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    Effects of Osteotomy on Hemodynamic Parameters and Depth of Anesthesia in Rhinoplasty Operations
    (NLM (Medline), 2020) Gencay I.; Muluk N.B.; Kilic R.; Yazici I.; Aydin G.; Sencan Z.; Tozar M.
    BACKGROUND: Bleeding during rhinoplasty leads to many undesirable effects, such as loss of vision in the surgery area, complications during the procedure, and postoperative complications. The most important effect that increases bleeding is hemodynamic changes during surgery. Considering that osteotomy is the most challenging process in rhinoplasty, this study aimed to examine the hemodynamic changes during osteotomy and changes in the depth of anesthesia. METHODS: A total of 50 patients, aged 18 to 65 years with an ASA (American Society of Anesthesiology) score of 1 and 2, who underwent osteotomy during rhinoplasty under general anesthesia, were examined retrospectively. After routine monitoring, the patients underwent general anesthesia induction and endotracheal intubation. Before the surgery, they received remifentanil 1??g/kg as an intravenous bolus followed by 0.5??g/(kg·min) as intravenous infusion until the end of the surgery. The hemodynamic parameters and depth of anesthesia [bispectral index (BIS) values] of the patients were examined before anesthesia, 10?minutes before osteotomy, during osteotomy, and 10?minutes after osteotomy. RESULTS: A significant difference was found in heart rate (beats/min), systolic and diastolic blood pressures (mm Hg), and BIS values of the patients measured before, during, and after osteotomy (P < 0.001). The heart rate, systolic and diastolic blood pressures, and BIS values were significantly higher during osteotomy. Until the 10th minute after osteotomy, all 4 parameters nearly reached the values measured before osteotomy. CONCLUSIONS: Osteotomy directly affects hemodynamic parameters and depth of anesthesia. Hence, it is of utmost importance that the analgesic need and depth of anesthesia are adequately monitored and adjusted during osteotomy. By suppressing hemodynamic stress responses, the amount of bleeding can be reduced, thus increasing the surgical success and the patient's comfort.
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    Topical sevoflurane: An alternative treatment for pressure ulcers
    (College of Physicians and Surgeons Pakistan, 2019) Gencay I.
    Pressure ulcers are a common problem in intensive care unit (ICU). Recently, topical sevoflurane has been used especially for treatment of venous ulcers and infected skin ulcers. We present a case of topical sevoflurane treatment of a pressure ulcer. Treatment was applied for one month without any antibiotic supplementation. After one month, the ulcer size was decreased, necrotic tissues were cleared, and wound cultures were negative. There are three beneficial effects of local sevoflurane treatment: good analgesic action, antibiotic effects, and acceleration of wound healing. These beneficial effects may make sevoflurane an alternative treatment for pressure ulcers in an ICU. © 2019 Informatics Publishing Limited. All rights reserved.
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    Transversus abdominis plane (TAP) block for postoperative analgesia after laparoscopic cholecystectomy, a retrospective study
    (Anestezi Dergisi, 2019) Yaman F.; Karaca G.; Colak S.; Ates G.; Pehlivanlı F.; Gencay I.; Aydın G.
    Objective: Laparoscopic cholecystectomy is a minimally invasive surgical procedure but it is still associated with postoperative pain within the first 24 hours. Ultrasound-guided transversus abdominis plane block is a regional anesthetic technique which provides postoperative analgesia in abdominal surgery. We aimed to determine the effects of the TAP block on discharge time, non-opioid and opioid consumption, shoulder tip pain, incidence of postoperative nausea and vomiting, and severity of pain evaluated with visual analogue scale in patients who underwent laparoscopic cholecystectomy. Methods: Seventy-two eligible patients who underwent laparoscopic cholecystectomy were included in the study. In 38 patients ultrasound-guided TAP block was performed, and 34 patients were treated with conventional methods such as non-steroid anti-inflamatory drugs. Data related to VAS pain scores, shoulder tip pain, intraoperative opioid consumption, postoperative non-opioid and opioid consumption, nausea vomiting and discharge time were collected retrospectively to determine statistically significant differences between TAP block and non-TAP block groups. Results: VAS pain scores were globally reduced at all time periods in two groups (significant group main effect, F(7.760)=94.47, P<0.001). VAS pain scores were significantly lower at all measurement intervals except 24h in the TAP group than in the non-TAP group. Shoulder pain was significantly higher in TAP block group than non-TAP block group (p<0.001). Any statistically significant difference was not found between the groups in terms of intraoperative, and postoperative opioid consumption, discharge time, nausea and vomiting. Conclusion: Ultrasound-guided TAP block is an effective regional analgesic technique to decrease postoperative abdominal pain, however TAP block does not reduce shoulder tip pain. Multimodal pain management is required after laparoscopic cholecystectomy. © Copyright Anesthesiology and Reanimation Specialists' Society.