IntroductionThe semi-Fowler position, defined as a body position at 30° head-of-bed elevation, has been shown to increase intra-abdominal pressure.AimTo investigate the impact of semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre (PRM) on post-laparoscopic shoulder pain.Material and methodsOne hundred and six patients (mean age: 43 ±12 years) undergoing gynaecologic laparoscopic surgery (LS) were included. The patients were divided into three groups: group 1 consisted of patients receiving PRM in the neutral position, group 2 comprised patients receiving PRM in the semi-Fowler position, and patients in the control group received neither PRM nor additional positioning. Information concerning wound and shoulder pain (post-laparoscopic shoulder pain – PLSP) at postoperative 6, 12 and 24 h was recorded using a visual analogue scale (VAS) for each patient.ResultsThe PLSP scores at postoperative 6 h (5.71 ±0.86, 5.28 ±0.84 and 6.61 ±0.91, respectively, p < 0.001), 12 h (4.41 ±0.83, 4.01 ±0.82 and 5.32 ±0.97, respectively, p < 0.001), and 24 h (3.24 ±0.78, 2.44 ±0.73 and 4.34 ±0.85, respectively, p < 0.001) were significantly different among the groups, the lowest being in those who received PRM in addition to semi-Fowler positioning.ConclusionsSemi-Fowler positioning in addition to PRM significantly reduces post-laparoscopic shoulder pain. We assume that the benefit gained using the semi-Fowler positioning is mainly derived from its potential to better evacuate the remaining abdominal gas following LS.

ObjectiveTo evaluate the effects of an ultrasound-guided transverse abdominis plane (US-TAP) block used for postoperative pain relief by comparing the efficacy of two different volumes/concentrations of the local anaesthetic bupivacaine in patients undergoing laparoscopic cholecystectomies.MethodsThis randomized study enrolled patients undergoing laparoscopic cholecystectomies. They were randomized to two groups: group A received a 20 ml US-TAP block (50 mg bupivacaine +10 ml saline solution) and group B received a 30 ml US-TAP block (50 mg bupivacaine + 20 ml saline solution). The intraoperative consumption of remifentanil, the requirement for postoperative rescue analgesics, patient satisfaction scores, postoperative complications, and postoperative pain as measured by a visual analogue scale at 20 min, 12 h, and 24 h were recorded.ResultsA total of 60 patients enrolled in the study. There were no differences between the two groups with respect to demographic characteristics, duration of anaesthesia and patient satisfaction scores. The intraoperative consumption of remifentanil, postoperative VAS scores (20 min, 12 h and 24 h) and the requirement for postoperative analgesics were all significantly lower in group B who received a larger volume but a lower concentration of local anaesthetic solution compared with group A.ConclusionA US-TAP block can form part of a balanced postoperative analgesic regimen following laparoscopic cholecystectomy.

OBJECTIVE: Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients’ education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C. METHODS: Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale. RESULTS: Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027). CONCLUSION: Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

Enhanced Recovery After Surgery (ERAS) is a standardized perioperative care within a programme aims to reduce postoperative morbidity and length of hospital stay. The aim of this study was to evaluate which technique (hyperbaric or hypobaric spinal anesthesia) should we use in geriatric patients undergoing total hip arthroplasty according to ERAS. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 104 patients' records (52 of them hypobaric spinal, 52 of them had been applied hyperbaric spinal anesthesia), American Society of Anesthesiologists (ASA) I-III, undergoing total hip arthroplasty between June 2017-December 2017 was elected for study. Haemodynamic values, postoperative complications, hospital length of stay, readmission or reoperation after surgery, intensive care unit (ICU) length of stay, mortality, 30-day readmission two months' mortality rates, duration of surgery, gender, age, ASA and additional co-morbidities were recorded from the patients' files. R Re es su ul lt ts s: : 38 males and 66 females were involved in the study, and their mean age was 76.24 years. The hospital length of stay, readmission or reoperation after surgery, ICU length of stay, duration of surgery were statistically significant differences between the groups. There were no statistically significant differences between the groups in 30-day readmission and mortality rates. When compared the blood pressures before and after the spinal block there were statistically significant differences between the groups. C Co on nc cl lu us si io on n: : The aim of ERAS in the arthroplasty is to reduce the hospitalization time without increasing complications and readmission. We conclude that hypobaric solutions are suitable for ERAS protocol in total hip arthroplasty, but more studies should be done for evaluate effect of hypobaric spinal anesthesia related with ERAS protocol. K Ke ey yw wo or rd ds s: : ERAS; hypobaric; arthroplasty Ö ÖZ ZE ET T A Am ma aç ç: : Cerrahi Sonrası Hızlandırılmış İyileşme (ERAS), bir program dahilinde standart bir perioperatif bakım olup, postoperatif morbidite ve hastanede kalış süresini azaltmayı amaçlamaktadır. Bu çalışmanın amacı, ERAS'a göre total kalça artroplastisi uygulanan geriatrik hastalarda hangi tekniği (hiperbarik veya hipobarik spinal anestezi) kullanmamız gerektiğini değerlendirmektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmamıza Haziran 2017-Aralık 2017 tarihleri arasında total kalça artroplastisi uygulanan Amerikan Anesteziyoloji Derneği (ASA) I-III olan 104 hasta (52'sinde hipobarik spinal, 52'sinde hiperbarik spinal anestezi) kaydedildi. Hemodinamik değerler, postoperatif komplikasyonlar, hastanede kalış süresi, tekrar hastaneye yatış veya yeniden ameliyat olup olmadığı, yoğun bakım ünitesi (YBÜ) kalış süresi, mortalite, 30 gün içinde tekrar yatış, iki aylık mortalite oranları, ameliyat süresi, cinsiyet, yaş, ASA ve ek hastalıklar hastaların dosyalarından kaydedildi. B Bu ul lg gu ul la ar r: : Çalışmaya 38 erkek ve 66 kadın katıldı ve yaş ortalamaları 76,24 yıl i...

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ÖZ Amaç

Laparaskopik cerrahide uygulanan Trendelenburg pozisyonu ve karbondioksit insüflasyonuyla oluşturulan pnömoperiton, serebral oksijen satürasyonu (rSO2) ile pek çok sistemi etkilemektedir. Laparaskopik cerrahi sırasında serebral oksijen satürasyonunda oluşan değişiklikler, serebral oksimetre (NIRS) ile ölçülmektedir. NIRS kullanılarak, rSO2 düşüklüğü ve doku hipoksisi erkenden tespit edilebilmektedir. Bu çalışmada, jinekolojik laparoskopi olgularında uyguladığımız farklı pozitif end ekspiryum basıncı (PEEP) düzeylerinin serebral oksijenasyon ve hastaların hemodinamik verileri üzerine olan etkilerini retrospektif olarak araştırmayı planladık. Gereç ve Yöntem: Jinekolojik laparoskopi uygulanmış, 69 hastanın dosyaları incelendi. 22 hastaya 8 PEEP, 23 hastaya 6 PEEP ve 24 hastaya 4 PEEP uygulanmış olduğu belirlendi. Bu hastaların oluşturduğu gruplara sırasıyla Grup 8, Grup 6 ve Grup 4 isimleri verildi. Non-invaziv ortalama kan basıncı (OKB), kalp hızı (KAH), oksijen satürasyonu (SpO2), end-tidal karbondioksit (ETCO2) ve rSO2 verilerini kaydedildi. Bulgular: Hasta Trendelenburg pozisyonuna alındıktan ve intraperitoneal insuflasyon uygulandıktan sonraki KAH ve OKB'nin tüm gruplarda belirgin olarak azaldığı görüldü. Üç grupta da entübasyon sonrası ETCO2 değerine göre, sonrasında meydana gelen tüm ölçümler istatistiksel olarak anlamlı artmış (p<0.05), SpO2 ve rSO2 değerlerinde meydana gelen değişimler ise istatistiksel olarak anlamlı olmamıştır. Tüm gruplardaki ETCO2 ile rSO2 arasında pozitif yönde anlamlı korelasyon vardı. Sonuç: Trendelenburg pozisyonundaki laparoskopik cerrahilerde; 8 PEEP, 6 PEEP ve 4 PEEP uygulanmasının serebral oksijenasyonu etkilemediğini, CO 2 insüflasyonuyla pnömoperiton oluşturulmasıyla meydana gelen ETCO2 artışın rSO2 değerlerini etkilediğini düşünmekteyiz.

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