We herein showed that the intraperitoneal instillation of local anesthetic during laparoscopic cholecystectomy is a noninvasive, rapid, safe and simple analgesic technique that reduces the total morphine consumption during first 24 h.

Purpose: we evaluated the effects of magnesium sulphate infusion on anesthetic requirement, early recovery and postoperative analgesia in desflurane-remifentanil-based, balanced anaesthesia. Methods: 60, ASA (American Society of Anesthesiologists) group 1-2 patients who were scheduled for laparoscopic cholecystectomy were randomly divided into two groups. Before anesthesia, the magnesium-treated group (n = 30) received a 15 min infusion of 40 mg/kg of magnesium sulphate followed by 10 mg/kg/h by continuous i.v. infusion during the operation. The same volume of isotonic saline was administered to the control group (n = 30). Anesthesia was induced with propofol, remifentanil and vecuronium, and maintained with desflurane 3-6%, O 2 /air and remifentanil infusion. Desflurane was titrated to maintain BIS (bispectral index) values of 40-60. The times from cessation of anesthesia to spontaneous breathing, eye opening, extubation, reaching BIS 70, and Aldrete scores were recorded. After surgery, patients received a patient-controlled, morphine analgesia device. Results: demographic variables were similar. During the 15 min infusion of magnesium sulphate, the BIS value was significantly lower in the magnesium sulphate-treated group. The amounts of propofol and desflurane used were less in the magnesium sulphate-treated group, by 18% and 22% respectively (p<0.05). The groups did not differ with respect to the time taken to reach BIS 70, spontaneous breathing, eye opening and extubation. Alderete and VAS (visual analogue scale) pain scores, and total morphine consumption were significantly lower in the magnesium sulphate-treated group. There were no differences in side effects, but the rate of re-intubation was higher in the group receiving magnesium sulphate (p = 0.03). Conclusion: perioperative use of magnesium sulphate reduced propofol and desflurane consumption, and the postoperative morphine requirement, while causing a delay in recovery by decreasing the Aldrete score.

Acupressure at the P6 meridian point is an effective alternative for the prevention of nausea and vomiting in patients receiving patient-controlled analgesia with morphine after gynaecological surgery.

7 Giriş E ndotrakeal entübasyon, ameliyathanede hastaya güvenli bir üst solunum yolu açıklığı sağlamak ve bu yolla anestezinin idamesini temin etmek üzere, yoğun bakım ve acil ünitesinde ise hastanın solunumuna yardım etmek veya solunumu duran hastaya kontrollü solunum yaptırmakta kullanılan en güvenli yoldur (1,2 Yöntemler: Bu çalışmaya genel anestezi altında elektif ameliyata alınan Amerikan Anestezistler Derneği (ASA) kriterlerine göre grup 1-2 olan, 18-70 yaş arası hastalar dahil edildi. Baş-boyun bölgesi-ne cerrahi girişim uygulanacak baş-boyun tümörleri ve baş-boyun anomalisi olanlar çalışma dışı bırakıldı. Olguların orofaringeal yapıları Mallampati'nin tanımladığı şekilde incelendi. Laringoskopiyi yapan anestezist Cormack-Lehane laringoskopik görünümüne göre değerlendirdi. Laringoskopik görünüm Cormack-Lehane 3-4 olan hastalar zor entübasyon olarak kabul edildi. Antropometrik ölçüm-ler için tiromental, sternomental mesafeler, mandibula uzunluğu, boyun uzunluğu ve genişliği ve bunlara ilaveten baş çevresi ölçüldü. Bulgular:Değişkenlerin kolay ve zor entübasyon grubu referans alına-rak yapılan Receiver Operating Characteristic (ROC) analizi sonucunda; triomental mesafe, sternomental mesafe, boyun uzunluğu, boyun çevresi ve baş çevresinin istatistiksel olarak anlamlı olduğu bulundu (p<0,05). Baş-boyun malignitesi dışındaki malignitesi olan hastalarda zor entübasyon oranı %8,3, olmayan hastalarda ise %7,1'dir ve istatistiksel olarak anlamlı bir fark saptanmamıştır (χ 2 =0,101; p=0,751). Baş çevresi 57,35 cm ve üstünde zor entübasyon öngörmede %85,7 seçicilik ve %57,1 pozitif tahmin değeri elde edildi. Sonuç:Zor entübasyon tahmini ile ilişkili olarak en seçici ve en yüksek pozitif tahmin değerlerine sahip test olarak Mallampati-tiromental mesafe kombinasyonunu bulduk. Mevcut antropometrik ölçümlere ilaveten baş çevresi ve boyun uzunluğu ölçümlerinin de zor entübasyonu tahmin etmede önemli olabileceğini düşünmek-teyiz. Ayrıca baş-boyun malignitesi dışındaki maligniteli hastalarda zor entübasyon beklentisi normal popülasyondan farklı olmadığı kanaatindeyiz.Anahtar Kelimeler: Zor entübasyon, Mallampati, antropometrik ölçümler, malignite, baş çevresi Objective: The aim of this study was to determine the combinations of the Mallampati test and anthropometric measurements with the highest selectivity value. In addition, we aim to identify a possible correlation between head circumference measurement, the presence of malignancy and difficult intubation. Methods:Patients who were scheduled to undergo elective surgery under general anaesthesia, who fell into Group 1-2 according to ASA criteria and were between the ages of 18-70 years were included in the study. Patients with Cormack-Lehane scores of 3-4 were considered to be difficult intubations. Thyromental distance, sternomental distance, mandibular distance, neck length, neck circumference and head circumference were measured during the anthropometric measurements.Results: According to the ROC analysis, there was a significant difference in the thyromental distance...

The continuous epidural infusion of ropivacaine with sufentanil provided superior pain relief than ropivacaine alone without causing any severe side effect or post-operative pulmonary impairment.