Pectoral Nerve Block As The Sole Anesthetic Technique For A Modified Radical Mastectomy In A Comorbid Patient

Breast surgery operations are generally performed by general anesthesia. In order to decrease postoperative pain, regional anesthesia is usually combined with general anesthesia. Pectoral nerve blocks is a novel technique to provide perioperative and postoperative pain control for patients underwent breast surgery. We performed pectoral nerve block I and pectoral nerve block II as a sole anesthetic technique with sedation by dexmedetomidine for modified radical mastectomy, for a 75-year-old female patient with multiple diseases. Pectoral nerve blocks with sedation could be a good technique for breast surgery than general anesthesia in comorbid patients.WoSScopu

A clinical comparison of etomidate-lipuro, propofol and admixture at induction

Objective: The purpose of this study was to compare etomidate-lipuro and propofol and 50%, (1:1) admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus. Methods: Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro−propofol admixture. After monitorization with bispectral index (BIS) all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 (BIS 40 time) and total amounts of induction doses were measured. Results: BIS 40 time measurements were P > E > PE (199.4 ± 40.9, 176.9 ± 31.6, 163.5 ± 20.6 s). The hemodynamic (systolic, diastolic and mean blood pressures, heart rate) changes were minimal in group PE than other two groups (P = 0.017). The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E (76.3%). Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were (83.8%) in group P and in (63.2%) group E. Conclusion: Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction

Comparison Of Propofol And Midazolam On Patients Undergoing Spinal Surgery With Intraoperative Wake-Up Test: Randomized Clinical Trial

Background and objectives: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. Methods: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg(-1) for group P or midazolam 0.5 mg kg-1 for group M with remifentanit 0.5 vig kg(-1) and cisatracurium 0.15 mg kg(-1) for both groups. At the maintenance of anesthesia O-2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg(-1) h(-1) and in group M, midazolam 0.5 mg mg kg(-1) were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BPS frequency throughout the operation was recorded. Results: The eye opening time was 9 + 2.15 min in group P and 7 +/- 3.15 min in group M. Motor movement time was 12 +/- 2.55 min in group P and 21.25 +/- 3.93 min in group M. Conclusion: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.WoSScopu

Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

Background and Aim: Severe pain and comfortlessness may be seen in patients after arthroscopic knee surgery despite various commonly administered analgesic methods, particularly based on local anesthetics. The aim of this study was to determine the effect of intraarticular levobupivacaine injected preoperatively on pain relief and time to first analgesic request during the postoperative period. Material and Methods: 40 adult-patients, ASA I and II, undergoing elective arthroscopic surgery were included in the study. Patients in the levobupivacaine group received intra-articular levobupivacaine at 5mg/ml dosages and 20 ml total volume 30 min before the procedure. Patients in the control group received 20 ml of normal saline. Visual analogue scale (VAS) scores were assessed at the 1st, 2nd, 4th, 8th, 12th and 24th hour postoperatively. Time to first analgesic request and total analgesics used over the course of 24 hours after the surgery were recorded. All patients received continuous morphine infusion via patient controlled analgesia (PCA) devices postoperatively. Additionally, patients&#146; pain satisfaction scores were recorded. Results: Lower VAS scores at the 1st, 2nd, 4th and 8th hours postoperatively - both at rest and during motion - were found in the levobupivacaine group compared to the normal saline group (p<0.001, p<0.001, p<0.001 and p<0.02 respectively). Time to first analgesic request was longer with the levobupivacaine group than the group with saline (22.50 vs 15.00 min, p<0.02). A significant difference was found in consumed total opioid doses (9.10 vs 31.75 mg, p<0.001). The number of analgesic demands using PCA were significantly different between groups (10.80 v.s. 36.1 times in 24 hours, p<0.001). Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume) provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000): 91-95

Comparison Of Intraarticular Bupivacaine And Levobupivacaine Injection In Rat Synovial Inflammation

Background/aim: Both bupivacaine and levobupivacaine are local anesthetics with strong analgesic efficacy that can be used intraarticularly. The aim of this study was to compare the effects of intraarticular bupivacaine and levobupivacaine injection on inflammation in articular cartilage and the synovium of the rat knee joint. Materials and methods: Twenty Sprague-Dawley rats were injected in the right knee joint with 0.2 mL of bupivacaine, while 0.2 mL of levobupivacaine was injected into the left knee joint. Groups of 5 were sacrificed on days 1, 7, 14, and 21 after bupivacaine and levobupivacaine administration and knee joints were examined for subintimal fibrosis, synovial hyperplasia, chronic inflammation, neutrophil infiltration, edema, and synovial and periarticular congestion by microscopy. Alterations in the articular cartilage structure were evaluated using Mankin scoring. Results: We found that both drugs have similar effects on synovial and articular cartilage resulting in mild to moderate congestion, edema, neutrophil infiltration, chronic inflammation, and synovial hyperplasia, which diminished gradually. However, increases in fibrosis were also seen to varying degrees. Thus, the use of these drugs intraarticularly can be recommended. Conclusion: Careful usage of bupivacaine and levobupivacaine is recommended in intraarticular applications since they cause inflammation shortly after injection and fibrosis at later time points.WoSScopu

The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: A pilot study

Background. Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive out. come and SIN beta protein (SIOO BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients-undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB)

Procaine and Saline Have Similar Effects on Articular Cartilage and Synovium in Rat Knee

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Major Ayak Cerrahisi Uygulanan Çocuklarda Postoperatif Analjezi İçin Devamlı Siyatik Sinir Bloğu ve İntravenöz Hasta Kontrollü Analjezi Yöntemi ile Morfin Kullanımının Karşılaştırılması

Objective: Peripheral nerve catheter for postoperative analgesia is new method in children. In this study, we aimed to compare the efficacy of systemic opioid use with continuous sciatic nerve blocks after foot surgery in children. Material and Methods: A total of 32 patients aged between 2-8 years were randomized into two groups prospectively. After general anesthesia, Group I (n= 16): Patients in the systemic opioid group were administered patient controlled analgesia (PCA) 30 minutes before the end of surgery and were administered 0.5 ml.mg.(-1) of morphine with a rate of 0.02 mg.kg.(-1) hour(-1). Bolus dose was adjusted as 0.01 mg.kg.(-1), lock out time was determined as 15 minutes and four hour limit was determined as 4 mg. Group II (n= 15): The sciatic nerve catheter was inserted using nerve stimulator under ultrasound and 0.4 ml.kg.(-1) of %0.5 bupivacain was injected and 0.2% bupivacain with a rate of 0.1 ml.kg.(-1) hour(-1) was administered with PCA at recovery through sciatic nerve catheter. Visual pain scale (VPS) (0-100 mm 0= no pain, 100= the worst pain) was used for evaluation of postoperative pain in children and CHIPPS (children and infants postoperative pain score) was used for children under 7 years for evaluation of pain When VAS>40 and CHIPPS >3, 15 mg.kg.(-1) paracetamol IV was administered, and if this was not enough to decrese the scores, 0.02 mg.kg.(-1) morphine was given. Pain scores, rescue analgesics, adverse effects and family satisfaction were recorded. Results: A statistically significant difference was not found between study groups when compared for demographic features, VPS and CHIPPS scores. Rescue analgesic administration, nausea, vomiting, pruritus and urinary retention was found higher in group I and the difference was statistically significant. Parent satisfaction was statistically significantly higher in PNC group. Conclusion: Sciatic nerve catheter is as effective as opioid use with PCA for children after appropriate operations and has fewer adverse effects, less need for rescue analgesics and better parent satisfaction.WoSScopu

Predicting Mortality and Morbidity of Geriatric Femoral Fractures Using a Modified Frailty Index and Perioperative Features: A Prospective, Multicentre and Observational Study

Introduction: Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures. Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours. Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79 +/- 11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p<0.001) and total hospitalization (p<0.012) duration. A logistic regression model revealed that frailty index, preoperative creatinine and centre type were independent mortality predictors. Conclusion: Increased modified frailty index was associated with higher postoperative mortality risk, thus providing an additional way for improving risk stratification. Preoperative creatinine increase and centre types are determining factors in mortality.WoSScopu