Obesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TUR-P) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI<25 kg/m², Group N) or obese (BMI≥30 kg/m², Group O) group. SB assessments were recorded afterthe LP. SB at 6 and 120 min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120 min SB levels were significantly higher for Group O (P<0.05). Blood pressure (BP) after the LP was significantly higher for Group N (P<0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients.

Aim: The position of the body during surgery may affect the patient’s body functions, especially the hemodynamic parameters. We aimed to comparatively analyze the effects of lithotomy and prone position on respiratory mechanics, arterial oxygenation, and hemodynamic parameters in patients who underwent percutaneous nephrolithotomy (PNL). Materials and methods: The study included 40 patients aged 16-63 years who underwent kidney stone surgery. The patients had no history of diabetes or cardiopulmonary disease and had an American Society of Anesthesiology (ASA) score of I–II. The pH, partial arterial oxygen pressure, partial arterial carbon dioxide pressure, HCO3, arterial oxygen saturation, end-tidal carbon dioxide (EtCO2), alveolar oxygen partial pressure, dead space volume/tidal volume ratio, P(A-a)O2, peak inspiratory pressure (PIP), inspiratory plateau airway pressure (PPlt), systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and heart rate (HR) values were assessed simultaneously throughout the surgery and comparatively analyzed both for lithotomy and prone positions. Results: There was a significant difference between lithotomy and prone positions with regard to pH and HCO3 values, which are among the arterial blood gas parameters measured at 20 minutes (p<0.05 and p<0.001, respectively). There was a significant difference between lithotomy and prone positions with regard to EtCO2, PIP, PPlt, and HR measured at 20 minutes (p<0.05, p<0.001, p<0.001, and p<0.05, respectively). Conclusions: The prone position decreased dynamic and static compliance and increased the PIP and PPlt values in patients undergoing PNL. However, these changes do not have a negative effect on the hemodynamic parameters in low-risk patients.

Aim: The prominent ear is the most common congenital deformity of the external ear. Otoplasty is performed to correct the appearance of the prominent ear. This study was planned to compare the analgesic and anesthetic effects of local nerve blockade and local infiltration anesthesia in the otoplasties. Method: Thirty-two patients who underwent otoplasty in both ears between February 2018 and March 2019 were included in the study. Three patients were excluded because they refused regional anesthesia. In the patients included in the study, only local infiltration anesthesia was applied to 1 ear and regional nerve blockade was applied to the other ear. Regional nerve blockade was applied to the study group; local infiltration anesthesia was applied to the control group. Surgical and anesthetic complications were recorded. The onset time, duration and severity of pain were followed. Numerical evaluation scale scores were used to evaluate pain levels. Results: It was observed that the first pain of the patients On the side where regional nerve block (RNB) anesthesia was applied after an average of 10.5 hours. On the other hand on the side where local infiltration anesthesia was applied; the pain was observed to start after an average of 3.5 hours. At the 6th and 12th hours postoperatively, the scores of the numerical evaluation scale were significantly lower in the study group than the control group (P < 0.05). At the 24th-hour pain score, the values were lower in the study group, but the difference was not significant between the groups (P > 0.05). In the regional anesthesia group, can develop such as difficulty in swallowing, weakness in the neck, weakness in the upper extremity, nausea, Horner syndrome; but all side effects resolve spontaneously within 6 to 12 hours. Conclusion: The application of regional anesthesia in prominent ear surgical procedures can be considered as an alternative method to provide better quality preoperative anesthesia and better quality postoperative analgesia in patients.

Aim: Since tonsillectomies and/or adenoidectomies performed in the pediatric age group under general anesthesia have a high rate of postoperative nausea and vomiting (PONV), the practice of using prophylactic antiemetic drugs is common. This study aimed to compare the benefits of systemic administration of a low dose of inj. methylprednisolone 1 mg/kg with inj. metoclopramide 0.15 mg/kg IV for the prevention of PONV in children undergoing adenotonsillectomy. Methodology: In this study, the files of children undergone adenotonsillectomy from August 2015 to January 2018 in our hospital were analyzed retrospectively. 408 children aged 4-12 years were included in the study. Patients who were given methylprednisolone 1 mg/kg IV as premedication were placed in Group P, and patients who received metoclopramide 0.15 mg/kg were grouped as Group M. Effects on PONV, vomiting episodes, oral intake time, postoperative analgesic requirement, postoperative respiratory complications, and drug side effects were recorded. Results: Vomiting rates between 1-4 hrs (late period) were 11.0% in Group M (n = 22); It was 3.8% (n = 8) in Group P. In the late period, a significant difference was found between the two groups in terms of nausea and vomiting (p = 0.02, p = 0.07, respectively). In Group M, the incidence of respiratory complications was also higher in the postoperative period compared to Group P. Postoperative acetaminophen requirement increased significantly in group M compared to Group P (p = 0.006). Conclusion: Prophylactic use of a single dose of methylprednisolone 1 mg/kg IV during the preoperative period was more effective in reducing the incidence of late postoperative vomiting compared to metoclopramide and led to earlier tolerance of oral intake. In addition to its anti-inflammatory properties and antiemetic effects, low-dose methylprednisolone is also useful for prevention of respiratory complications. Key words: Methylprednisolone; Metoclopramide Hydrochloride; PONV; Respiratory complications; Tonsillectomy Citation: Kepekci AB, Subasi B, Kepekci AH, Yarbil A. Comparison of the effects of low dose methylprednisolone and metoclopramide on nausea and vomiting and respiratory complications after adenotonsillectomy in children. Anaesth. pain intensive care 2020;24(5): Received: 29 July 2020, Reviewed: 22 September 2020, Revised: 30 August 2020, Accepted: 2 October 2020

Cerrahinin ve ameliyathanenin gelişim sürecinin bilinmesi sağlıkta yapılacak araştırma geliştirme çalışmalarında ve geleceğin planlanmasında anahtar rol oynar. Özellikle anestezinin keşfi ve kullanımının yaygınlaşması cerrahinin de gelişmesini arkasından getirmiştir. Günümüz cerrahi uygulamalarına gelene dek bu konuda önemli merhaleler aşılmıştır. Özelikle laparoskopik cerrahinin ve robotik cerrahinin klinik kullanıma girmesi cerrahi branşlarda büyük atılımlara yol açmıştır. Son yıllarda yaşadığımız pandemi süreci de sağlık sektörürünün gelişen çevre koşullarına uyumun sağlanması açısından önemli bir süreç olmuştur. Covid-19 pandemi sürecinde klinik ortamda viral bulaşma riskini en aza indirmek, hastalar ve sağlık personeli için daha güvenli koşulları oluşturmak için kişisel koruyucu ekipman (KKE) kullanımı farkındalığı artmıştır. Cerrahi ve ameliyathanenin tarihsel gelişimi sağlık hizmetlerindeki gelecek projeksiyonu için bilinmesi gereken bir süreçtir.