The comparison of two different local anesthetics in labor analjesia with combine spinal-epidural method.

Bu çalışmanın amacı doğum analjezisi için kombine spinal-epidural analjezi yöntemi ile fentanil ilave edilmiş levobupivakain ve bupivakaini karşılaştırmaktır.Fakülte etik kurul onayı alındıktan sonra ASA I-II risk grubuna giren, 20-35 yaş grubunda 40 gebe rastgele iki eşit gruba ayrıldı. Gebelere ağrılarını değerlendirecekleri VAS ve MVPS hakkında bilgi verildi. Rejyonel anestezi için kontrendikasyonu olmayan, aktif kontraksiyonu ve servikal dilatasyonu 4-6 cm olan gebelere intratekal olarak Grup I'de 2.5 mg levobupivakain + 12.5 µg fentanil; Grup II'de ise 2.5mg bupivakain +12.5µg fentanil total volümü 2ml olacak şekilde uygulandı. Epidural kateterleri intratekal enjeksiyonları sonrasında yerleştirildi. Gebelere vajinal tuşe ile ağrı duyduklarında, epidural kateterlerinden Grup I'de 10ml %0.125 bupivakain + 50mg. fentanil, Grup II'de ise 10ml % 0.125 levobupivakain + 50mg. fentanil verildi. Bolus dozundan sonra, Grup I için % 0.005 levobupivakain + 1.5 ?g/ml fentanil, Grup II için % 0.005 bupivakain + 1.5 µg/ml fentanil solusyonu hazırlanarak 10 ml.h-1 bazal infüzyon hızında başlandı. Hasta kontrollü epidural analjezi için aynı konsantrasyon, 10 ml bolus, 20 dakika kilitlenme zamanı olarak ayarlandı. Sistolik, diastolik ve ortalama arter basınçları, maternal kalp hızları, puls oksimetri, fetal kalp hızları analjezi öncesi ile 5, 10, 15, 20, 30, 40, 50, 60. dakikalar ve her 30 dakikada bir doğum gerçekleştirilene kadar kaydedildi. Aynı zamanlarda VAS ve MVPS skorları kaydedildi. Sensoriyal blok pin prik ve motor blok ise MVPS ile değerlendirildi. Doğum şekli spontan, enstrumental ve sezaryen olarak kaydedildi. Analjezi başlama zamanı, doğumun 1. ve 2. evre süreleri, total epidural infüzyon süresi, total kullanılan lokal anestezik miktarı, maternal ve neonatal yan etkiler kaydedildi. Gruplar arası demografik ve parametrik verilerin değerlendirilmesinde, Independent Samples T Test, Paired-Samples Test ve Chi-Square Test kullanıldı. p<0.05 düzeyi anlamlı kabul edildi.İki grup arasında demografik ve hemodinamik değerler arasında anlamlı fark yoktu. Yetersiz bloğa rastlanmadı. Analjezi tüm olgularda yeterliydi. Olguların VAS ve MVPS skorları benzerdi. Analjezi başlama zamanı Grup I'de daha hızlı ve analjezi süresi Grup II'den daha kısaydı (67.75 ± 16.97, 70.00 ± 14.59 ). Grup I'de daha düşük motor blokaja rastlandı (p<0.05). Tüketilen lokal anestezik ve total epidural infüzyon miktarı Grup II' de daha düşük bulundu ve bu lokal anestezik miktarının daha düşük olması Grup II' deki multipar sayısının fazla olmasına bağlandı. Olguların hiçbirisinde tedavi gerektirecek yan etkiye rastlanmadı. Gebe, obstetrisyen ve anestezist memnuniyetleri her iki grupta benzerdi.Sonuç olarak doğum analjezisi için KSE teknikle uyguladığımız fentanil ilave edilmiş levobupivakain ve bupivakain yan etki olmaksızın yeterli analjezi sağlamıştır. Hızlı etki başlangıcı ve düşük motor blok skorları avantajı ile levobupivakainin tercih edilebileceği kanaatindeyiz.The aim of this study is to compare fentanyl added levobupivacaine and bupivacaine with combined spinal-epidural technique in labor analgesia.After Faculty ethical committee aproval, fourty ASA I-II pregnants, aged between 20-35 years randomly diveded into two groups. VAS and MVPS were informed to the patients. Patients with active contractions and servical dilatation between 4-6 cm without any contraendications for regional analgesia received 2.5 mg levobupvacaine + 12.5 µg fentanyl for group I and 2.5 mg bupivacaine + 12.5 µg fentanyl for group II intrathecally in a total volume of 2 ml. Epidural cathaters have been placed following intrathecal injections. A loading dose of 10 ml 0.125 % levobupivacaine and 1 ml 50 µg fentanyl for group I and 10 ml 0.125 % bupivacaine and 1 ml 50 µg fentanyl for group II have been given from epidural cathater to the women when they feel pain with per vaginal examination.Epidural infusion have been prepared with 0.05 % levobupivacaine (0.5mg) in group I and 0.05 mg % bupivacaine (0.5mg) in group II with 0.00015 fentanyl (1.5µg/ml) in 100ml saline for use.Loading dose 10ml 0.125 % levobupivacaine /bupivacaine and 50 µg fentanyl, basal infüsion rate of 10 ml/hour . Women have been provided to able to apply a bolus dose of 10 ml when they need the internal between the bolus dose have been restricted to 20 minutes.Systolic, diastolic and mean arterial pressures, maternal heart rates, puls oxymetry, fetal heart rate have been recorded before the analgesia with 5th, 10th, 15th, 20th, 30th, 40th, 50th, 60th minutes and every 30 minutes to accomplished of delivery in all pregnants. VAS and MVPS were also recorded at that times. Sensorial block was evaluated with pin prick and motor block was evaluated with Modified Bromage Scala. The route of labor is recorded as spontaneous, instrumental and cesarean. The begining time of analgesia, the duration of first and second stages of labor, total duration of epidural infusion, total amount of consumed local anasthetics, maternal and fetal side effects have all been recorded.İndependent Sample T Test, paires Sample Test and Chi Squeare test were used for comparison of date between the two groups. p<0.05 was considered to be statistically significant.No demographic and hemodynamic differences among the two groups were observed. There were no ineffective blocks. Analgesia was effective in all patients. There were no differences in the serial VAS and MVPS. The begining time of analgesia was faster in group I, the duration of analgesia was shorter in group I than group II (67.75± 16.97, 70.00±14.59 respectively). Group I had lowest incidence of lower limb motor block (p<0.05). The amount of consumed local anasthetic and total amount of epidural infusion were found to be lower in group II. A smaller dose of local anasthetic found in group II may be due to the larger number of multipar parturients in this group. No patient had any side effects required treatment .The partuirents, the obstetrician and the anasthetists satisfactions were similiar in both groups.In conclusion, combined spinal-epidural technique with both fentanyl added levobupivacaine and bupivacaine for labour analgesia able to provide sufficient analgesia without any side effects. Levobupivacaine may be profreed if foster onset time and lower motor block scores were desired

A simple method to be used to predict the severity of pain in transrectal ultrasound- guided prostate biopsy: Digital rectal examination staging

Amaç: Transrektal ultrason rehberliğinde biopsi (TRUS-bx) sırasında ağrı seviyeleri değişik olan hastalardaki farkları inceleyip, ağrıyı tahmin etmede parmakla rektal muayene (PRM) evrelemesinin etkinliğini araştırmaktır. Yöntem: Nisan 2012 - 2013 arasında PRM evrelemesi ve prostat kanser şüphesiyle TRUS-bx yapılan 77 hasta retrospektif olarak tarandı. PRM evresi üç evre olarak sınıflandırıldı. Hastalar vizuel analog skalası (VAS)’na göre iki gruba ayrıldı (median=4) (Grup 1: <4; group 2: ?4). Gruplar ile ilişkisi olabilecek parametreler (yaş, vucut kitle indeksi (BMİ), prostat volümü, PRM evresi, PSA, serbest/total PSA oranı, biopsi patalojisi) karşılaştırıldı ve korelasyon analizleri yapıldı. Bulgular: Yaş ortalaması 65.74±7.5 (47-84) olan 77 erkek TRUS-bx hastası çalışmaya alındı. Grup 1’de 31 hasta, Grup 2’de 46 hasta değerlendirildi. VAS skroru ile prostat boyutu ve PRM evresi arasında korelasyon bulundu (sırasıyla, p=0.019, p=0.002), VAS grupları karşılaştırıldığında sadece PRM evresinde anlamlı bir fark bulundu (p=0.038). PRM evrelemesine göre Grup 2’de evre I’e %58.3, evre II’ye %62 ve evre III’e %88.9 hastada saptandı. Sonuç: VAS PRM evresi ile ilişkilidir. TRUS-bx esnasında, prostat boyutundan bağımsız olarak, PRM evresi artan hastalar daha fazla ağrı duyabilirler.Aim: To examine the differences in patients with different levels of pain during transrectal ultrasound guided biopsy (TRUS-bx) of prostate, and to evaluate the effectiveness of digital rectal examination (DRE) staging. Methods: Between April 2012 and 2013, patients who underwent DRE staging and TRUS-bx due to suspicion of prostate cancer were retrospectively evaluated. All patients were categorized into two groups according to visual analog scale (VAS) (median = 4) (Group 1: &lt; 4; Group 2: &amp;#8805;4). Parameters regarding the relationship between groups were compared and investigated for the correlations. Results: The mean age of 65.74 &plusmn; 7.5 (47-84) total 77 TRUS-bx patients were studied. 31 and 46 patients were included in Group 1 and 2, respectively. A correlation was found between VAS and prostate volume and DRE staging (p=0.019, p=0.002, respectively), but when the VAS groups were compared, there was only significant difference in DRE staging (p=0.038). Accoding to DRE staging, in group 2, patients were 58.3%, 62% and 88.9% in stage I, stage II and in stage III, respectively. Conclusion: There was a relation between VAS and DRE staging. Independent of the size of the prostate, patients with increased DRE stage may experience more pain during TRUS-bx

Cystic echinococcosis : Family infection

Kistik ekinokokkozis, Echinococcus granulosus’un neden olduğu ülkemizde de görülen zoonotik bir enfeksiyon hastalığıdır. Mustafa Kemal Üniversitesi Göğüs Cerrahisi Kliniği’ne başvuran bir olgunun akciğer ve karaciğerinde kist hidatik tespit edildi. Olgunun öyküsünden oğlunun karaciğerde kist hidatik nedeni ile ameliyat olduğu öğrenildi. Diğer aile bireylerinin incelenmesinde de bir olguda akciğerde, iki olguda da karaciğerde kist hidatik saptandı ve serolojik incelemeleri de pozitif olarak bulundu. Aynı ailede akciğerde ve karaciğerde kistik ekinokokkozis saptanması, ekinkokkoziste genetik faktörlerin de etkin olabileceğini, rutinde aile fertlerinin araştırılması gerekmese de, risk faktörü mevcut olan yörelerde aile bireylerinin araştırılmasının faydalı olabileceğini düşünerek olguları sunmaya değer gördük.Cystic echinococcosis is a zoonotic infectious disease caused by Echinococcus granulosus, and it is also seen in our country. Cyst hydatid was detected in the lung and liver of a patient who presented to Mustafa Kemal University, Department of Thoracic Surgery. The patient&amp;#8217;s history revealed that his son underwent an operation due to hydatid cyst of the liver. When the other members of the family were studied, it was determined that one of them had hydatid cyst of the lung and the other 2 had hydatid cyst of the liver. Their serological evaluations were also positive. Detection of lung and liver cystic echinococcosis within the family suggests that genetic factors may also be effective in echinococcosis. It is not necessary to study the family members routinely, but investigation of the family members in regions with risk factors may be helpful. We thus thought that the patients warranted presentation in this report

Our experience with esophageal foreign bodies

Amaç: Özofagus yabancı cisim aspirasyonları; tanı ve tedavisi geciktiğinde ölümle sonuçlanabilen komplikasyonlara yol açabilmektedir. Bizde kliniğimi- ze özofagus yabancı cismi tanısıyla başvuran olguları retrospektif olarak de- ğerlendirip, erken tanının önemini ve tedavi yöntemlerini irdelemeyi amaçladık. Gereç ve Yöntemler: Ağustos 2008 ile Haziran 2011 tarihleri arasında Antakya Devlet Hastane’si ve Mustafa Kemal Üniversitesi Göğüs Cerrahi kliniği’nde özofagus yabancı cismi tanısıyla yatarak tedavi gören 52 olguyu; yaş, cinsiyet, yabancı cisim tipi, hastaneye başvurma süresi, yabancı cismin lokalizasyonu, uygulanan tedavi, semptom ve komplikasyonlar açısından retrospektif olarak değerlendirildi.Bulgular: Olguların en küçüğü 12 aylık, en büyüğü 80 yaşında olup 24’ü(%46) erkek, 28’i (%54) kadın idi. 34’ü (%65) 60 yaş ve üzeriydi. Bu yaş grubunda çıkarılan yabancı cisimlerin %50’sini kemik oluşturuyordu. Olgularda; en sıkyakınmayı hipersalivasyon (%58) oluşturmaktaydı. Bunu disfaji (%20), batmahissi (%15), dispne (%7) takip ediyordu. Hastalarda yabancı cisim çıkarılma işlemi sonrasında komplikasyonla karşılaşılmadı. Sonuç: Özofagus yabancı cisimleri hayatı tehdit edebilecek komplikasyonla- rından dolayı çok önemlidir. Bu nedenle erken tanı ve tedavi önemlidir. Te- davisinde; rijit özofagoskopi en güvenilir yöntem olmaya devam etmektedir. (JAEM 2012; 11: 77-80)Objective: Foreign bodies in the esophagus can lead to fatal complications if diagnosis and treatment are delayed. The importance of early diagnosis and treatment methods were evaluated in this retrospective study on cases ad- mitted to our clinics with a diagnosis of esophageal foreign body. Material and Methods: Fifty-two patients who had been admitted to An- takya State Hospital and the Department of Thoracic Surgery at Mustafa Ke- mal University with a diagnosis of esophageal foreign body between August 2008 and June 2011 were evaluated retrospectively for age, gender, type of foreign body, time interval to admission, location of the foreign body, treat- ment method, symptoms and complications. Results: Twenty-eight of the patients were female (54%) and 24 were male (46%). The youngest patient was 12 months old and the oldest was 80 years old. Thirty-four patients (65%) were aged 60 and over. In this age group, 50% of the removed foreign bodies were bone. Hypersalivation was the most com- mon symptom among patients (58%), followed by dysphasia (20%), a sting- ing sensation (15%) and dyspnea (7%). No patients developed complications after the removal of the foreign body. Conclusion: Esophageal foreign bodies are significant due to the life-threat- ening complications they may cause. Thus, early diagnosis and treatment are crucial. Rigid esophagoscopy is still the most reliable method of treatment. (JAEM 2012; 11: 77-80

Predictors of difficult intubation in patients with ankylosing spondylitis : do disease activity and spinal mobility indices matter?

Objectives: This study aims to determine the predictors of difficult intubation and their possible correlations with disease activity and spinal mobility indices in patients with ankylosing spondylitis. Patients and methods: Forty-five ankylosing spondylitis patients were included in the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI). The predictors of difficult intubation were evaluated by using the modified Mallampati test, upper lip bite test, thyromental distance, sternomental distance, inter- incisor distance and neck extension. Results: There was no correlation between Bath Ankylosing Spondylitis Disease Activity Index and predictive test values (all p&gt;0.05). There were significant correlations between BASMI with modified Mallampati test, sternomental distance, neck extension, and inter-incisor distance values (all p&lt;0.05). The BASMI scores in patients with two or more predictors were significantly higher than BASMI scores in patients with none or one predictor (5.28&plusmn;2.12 vs. 1.58&plusmn;1.50; p&lt;0.001). Among the patients with moderate to severe BASMI, the number of patients with two or more predictors was higher than in those patients with none or one predictor (p=0.001). Conclusion: Neck extension, inter-incisor distance, sternomental distance and modified Mallampati test are significant predictors for difficult intubation in patients with ankylosing spondylitis. These predictors were found to be correlated with spinal mobility index, but not with disease activity index. Clinicians should be aware of difficult intubation in ankylosing spondylitis patients with moderate to severe spinal mobility limitation.Objectives: This study aims to determine the predictors of difficult intubation and their possible correlations with disease activity and spinal mobility indices in patients with ankylosing spondylitis. Patients and methods: Forty-five ankylosing spondylitis patients were included in the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI). The predictors of difficult intubation were evaluated by using the modified Mallampati test, upper lip bite test, thyromental distance, sternomental distance, inter- incisor distance and neck extension. Results: There was no correlation between Bath Ankylosing Spondylitis Disease Activity Index and predictive test values (all p&gt;0.05). There were significant correlations between BASMI with modified Mallampati test, sternomental distance, neck extension, and inter-incisor distance values (all p&lt;0.05). The BASMI scores in patients with two or more predictors were significantly higher than BASMI scores in patients with none or one predictor (5.28&plusmn;2.12 vs. 1.58&plusmn;1.50; p&lt;0.001). Among the patients with moderate to severe BASMI, the number of patients with two or more predictors was higher than in those patients with none or one predictor (p=0.001). Conclusion: Neck extension, inter-incisor distance, sternomental distance and modified Mallampati test are significant predictors for difficult intubation in patients with ankylosing spondylitis. These predictors were found to be correlated with spinal mobility index, but not with disease activity index. Clinicians should be aware of difficult intubation in ankylosing spondylitis patients with moderate to severe spinal mobility limitation

DELAYED EMERGENCE FROM ANESTHESIA ASSOCIATED WITH UNDIAGNOSED CENTRAL SLEEP APNEA SYNDROME

Delayed awakening from anesthesia is often multifactorial including residual anesthetic drugs, excessive reaction to narcotics and sedatives, residual neuromuscular blockade and duration of surgery. Hypercapnic central sleep apnea syndrome is often encountered at central hypoventilation syndromes which may be secondary to other diseases that cause respiratory centre dysfunction. In this case, 36 years, which had operated from pontine cavernomas awakening complications following general anesthesia after pilonidal sinus surgery was reported. This disorder may be due to central sleep apnea syndrome in a patient without previous diagnosis. He was referred to the sleep laboratory in aspect of the differential diagnosis. The patient was diagnosed as central sleep apnea syndrome and home device for CPAP was recommended. The patient who had a history of brainstem surgery should be taken into consideration for the candidate of central sleep apnea syndrome, and a meticulous evaluation should be done before surger

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Aim: Cardiac toxicity due to the administration of local anesthetics may be fatal. In this study, we evaluated the efficacy of a 20% lipid solution combined with epinephrine in a levobupivacaine-induced cardiac arrest model. Materials and methods: A total of 14 New Zealand rabbits were sedated and mechanically ventilated. Asystole was induced with intravenous levobupivacaine injection. The rabbits were randomized into groups receiving the same volume of either 0.9% saline (CR group) or a 20% lipid solution (LE group) along with a 100 &micro;g/kg epinephrine bolus, which were administered immediately upon asystole. Standard advanced cardiac life support protocols were performed. Results: Four subjects in the LE group as well as 3 subjects in the CR group had a spontaneous recovery (P = 0.592). In the 20th minute after arrest, 3 subjects in the LE group had maintained spontaneous circulation, while there was only 1 subject from the CR group with the same outcome. Conclusion: We found that adding a lipid solution to epinephrine for the resuscitation of rabbits that underwent levobupivacaineinduced cardiac arrest increased recovery rates of circulation and therefore the likelihood of survival. Further studies are needed to develop clinical therapies for the systemic toxicity of local anesthetics.Aim: Cardiac toxicity due to the administration of local anesthetics may be fatal. In this study, we evaluated the efficacy of a 20% lipid solution combined with epinephrine in a levobupivacaine-induced cardiac arrest model. Materials and methods: A total of 14 New Zealand rabbits were sedated and mechanically ventilated. Asystole was induced with intravenous levobupivacaine injection. The rabbits were randomized into groups receiving the same volume of either 0.9% saline (CR group) or a 20% lipid solution (LE group) along with a 100 &micro;g/kg epinephrine bolus, which were administered immediately upon asystole. Standard advanced cardiac life support protocols were performed. Results: Four subjects in the LE group as well as 3 subjects in the CR group had a spontaneous recovery (P = 0.592). In the 20th minute after arrest, 3 subjects in the LE group had maintained spontaneous circulation, while there was only 1 subject from the CR group with the same outcome. Conclusion: We found that adding a lipid solution to epinephrine for the resuscitation of rabbits that underwent levobupivacaineinduced cardiac arrest increased recovery rates of circulation and therefore the likelihood of survival. Further studies are needed to develop clinical therapies for the systemic toxicity of local anesthetics

DESENDAN SEYİRLİ BİR GUİLLAİN BARRE SENDROMU OLGUSU

ÖZETGuillain Barre Sendromu (GBS), sıklıkla simetrik güçsüzlük ve arefleksi ile karakterize akut inflamatuar polinöropatidir. Geçirilmiş bakteriyel veya viral enfeksiyonların tetiklediği otoimmün bir hastalık olduğu kabul edilmektedir. Çocukluk çağı GBS'de mortalite %1-2 oranındadır ve genellikle solunum yetersizliğine bağlı olarak gelişir. Burada 14 yaşında viral enfeksiyon sonrası GBS gelişen bir erkek çocuk sunularak bu sendromun klinik özellikleri gözden geçirildi.Anahtar kelimeler: Çocuk, Guillian-Barre Sendromu, Klinik bulgula

Intraoperative ephedrine allergy in a patient who received chemotherapy and perioperative hypersensitivity reactions

Kemoterapi almış hastada intraoperatif efedrin alerjisi ve perioperatif hipersensitivite reaksiyonları anestezi, farmakolojik açıdan özgül bir durumu temsil eder ve bu süre boyunca çok sayıda yabancı maddelere maruz kalan hastalarda erken aşırı duyarlılık reaksiyonları veya anafilaksi gelişebilir. Otuz yedi yaşındaki, total abdominal histerektomi planlanan hastada intraoperatif hipotansiyon gelişmesi nedeniyle (5 mg) efedrin iv uygulandı. Uygulama sonrası aynı ekstremitenin iv kanülün yerleştirildiği ven trasesi hattında kızarıklık görüldü. Yaklaşık 15 dakika sonra her iki ekstremitede, batında yaygın ürtiker plakları gözlendi. İntravenöz kristalloid infüzyon hızı arttırılarak, metilprednisolon (100 mg+100 mg), Feniraminmaleat (45,5 mg) verildi. Postoperatif sorunsuz ekstübe edilerek postoperatif bakım ünitesinde gözleme alındı. Lezyonları postoperatif 60. dakikada tamamen ortadan kalkmasının ardından yaşamsal bulgularının da istikrarlı olması nedeniyle servise alındı. Cerrahi takibinde herhangi bir komplikasyon gelişmeyen hasta yatışının ikinci gününde taburcu edildi.Anaesthesia represents a specific set-up in respect to pharmacology, and during this time, early hypersensitivity reactions or anaphylaxis may occur in patients who are exposed to a great number of foreign substances. Intravenous ephedrine (5 mg) was applied to a 37-year-old patient due to the development of intraoperative hypotension in a total abdominal hysterectomy operation. After application, hyperaemia was seen in the track of the intravenous catheter of that extremity. Approximately 15 minutes later, urticarial plaques were observed extensively in the abdomen and in both extremities. Methylprednisolone (100 mg+100 mg) and pheniramine (45.5 mg) were given with an increasing infusion rate of intravenous crystalloid. The patient was extubated without any problem and removed to the recovery unit for observation. After the total disappearance of lesions at postoperative 60 minutes and because of the stability of vital signs, the patient was removed to the service. In the follow-up of surgery, no complication developed, and the patient was discharged on postoperative day 2

Sugammadex usage f or rocuronium caused residual curarization in which neostigmine f ailed

Nondepolarizan kas gevşetici ajanların etkilerinin uzamasına bağlı olarak gelişen postoperatif rezidüel kürarizasyon modern anestezide hala yaygın görülen ve hasta güvenliğine ciddi tehdit oluşturan önemli bir problemdir. Anestezi sonrasında rezidüel nöromusküler blok, uygun şekilde döndürülmezse postoperatif pulmoner komplikasyonların gelişimini ve postoperatif mortaliteyi arttırır. Spinal kitle nedeniyle opere edilen Amerikan Anestezistler Derneği II risk grubu olgumuzda nöromusküler bloker olarak roküronyum kullanıldı. Operasyonun sonunda roküronyuma bağlı rezidüel nöromusküler bloğu döndürmek için neostigmin kullanılmasına rağmen hastada solunum yetmezliği gelişti. Kas gücü yetersiz olan hasta ajite, taşikardik, takipneik ve tidal volümü düşüktü. Postoperatif rezidüel kürarizasyonu döndürmede neostigminin başarısız olması üzerine, hastaya modifiye ?- siklodekstrin yapısındaki 200 mg sugammadeks uygulandı. Nöromusküler bloğun hızlı ve etkili bir şekilde döndüğü tespit edildi. Sonuç olarak geleneksel antikolinerjik ajanların başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımının güvenilir ve etkin olduğunu düşünüyoruz.Postoperative residual curarization caused by prolonged effect of non-depolarizing neuromuscular blocking agents is still a serious, frequent and life threatening problem in modern anesthesia. If postoperative residual neuromuscular block cannot be recovered properly, postoperative pulmonary complications and mortality may increase. We used rocuronium as a neuromuscular blocker in our American Society of Anesthesiologists II risked patient which was operated for a spinal mass. Respiratory failure was occurred in our patient despite the usage of neostigmine for recovering neuromuscular block caused by rocuronium. The patient was tachycardic, tachypneic, the tidal volume was decreased and the muscle strength was weak. After the ineffectiveness of neostigmine in recovering neuromuscular blockage, 200mg sugammadex which is a modified &amp;#947;- cyclodextrin was given to the patient. We observed that neuromuscular blockage was recovered rapidly and effectively. In conclusion, we think that using sugammedex is effective and safe in residual curarization caused by rocuronium in which traditional anticholinergic agents are not successful