Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

<p>Abstract</p> <p>Introduction</p> <p>A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature.</p> <p>Case presentation</p> <p>We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours.</p> <p>Conclusion</p> <p>We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.</p

Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial

Purpose Anxiety is one of the most important causes of hypertension, increasing direct blood pressure and affecting postoperative morbidity and mortality. The aim of this study was to investigate the effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension. Methods We enrolled 90 patients with hypertension undergoing cholecystectomy in this trial. Patients were randomly divided into two groups using a sealed-envelope system. Group STOR was shown the operating room the day before surgery, while Group No STOR was not shown the operating room. Results State-Trait Anxiety Inventory scores measured on the day of surgery were lower for Group STOR (43.2 ± 6.0) than Group No STOR (49.8 ± 7.9) (p = .001). Systolic (p = .001, p = .006, respectively), diastolic (p = .001, p = .004, respectively), and heart rate (p = .018, p = .031, respectively) values in the operation room and preoperative unit were lower in Group STOR than in Group No STOR. The number of postponed operations in Group STOR was lower than in Group No STOR (p = .043), and the patient satisfaction score in Group STOR was higher than in Group No STOR (p = .031). Conclusion In patients with hypertension, preoperative anxiety, blood pressure, heart rate, and respiratory rate all increase in the preoperative unit and operation room. Our findings indicate that showing the operating room to patients with hypertension decreases preoperative anxiety, as well as blood pressure and heart rate inside the operating room and preoperative unit. It also reduces the number of postponed operations and increases patient satisfaction

Effect of Adding Dexamethasone to Bupivacaine on Transversus Abdominis Plane Block [Transversus Abdominis Plane Bloga Eklenen Deksametazonun Etkisi]

We aimed to evaluate the effect of dexamethasone added TAP block on postoperative analgesia accompanied by ultrasound in the TAH. After obtaining the Ethics Committee and the patient's consent a total of 60 ASA I-II patients undergoing planned total abdominal hysterectomy with general anesthesia were enrolled in the study. After surgical termination, ultrasound guided TAP block was performed by the same anesthesiologist. The patients were randomly divided into two groups using the envelope method. TAP block was obtained with 19 mL of bupivacaine hydrochloride 0.25%+1 mLsaline 0.9% (Group B, n=30) or 19 mL of bupivacaine hydrochloride 0.25%+1 mLdexamethasone (4 mg) (Group BD, n=30). Postoperatif pain scores were evaluated with Visual Analog Scale (VAS) at the recovery room and postoperative 2, 4, 6, 12 and 24 hours. Time to first analgesic requirement, morphine consumption, incidence of nausea and vomiting, and sedation scores were recorded. VAS scores at rest and on movement in recovery room and postoperative 2 h were significantly lower Group BD than Group B (p [Med-Science 2015; 4(4.000): 3732-42

The Relationship between preoperative Smoking Cessation, Anxiety, and postoperative Anxiety and Pain: A Prospective Clinical Trial at a University Hospital in the East of Turkey by 120 Participants

Objective: To reveal the relationship among smoking cessation before surgery, pre- and post-operative anxiety, and pain among chronic smokers. Method: The randomized controlled prospective clinical study was conducted in 2018 on the east of Turkey, in Van Yuzuncu Yil University Dursun Odabas Medical Center in city of Van. After approval from the ethics committee participants of either gender aged 20-60 years scheduled to undergo rhinoplasty surgery and graded as American Society of Anaesthesiologists I–II were included. The participants were categorised into smokers group S and non-smokers group NS. Spielberger State-Trait Anxiety Inventory values for preoperative period, postoperative 0, which is the moment when the modified Aldrete score is 9, as well as for 2, 4 and 6 hours, and visual analogue scale values for the postoperative 0, 2, 4 and 6 hours were recorded. Data was analysed using SPSS 26. Results: Of the 120 patients, there were 60(50%) in group S; 28(46.7%) females, 32(52.3%) males, overall mean age 33.0±9.7 years. In group NS, there were 34(56.7%) females and 26(43.3%) males with an overall mean age of 34.7±10.1 years (p 0.05). Group S had Spielberger State-Trait Anxiety Inventory preoperative and postoperative values significantly higher than group NS (p 0.05). While the values for postoperative 4 and 6 hours increased in group S, corresponding values decreased in group NS (p 0.05). Conclusion: High anxiety scores in preoperative period appeared to be associated with stress from surgery and anaesthesia and could have been caused by smoking dependency during the preoperative and postoperative periods

Our clinical experiences in ultra-sound guided peripheral nerve blocks: a retrospective evaluation

Peripheral nerve blocks are commonly used in extremity surgeries for anesthetic and/or postoperative analgesic purposes with general anesthesia. Ultra-sound (US) guided peripheral nerve blocks that have been used in recent years provide many superiorities in comparison with other conventional methods. The objective of this retrospective study was to carry out a retrospective evaluation of our experiences regarding 400 patients on whom US guided peripheral nerve was applied at the Inonu University Faculty of Medicine, Department of Anesthesiology and Reanimation during June 2012-March 2016. Demographic data of the patients, block type, purpose of block (for surgical or analgesic), type and volume of the local anesthetic, type of US probe, needle length, block success, toxicity finding and complications were all recorded. Blocks were performed for analgesia in 16% of the patients and for anesthesia in 84%. Lidocaine+bupivacaine combination, bupivacaine+prilocaine combination and bupivacaine were used on 82%, 13% and 5% of the patients as local anesthetic agent, respectively. Linear US probe (6-13 MHz) was used for all patients. In conclusion, US guided peripheral nerve blocks provide adequate depth of anesthesia and analgesia. It was found to be safe and useful and may be a good alternative to general anesthesia. [Med-Science 2017; 6(2.000): 195-8

The Effect of Dexamethasone in Tramadol Induced Nausea and Vomiting

We aimed to investigate the efficacy of a single dose bolus of dexamethasone on tramadol induced nausea and vomiting in our study. After approval was taken from ethics committee and patients, a total of 60 ASA I-II patients who were planned to undergo total abdominal hysterectomy (TAH) under general anesthesia were included in this study. A patient-controlled analgesia device was explained for the patients with preoperative visit. After the non-premedicated patients were taken in the operation room, the routine monitorization was performed. Induction was provided with 1&#956;g/kg of fentanyl, 2 mg/kg propofol and 0.1 mg/kg vecuronium. 6-8% concentration of desflurane in a mixture of 50% air and 50% O2 was used for maintenance of anesthesia. When the incision was started to be closed, the patients were randomized into two groups by envelope method. 8 mg iv dexamethasone (2 mL) was given for Group D (n=30), iv Saline solution (2 mL) was given for Group K (n=30). After the incision was closed, a loading dose of intravenous tramadol 1 mg/kg was administered in both groups. The patients were taken in the postanesthesia care unit by extubating following the antagonism of muscle relaxant at the end of surgery. The patient-controlled analgesia device was scheduled to be as infusion: no, bolus: 12 mg, lock-out time: 10 min, 24 hour dosing limit: 400 mg. The pain and nausea and vomiting scores, additional analgesic and antiemetic requirements, the total amount of tramadol consumption were recorded at post-operative recovery and postoperative 2, 4, 6, 12 and 24 hours. Although the incidence of nausea and vomiting, and pain scores at 2 and 4 hours were not statistically significant, they were lower in Gorup D compared to Group K (p&gt;0.05). 14 patients in Group K required additional antiemetics and 12 patients in Group D required additional antiemetics (p&gt;0.05). Six patients in Group K required additional analgesics and 4 patients in Group D required additional analgesics. Although the total amount of tramadol consumption was not statistically significant, it was lower in Group D compared to Group K. It was concluded that a single bolus dose of dexamethasone 8 mg has not reduced tramadol induced nausea and vomiting in patients who were planned to undergo TAH. [Med-Science 2016; 5(1.000): 94-101

The effects of propofol-ketamine combination on QTc interval in patients with coronary artery disease

The purpose of this study was to evaluate the effects of propofol-ketamine combination on QTc, T wave (Tp-e) interval, hemodynamics during the induction of anesthesia in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG). Patients were prospectively randomized, in a double blinded manner, to either the propofol group (Group P, n=41) or the propofol-ketamine combination group (Group PK, n=45). In both groups the drugs were infused at an IV dose of 2 mg/kg administered over 30 seconds. After that, 5µg/kg fentanyl and 0.1mg/kg vecuronium were administered and tracheal intubation was performed. ECG recordings were performed prior to induction of anesthesia (baseline, T1), 2 min after the beginning of study drugs (T2), 3 min after vecuronium (immediately before intubation, T3), and 30 s (T4), 1 min (T5) and 5 min (T6) after intubation. Eighty-six patients were evaluated in the study. The baseline QTc interval values were similar between the groups, In Group P, QTc interval increased significantly for T3-T6 in all periods according to baseline value. Also in Group P, QTc interval increased significantly in T4, T5, T6 according to T3. In group PK, QTc interval increased significantly in T3-T6 according to baseline value. Group PK increased significantly in T5 and T6 compared to T3. In both groups a statistically significant change was not found in Tp-e intervals of all periods. Following induction with propofol-ketamine combination, QTc interval did not increase, but it prolonged postintubation QTc interval just like propofol. Assuming that increased repolarization transmural dispersion (TDR) is a reliable indicator of risk of torsade de pointes (TdP), and lack of any change in Tp-e interval, in the presence of depressed hemodynamic response to intubation, we think that this combination can be safely used for the induction of anesthesia in patients with CAD undergoing CABG. [Med-Science 2021; 10(2.000): 278-82