Regional intravenous anesthesia in knee arthroscopy

OBJECTIVE: The goal of the study was to investigate the regional intravenous anesthesia procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain. MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted.The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters. RESULTS: The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer. CONCLUSION: Regional intravenous anesthesia using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required

Neuroaxial anesthesia in a patient with progressive systemic sclerosis : case presentation and review of the literature on systemic sclerosis

BACKGROUND: Systemic sclerosis (SSc), a progressive disease characterized by excessive accumulation of connective tissue components. Although most patients have long survival, some of them progress rapidly to death. Pulmonary system involvement and pulmonary hypertension are the most frequent cause of death. When the patient with SSc is to be operated, the anesthetic procedure could be a serious problem. In this article, we report a combined spinal – epidural technique in a patient with progressive SSc and the anesthetic considerations that could be recommended for these patients. CASE PRESENTATION: A 68-year-old woman who had a history of progressive systemic sclerosis, pulmonary fibrosis, kyphoscoliosis and decreased oral apertura underwent total hip arthroplasty. This operation was performed successfully under combined spinal epidural anesthesia. CONCLUSION: Systemic sclerosis is a complex disease that involves multiple organ systems. Every aspects of anesthetic care may be altered or hindered by the pathogenesis of disease. Although the choice of regional or general anesthesia is unclear, to choose combined spinal epidural anesthesia may be useful

Snake Bite: Case Report

We present a case of a fourty-year-old man who was bitten by a snake on his left leg. It was a severe envenomation with ensuing marked edema and severe pain with complicated coagulation defects. After medical treatment with antivenom and fresh frozen plasma the patient discharged without any complication. (Journal of the Turkish Society of Intensive Care 2010; 8: 73-6

The Views of Urology Doctors in Turkey Towards Regional Anaesthesia

Despite regional anaesthesia (RA) being the most appropriate anaesthesia method in several surgeries, primarily urology surgery, it is not widely practised by anaesthetists. We aimed to research the knowledge, opinions and attitudes of urologists towards regional anaesthesia(RA)A questionnaire consisting of 29 questions to be answered with Likert type answers was applied face to face to urology specialists and assistants in hospitals in the center of Ankara. By stating the preferred anaesthesia method it was aimed to evaluate the knowledge and opinions of urologists to RA. A total of 152 urology assistants or specialists were included in the study. The source of the knowledge related to RA was determined as from experience during specialist training in 38%, from observation and learning from anaesthetists when working together in 25% and from medical faculty education in 25%. The most common reasons for selecting RA were determined as a better state of consciousness in the patient compared to general anaesthesia (92.8%), that it is a safe anaesthesia method (86.2%), lower rates of postoperative nausea and vomiting (73.7%) and greater patient satisfaction (73%). Reasons for not selecting RA were determined as the risk of complications developing associated with unwanted movements of the patient (45.4%) and that the patient can follow their own endovision monitor and hear the doctors talking amongst themselves, as they are conscious during surgery (40.8%). The results of this study showed that the majority of urologists knew the advantages of RA and supported the use of RA in appropriate operations. The disadvantages of the RA can be eliminated with anaesthesia applications such as sedation or nerve blockage additional to RA. Periodic training sessions between clinics and meetings may be useful both in terms of updating information and in reducing negative opinions of RA. Inter-clinical meetings and periodic training can be beneficial both in terms of updating information and reducing negative opinions about RA

Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

ABSTRACT CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary