Use of a Ketamine-Propofol Combination During Sedation and Analgesia

Aim: The aim of this study was to evaluate 1:1 mixture of ketamine and propofol for sedative/analgesic efficacy, patient comfort and postoperative complications. Methods: The anesthesia and nursing records of patients who received ketamine-propofol mixture in Bezmialem Vakıf University Hospital between 2009 and 2010 were retrospectively documented. Results: Of the 51 adult patients who received ketamine-propofol sedation, 39 patients had ASA 1-2 score while 12 patients had ASA 3-4 score. No patient had apnea, desaturation, hypotension or vomiting. Two patients who had postoperative agitation received midazolam. All patients were transferred to the surgical ward when Aldrete scores were >8. Surgeon and patient satisfaction were high except in 2 patients. Conclusion: Ketamine and propofol mixture for the purpose of sedation and analgesia is a practical method with minimal negative effects on respiration and hemodynamic variables, however, hallucination associated with ketamine may be observed. We conclude that due to the lack of hypnotic activity, 1/2 or 1/3 instead of 1/1 ketamine and propofol mixture would be more appropriate. (The Medical Bulletin of Haseki 2015; 53:41-6

Application of anesthesia under the guidance of transesophageal echocardiography in a pregnant with left atrial myxoma

Atrial myxoma in pregnancy is rare and its clinical manifestations vary according to the size, location and mobility of the tumor. Transesophageal echocardiography which is useful to visualize cardiac anatomy and function can reveal possible wall movement abnormalities and tumor embolism. In this article, we report application of anesthesia under the guidance of transesophageal echocardiography in a pregnant patient with an intra-atrial myxoma developed within three months

Mallory-Denk Bodies in chronic hepatitis

Mallory-Denk Bodies (MDB) are important as investigators, suggesting MDB as an indicator of the histologic severity of chronic hepatitis, causes of which include hepatitis C, primary biliary cirrhosis (PBC), and nonalcoholic fatty liver disease (NAFLD). Matteoni et al scored MDB in patients with NAFLD as none, rare and many, and reported that MDB plays a prominent role in this classification scheme in an earlier classification system. In this study, we evaluated 258 patients with chronic hepatitis due to metabolic, autoimmune and viral etiologies. Liver biopsy samples were evaluated with hematoxylin and eosin, periodic acid-Schiff-diastase, Gordon and Sweet's reticulin, Masson's trichrome, and iron stains. Both staging and grading were performed. Additionally, MDB were evaluated and discussed for each disease. We examined patients with nonalcoholic steatohepatitis (NASH; 50 patients), alcoholic hepatitis (10 patients), PBC (50 patients), Wilson disease (WD; 20 patients), hepatitis B (50 patients), hepatitis C (50 patients) and hepatocellular carcinoma (HCC; 30 patients). Frequency of MDB was as follows; NASH: 10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3. PBC: 11 patients with mild in 10%, moderate in 70%, and cirrhosis in 20%, and frequently seen in zone 1. WD: 16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1. Hep B: 3 patients with mild in 66% and severe in 34%. Hep C: 7 patients with mild in 40% and moderate in 60% and observed in every stage. HCC: 3 patients with hep B in 2 patients. We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology. (C) 2011 Baishideng. All rights reserved

Temporary Vision Loss After Spinal Anesthesia

Perioperative visual loss is a rare complication mostly associated with cardiac, spine, and head and neck surgery that could severely affect quality of life. We report a case of temporary visual loss without any other subjective symptom after spinal anesthesia

Peripartum Management of a Pregnant with Glanzmann’s Thrombasthenia: A Case Report

In this study, we aimed to present the case of a patient with Glanzmann’s thrombasthenia (GT) which is a hereditary disorder characterized by defective platelet function. A twenty-six-year old woman with GT who underwent cesarean section due to labor arrest and persisting vaginal bleeding despite receiving 18 unit of random platelet concentrates, 6 units of apheresis platelet concentrates, and 2 units of erythrocyte suspension. Since patients with GT are at high risk for massive bleeding during and after delivery, they should give birth under close monitoring in advanced healthcare centers where experienced hematologists are available.(The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 208-11

Comparison of SpO(2) values from different fingers of the hands

Pulse oximetry is a frequently used tool in anesthesia practice. Gives valuable information about arterial oxygen content, tissue perfusion and heart beat rate. In this study we aimed to provide the comparison of peripheral capillary hemoglobin oxygen saturation (SpO(2)) values among every finger of the two hands. Thirty-seven healthy volunteers from operative room stuffs between the ages of 18-30 years were enrolled in the study. They were monitored after 5 min of rest. After their non invasive blood pressure, heart rate, fasting time and body temperature were measured, SpO(2) values were obtained from every finger and each of two hands fingers with the same pulse oximetry. All the SpO(2) values were obtained after at least 1 min of measurement period. A total of 370 SpO(2) measurements from 37 volunteers were obtained. The highest average SpO(2) value was measured from right middle finger (98.2 % +/- 1.2) and it was statistically significant when compared with right little finger and left middle finger. The second highest average SpO(2) value was measured from right thumb and it was statistically significant only when compared with left middle finger (the finger with the lowest average SpO(2) value) (p < 0.05). SpO(2) measurement from the fingers of the both hands with the pulse oximetry, the right middle finger and right thumb have statistically significant higher value when compared with left middle finger in right-hand dominant volunteers. We assume that right middle finger and right thumb have the most accurate value that reflects the arterial oxygen saturation

Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females) were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years). There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc.) and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM) and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9%) and individuals of young age (median age: 27.45 years). Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7