Objectives:To compare analgesia nociception index (ANI) values, visual analog scale (VAS) values, and hemodynamic parameters in hysteroscopy patients who received remifentanil and dexmedetomidine during general anesthesia.Methods:In total, 30 patients who underwent hysteroscopy between March and September 2016 at the University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, Turkey were included in this prospective study. Standard hemodynamic monitoring, ANI, and bispectral index (BIS) monitoring were applied to the patients. At 10 min prior to induction, 1 µg/kg of remifentanil was applied in Group R (n=15) and 1 µg/kg of dexmedetomidine was applied in Group D (n=15). After induction, sevoflurane was used for maintenance with dexmedetomidine at 0.2-0.7 µg/kg/hour in Group D and remifentanil at 0.05-0.5 µg/kg/minute in Group R. Perioperative and postoperative analgesia levels (ANI and VAS, respectively), hemodynamics, and complications were recorded.Results:Even though the ANI levels in Group D were lower at the perioperative 5th and 10th minutes, the ANI values were between the targeted limits, except for the measurement after I-gel insertion, in both groups. Hemodynamic parameters were within normal limits, but the mean arterial pressures in Group R after induction, following I-gel placement, and at the perioperative 5th, 10th, and 20th minutes were lower and at postoperative 30th minute were significantly higher.Conclusion:Dexmedetomidine and remifentanil are both efficacious agents for perioperative analgesia in hysteroscopy cases.

Objectives:To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups.Methods:Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpaşa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded.Results:The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar.Conclusion:Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.

OBJECTIVE: Investigating the effects of coenzyme Q10 on organ damage and survival on mice in cecal ligation perforation (CLP) model in sepsis. BACKGROUND: Coenzyme Q10 is an antioxidant molecule playing an important role in mitochondria. Mitochondrial dysfunction is an important mechanism in sepsis pathophysiology. METHODS: Nintyfour Swiss Albino male mice were divided into 8 groups. CLP was performed in Group I. Coenzyme Q10, 100 mg/kg subcutaneously, was given 5 hours after CLP to Group II and 20 hours after CLP to Group III. Sham operation was performed in Group IV, 100 mg/kg coenzyme Q10 subcutaneously was given 5 hours after sham operation to Group V and 20 hours after sham operation to Group VI. No operation was performed in Group VII; coenzyme Q10, 100 mg/kg subcutaneously, was given to Group VIII. Antibiotics and fl uid replacement were applied for 3 days. The mice still living were sacrifi ced at 576th hour. The organ damages were scored under light microscopy. RESULTS: The survival of Group I and Group II was lower than that of the control groups, but the survival in the Group III was similar to control groups. It was established that spleen, kidney, heart damage and total organ damage were decreased when compared to CLP group. CONCLUSIONS: Coenzyme Q10 is effective in decreasing histological organ damage in sepsis (Tab. 3. Fig. 1, Ref. 30).

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Background: In the present study, we compared the effects of total intravenous anaesthesia (TIVA) and desflurane anaesthesia on tcMEPs in scoliosis surgery.Methods: The study included 45 patients between the ages of 18 to 50 years, and classified as ASAI-II; which were planned to undergo posterior fusion/instrumentation operations for elective scoliosis.  Anaesthesia was maintained using 50-150 mcg/kg/min propofol in Group T(TIVA), and desflurane (0.5 MAC) in Group D, and with infusions of 0.05-0.3 mcg/kg/min remifentanil at 50 % O2 + air in both groups, by applying drugs at doses so that bispectral index (BIS) would be maintained between 40 and 60 throughout the course of anaesthesia. The tcMEP responses were measured four times during the operation, and BIS, train-of-four (TOF), mean arterial pressure (MAP), heart rate(HR), and end tidal CO2(ETCO2) values were recorded simultaneously. In both group the anaesthesia was ended at the final surgical suture.  The recovery parameters were recorded.Results: The groups were found not to differ regarding the demographic characteristics, duration of the anaesthesia and the surgery, remifentanil dosage, tcMEP, the simultaneously recorded TOF, MAP, HR and ETCO2 values, and the amount of perioperative bleeding. The cooperation time and the orientation time were shorter in group D. The tcMEP responses were recorded in the appropriate times and amplitudes in both groups. Conclusions: TIVA is primarily used in routine applications in spinal surgery; however our study results revealed that 0.5 MAC desflurane may also be safely used in association with remifentanil, with the resultant correct tcMEP responses.

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Introduction: Demographic changes have resulted in increasing numbers of geriatric patients needing respiratory support in intensive care units. Conversely, these patients are faced with an increased risk of weaning failure and can be discharged with home mechanical ventilation. This study aimed to investigate the discharge status and home mechanical ventilator use of the elderly patients who experienced weaning failure. Materials and Method: We retrospectively investigated the data of 51 patients older than 65 years who required home mechanical ventilator prescription due to delayed mechanical ventilation during their treatment in intensive care unit between January 2016 and January 2018. Results: The patients' mean age was 78.33±8.12 years. Twenty-six patients (51%) switched to home mechanical ventilator, 12 weaned and 13 died before switching to home mechanical ventilator. Eleven patients (42.3%) were discharged with home mechanical ventilator and 15 (57.7%) were spontaneously breathing. Four patients were prescribed palliative care, 3 were sent home, 3 to a nursing home, 2 to the hospital ward and 14 to a secondary intensive care unit. After discharge, 9 patients were re-admitted to the intensive care unit and 12 of the 15 patients we contacted, died within 1 year. Conclusion: Although the estimated mortality rate is high in geriatric patients in intensive care units, our study showed that the rate of discharge with a home mechanical ventilator was also high in these patients. Considering the prolonged length of stay in intensive care unit, we think that it is important to plan the discharge with a home mechanical ventilator in this patient group.

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