The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P > 0.05), and high satisfaction levels (90.1+/-3.0 for dexmedetomidine versus 84.9+/-4.5 for midazolam; P > 0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8+/-6.5 versus 73.5+/-16.4, P < 0.05; and 20.6+/-4.4 versus 45.2+/-6.0; P < 0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P < 0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy.
We conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia.
Working in extraordinary conditions as healthcare professionals is a situation where your standard rules and working order disappear. In this process, the transfer of experiences facilitates adaptation to these extraordinary conditions. In the ongoing pandemic process, we, as Duzce University Department of Anesthesiology and Reanimation, have benefited from the experiences of clinicians who have experienced COVID-19 outbreak before us. In this article, we aimed to share a presentation about our working plan, the resources we took advantage of and the difficulties we experienced, with other clinicians. In our initial evaluations, when there is no official case in the region yet, based on the data of countries with similar region abroad, we encountered how many cases we have the capacity to support and how much we can increase this capacity in the worst conditions. During this discussions, we have planned material, equipment and our possible work order.We tried to provide protective equipment procurement, equipment use training in terms of employee health, we talked through case scenarios to create a safe working environment and for safe anesthesia practices. Our scenarios contained the questions like how many people and at what level of seniority should be and how the task should be done. We followed the Turkish Anesthesiology and Reanimation Association (TARD), the Turkish Intensive Care Association(TYBD), European Society of Anesthesiology (ESA) , European Society of Intensive Medicine (ESICM) guidelines for safe anesthesia and intensive care practices. In this process, the guides we used the most for Novel Coronavirus Disease follow-up and treatment were the Guide of Scientific Advisory Board of Turkish Ministry of Health , besides the Zhejiang University School of Medicine (FAHZU) COVID-19 Prevention and Treatment Handbook and Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19. While planning a pandemic ICU physically, it was decided to create a new area, it was seen that this area reduced the risk of transmission, but brought about the adaptation and placement problems to the working area. It should be taken into consideration that multidisciplinary approach may lead to problems in followup and orientation, although it has a positive contribution to the treatment process.
Objective: Trigeminocardiac reflex is a reflex characterized by hypotension, bradycardia, gastric hypermotility or asystole that develops as a result of stimulation of the trigeminal nerve. In our retrospective study, in septorhinoplasty operations performed under general anesthesia, trigeminocardiac reflex development was investigated primarily during the periods where the reflex was surgically stimulated. Secondly, the effect of different inhalation anesthetic agents on the emergence of this reflex was investigated. Methods: Anesthesia notes and Datex Ohmeda icentral central monitor records of septorhinoplasty cases operated between 01 / January / 2016 -30 / November / 2016 were retrospectively examined and detected through the Hospital Information Management System software. Induction, application of local anesthesia, surgical incision, initiation of incision suturing and 5 minutes after extubation were recorded from the records. It was determined that two different inhalation anesthetics were administered in 60 patients who met the criteria, and analyzes were performed in 2 separate groups as group sevoflurane and group desflurane, and the development of QT, QTc and Trigeminocardiac reflex was investigated. Results: Although there was no difference between the groups, when the basal values were compared with the other periods, it was found that the development of TKR and QT and QTc experts were mostly observed in the periods of local anesthesia, surgical incision and incision suturing. (p <0.001). Conclusions:We think that the inhalation anesthetic agents used mostly in the sevoflurane group play a facilitating role in the development of TKR, especially by creating a cumulative effect during periods when the trigeminal nerve is maximally stimulated.
Background/aim This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. Material and methods Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg/kg was administered to one group (Group sugammadex) and atropine and neostigmine was administered to the other group (Group neostigmine) intravenously. In the data analysis stage, the group was divided into two subgroups according to sugammadex and group neostigmine in itself, with vitamin D levels above and below 30 ng/mL. Statistical analysis was performed on these 4 groups (Group neostigmine and vitamin D < 30 ng/mL), (Group neostigmine and vitamin D ≥ 30 ng/mL), ( Group sugammadex and vitamin D < 30 ng/mL), (Group sugammadex and vitamin D ≥ 30 ng/mL).When two responses to train of four (TOF) stimulation were taken, the following times were recorded until extubation phase. The time until TOF value 50%, 70%, 90%, and extubation were recorded. Results There were statistically significant differences between Group sugammadex and vitamin D < 30 ng/mL and Group sugammadex and vitamin D ≥ 30 ng/mL (P = 0.007) for extubation times and 50% TOF reach times (P = 0.015). However, there was no difference observed between Group neostigmine and vitamin D < 30 ng/mL and Group neostigmine and vitamin D ≥ 30 ng/mL (P = 0.999). Conclusion Vitamin D deficiency is important for anesthesiologists in terms of muscle strength and extubation time. Vitamin D deficiency seems to affect sugammadex reverse times but seems not to affect neostigmine reverse times. This conclusion needs further studies.
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