Glutaraldehidin kazara epidural uygulanmasının ağır komplikasyonu

Epidural anestezi altında sol femoropopliteal bypass uygulanan hastaya ameliyat sonrası altıncı saatte epidural kateter yoluyla kazara 3 ml %3 glutaraldehid solüsyonu uygulandı. Glutaraldehid uygulamasını takiben hastada hipotansiyon, taşikardi, bulantı ve kusma gibi sistemik semptomlara ek olarak parapleji gelişti. Bir yıllık medikal tedavi ve rehabilitasyon programı sonunda nörolojik semptomlarda iyileşme olmadı.In a patient operated for left femoropopliteal bypass under epidural anesthesia, 3 ml of 3% glutaraldehyde solution was administered through the epidural catheter at the postoperative sixth hour accidentally. Following glutaraldehyde administration, the patient developed paraplegia in addition to systemic symptoms such as hypotension, tachycardia, nausea and vomiting. At the end of the first year, neurologic symptoms didn't improve despite medical treatment and rehabilitation program

A comparison of the effects of different types of laryngoscope on the cervical motions: randomized clinical trial

Background: The rate of cervical injury among all trauma patients is 3.1%. The most important point dur- ing intubation of those patients is not to increase the cervical injury. Aims: In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. Study Design: Prospective, randomized clinical trial. Methods: One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly as- signed the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2® type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying gen- eral anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. Results: One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). Conclusion: A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904). Keywords: Airtraq®, airway management, intratracheal equipment, intubation, Macintosh, Truview EVO2&reg

Fat embolism associated with anesthesia induction with propofol-lidocaine combination: A case report

Yağ embolisi sendromu travmatik, cerrahi ve travma dışı olayları takiben tanımlanmıştır. Uzun kemik kırıkları bu sendromun en olası nedenidir. Yağ embolisine bağlı klinik tablo sıklıkla belirgin olmayabilir. Belirtiler değişiklik gösterdiğinden ve rutin laboratuvar ve radyografik tanı yöntemi olmadığından tanı konması zordur. Propofol, anestezi indüksiyonu ve idamesinde yaygın olarak kullanılmaktadır. Propofole lidokain eklenmesiyle, yağ damlacıkları birleşerek ayrı tabaka meydana getirebilmektedir. Propofol-lidokain karışımının yağ embolisi oluşturma riski, kombinasyonun hazırlanması ve verilmesi arasındaki süreye ve lidokain dozuna bağlıdır. Bu yazıda, trafik kazası sonrası alt ekstremite kırığı nedeniyle uygulanan genel anestezi indüksiyonunda yağ embolisi gelişen bir olgu sunuldu. Yağ embolisinin propofol-lidokain karışımına bağlı olduğu düşünüldü. Yağ embolisi tanısı, klinik değişiklikler, radyolojik ve laboratuvar bulgularının yanı sıra gelişen arteryel hipoksemiye neden olabilecek başka bozuklukların olmaması ile kondu.Fat embolism syndrome has been described following traumatic, surgical, and atraumatic conditions. Long-bone fractures are probably the most common cause of this syndrome. Fat embolic events are often clinically insignificant and difficult to recognize since clinical manifestations vary and there is no routine laboratory or radiographic means of diagnosis. Propofol is widely used for the induction and maintenance of anesthesia. Addition of lidocaine to propofol may result in a coalescence of oil droplets, forming a separate layer. The risk of propofol and lidocaine combination to cause fat embolism depends on the dose of lidocaine and the duration between its preparation and administration. We presented a patient who developed fat embolism following anesthesia induction during surgery for a lower extremity fracture due to a traffic accident. The occurrence of fat embolism was attributed to propofol-lidocaine use. The diagnosis of fat embolism was based on clinical manifestations, radiographic and laboratory findings, and elimination of other causes associated with arterial hypoxemia

Continuous spinal anesthesia application in a patient with high cardiac risk: Case report

Alt ekstremite cerrahisi anestezisinde, genel anesteziden çok rejyonel yöntemler tercih edilmektedir. Özellikle yaşlı ve yüksek kardiyak riskli hastalarda hemodinamik stabiliteyi koruyarak yeterli anestezi sağlanması temel amaçtır. Acil sağ diz üstü amputasyon planlanan 63 yaşındaki kadın hasta, altı gün önce ST yükselmesiz miyokard infarktüsü (Mİ) tanısı konularak tedavi edilmişti. Olgunun 15 yıldır tip 2 diabetes mellitusu, 10 yıldır hipertansiyonu vardı. İki yıl önce iki damar baypas ile mitral annuloplasti ve iki ay önce sağ diz altı amputasyon uygulanmıştı. Sağ lateral pozisyonda, L3-4 intervertebral aralıktan kateter içinden iğne tekniği ile intratekal kateter yerleştirildi. Serbest BOS akışı görüldükten sonra 2.5 mg %0.5'lik bupivakain uygulandı. Yeterli duyusal blok seviyesi sağlanana kadar her beş dakikada bir tekrarlanan 2.5 mg'lık dozlarla toplam 7.5 mg %0.5 bupivakain uygulanarak anestezi sağlandı. Duyusal blok T10 seviyesine ulaştıktan sonra sırtüstü pozisyon verildi. Ameliyat süresince hemodinamik olarak stabil seyreden olguya kateterden ek ilaç uygulanmadı ve bir saatlik ameliyat sonunda spinal kateteri çıkarılarak servise gönderildi. Sonuç olarak, özellikle yaşlı ve kardiyak riski yüksek olgularda alt ekstremite ameliyatları için sürekli spinal anestezi tekniğinin uygun bir anestezi seçeneği olarak kullanılması gerektiğini düşünmekteyizRegional techniques are preferred to general anesthesia in lowerextremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T10 level. The patient was hemodynamically stable during the operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery

A Fatal Complication of Acupuncture in a Patient with Romatoid Arthritis: Necrotizing Fasciitis

Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Acupuncture is a relatively safe procedure but fatal and near fatal complications have been reported in the international literature. We report a case where fatal necrotizing fasciitis developed in a patient who had acupuncture treatment for romatoid arthritis of the knee. (Journal of the Turkish Society of Intensive Care 2011; 9: 23-5