A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

BACKGROUND: We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. METHODS: One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS: The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. CONCLUSIONS: TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile

The Effects of Adding Various Doses of Clonidine to Ropivacaine in Spinal Anesthesia

Objective: In this study, we compared the clinical effects of combined doses of ropivacaine and clonidine

Retrospective analysis of kidney transplanted patients

Kidney transplantation has become one of the best treatment methods for significantly improving the quality of life for patients suffering from kidney disease. This study aimed to provide a retrospective evaluation of kidney transplantation cases between the years 2004 and 2007.Initially, the following data was collected: number of annual cases, age, gender, hepatitis serology, hypertension, and cardiovascular illness, number of cadaver and living donors, kinship, and duration of hospital stay, post-operational complications, mortality and graft loss. 39% of the patients were female whilst 61% were male. 3.8% of the patients were positive for hepatitis serology. 28.8% of the patients were hypertensive. 61% of the patients received their kidneys from live donors. 60.6% of the live donors were the mothers of the patients and 18.2% were the fathers. The average length of hospital stay was 48 days. 21.4% of the patients were identified as having developed major complications including sepsis, heart failure, pulmonary emboli, respiratory insufficiency and rejection. 5.4% of the patients developing major complications ended with mortality and 1.8% with graft loss. Even though the total number of annual cases is constantly rising, we think that this figure is much lower that it should be considering the number of patients dependent on dialysis machines. Kidney transplantation is the most appropriate treatment in terms of cost-effectiveness and thus increasing the ratio of kidney transplantations would be beneficial to both the patient’s health and to the national economy

Surgical Treatment of Patients with Tracheal Rupture Following Endotracheal Intubation

Objective: We aimed to present clinical features and treatment outcomes of patients who had tracheal rupture following intubation due to surgical interventions

Surgical Treatment of Patients with Tracheal Rupture Following Endotracheal Intubation

Objective: We aimed to present clinical features and treatment outcomes of patients who had tracheal rupture following intubation due to surgical interventions.Material and Methods: Five patients (M/F, 1/4; Mean age, 53.8±10.9 years) who were diagnosed as having tracheal rupture during or soon after surgery were included in the study and evaluated retrospectively. History, clinical features, patient characteristics, and localizations of rupture, diagnostic modalities, and treatment outcomes were reported.Results: Two of the patients were intubated with a single-lumen tube, whereas 3 patients were intubated by using a double-lumen tube. The most common symptom that led to diagnosis was subcutaneous emphysema. One patient was diagnosed during stump control before the occurrence of symptoms. It is considered that using a stylet during intubation might be a risk factor, as four of our patients were intubated with the help of a stylet. Only one patient had a difficult intubation. Conclusion: Close postoperative monitorization of patients intubated due to surgical interventions, may enable us to determine tracheal ruptute cases in the early period before symptoms occur. The most common symptom was subcutaneous emphysema in the present case series. Thus, it is considered as the most effective warning symptom. In the light of the above findings, it is suggested that difficult intubation may not add to the risk of tracheal rupture

The Effects of Hypertonic Saline Solution, Ascorbic Acid and Low-Molecular-Weight Heparin on Acute Necrotizing Pancreatitis in Rats

Objective: We investigated the biochemical and histopathological effects of vitamin C, low-molecular-weight heparin (LMWH), and hypertonic solution on acute necrotizing pancreatitis and on lungs as a terminal organ

Comparison of patient-controlled analgesia and continuous infusion with intravenous tramadol in post-thoracotomy analgesia

Objectives: We aimed to compare the consumption, and analgesic and adverse effects of tramadol that given via continuous intravenous infusion and intravenous patient-controlled analgesia.Materials and methods: Forty patients who planned for elective thoracotomy were included in this study. Group I patients received 100 mg loading dose, 5 mg hour-1 basal infusion, 20 mg bolus dose, 5 minutes locked out time, 4 hours limit of 300 mg tramadol. Group II patients received 100 mg loading dose followed by continuous infusion of 12 mg hour-1. Visual Analogue Scale (VAS) scores and sedation scores were determined at postoperative 0, 4, 16, 24th hours. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, respiratory rate, heart rate, peripheral O2 saturation scores were recorded at postoperative 0,1,2,4,8,16,24th hours. After 24 hours complications and amount of used tramadol were recorded.Results: A significant decrease was observed in VAS scores starting from the fourth hour compared to all other times in both groups (p<0.001). When the beginning time and the other times in groups was compared, there was a statistically significant decreasing observed in sedation scores starting from the 4th hour to all other times (p<0.001). Total tramadol consumption in group I (374.2±132.5 mg) was found to be significantly higher compared with group II (292.4±80.1 mg) (p<0.05). Hypotension was observed in four patients in group I and this difference was statistically significant (p<0.05).Conclusion: We concluded that tramadol given both intravenous methods was effective for analgesia after postthoracotomy pain