There is no need to administer extra volume of fluid to obese patients undergoing laparoscopic bariatric surgery. Use of dynamic indicators like PVI helps to decrease intraoperative volume of infused fluids with no effects on either intraoperative or postoperative lactate levels in laparoscopic bariatric interventions.

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Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia. Design: This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m 2 ). Methods: Patients were randomly divided into four groups; group P-PSI (n ¼ 30): TIVA with PSI monitoring; group P (n ¼ 30): TIVA without PSI monitoring; group D-PSI (n ¼ 30): desflurane with PSI monitoring; and group D (n ¼ 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated. Findings: No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D. Conclusions: Although TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.

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Bu çalışmada algoloji kliniğine başvuran pankreas kanserli hastaların özellikleri ve analjezik tedavisi değerlendirildi. Gereç ve Yöntem: Algoloji kliniğine başvuran 60 pankreas kanserli hastanın demografik özellikleri, patolojik tanısı ve metastazı, kanser tedavisi ve analjezik müdahaleleri incelendi. Bulgular: Algoloji kliniğine başvuru süresi tanı aldıktan sonra ortalama 3.9±0.92 ay, başvurudaki visual analog skala (VAS) skoru ortalama 6.96±0.11'idi. Analjezik basamak tedavisine göre hastaların %58.33'de nonopioid+zayıf opioid+kuvvetli opioid (transdermal form), %5'de nonopioid+zayıf opioid+kuvvetli opioid (oral form), %36.66'da nonopioid+zayıf opioid tedavi uygulandı. Hastaların %31.66'a adjuvan eklenmezken %68.33'e adjuvan eklendi (%80.48 benzodiazepin, %19.51 antidepresan). Metastatik pankreas kanserli hastalarda ortalama sağ kalım süresi 3-6 ay arasında değişirken ağrı kliniğine başvuran hastalarda 8.48±7.46 ay olarak tespit edildi. Sonuç: Pankreas kanserinde karın ağrısı hastaların yaşam kalitesini olumsuz etkileyen en yaygın semptomdur. Ağrı sağ kalımı azaltırken iyi bir analjezi ise sağ kalımı iyileştirir. Bu çalışmanın sonuçları, algoloji kliniğinde etkili ağrı tedavisi alan metastatik pankreas kanserli hastaların sağ kalımının daha uzun olabileceğini göstermektedir.

In this study of different needle tips, it was seen that with atraumatic needle with special bending a significantly smaller number of cells were transported when compared to the Quincke tip needles, and with pencil point needles.

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