Objective: Laryngoscopy is a procedure that induces hemodynamic alterations as well as increased intracranial pressure (ICP). Many procedures have examined ICP changes with optic nerve sheath diameter (ONSD) measurements. However, a small number of research has investigated the influence of suspension laryngoscopy on ONSD measurements. The present study has examined the effect of suspension laryngoscopy on ONSD measurements and ICP. Methods: The study included 50 patients, who were scheduled for suspension laryngoscopy. Optic nerve sheath diameter measurements were taken after anesthesia induction (T0), after intubation (T1), when the neck was in hyperextension at the start of the suspension laryngoscopy (T2), when the neck was in hyperextension at the end of the suspension laryngoscopy (T3), and 5 minutes after the suspension was terminated and the neck was brought to the straight position (T4). Results: The mean ONSD measurements were 3.8 ± 0.3 mm in T0, 4.0 ± 0.5 mm in T1, 5.1 ± 0.8 mm in T2, 5.1 ± 0.8 mm in T3 and 4.1 ± 0.5 mm in T4. The T1, T2, T3 and T4 values were considerably higher than the T0 values (p<0.05). There was no statistically significant correlation between suspension laryngoscopy time and ONSD measurements (R: -0.050, p: 0.729 - R: 0.089, p: 0.541). Conclusion: Suspension laryngoscopy causes a significant increase in ONSD measurements. Suspension time, on the other hand, does not lead to a progressive increase. Ending the suspension by straightening the neck at the end of the procedure permits ONSD measurements to approach the baseline values. Keywords: Suspension, laryngoscopy, intracranial pressure, optic nerve, ultrasonography

ABSTRACT Aim: Sociodemographic characteristics such as age, gender, and educational status are factors associated with preoperative anxiety. Health literacy may be the influencing factor in different results obtained in various studies regarding the relationship between educational status and preoperative anxiety. Materials and Methods: This prospective survey was carried out on 155 patients scheduled for elective surgery at the Department of Otorhinolaryngology between September and November 2019. Sociodemographic and basic health status data were recorded using the State-Trait Anxiety Inventory (STAI-I) and the Health Literacy Index (HLI). Results: While there was a highly statistically significant difference between average scores of the access, understanding and appraisal of health information subscales according to the HLI (p0,05). A negative medium level relationship was found between average scores of the STAI-I and the HLI (r=-0,424) and application subscale (r=-0,482), and a negative low level relationship was found between the overall STAI-I and the access (r=-0,335), understanding (r=-0,368) and appraisal of health information (r=-0,353) subscales. Conclusions: It was concluded that the low level of health literacy may be effective in the increased preoperative anxiety levels in patients, and further studies are required to be conducted in this matter.

BACKGROUND:Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure.Inhalation anesthetics are cerebral vasodilators.In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide.This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia.METHODS: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study.Routine monitoring was performed on the patients.Mean arterial pressure (MAP) values were recorded.Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms.Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms.These measurements were recorded as preoperative measurements.The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients.These measurements were recorded as peroperative measurements. RESULTS:The average age of the patients was 56.6±15.1.The MAP of the patients before induction was 76.28±5.13mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30mmHg, there was a statistically significant difference.There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters.There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001,p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033,p=-0.338). CONCLUSION:In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.

ÖzGebelikte kalp hastalığı varlığı anne ölümlerinin halen en önemli sebeplerinden biridir

Amaç: Elektif sezaryen operasyonlarında anestezi yönteminin anksiyete, hasta memnuniyeti ve ağrı düzeyine etkisinin araştırılması ek olarak hizmet kalitesi hakkında bilgi edinmek amaçlanmıştır.Hastalar ve Yöntem: Genel Anestezi (GA) veya Spinal Anestezi (SA) ile sezaryen planlanan gönüllülerde prospektif anket çalışması şeklinde gerçekleştirildi.Anksiyete düzeyleri Durumluluk Anksiyete Ölçeği(STAI-D) ile, ağrı düzeyleri Vizüel Analog Skala(VAS) skorlarıyla, memnuniyet düzeyleriyse Memnuniyet-Derlenme Kalitesi (QoR40T

Aim: Flexible bronchoscope is widely used by pediatric pulmonologists as a diagnostic and therapeutic tool. The objective of this study was to present our anesthesia experience in pediatric flexible bronchoscopy in which airway management was provided with laryngeal mask airway (LMA) and the complications developed.Material and Methods: This study was conducted in children aged between 2-15 years who underwent bronchoscopy for diagnosis and/or treatment between January 2017 and November 2018. Patients’ demographic data, diagnosis, anesthesia and airway management were recorded from the patient files. Times of anesthesia, operation and recovery were recorded. Complications during the procedure, awakening and recovery were recorded. Patients’ sore throat and hoarseness during resting and swallowing were recorded. Results: This study included 31 patients whose airway management was provided with LMA. The mean age was 8.58±4.14 years. Persistent cough was the most common indication for bronchoscopy (35.5%). Anesthesia time was 15.46±10.99 minutes, bronchoscopy time 12.87±10.57, awakening time 16.38±4.53 minutes, and recovery time 23.32±10.24 minutes. The most common complication was cough (45.2%). Sore throats of the patients were observed as mild and moderate at the 0th and 2th hours. Both resting and swallowing sore throats were observed as mild at the 4th hour, while no sore throat was seen in any patient at the 12th hour. Hoarseness was observed at mild level in 4 patients (12.9%) at the 0th hour.Conclusion: Providing airway with LMA in pediatric flexible bronchoscopy applications offers a safe anesthetic management, and it has a low rate of complications.Keywords: Flexible bronchoscopy; pediatric bronchoscopy; laryngeal mask airway.

ÖzAmaç: Bu çalışmada ameliyathane dışı anestezi deneyimlerimizi ve sonuçlarını tartışmayı amaçladık

Amaç: Bu çalışma; tıpta uzmanlık eğitimi alan klinik branş araştırma görevlilerinin havayolu yönetimi ile ilgili deneyimlerini ve bu deneyime Anesteziyoloji ve Reanimasyon staj ve rotasyonunun katkısını belirlemeyi amaçlamaktadır.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi’nde, dahili ve cerrahi branşlarda uzmanlık eğitimi alan araştırma görevlileri üzerinde, havayolu yönetiminde teorik bilgi ile pratik deneyimlerini ve Anesteziyoloji ve Reanimasyon staj ve rotasyonunun bu deneyime katkısını ölçmek için 26 sorudan oluşan bir anket çalışması yapıldı. Anket sorularına verilen cevapların değerlendirmesinde tanımlayıcı istatistiki analizler kullanıldı.Bulgular: Anket sonuçlarının cevapları değerlendirildiğinde; katılımcıların %95,7’si havayolu gereçleri ve kullanımları ile ilgili eğitim aldıklarını, %82,2’si bu eğitimi ilk olarak anestezi stajında aldıklarını, %56,7’si ilk endotrakeal entübasyonu anestezi stajında yaptığını, %59,2’si airwayi ilk anestezi stajında kullandığını, %34,2’si laringeal mask airway kullandığını, %50’si laringeal mask airwayi ilk olarak anestezi stajında kullandığını belirtmiştir. Anesteziyoloji ve Reanimasyon rotasyonu yapmayan katılımcıların %61’i bu durumu uzmanlık eğitimleri açısından bir eksiklik olarak görmektedir. Katılımcıların %70’i rotasyon sonrası kendilerini havayolu yönetimi açısından yeterli bulmaktadır. Kendini yeterli bulmayan katılımcılar ise pratik uygulamaların artırılması gerektiğini ve sürenin az olduğunu belirtmişlerdir. Sonuç: Anket sonuçlarımıza göre havayolu yönetimi eğitiminde Anesteziyoloji ve Reanimasyon stajı önemli bir yer tutmaktadır. Farklı branşlarda uzmanlık eğitimi alan hekimlerin Anesteziyoloji ve Reanimasyon rotasyonunun gerekliliğini belirtmeleri rotasyon programlarının yeniden gözden geçirilmesini gündeme getirebilir. Verilen eğitimlerin özellikle pratik bölümündeki eksiklikler gözardı edilmemelidir. Çalışmamızın havayolu yönetimi eğitimi ile ilgili düzenlemelere katkı sağlayacağı kanaatindeyiz.

Takayasu arteriti (TA); idiyopatik, kronik inflamatuvar, aorta ve dallarını tutabilen nadir bir hastalıktır. %80 oranında 40 yaşın altındaki kadınlarda görülür. TA aynı zamanda periferik nabızların alınamaması ile karakterizedir. TA hastalarının anestezi yönetimi ile ilgili bilgiler, literatürde çoğunlukla sezaryen vakaları olmak üzere, izole olgu sunumları ile sınırlıdır. Bu olgu sunumunda TA'li 69 yaşında bilateral karotis, pulmoner arter ve subklavian arter tutulumu olan, laparoskopik kolesistektomi operasyonu geçirecek hastamızda Near Infrared Spectroscopy (NIRS) gibi ileri monitörizasyon yöntemi uygulanmış, TA'ya bağlı olası postoperatif komplikasyonların önlenmesi ve uygun anestezi yönetiminin seçilmesi amaçlanmıştır.

Herediter anjiyoödem (HAÖ), C1 esteraz inhibitör eksikliği nedeni ile ortaya çıkan ve otozomal dominant geçiş gösteren kalıtsal bir hastalıktır. Genellikle çocukluk ve puberte dönemlerinde, ataklar hâlinde ağrısız ve kaşıntısız şişlikler görülmesiyle başlar. Cerrahi sırasında, atakların en fazla sebebi basıya bağlı travmalar ve strestir. HAÖ hastalarının anestezi yönetiminde oluşabilecek ataklar göz önünde bulundurulmalı ve acil havayolu yönetimi için bütün hazırlıklar yapılmalıdır. Uygulanacak anestezi yöntemi cerrahinin tipine, hasta-cerrah-anestezist görüşlerine göre belirlenmelidir. Bu çalışmada, testis torsiyonu nedeni ile acil operasyon planlanan, HAÖ nedeni ile izlem altında olan çocuk olgudaki anestezi deneyimimizin sunulması amaçlanmıştır.

Background: Sugammadex has been shown to decrease the efficiency of progesterone-containing oral contraceptive drugs which possess a steroid structure. Aims: The aim of the present study was to evaluate the effects of sugammadex on progesterone levels in pregnant rats as well as on the physiological course of the pregnancy. Study Design: Animal experiment. Methods: This study was approved by the Selçuk University Ethical Committee for Experimental Animal Research. Pregnant Winster Albino rats (n=26) were divided into three groups and administered with various intravenous injections on the 7th day of pregnancy. The control group (Group K, n=6) received 1.5 mL serum physiologic, the sugammadex group (Group S, n=10) received 30 mg/kg sugammadex and the sugammadex + rocuronium group (Group SR, n=10) received 30 mg/kg sugammadex and 3.5 mg/kg rocuronium. Progesterone levels were measured and the offspring were monitored for morphologic status. Results: Mean progesterone levels were 94.16±15.54 ng/mL in Group K, 87.86±12.48 ng/mL in Group S, and 94.53±16.10 ng/mL in Group SR (p>0.05). No stillbirth or miscarriage was observed in the rats. The mean number of offspring was 6.8±1.47 in Group K, 6.5±1.35 in Group S, and 6.4±1.17 in Group SR. The offspring appeared macroscopically normal. Conclusion: Sugammadex does not appear to affect the progesterone levels in pregnant rats in the first trimester and the clinical course. Successful completion of pregnancy and the absence of stillbirth or miscarriage will guide future studies about the use of sugammadex, particularly in the first trimester of the pregnancy.

Justificativa e objetivos: O objetivo deste estudo foi fazer uma revisão das experiências de um departamento de anestesiologia em relação ao uso do videolaringoscópio C-MAC em tentativas malsucedidas de intubação. Métodos: Analisamos os dados de 42 pacientes, cujas tentativas de intubação com o uso delaringoscopia direta (Macintosh) tinham falhado e nos quais o videolaringoscópio C-MAC foi usado como o dispositivo de resgate primário. A taxa de sucesso do C-MAC em intubação foi avaliada e a visão da laringe em ambos os dispositivos foi comparada. Resultados: Com o laringoscópio Macintosh, o escore de Cormack e Lehane foi 3 em 41 pacientes e 4 em um paciente e com o CMAC, foi 1 em 27 pacientes, 2 em 14 pacientes e 3 em um paciente. Intubação traqueal com CMAC foi bem-sucedida em 36 pacientes (86%) na primeira tentativa e em seis pacientes (14%) na segunda tentativa. Nenhuma complicação foi observada, além de pequena lesão (sangue na lâmina) em oito pacientes (19%). Conclusão: Esses dados fornecem evidência para a eficácia clínica do videolaringoscópio C-MAC no manejo de intubações malsucedidas inesperadas em assistência rotineira de anestesia. O videolaringoscópio C-MAC é eficiente e seguro como dispositivo de resgate primário em intubações malsucedidas inesperadas.

Amaç: Santral venöz kateterizasyon

El objetivo de este estudio fue hacer una revisión de las experiencias de un departamento de anestesiología con relación al uso del videolaringoscopio C-MAC® en intentos de intubación que fracasaron. Analizamos los datos de 42 pacientes, cuyos intentos de intubación con el uso de laringoscopia directa (Macintosh) habían fallado y en los cuales el videolaringoscopio C-MAC® fue usado como el dispositivo de rescate primario. Se calculó la tasa de éxito del C-MAC® en la intubación y se comprobó la visión de la laringe en los 2 dispositivos. Con el laringoscopio Macintosh, la puntuación de Cormack y Lehane fue 3 en 41 pacientes y 4 en un paciente; y con el C-MAC®, fue 1 en 27 pacientes, 2 en 14 pacientes y 3 en un paciente. La intubación traqueal con C-MAC® fue exitosa en 36 pacientes (86%) en el primer intento y en 6 pacientes (14%) en el segundo intento. No se observaron complicaciones, a no ser una pequeña lesión (sangre en la lámina) en 8 pacientes (19%). Esos datos suministran evidencias para la eficacia clínica del videolaringoscopio C-MAC® en el manejo de intubaciones no exitosas inesperadas en asistencia de rutina en anestesia. El videolaringoscopio C-MAC® es eficiente y seguro como dispositivo de rescate primario en intubaciones no exitosas inesperadas.

Needle tip visualization during ultrasound-guided regional anesthesia (UGRA) is necessary for safety and efficacy. However, disruption of the image of the needle tip driven toward the target is a general problem, especially for beginners. The purpose of this study was to compare performance parameters between using the Sonoplex and Stimuplex D-Plus echogenic needles in a simulated ultrasound-guided interventional task by inexperienced anaesthesia residents. After a standardized training session, 28 anesthesiology residents performed simulated nerve blocks in a beef phantom with each needle. All ultrasound images were digitally stored for analysis. The absolute time the needle tip was in view, total procedure time, and angle of needle insertion were subsequently measured objectively by two single investigators. The procedures that used the Sonoplex echogenic needle had significantly better tip visibility and shorter total procedure time at insertion angles between 42° and 64° relative to the phantom surface. We have demonstrated that inexperienced users who used the Sonoplex echogenic needle were able to complete the procedure more quickly. Needles with improved visibility would be a very useful addition to UGRA for inexperienced users.

BACKGROUND AND OBJECTIVES:The purpose of this study was to review the experiences of an anesthesiology department regarding the use of a C-MAC videolaryngoscope in unexpected failed intubation attempts. METHODS:Data were analyzed from 42 patients whose intubation attempts using Macintosh direct laryngoscopes had failed, and on whom a C-MAC videolaryngoscope was utilized as the primary rescue device. The success rate of C-MAC in intubation was assessed, and laryngeal views from both devices were compared. RESULTS:The Cormack and Lehane score was III in 41 patients, and IV in one patient, with the Macintosh laryngoscope, while Cormack and Lehane score was I in 27 patients, II in 14 and III in one with CMAC. Tracheal intubation with CMAC was successful on the first attempt in 36 patients (86%), and on the second attempt in 6 patients (14%). No complications were observed other than minor damage (blood on blade) in 8 patients (19%). CONCLUSION:These data provide evidence for the clinical effectiveness of C-MAC videolaryngoscope in managing the unexpected failed intubations in routine anesthesia care. The C-MAC videolaryngoscope is efficient and safe as a primary rescue device in unexpected failed intubations.

Our aim was to compare the effects of desflurane and sevoflurane on cognitive functions of geriatric patients that were planned for elective surgery under general anestesia. After national ethical committee approval, 40 patients (aged 65-75 yr) were enrolled. Patients were allocated to either the desflurane (n= 20) or the sevoflurane (n= 20) group. In all patients anaesthesia will be induced with propofol and remifentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, and remifentanyl. Emergence times from anaesthesia and Aldrete scores were recorded. Cognitive function will be evaluated with two cognitive test; Blessed Short Orientation Memory Concentration Test (BOMC) and standardized mini mental test (SMMT) preoperatively and postoperatively at 60, and 180 minute after extubation. The mean extubation time, eye opening time and Aldrete scores were similar in the desflurane and sevoflurane groups (p> 0,05). There were no significant differences between the desflurane and the sevoflurane groups when the BOMC and MMST scores were compared preoperatively, and postoperatively at 60, and 180 min (p> 0,05). The result of this study indicate that there is no difference between effects of desflurane and sevoflurane anesthesia on postoperatif cognitive functions in the elderly.