EFFECTS OF EPIDURAL CORTICOSTEROID ACCOMPANIED BY FLUOROSCOPY ON PAIN VALUES OF PATIENTS WITH SYMPTOMATIC CERVICAL DISCOPATHY

Amaç: Semptom veren servikal diskopatisi olan hastalarda, Servikal İnterlaminar Epidural Steroid Enjeksiyonu (SİESE)’unun Visual Analogua Scale (VAS) değerleri üzerine etkilerini incelemeyi amaçladık. Yöntemler: 01 Şubat 2011 – 01 Temmuz 2012 tarihleri arasında, 45 hastada semptomatik servikal diskopatiye bağlı radikülopati tedavisinde uyguladığımız SİESE'nin, VAS değerleri üzerine olan etkilerini geriye dönük olarak inceledik. Hastalar yan yatar pozisyonda iken C7-T1 aralığından floroskopi eşliğinde Low-rezistans tekniği ile epidural aralığa 80 mg triamsinolon ve 3 mL serum fizyolojik karışımı toplam 5 mL volüm içinde enjekte edildi. Bulgular: Servikal interlaminar epidural steroid enjeksiyonu uygulaması sonrası hastaların VAS skorları bazal VAS skorlarına göre istatistiksel olarak anlamlı düşüktü. SİESE sonrası başarı oranları sırasıyla 1. hafta %85, 1. ay %95, 6. ay %89 ve 1. yıl %89'du. Sonuç: Servikal interlaminar epidural steroid enjeksiyonu uygulaması semptomatik diskopati tedavisinde etkili bir yöntemdir ve hasta memnuniyetini arttırır

Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery

Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA) I-II patients (n=60) who underwent hand surgery were included. For this purpose, only lidocaine (LDC), lidocaine+adjunct tramadol (LDC+TRA group), or lidocaine+systemic tramadol (LDC+SysTRA group) was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority

ANESTHETIC MANAGEMENT IN A PATIENT WITH KEARNS-SAYRE SYNDROME

Kearns-Sayre sendromu; Kronik-progresif, eksternal oftalmopleji ve pigmenter retinadejenerasyonu ile karakterize, 20 yaşından önce bulgu veren, mitokondriyal birhastalıktır. Kearns-Sayre sendromlu hastalarda; potansiyel aspirasyon riski, zayıffaringeal kas kontrolü ve oral sekresyonlara bağlı hava yolu komplikasyonlarınedeniyle, genel anestezi uygulaması dikkatli bir şekilde yürütülmelidir. Kalp iletimdefektleri de hastalığın sık görülen ve önlenebilen ölümcül komplikasyonlarındandır.Bu sunuda; Kearns-Sayre sendromlu bir hastaya olan anestezik yaklaşımımızı sunmayıamaçladık. Kearns-Sayre syndrome is a mitochondrial dissease characterized by a triad of featuresincluding oncet in persons younger than 20 years, chronic progressive externalophtalmoplegia and pigmentary degeneration of retina. In patient with Kearns-Sayresyndrome, General anesthetic management should be carefully implemented inconsideration of the potantial risk of aspiration and air-way complications due to poorpharyngeal muscle control and oral secretions. Cardiac conduction defects aresignificant and preventable cause of mortality. Here we aimed to report our anestheticmanagement of a patient with Kearns- Sayre syndrome

Sedation/Anestehesia Experiences During Magnetic Resonance Imaging Procedure in the Pediatric Patients

Introduction: Sedation is often needed for magnetic resonance imaging (MRI) in pediatric patients for diagnostic purposes. In this study, we aimed to present anesthesia techniques and complications that occurred during sedation in pediatric patients. Methods: A total of 337 pediatric patients, in whom MRI was performed with sedation between January 1, 2016 and December 31, 2016, were retrospectively reviewed. The procedure, anesthetic drugs used, complications, and the need for additional medications were recorded. The patients were divided into 3 groups. Group 1: MRI procedure lasted 15 minutes, group 2: MRI procedure lasted 15-30 minutes and group 3: MRI procedure lasted more than 30 minutes. Within the groups, subgroup evaluations were made according to the type of anesthetic drug used. Results: There was no statistically significant effect of drug types used on complication development (bradicardia, hypoxia) and additional drug requirements in binary comparisons among subgroups (p=0.655, p=0.655 and p=0.317). In comparison of the groups according to the duration of the MRI procedure, complication development and need for additional medication were found to increase with prolonged imaging time (p=0.008, p=0.012 and p=0.02). Conclusion: Combinations of anesthetic and sedative drugs used during MRI in the pediatric patient group have no effect on complication development (bradicardia, hypoxia) and additional drug need. However, as the duration of the imaging procedure increases, complications and need for additional medication increase

Cushing reflex: A sign of vessel perforation during mechanical thrombectomy performed under general anesthesia

We aimed to present the assessment of the Cushing reflex caused by intracranial haemorrhagia developing during mechanical thrombectomy in a case presenting with acute ischemic stroke. A 59-year old male patient was scanned by CT angio due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarction was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the anesthesiology team was warned and 1 mg IV atropine was administered for bradycardia. Acute infarction has to be removed because it is understood as mechanical thrombectomy has been performed to a patient with an infarction. Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed. As conclusion, anesthesia and operation team must be alert for vessel perforation when Cushing triad develops during navigation of the thromboaspiration catheter

Evaluation of the Short- and Long-Term Effectiveness of Pulsed Radiofrequency and Conventional Radiofrequency Performed for Medial Branch Block in Patients with Lumbar Facet Joint Pain

Background. Diagnosis of lumbar facet joint disease is the sum of the combinations consisting of history, physical activity, and diagnostic imaging frequently including computed tomography and magnetic resonance imaging scans. Prevalence of facet-based chronic low back pain is 15–45%. Intra-articular injections with corticosteroid or medial branch block are traditionally used prevalently in the management of chronic low back pain due to lumbar facet joints. However, the evidence levels of these procedures are at either a low or a medium level. Radiofrequency neurolysis of the lumbar medial branch can be used as an alternative in the management of lumbar facet joint pain. There are two types of radiofrequency applications for radiofrequency neurolysis as pulsed radiofrequency and conventional radiofrequency. Materials and Methods. Patients with lumbar facet pain were separated into 2 groups. Group 1 (n=75): patients were given pulsed radiofrequency under fluoroscopy. Group 2 (n=43): patients were given conventional radiofrequency under fluoroscopy. Pre-op and post-op 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values of all patients were asked, recorded, and statistically compared. Visual Analogue Scale values of the groups in the same months were compared as well. At the end of the second year, Odom criteria of both groups were recorded and statistically compared. Results. Preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values were compared in Group 1 and Group 2, and there was a statistically significant difference between preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values in both groups. However, the number of repetitions of the operation was higher in Group 1. In the comparison of Odom criteria for both groups at the end of the second year, it was observed that the patients in Group 2 were more satisfied with the treatment. Conclusion. Conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurolysis effectively decreases Visual Analogue Scale values in both short and long term. The quality of life and daily activities of patients were better at conventional radiofrequency

Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach

ABSTRACTOBJECTIVE: Dexmedetomidine is an a-2 adrenergic agonist having wide range of effects including sedation in mammalian brain, and has analgesic as well as sympatholytic properties. This study aimed to compare the effects of dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing combined sciatic nerve and femoral nerve block via anterior approach for lower limb orthopedic procedure.METHODS: Forty patients, who were between 18 and 65 years old, this study was made at anesthesiology clinic of Bagcilar training and research hospital in 08 September 2011 to 07 June 2012, and underwent surgical procedure due to fractures lateral and medial malleol, were included. Sciatic nerve and femoral nerve block were conducted with an anterior approach on all patients included in the study, with an ultrasonography. The patients were randomly divided into dexmedetomidine [Group D (n = 20); 0.5 µg kg-1 h-1] and propofol [Group P (n = 20); 3 mg kg-1 h-1] infusion groups.RESULTS: The vital findings and intra-operative Ramsay sedation scale values were similar in both groups. Time taken for sedation to start and time required for sedation to become over of Group D were significantly higher than those of Group P (p < 0.001 for each).CONCLUSIONS: Substitution of dexmedetomidine instead of propofol prolongs the times to start of sedation, the times to end of sedation and duration of sedation