Factors Affecting Oculocardiac Reflex Incidence In Pediatric Strabismus Surgery: Retrospective Study

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

Dexmedetomidine as an Adjuvant to Lignocaine for Intravenous Regional Anesthesia for Forearm and Hand Surgeries: A Prospective, Randomized, Controlled Study

Objective: Intravenous regional anesthesia (IVRA) is an effective anesthetic technique for surgical procedures of short duration involving the distal parts of the limbs. Intraoperative tourniquet pain is the major restraint of this technique, and to overcome this limitation, various adjuvants to local anesthetics have been used. This study investigated the effect of a fixed low dose of dexmedetomidine as an adjuvant to lignocaine on intraoperative tourniquet pain, onset of block, duration of block, and patient satisfaction. Methods: A total of 100 adult patients with ASA grade I and II who were scheduled for upper limb surgery of approximately 1 hour in duration were randomly divided into two groups (n=50 in each group). Group A received 35 mL of preservative-free lignocaine alone and Group B received 35 mL of preservative-free lignocaine along with 30 μg of dexmedetomidine. The incidence of tourniquet pain, intraoperative fentanyl consumption, duration of onset and recovery of sensory and motor block after tourniquet deflation, postoperative numeric pain rating scale (NPRS) scores, duration of analgesia, and overall patient satisfaction were noted. Result: The incidence of tourniquet pain and intraoperative fentanyl consumption were significantly lower in Group B. The onset and duration of sensory and motor blocks were faster and longer, respectively, in Group B. Postoperative NPRS scores were lower, duration of analgesia was longer, and overall patient satisfaction was better in the dexmedetomidine group. Conclusion: Dexmedetomidine at a dose of 30 μg as a lignocaine adjuvant significantly reduces tourniquet pain and intraoperative fentanyl consumption in IVRA. Dexmedetomidine shortens the onset of block, prolongs the duration of block, and provides a more satisfactory anesthesia than lignocaine alone.

Anesthetic Management of a Pediatric Patient with Emanuel Syndrome

Emanuel syndrome is a very rare recessive hereditary disorder characterized by multiple congenital anomalies, craniofacial dysmorphism, significant developmental delay and mental retardation. In this case report, we discussed our anesthetic management of a pediatric patient with Emanuel Syndrome undergoing isolated cleft palate repair operation. General anesthesia was maintained with total intravenous anesthetic techniques. Videolaryngoscopy was used for endotracheal intubation. The patient was extubated at the operating room following an uneventful intraoperative period, however she developed respiratory distress and was reintubated and transferred to pediatric intensive care unit. Anesthesiologists should be prepared for difficult airway management because of concomitant micro-retrognathia, as in our patient. Most of the problems regarding anesthetic management of this extremely rare syndrome can be reduced by a detailed preoperative assesment, preparation for diffucult airway and a careful hemodynamic monitoring.

EVLW and its Importance in Fluid Management

Fluid management and optimization is one of the most frequently observed problems in anesthesiology and critical care. An ideal hemodynamic management increases oxygen supply to tissues, improves postoperative outcomes and decreases surgical costs. Extravascular lung water (EVLW) measurement has gained widespread acceptance in the early prediction and management of adverse effects caused by fluid treatment. The fundamental aim of acute circulatory failure treatment is to improve tissue perfusion and oxygenation while avoiding fluid overload. EVLW consists of extravascular interstitial, intracellular, alveolar and lymphatic fluid in the lungs and its normal values are 3-7 ml kg-1. Studies have reported that values above 10 ml kg-1 as a cut-off value points to pulmonary edema. Although the gold standard in EVLW measurement is the gravimetric method, lung ultrasound and transpulmonary thermodilution is more widely utilized since gravimetric measurement can only be performed post-mortem. EVLW measurement is expected to gain importance in the hemodynamic measurement of ALI/ARDS patients and future studies will benefit from focusing on EVLW based fluid therapy.

Effects of Granisetron on Spinal Anesthesia-induced Hypotension

Objective: It was aimed to evaluate the effect of intravenous (IV) granisetron used for nausea and vomiting prophylaxis on hypotension and bradycardia caused by spinal anesthesia. Methods: 120 ASA 1-2 patients undergoing elective surgery under spinal anesthesia were randomly divided into Group G (Ganisetron; n=60) and Group P (Placebo; n=60) groups. Five minutes before spinal anesthesia, Group G received 1 mg intravenous granisetron diluted in 10 mL of isotonic sodium chloride solution and Group P received 10 mL of isotonic sodium chloride solution. Spinal anesthesia with hyperbaric bupivacaine 0.5%, 15 mg at the level of L4-5 was applied for both groups. Hemodynamic data, sensory and motor block parameters were recorded before and after spinal anaesthesia every 5 minutes during 20 minutes of surgery. Results: There was no difference in the demographic data of both groups. Although hemodynamic data showed a decrease in both groups according to initial values, blood pressure measurements in group G were significantly higher than the first measure values. There was no significant difference in heart rate values between the groups. Conclusion: Intravenous granisetron reduces hypotension after spinal anesthesia, but it has no significant effect on heart rate.

Retrospective Analysis of Brain Death Cases

Objective: Organ transplantation is important for patients with end-stage organ failure to survive. For this reason, detection of brain death cases and adequate number of donations are necessary. Methods: 31 cases diagnosed with brain death between 01.01.2018-01.01.2020 were evaluated retrospectively. Demographic characteristics, diagnoses causing brain death, time to detect brain death, additional tests applied for the diagnosis of brain death, time to diagnosis of brain death and cardiopulmonary arrest or donation, the proportion of families accepting organ donation, the proportion of donors, organ removed from donors the number and blood types of the cases were recorded Results: The number of cases diagnosed with brain death was 31, and the mean age of the cases was 46,71 (1-89) years. 71% (n=22) of the patients were admitted to the intensive care unit from the emergency department. The most common reason for admission to the intensive care unit 67.7% (n=21) was intracranial bleeding. While the family donation rate was 19% (n=5), three cases who accepted the donation could be donors. The mean age of the patients for whom organ donation was accepted was 35.80±11 years, while the mean age of the patients for whom organ donation was not accepted was 57.43±21.30 years (p=0.04). Conclusion: Due to the increasing number of end-stage organ failure patients awaiting transplantation, it is necessary to increase the number of cadaveric donors. Timely and sufficient detection of brain death cases, increasing the family donation rate and increasing the number of cadaveric donors will be contributed.

Palliative Care in Turkish Medical History

From the moment that human beings begin perceiving the value of life, they have also started to strive for the continuation of life. It would not be wrong to divide Turkish societies into three parts as sociological history. Turkish social life before Islam, the differences in the social structure with Islam, and Europe's social structure with the westernization influx with the end of the 19th century can be examined. Health system and patient care was also greatly affected by these processes. Health care, which was carried on with Shamanism and Herbalism in the old Turkish states and continued with bimarhanes and darüssifas, and health professionals have been mobilized to serve the society with the opportunities of modern medicine today. Acute and chronic diseases that occur with the continuation of life make it difficult to lead a quality life. This process can sometimes be painful. Palliative care is also useful in chronic diseases whose mortality has decreased with successful treatment methods recently applied, but which impairs the quality of life due to the disease. Thus, this process, which puts the patient's relatives psychologically, socially, and financially difficult, and the patient, can be managed more easily. Although it started with reducing and caring for cancer patients' pain, palliative care has now become a necessity in all areas of clinical practice. Our aim in this review is to examine the development process of the concept of palliative care in Turkish medical history.

The Use Of Intravenous Immunoglobulin For The Treatment Of Severe Covid-19: Case Presentation For Three Patients

Although the treatment of the hyperinflammatory response due to COVID-19 has not yet been found, high-dose corticosteroids, interleukin receptor blockers and intravenous immunoglobulin (IVIG) are used to improve the hyperinflammatory response.In this article, we aimed to share our experiences with 3 patients who received IVIG therapy in ICU.