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The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 μg) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side-effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether esmolol has an effect on QT interval during induction of anaesthesia using etomidate and fentanyl in patients with known coronary artery disease. Sixty patients were prospectively randomised to either a control group or the esmolol group. Esmolol was administered as a bolus 1 mg.kg−1, followed by a continuous infusion at 250 μg.kg−1min−1. All patients received etomidate 0.3 mg.kg−1 and fentanyl 15 μg.kg−1. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 1 min following etomidate (T2), 3 min following vecuronium (T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. In the esmolol group, QTc interval was significantly shorter at T1, T2 and T4 compared to the control group (p < 0.05). In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. An infusion of Esmolol attenuated the QTc interval prolongation associated with tracheal intubation. [ABSTRACT FROM AUTHOR]

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway® (PLMA) insertion conditions in children. Eighty children, aged between 3–132 months, were randomly allocated to receive either alfentanil 20 μg.kg−1 (alfentanil group) or ketamine 0.5 mg.kg−1 (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg−1, a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg−1 with propofol 4 mg.kg−1 preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 μg.kg−1 during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil. [ABSTRACT FROM AUTHOR]

Background: This study was designed to evaluate the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity and recovery times in patients undergoing electroconvulsive therapy (ECT). Methods: Fourteen patients underwent a total of 84 ECT sessions as a crossover design. Patients were randomly allocated to receive either dexmedetomidine (1 μg/kg IV over a period of 10 min) or saline (control). Anaesthesia was induced with propofol 1 mg/kg, and then succinylcholine 0.5 mg/kg IV was administered. Arterial blood pressure and heart rate (HR) were recorded during the study period. Results: HR in the dexmedetomidine group was lower than that in the control group at 5 and 10 min after the start of study drug infusion, and at 1, 3 and 10 min after the seizure ended ( P<0.05). Peak HR was lower in the dexmedetomidine group compared with that in the control group ( P<0.05). The mean arterial pressure (MAP) values in the dexmedetomidine group were lower at 0, 1, 3 and 10 min after the seizure ended compared with the control group ( P<0.05). Both motor and electroencephalography (EEG) seizure duration in the control group (35.65 ± 14.89 and 49.07 ± 9.94 s, respectively) were similar to that in the dexmedetomidine group (33.30 ± 12.01 and 45.15 ± 17.79 s, respectively) ( P>0.05). Time to spontaneous breathing, eye opening and obeying commands were not different between the groups. Conclusion: A dexmedetomidine dose of 1 μg/kg IV administered over 10 min before the induction of anaesthesia with propofol may be useful in preventing the acute hyperdynamic responses to ECT without altering the duration of seizure activity and recovery time. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of a single dose of tramadol administered prior to extubation on post-operative pain and morphine consumption after coronary artery bypass surgery. Methods: Patients were randomized post-operatively into two groups (group T, n= 30; group P, n= 30). The technique of anaesthesia was standardized for all patients. The patients in group T received intravenous tramadol, 1 mg/kg, and the patients in group P received 2 ml of saline 0.9%, both approximately 1 h before extubation. After extubation, all patients were allowed to use the morphine patient-controlled analgesia (PCA) device for 24 h post-operatively. Post-operative data were recorded in the cardiac intensive care unit at 30 min, 1 h, 2 h, 4 h, 12 h and 24 h after extubation by the same anaesthesiologist, who had no knowledge of the groups, and the side-effects were also evaluated. Results: In group P, the visual analogue scale (VAS) scores were found to be higher 30 min ( P < 0.01), 1 h ( P < 0.01), 2 h ( P < 0.01) and 4 h ( P < 0.05) after extubation. The patient comfort scores were higher in group T 30 min ( P < 0.01), 1 h ( P < 0.05), 2 h ( P < 0.01) and 4 h ( P < 0.01) after extubation. The total morphine consumption was higher in group P at all evaluation times ( P < 0.01), and the numbers of PCA demands and boluses were also higher in group P ( P < 0.01). Conclusions: The study demonstrated that a single dose of tramadol administered prior to extubation following coronary artery bypass surgery is associated with a decrease of up to 25% in morphine consumption, a decrease in the VAS scores and an improvement in patient comfort within the first 4 h post-operatively. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the effects of a combination of gabapentin and paracetamol with gabapentin alone and placebo on post-operative pain and morphine consumption. Methods: Seventy-five ASA I–II patients undergoing abdominal hysterectomy were included in the study and randomly divided into three groups. Placebo capsules (Group I, n= 25), 1200 mg of gabapentin (Group II, n= 25), or 1200 mg of gabapentin and 20 mg/kg paracetamol in combination (Group III, n= 25) were administered 1 h prior to surgery. Anaesthesia was standardized for all patients. Non-invasive arterial pressure, heart rate, respiratory rate, peripheral oxygen saturation, morphine consumption, nausea and vomiting, visual analogue scale-pain intensity scores (VAS-PI) and sedation scores were recorded at 1, 2, 4, 6 and 24 h following the operation. Results: Morphine consumption at 24 h was 66.60 ± 11.49 mg, 42.74 ± 12.33 mg and 30.50 ± 11.55 mg, respectively, in groups I, II and III ( P < 0.05). Post-operative VAS-PI scores at movement and at rest were decreased with gabapentin and even more with a combination of gabapentin and paracetamol. Post-operative sedation scores were higher in groups II and III during the initial 4 h while these scores were higher in group I at 24 h. Conclusions: The single dose of gabapentin as well as a combination of gabapentin and paracetamol decreased the opioid requirement and increased the patients’ satisfaction post-operatively. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to compare the effectiveness of dexpanthenol pastille and benzydamine hydrochloride spray on the prevention of a sore throat. Methods: One hundred and eighty patients undergoing general anaesthesia, who were ASA I–II and with their ages ranging between 15 and 70 years, were randomly allocated to three groups, each consisting of 60 patients. For group B, four puffs of benzydamine hydrochloride were sprayed into the mouth initially 30 min before the operation and repeatedly 5 min before anaesthesia induction. For group D, two pastilles of dexpanthenol were administered orally to be sucked 30 min before the operation. For group P, four puffs of distilled water were sprayed into the mouth initially 30 min before the operation. Post-operatively, patients were evaluated for a sore throat for the duration of 24 h. Results: The incidence of a sore throat was significantly lower for group D when compared with group B and group P. The incidence of a sore throat was similar for group B and group P. According to the sore throat grading system, the number of patients experiencing no complaints was significantly higher for group D when compared with group B and group P. The number of patients achieving moderate scores was significantly higher for group B when compared with group D. Conclusion: The administration of 200 mg of dexpanthenol prophylactically before endotracheal intubation is effective in the prevention of post-operative sore throat. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Methods: Patients were randomly divided into placebo (group P, n= 16) and dexmedetomidine (group D, n= 16) groups. In group D, a 1 μg/kg bolus dose of dexmedetomidine was administered 10 min before the induction of anesthesia, followed by a 0.4 μg/kg/h infusion until the surgical incision. Anesthesia was induced with lidocaine (1 mg/kg), midazolam (0.2 mg/kg) and fentanyl (5 μg/kg) in both groups. Anesthesia was maintained with 0.5% isoflurane and fentanyl depending on the hemodynamic situation. The hemodynamic values during the investigation were obtained. Results: In group D, the mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were decreased effectively in comparison with the values in the placebo group ( P < 0.05), and there was an attenuation in the increase in the systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) at the post-sternotomy period. Conclusions: The pre-operative administration of the α2-agonist dexmedetomidine decreases the fentanyl requirement and attenuates the increase in SVRI and PVRI at the post-sternotomy period relative to the baseline levels, and decreases effectively MAP, MPAP and PCWP in comparison with the values in the placebo group, in patients with pulmonary hypertension undergoing mitral valve replacement surgery. [ABSTRACT FROM AUTHOR]

Objective: We performed this study to investigate the morphologic and topographic anatomy, and variations of the infraorbital canal (IOC), infraorbital nerve (ION), and infraorbital foramen (IOF).Study Design and Setting: This study was performed at the Anatomy Department of Ankara University School of Medicine between 1999 and 2000. The morphometry of these anatomic areas on cadaver heads were studied microscopically. The morphologic and topograpic anatomies of IOC, ION, and IOF were carried out microscopically with x 25 to x 40 magnification on 10 cadaver heads (20 sides).Results: We found the shape of the IOF as oval in 30% (6 sides), round in 40% (8 sides), and semilunar in 30% (6 sides) of the cadaver heads. We detected the IOF as single in 90% (18 sides), double in 5% (1 side), and triple in 5% (1 side) of the cases. We determined a complete roof (we called it as "canal") in 50% of cases and groove plus canal in 50% of the heads. The mediolateral relationship of the vessels to the nerve while emerging from the IOF was investigated, and the artery was always found in a mediosuperior position and the vein was inferior to it. In all specimens, the ION was found to be consisting of 3 to 8 fascicles interwoven with the artery and the vein in the loose connective tissue sheath.Conclusion: A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon while performing maxillofacial surgery and regional block anesthesia. Anatomic variations on this area may take place and a surgeon must take this into consideration so as to increase the surgical success. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery.Methods: Eighty ASA physical status I children aged 3-12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 micro g kg-1 in apple juice 0.2 ml kg-1, and each of the controls (n=40) received apple juice 0.2 ml kg-1 only. The protocol for general anesthesia was propofol-sevoflurane in N2O/O2. A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0-48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic.Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h.Conclusion: Oral premedication with clonidine 4 micro g kg-1 did not reduce the rate of POV in the children undergoing strabismus surgery. [ABSTRACT FROM AUTHOR]

A response by F. Erdil and colleagues to a letter to the editor about the article intrathecal drug in the 2010 issue is presented.

Objectives: To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures., Study Design: This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed., Methods: Thirty-five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram., Results: Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 +/- 1.39 mm, 33.94 +/- 3.15, and 17.23 +/- 2.64 mm, respectively. In cephalometric analysis, when S-N (the distance between the center of the sella turcica and the nasion) and N-ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant., Conclusion: While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.