammatory response syndrome and their influence on mortality. METHODS: The prospective study was conducted at a tertiary care university hospital in Zonguldak city in the western Black Sea region of Turkey from January 2012 to December 2013, and comprised patients with sepsis and systemic inflammatory response syndrome. Blood samples were taken on 1st, 3rd, 5th and 7th days to measure serum selenium, copper, zinc and iron levels. Patients' demographic data, presence of additional diseases and mortality were recorded. RESULTS: Of the 57 patients, 28(49.1%) were female and 29(50.9%) were male, with an overall mean age of 60.3±19.4 years, mean height of 166.1±11.4cm, mean weight of 76.5±17.5kg. Copper and zinc levels were in the normal range, while selenium and iron levels were lower than the limit values at all measuring periods. There was no significant difference between first and other days in accordance with element levels (p>0.05). Baseline copper levels in patients with malignancy were lower than patients without malignancy (p< 0.05). In hypertensive patients, baseline copper levels were higher and 7th day levels were lower than non-hypertensive (p< 0.05). Baseline selenium levels of those who died were lower than the other patients (p< 0.05). Selenium and iron levels were decreased in patients with sepsis-systemic inflammatory response syndrome and copper levels were lower in patients with malignancy, hypertension and chronic obstructive pulmonary disease (p< 0.05). There was no change in zinc levels of the patients. CONCLUSIONS: Reduced basal selenium levels of patients with sepsis and systemic inflammatory response syndrome were associated with mortality.