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

Effects of Preoperative Anxiety on Intraoperative Hemodynamics and Postoperative Pain

Objective: To determine the effects of the level of the anxiety of the patients on the intraoperative hemodynamic parameters and postoperative pain, patient satisfaction and the stay period at the hospital

Major Extremity Injuries Associated with Farmyard Accidents

Background. The aim of the study is to analyze the major agricultural injuries related to the extremities. Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60–360). Mean length of stay was 24 days (4–150), and mean number of operations during hospitalization was 2.4 (1–30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall

Letter to editor on noninvasive ventilation to prevent reintubation

We would like to reply to the comments are as follows: 1-Our patients were published in Letter to Editor entitled "Non invasive ventilation to prevent reintubation. Key methodological concerns in cardiothoracic unit" by the authors Beyoglu C.A., Ozdilek A., Esquinas A.M. in Int J Clin Exp Med. The main issues that the authors Beyoglu and her collegues have put forward and our answers to these comments are as follows: 1- The patients in our study have a history of cardiac dysfunction and they underwent cardiac or thoracic surgeries and because of these reasons they are not hemoynamically in stable state, 2- The materials and methods have been well presented in our study, 3- The inclusion criterias are well established in our study. We do not wait on room air oxygen until patients have an acute respiratory failure before application of noninvasive ventilation and patient's clinical deterioration while receiving oxygen therapy via face mask is necessary to decide whether patient has respiratory distress or not. These decisions are made depending on acute respiratory failure criterias on textbooks. 4- Cardiac and thoracic surgeries are both included as these operations are involved significantly with postoperative pulmonary dysfunction because of incision on chest wall causing atelectasis, pleural opening, possible phrenic nevre injury, pain, prolonged recumbent position and reduction of diaphragmatic movement, 5- Pain is an important factor for postoperative pulmonary complications and we thank you for your comment and describe our pain relief methodology during our study, 6- The complication rates were statistically not different from each other between the groups, 7- Carbondioxide retention, hypoxia and bradycardia are a part of the definition of failure of noninvasive ventilation and bradycardia is not listed in acute respiratory failure criteria in our study

Awake Videothoracoscopic Resection With The Help Of Thoracal Paravertebral Block: Two Case Report And Review Of Literature

Thoracic paravertebral block (TPB) can be administered for VATS (video-assisted thoracic surgery) method and often used for analgesic purposes and provides good results. Awake VATS (AVATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. AVATS had been reported local anesthesia and sedation, intercostal blocks or TEA was used in terms of regional anesthesia in many studies. We present our experience with the two cases undergoing AVATS accompanied by TPB due to such cases are rarely seen in the literature. Specially, our second case of spontaneous pneumothorax surgery using AVATS with TPB anesthesia has not been reported previously in the literature

Anaesthesia Management of a Child with West Syndrome

West syndrome (WS) is an epileptic encephalopathy usually occurring during the first year of life and is characterized by severe electroencephalography (EEG) derangement. Most of these patients may develop cerebral palsy, facial malformations, and skeletal deformities. The anaesthesiologist should make the preoperative assessment carefully due to epileptic seizures and should consider the possibility of difficult intubation because of coexisting anatomic malformations during the anaesthesia management of patients with WS. This report presents a case of general anaesthesia management in a left femoral fixation operation in an 11-year-old, 18 kg male patient