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    Effects of partial neuromuscular blockade on facial nerve monitorization in otologic surgery
    (Taylor & Francis As, 2003) Kizilay, A; Aladag, I; Cokkeser, Y; Miman, MC; Ozturan, O; Gulhas, N
    Objective-Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the Patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery. Material and Methods-Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action. Results-All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10 +/- 0.08 and 0.11 +/- 0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%. Conclusion-This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.
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    Oral clonidine premedication does not reduce postoperative vomiting in children undergoing strabismus surgery
    (Blackwell Munksgaard, 2003) Gulhas, N; Turkoz, A; Durmus, M; Togal, T; Gedik, E; Ersoy, MO
    Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery. Methods: Eighty ASA physical status I children aged 3-12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 mug kg(-1) in apple juice 0.2 ml kg(-1) , and each of the controls (n=40) received apple juice 0.2 ml kg(-1) only. The protocol for general anesthesia was propofol-sevoflurane in N-2 O/O-2 . A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0-48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic. Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h. Conclusion: Oral premedication with clonidine 4 mug kg(-1) did not reduce the rate of POV in the children undergoing strabismus surgery.
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    The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study
    (Blackwell Publishing Ltd, 2003) Gulhas, N; Durmus, M; Demirbilek, S; Togal, T; Ozturk, E; Ersoy, MO
    Background : Laryngospasm is the most common cause of upper airway obstruction after tracheal extubation. Magnesium has a central nervous system depressant property, which contributes to the depth of anaesthesia. It also has calcium antagonist properties, which provide muscle relaxation. In this study, we aimed to determine the effect of magnesium on preventing laryngospasm. Methods : After approval of the Ethics Committee and informed parental consent, 40 patients, ASA I-II, aged 3-12 years, who were scheduled for tonsillectomy or/and adenoidectomy, were randomly divided into two groups. Anaesthesia was induced with sevoflurane, lidocaine 1 mg.kg(-1) , alfentanil 10 mug.kg(-1) , vecuronium 0.1 mg.kg(-1) and maintained with sevoflurane 2% and 60% nitrous oxide in oxygen. After intubation, patients in group I received 15 mg.kg(-1) magnesium in 30 ml 0.9% NaCl over 20 min. Patients in group II received 0.9% NaCl alone in the same volume. After reversal of neuromuscular blockade, all patients were extubated at a very deep plane of anaesthesia. The incidence of laryngospasm was determined until the time of discharge from the postanaesthesia care unit. Results : Although laryngospasm was not observed in group I, it was observed in five patients in group II (25%). The incidence of laryngospasm in group II was significantly higher than group I. The plasma magnesium concentrations were significantly higher in group I than group II. Conclusions : We found a significant decrease in the incidence of laryngospasm in paediatric patients receiving magnesium. It is suggested that the use of intravenous magnesium intraoperatively may prevent laryngospasm.