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

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

Comparison of recovery criteria following anaesthesia with sevoflurane and isoflurane in geriatric patients

Amaç: Bu çalışmada, geriyatrik hastalarda volatil anesteziklerden sevofluran ve isofluranın derlenme kriterleri üzerine etkileri karşılaştırıldı. Çalışma Planı: Elektif ürolojik ve jinekolojik cerrahi girişim planlanan ASA I-II grubundan 65 yaş ve üzeri 40 hasta rastgele eşit sayıda iki gruba ayrıldı. Tüm olguların premedikasyonu intramusküler 0.06 mgkg-1 midazolam, anestezi indüksiyonu intravenöz 1.5 mgkg-1 propofol, 0.6 mgkg-1 atrakuryum besilat ve 500 ?g alfentanil ile gerçekleştirildi. Anestezi idamesi grup I’de 1 MAC isofluran, grup II’de 1 MAC sevofluran ve gerektikçe intravenöz 0.1 mgkg-1 atrakurium ile sürdürüldü. Ameliyat sonunda her iki grupta da derlenme kriterleri olarak belirlenen spontan göz açma, ekstübasyon, sözel yanıt ve oryantasyon süreleri kaydedildi. Bulgular: Sevofluran grubunda, isofluran grubuna göre spontan göz açma (p=0.0002), ekstübasyon (p=0.0002), sözel yanıt (p=0.0001) ve oryantasyon (p=0.0001) süreleri anlamlı derecede kısa bulundu. Sonuç: Geriyatrik olgularda sevofluranın derlenme kriterleri açısından isoflurana göre daha avantajlı olduğu kanısına varıldı.Objectives: The aim of this study was to compare the effects of volatile anesthetics, sevoflurane and isoflurane, on recovery criteria in geriatric patients. Study Design: Forty ASA I-II patients at the age of 65 years or above, who were planned for elective urological or gynecological operation were randomized to two groups equal in number. Each group received 0.06 mgkg-1 intramuscular midazolam for premedication, and intravenous 1.5 mgkg-1 propofol, 0.6 mgkg-1 atracurium besylate, and 500 µg alfentanil for induction. Anesthesia was maintained with approximately 1 MAC isoflurane in group I, and 1 MAC sevoflurane in group II, and, when necessary, intravenous 0.1 mgkg-1 atracurium. Recovery criteria included spontaneous eye opening, extubation, verbal response, and orientation times at the end of operation. Results: Compared to the isoflurane group, durations of spontaneous eye opening (p=0.0002), extubation (p=0.0002), verbal response (p=0.0001), and orientation (p=0.0001) were significantly shorter in the sevoflurane group. Conclusion: We concluded that sevoflurane anesthesia is more advantegous over isoflurane in geriatric patients

Epidural Anesteziye Eklenen İntravenöz Deksmedetomidin ve Ketamin Etkilerinin Karşılaştırılması

Objective: Monitored anesthesia care is the combination of local anesthetics and intravenous anesthetics drugs for sedation and analgesia. The aim of this prospective, randomized double blinded study was to compare intraoperative and postoperative effects of dexmedetomidine and ketamine infusion in patients scheduled for lower extremity surgery under epidural anesthesi

Anesthesia Approach in Endovascular Aortic Reconstruction

Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7%) cases were male and 2 (13.3%) female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7%) cases had infrarenal abdominal aortic aneurysm and 2 (13.3%) had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0%) patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia). The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control

Central Venous Catheterization Complication: Delayed Diagnosis of Venous Perforation and Hemothorax

Mechanical complications of central venous catheterization (CVC) include artery puncture, vein injuries, catheter malposition (CM), pneumothorax, hemothorax, air embolism, subcutaneous hematoma and arrhythmia. This report was aimed to present the case developing hemothorax due to multilumen catheter (MLC) malposition following venous perforation which is overlooked during CVC. A 21-year old female patient was planned urgent surgery due to a sharp object injury on the right arm. MLC was inserted to left internal jugular vein (IJV) using the seldinger technique in the second attempt. Despite administration of erythrocyte suspension, fluid and noradrenaline infusion through the MLC, patient’s Hct did not increase, hypotension and tachycardia were continued. Catheter was not used and peripheral venous vascular access was used for replacement and infusions. Postoperatively, opacity covering the left hemithorax was detected on the chest radiograph, marked pleural effusion and pneumothorax on the left side was detected on thorax computed tomography. MLC was removed and tube thoracostomy drainage was administered. Hemorrhagic fluid was drained from thorax. Conservative treatment was deemed appropriate since stable vital signs after chest tube application. The complication rate is low and success rate is high in CVC from IJV. Malposition is rare in CVC application from right IJV than in CVC application from left IJV. There is a sharp curve in CVC from the left IJV, which frequently leads to malposition of the MLC. CM should be suspected with no aspiration of blood through catheter or aspiration of another substance such as air, chylous fluid, etc. and non-pulsatile blood flow. If dyspnea, tachycardia, tachypnea, hypotension and desaturation develop after catheter administration we should be alert

A Forgotten Guidewire: Complication of Central Venous Catheterization

Central venous catheterization is an invasive procedure commonly preferred for hemodynamic monitorization, total parenteral nutrition, cardiac pacemaker implantation, long-term use of vasoactive or irritating agents and hemodialysis. We present a 19-year-old woman with acute renal failure scheduled for hemodialysis catheterization. A catheter guidewire extending from the right internal jugular vein to the right external iliac vein was detected in the chest X-ray, taken two hours following catheterization after occurrence of arrhythmia and hypotension. Catheteter guidewire was extracted noninvasively without any complications. Most common reasons for this complication are stated to be attention deficits, lack of experience, overtired staff, and inadequate supervision of trainees. In this paper, we discussed this complication’s causes and preventive methods. (Journal of the Turkish Society Intensive Care 2011; 9:64-7

Neurogenic Pulmonary Edema (A Case Report)

Neurogenic pulmonary edema is a life threatening complication of severe central nervous system injury. The most common cause of neurogenic pulmonary edema is subarachnoid hemorrhage followed by head trauma and epilepsy. The rare causes are cervical spine trauma, multiplesclerosis, cerebellar hemorrhage and intracranial tumors. Neurogenic pulmonary edema is characterized by an increase in extravascular lung water in patients who have sustained a sudden change in neurologic condition. The exact pathophysiology is unclear but it probably involves an adrenergic response to the central nervous system injury which leads to increased catecholamine, pulmonary hydrostatic pressure and increased lung capillary permeability. The presenting symptoms are nonspecific and often include dyspnea, tachypnea, tachycardia, hypoxemia, pinkfroty secretion, bilateral pulmonary infiltrates and crackles. These symptoms start within minutes or hours and resolves 48-72 hours that typically for neurogenic pulmonary edema. Basic principles of treatment, surgical decompression, reduce intracranial pressure, controlled ventilation with suplemental oxygen, positive end expiratory pressure and diuresis. We report a case with neurogenic pulmonary edema that occured after head trauma. (Journal of the Turkish Society Intensive Care 2012; 10: 59-62

Perineural dexmedetomidine effects on sciatic nerve in rat

Abstract The present study was designed to test the hypothesis that high dose dexmedetomidine would increase the duration of antinociception to a thermal stimulus in a rat model of sciatic nerve blockade without causing nerve damage. The rats were anesthetized with isoflurane. After electromyography (EMG) recordings, right sciatic nerves were explored and perineural injections were delivered: Group D (n = 7), 40 µg µg kg-1 dexmedetomidine administration, Group II (n = 6), (0.2 mL) saline administration, Group III (n = 2), only surgically exploration of the right sciatic nevre. Time to paw withdrawal latency (PAW) to a thermal stimulus for both paws and an assessment of motor function were measured every 30 min after the nerve block until a return to baseline. The compound muscle action potential (CMAP) of right and left sciatic nerves were recorded 10 times per each nerve once more after perineural injections at 14 day. After EMG recordings, right and the part of left sciatic nerve were excised at a length of at minimum 15 mm for histopathological examination. Comparison of right/left CMAP amplitude ratios before and 14 days after the procedure showed a statistically significant difference (p = 0.000). There were no differences in perineural inflammation between the Group D, Group S, and Group E at 14 days