Anesthetic maintenance with either remifentanil or dexmedetomidine infusion until extubation provided a more smooth and hemodynamically stable emergence, without complications after nasal surgery. While remifentanil was superior to dexmedetomidine with regard to avoiding EA, dexmedetomidine was more effective than remifentanil regarding vomiting and pain.

To compare sugammadex and neostigmine regarding the efficacy in reversing rocuronium-induced neuromuscular block, the incidence of post-operative respiratory complications and costs in patients undergoing surgery for the treatment of obstructive sleep apnoea (OSA). Methods: After obtaining ethical approval and patient consent, 74 patients in ASA physical status I or II were randomised into two groups to receive 2-mg kg −1 sugammadex (Group S) or 0.04-mg kg −1 neostigmine+0.5-mg atropine (Group N). Groups were compared regarding time to TOF (train-of-four) 0.9, operating room time, post-anaesthesia care unit (PACU) stay, post-operative respiratory complications, costs related to neuromuscular block reversal, anaesthesia care and complication treatment. Results: Patient demographics, anaesthesia, surgical data and total rocuronium doses were similar between groups. Time to TOF 0.9 was shorter for group S [Group N: 8 (5-18) min; Group S: 2 (1.5-6) min (p<0.001)]. Operating room time [Group S: 72.4±14.3 min; Group N: 96.6±22.8 min (p<0.001)] and PACU stay [Group S: 22.9±10.1 dk; Group N: 36.3±12.6 dk (p<0.001)] were also shorter in Group S. After extubation, desaturation was observed in 12 (32.4%) patients in group N and in 4 (8%) patients in group S (p=0.048). In group N, three patients were reintubated; there were eight (21.6%) unplanned intensive care unit (ICU) admissions. There was one unplanned ICU admission in group S. Negative pressure pulmonary oedema was observed in one patient in group N. The results regarding costs were as follows. The reversal cost was higher in the sugammadex group (vial cost 98.14 TL) than that in the neostigmine group (ampoule cost 0.27 TL; total 6147.88 TL vs. 3569.5 TL); however, complication treatment cost and total cost were lower in group S than those in group N (199.5 TL vs. 3944.6 TL) (staff anaesthesia doctor cost was 0.392 TL per min and the cost of nurse anaesthetist was 0.244 TL per min). Conclusion: This study confirmed the efficacy of sugammadex over neostigmine for the reversal of rocuronium-induced neuromuscular block. Sugammadex decreases the incidence of post-operative respiratory complications and related costs in patients with OSA.

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD).Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively.Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1 μg kg−1and mean infusion rate was 0.26 μg kg−1 h−1(0.21) [mean total dexmedetomidine dose: 154.68 μg (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68 mg kg (0.84) [mean total propofol dose: 117.72 mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation).Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials IdentifierNCT01789385.

INTRODUCTION: Airway management in the elderly may be challenging. Supraglottic airway devices (SADs) may be used to provide airway security. The aim of study was to compare the efficacy and safety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised and non-paralysed elderly patients. METHODS: The study was approved by a local ethics committee. Eighty patients, aged older than 65 years, who were scheduled to undergo elective urological or orthopaedic surgery participated in the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n = 26), Group P: p-LMA (n = 27) or Group I: i-gel (n = 27). The primary outcome was oropharyngeal sealing pressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, ease of insertion, success rates, time to insertion, haemodynamic response and complications such as sore throat and dysphagia. RESULTS: There were no significant differences among the groups with respect to OSP (p=0.852), whereas there was a statistically significant difference between Group I and Group C in terms of leak volume and leak fraction ( p= 0.042 and p = 0.020, respectively ). Adverse events were similar among the groups (p > 0.05). DISCUSSION AND CONCLUSION: In this study, although the leak volume and leak fraction were lower in i-gel inserted patients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patients who were not applied muscle relaxants and will be operated under general anesthesia.

No abstract

No abstract

No abstract

ÖZAmaç: Titreme ve aktif hareket bilinci açık ve hareket edebilen hastalarda ısı üretimi ve ısınma için çok etkin bir mekanizmadır. Bu çalışma, genel anestezi sırasında kas gevşetici (KG) kullanılan erişkinlerde intraoperatif hipotermi ve buna bağlı postoperatif titreme olabileceği hipotezini test etmeyi amaçlamıştır. Yöntem: Retrograd intrarenal cerrahi (RIRS) geçirecek 80 hasta rastgele kas gevşetici (KG) kullanılan (Grup R, N=40), KG kullanılmayan (Grup K, N=40) olarak iki gruba ayrıldı. Tüm hastalara hava yolu kontrolü için Laringeal Maske (LMA) kullanıldı ve KG verilmesi dışında, standart bir anestezi protokolü uygulandı. Cilt ve iç sıcaklıklarının monitörizasyonlarından elde edilen veriler ve titreme muayeneleri anestezi indüksiyonundan önce (t0), KG verildiğinde (t 1 ), intraoperatif 15 (t 2 ), 30 (t 3 ), ve 60 (t 4 ) ve postoperatif 0 (t 5 ), 10 (t 6 ), 15 (t 7 ), 30 (t 8 ), 60 (t 9 ) dk.'larda kaydedildi. Bulgular: Grup R'de t 0 , t 1 , t 2 , t 3 ve t 5 cilt ısısı Grup K'den anlamlı derecede yüksek iken iç sıcaklıklar bakımından gruplar arasında fark yoktu. (t 5 , t 6 ve t 7 'de titreme olanların oranı Grup R'de Grup K'den anlamlı derecede fazla idi (p<0.05). Her iki grupta da cilt sıcaklığında t0'a göre istatistiksel olarak anlamlı fark görülmektedir. Buna göre K grubunda t 7,8,9 'da t 0 'a göre anlamlı fark saptanırken R grubunda t1'de farklılık saptanmıştır. Grup R'de iç sıcaklık t 3 'de t 2 'ye ve Grup K'de t 3 de t 1 , ve t 2 'ye göre anlamlı düşüktü. Sonuç: Postoperatif titreme ve buna neden olan mekanizmaların anlaşılması önemli bir konudur. Hipotermi üzerinden sinir kas gevşetici kullanımı ile olası bir ilişki ise intraoperatif ısı yönetimi ve respiratuar ve kardiyak rezervi düşük hastalar açısından araştırılmaya değer. Bu çalışmadan elde edilen veriler, KG kullanımı ile intraoperatif hipotermi arasında bir ilişkiyi desteklemezken, postoperatif titreme ile bir ilişkiyi açıkça göstermiştir. Bununla beraber, vücut sıcaklığına kas gevşeticilerin olası etkileri ve erişkinlerdeki periferik savunma mekanizmalarının ve belki ilave olarak santral mekanizmaların çalışılmasına gereksinim vardır.Anahtar kelimeler: Postoperatif titreme, sinir kas gevşetici, vücut sıcaklığı, hipotermi, genel anestezi ABSTRACT Objective: Shivering, and active movements, are very effective mechanisms for heat generation and warming in ambulatory mobile patients with open conscious. This study aimed to test the hypothesis that intraoperative hypothermia and postoperative shivering may be present in adults for whom neuromuscular blocker (NMB) was used during general anesthesia. Method: Eighty patients who underwent retrograde intrarenal surgery (RIRS) were randomly divided into two groups as those receiving or not receiving neuromuscular blocking agent (NMB) [Group R (NMB+), N=40; Group K (control), N=40)]. Laryngeal mask (LMA) was used for airway control in all patients and a standard anesthetic protocol was performed except for NMB administration. Data obtained from the monitoring of skin and internal temperatures and shiverin...