Hypertensive crisis in a patient with an undiagnosed pheocromocytoma

Pheochromocytoma is a catecholamine secreting tumor which originates in the chromaffin cells of adrenal medulla. Silent heochromocytomas can become evident with hypertensive attack during anaesthesia. Here is presented a case of heochromocytoma without high plasma or urinary levels of catecholamines, and without history of hypertension which was detected with hypertensive attack during surgical extirpation. With all the newest medications and techniques that have been developed the anesthetic management of undiagnosed pheochromocytomas are still sources of unexpected problems for the anesthetists. In this case it was a great chance that there were no complications despite the hypertensive crisis

Intraarticular levobupivacaine or bupivacaine administration decreases pain scores and provides a better recovery after total knee arthroplasty

Purpose The aim of this prospective randomized blinded controlled study was to compare the efficacy of the two local anesthetics, intraarticular bupivacaine and levobupivacaine administration, versus control for postoperative pain control and functional recovery. Length of hospital stay, opioid consumption, and the side effects of opioids were also evaluated. Methods Sixty patients of American Society of Anesthesiologists class I–III undergoing elective knee arthroplasty under spinal anesthesia were randomized into three groups. Groups B (n = 20) and L (n = 20) both received 150 ml solution intraarticularly, containing 200 mg bupivacaine or 200 mg levobupivacaine combined with 0.5 mg epinephrine, respectively, at the end of the surgery. Group C (n = 20) received 150 ml saline intraarticularly. Postoperatively, all groups received injections through the intraarticular catheters in quantities of 120 mg (levobupivacaine for group L, bupivacaine for group B) and 0.5 mg epinephrine whereas group C received a saline bolus at 10 and 22 h. Patients were given tramadol by intravenous patientcontrolled analgesia (PCA), and sodium diclofenac 75 mg intramuscularly was used for rescue analgesic medication. Visual analogue score (VAS) for pain at rest and during mobilization (which was defined as flexion exercise supported by physiotherapist in postoperative first 8 h and afterward a 3-m walk with walker), consumption of tramadol, side effects, and patient satisfaction were recorded until the 48th hour postoperatively. Results Area under the curve values for VAS were lower in groups B and L compared to the control, both at rest and during mobilization (first 48 h) (P = 0.032 and P = 0.029, respectively). Tramadol consumption was lower (P\0.05), patient satisfaction as evaluated with a five-point Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) was higher (P = 0.03), and length of hospital stay was shorter (P = 0.03) in groups B and L compared to group C. Conclusion Intraarticular bupivacaine and levobupivacaine provided better postoperative analgesia both at rest and during mobilization in total knee replacement surgery compared to control. Tramadol consumption and hospital stay were also decreased in the study groups

The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations

Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups.The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively

The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction

Purpose The aim of this prospective randomised doubleblind study is to investigate the effect of magnesium added to local anaesthetics on postoperative VAS scores, total opioid consumption, time to first mobilisation, patient satisfaction and rescue analgesic requirements in arthroscopic ACL reconstruction surgery. Methods A total of 107 American Society of Anaesthesiologists physical status grade I and II patients between 18 and 65 years of age who were scheduled to undergo elective anterior crucial ligament (ACL) reconstruction with hamstring autografts were enrolled in the study. The patients were randomly allocated to Groups L (n = 51) and LM (n = 56) using the closed-envelope method. Group LM was administered 19 ml of 0.25 % levobupivacaine and 1 ml of 15 % magnesium sulphate, while Group L was administered 20 ml of 0.25 % levobupivacaine for femoral blockade. General anaesthesia was administered using laryngeal airway masks following neural blockade in both groups. The patients were evaluated for heart rate and mean arterial pressure, oxygen saturation, visual analogue score (VAS), verbal rating scale (VRS), rescue analgesic requirements, total opioid consumption, side effects and time to first mobilisation at the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. Results There was no statistically significant difference in terms of demographic data, mean arterial pressure, heart rate or oxygen saturation between groups. The area under the curve VAS and VRS scores were lower at 4, 6, 12 and 24 h in Group LM (p = 0.001, p = 0.016, respectively). The rescue analgesic requirement and the total opioid consumption were significantly lower in Group LM (p = 0.015, p = 0.019, respectively). The time to first mobilisation and the Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) were higher, and the block onset time was lower in Group LM (p = 0.014 and p = 0.012, respectively). There was no difference in terms of side effects. Conclusions The addition of magnesium to levobupivacaine prolongs the sensory and motor block duration without increasing side effects, enhances the quality of postoperative analgesia and increases patient satisfaction; however, the addition of magnesium delays the time to first mobilisation and decreases rescue analgesic requirements

Determination of some physical and chemical characteristics of soil properties from digital color parameters

Tarım topraklarının fonksiyonlarının sürdürülebilirliği doğru tanımlanmaları, uygun idare edilmeleri ve toprak kalitesinde zaman içerisinde meydana gelen değişimin izlenmesi ile mümkün olabilir. Toprak özelliklerinin klasik yöntemlerle belirlenmeleri oldukça uzun zaman, maliyet ve iş gücü gerektirdiğinden, üreticiler çoğu zaman toprak analizi yaptırmaktan kaçınmaktadır. Bu çalışma, kolaylıkla belirlenebilen sayısal renk parametreleri ile geniş bir tarımsal araziden alınan toprakların bazı fiziksel ve kimyasal özellikleri arasındaki ilişkileri belirlemek ve sayısal renk parametrelerinin toprak özelliklerinin belirlenmesinde kullanılabilirliğini araştırmak için yürütülmüştür. Bu amaçla, yoğun tarımsal üretimin yapıldığı Kazova’da 63 noktadan 0-30 cm derinlikte toprak örnekleri alınmıştır. Toprak örneklerinin renk parametreleri (L, a ve b), kil, kum ve silt içeriği, toprak reaksiyonu (pH), elektriksel iletkenlik (EC), kireç içeriği, organik madde (OM), tarla kapasitesi (TK), solma noktası (SN), agregat stabilitesi (AS), değişebilir katyonlar (Na, K ve Ca), katyon değişim kapasitesi (KDK) ve demir (Fe) konsantrasyonları belirlenmiştir. Toprağın parlaklık (L) ve kırmızılık (a) değerleri ile kil, kireç, AS, SN, TK, KDK, Ca, Na, ve K arasında önemli düzeyde negatif (P<0.01) bir korelasyon tespit edilmiştir. Regresyon analizi sonucunda “L” parametresinin AS, kireç içeriği, KDK, EC ve değişebilir Na’un belirlenmesinde kullanılabileceğini, “a” parametresinin ise toprakların AS’si (R2=0.65), kireç içeriği (R2=0.64), değişebilir Ca (R2=0.58) ve değişebilir K (R2=0.51) kapsamlarının belirlenmesinde kullanılabileceği tespit edilmiştir. İstatistiksel analizler sayısal renk parametrelerinden L ve a’nın Kazova topraklarının bazı toprak özelliklerinin belirlenmelerinde güvenilir bir şekilde kullanılabileceklerini ortaya koymuştur

Şans ve şanssızlık bir arada: İnternal juguler ven kateterizasyonu sonrasında ortaya çıkan kalp tamponadı olgusu

Prior to serious surgical interventions, central venous catheterization (CVC) is used with such purposes as obtaining venous tract and hemodynamic monitorization as well as applying medicine. Although it is rare, serious complications might develop after catheterization. A 72-year-old female patient who was being prepared for coronary bypass surgery was inserted a CVC into right internal jugular vein. Her pericardium was opened upon the bradycardia that developed following the sternotomy, and it was observed that hemopericardium had developed. The tip of the central catheter was seen on vena cava superior and was pushed back by the surgery team. Cannulations were completed quickly and the pump was entered, vena cava was repaired and surgery was completed and then the patient was transferred to intensive care unit. In this article cardiac tamponade, which is a rare but potentially fatal complication associated with CVC, has been presented

Does the Addition of Magnesium Sulfate to Continuous Femoral Block in Knee Arthroplasty Decrease Postoperative Analgesic Requirements?

Objectives: We aimed to determine the effect of magnesium infusion added to continuous femoral nerve block on postoperative opioid consumption and pain scores in total knee arthroplasty. Materials and Methods: Sixty-five American Society of Anesthesiologists I-II patients who were between 18 and 65 years of age, scheduled to undergo elective unilateral knee arthroplasty, were recruited and randomized into groups LM and L. All patients were given 30 mL 0.5% levobupivacaine and 1 mL 1:200.000 adrenaline through a femoral catheter. Arthroplasty was performed under spinal anesthesia using 10 mg hyperbaric bupivacaine. Patients in group LM (n=30) were given 40 mg MgSO4 in normal saline as intravenous infusion over 20 minutes intraoperatively and 12 mg MgSO4 in 240 mL 10 mL/h normal saline over 24 hours postoperatively. Patients in group L (n=30) were given 100 mL normal saline over 20 minutes intraoperatively and 240 mL normal saline 10 mL/h over 24 hours postoperatively. All patients were given 0.125% 10 mL/h levobupivacaine via the femoral catheter and morphine intravenous patient controlled anesthesia for 24 hours postoperatively in addition to acetaminophen 4x1 g and lornoxicam 2x8 mg. Hemodynamic parameters, opioid consumption and pain at rest and movement were recorded at 1, 2, 4, 6, 12, 24, 36 and 48th postoperative hours. Results: The patients in group LM had significantly lower resting visual analogue score (VAS) and verbal pain rating score (VPRS) scores at the postoperative 4, 6, 12 and 24th hours. VAS and VPRS scores during movement were significantly lower in group LM at postoperative 12 and 24th hours. Total opioid consumption was 11.6±4.6 mg in group L and 9.8±4.3 mg in group LM (p=0.032). Conclusion: Multimodal analgesia is necessary when the effects of postoperative pain on morbidity and mortality following total knee arthroplasties are considered and magnesium added to continuous femoral nerve block, intravenous morphine PCA, lornoxicam and acetaminophen provides effective pain control as a part of multimodal analgesia

Hipertiroidili sıçanlarda uzamsal öğrenme performansına cinsiyetin etkisi

Amaç: Gelişimsel dönemdeki hipotiroidi ve hipertiroidi gibi tiroid hormon seviyesi bozukluklarında, beyinde yapısal ve fonksiyonel değişikliklerin olduğu deneysel çalışmalarda gösterilmiştir. Bu değişikliklerin, hipokampüsün önemli rol oynadığı öğrenme ve bellek gibi bilişsel süreçlerde bozulmalara ve nörolojik bozukluklara neden olduğu bilinmektedir. Bu amaçla hipertiroidili erkek ve dişi sıçanlar arasında uzamsal öğrenme performansının araştırılması amaçlanmıştır. Gereç ve Yöntem: Hipertiroidi oluşturmak için erkek ve dişi sıçanlara 21 gün süreyle 0,2 mg/kg dozda L-Tiroksin İp olarak uygulanmıştır. Öğrenme ve bellek performansını değerlendirmek için Morris su tankı testi MST kullanılmıştır. Bulgular: Tekrarlayan ölçümlerle ANOVA testi yapıldığında cinsiyet faktörü platforma olan ortalama uzaklığı anlamlı

Anesthesia and surgical collaboration on an extremely low birth weight infant undergoing ligation of patent ductus arteriosus

Patent ductus arteriosus (PDA) is one of the most common congenital cardiac anomalies in infants. Spontaneous closure of ductus arteriosus takes long time in preterm infants. Early ligation is advised in very low birth weight infants but surgical risk is bigger in older infants. In this presentation we report an anesthetic management in a male preterm infant weighing 600 grams, who underwent PDA ligation. He was born at gestation age of 24 weeks at another hospital, and since his birth he has been observed to have infant respiratory distress syndrome. Hemodynamic deterioration, ventilator dependency, increase in heart murmur, deterioration of the general status and irresponsivity to indomethacine was observed in the patient and the patient was referred to our center for surgical ligation of the PDA. He was transferred to our center in an incubator and with diagnosis of PDA. Bradycardia (50 beats/min) developed during echocardiography in our center and the patient was intubated and transported to the operating room. General anesthesia was induced by fentanyl 5µg, 0.4mg rocuronium and ketamine 0.15 mg intravenously. Anesthesia was maintained with 1.5-2.5 % sevoflurane in 50 % air and oxygen at an inspired concentration titrated to stabilize the vital signs. Because of the extreme low weight of the infant, invasive arterial monitorization and positioning was difficult. The PDA was ligated with titanium clips through left thoracotomy. The postoperative course was uneventful and he was discharged on the 77 th day,1750g of weight