Effects of Spinal and Epidural Anaesthesia on Brain Oxygenation in Lumbar Disc Surgery

Aim: Due to the sympathetic blockage in spinal and epidural anesthesia applied in lumbar disc surgery, hemodynamic effects are different from each other and these effects may cause changes in cerebral oxygenation. In our study, we aimed to compare the effects of spinal and epidural anesthesia on brain oxygenation in patients undergoing elective LDS. Material and Methods: ASA I-II, 50 patients were included in our study. Group S: (n = 25) 15mg(3ml) 5% isobaric bupivacaine intrathecal and Group E: (n = 25) 40mg(8ml) isobaric bupivacaine (5%), 70mg(3.5ml) lidocaine hydrochloride (2%), 75 µg(1.5ml) fentanyl and 3 ml saline were applied to lomber epidural gap. The hemodynamic variables and bilateral regional cerebral oxygen saturation (rScO2) of the patients were recorded with the Near-Infrared Spectroscopy (NIRS) method in the basal, supine position in the 5th, 10th minutes after the central block, 10th minute in the prone position and the patient was placed in the supine position again. Results: In demographic data, hemodynamic parameters and periodic measurements in Group S and Group E, brain right and left hemisphere rScO2 values (Group S: right hemisphere rScO2 (basal) 69.7 ± 5.5, (60 minutes) 64 ± 7; left hemisphere rScO2 (basal) 70.2 ± 5.1, (60 minutes) 64 ± 8, Group E: right hemisphere rScO2 (basal) 71.6 ± 7.2, (60 minutes) 66.6 ± 5; left hemisphere rScO2 (basal) 71.7 ± 7.3, (60 minutes) 66.8 ± 5), no statistically significant difference was found (p> 0.05). Conclusion: Spinal and Epidural anesthesia affect rScO2 in a similar way. Since epidural anesthesia causes a more balanced anesthesia, it can balance cerebral blood volume and oxygenation. This study may be a guide for studies evaluating the effects of spinal and epidural anesthesia on brain oxygenation, especially in geriatric patient groups. Keywords: Lumbar disc surgery, Spinal anaesthesia, Epidural anaesthesia, Near-Infrared Spectroscopy (NIRS), Regional Brain Oxygenation Saturation(rScO2) DOI: 10.7176/JHMN/79-09 Publication date:August 31st 202

Pre-emptive analgesic effect of ultrasonography-guided transversus abdominis plane block performed by adding dexamethasone to bupivacaine

The objective of this study was to evaluate the preemptive analgesic effect of ultrasound-guided transversus abdominis plane block performed with bupivacaine or adding dexamethasone on bupivacaine in laparoscopic cholecystectomy. This retrospective study was conducted on a total of 84 patients who underwent ultrasound-guided TAP block in laparoscopic cholecystectomy. Patients were divided into two groups: Group Bupivacaine (Group B) and Group Bupivacaine+Dexamethasone (Group B+D). Intraoperative hemodynamic changes, intraoperative remifentanil consumption, postoperative visual analog scale scores, tramadol consumption in 24 hours postoperatively, and postoperative first analgesic time were obtained from the records and compared between the groups. There were no statistically significant differences between both groups in terms of intraoperative heart rate, mean arterial pressure, oxygen saturation, and end-tidal CO2 values. Postoperative visual analog scale scores, doses of remifentanil and total tramadol, and time of receiving the first analgesic were similar. Dexamethasone can be added to the bupivacaine for the TAP block without major side effects. Adding dexamethasone to bupivacaine in transverse abdominis plane block performed in laparoscopic cholecystectomy procedures did not create a significant difference in VAS score. We think that the use of dexamethasone does not have an additional analgesic effect. However, our results should be supported by further studies

Incidence of perioperative hypothermia in geriatric patients undergoing elective surgery

Introduction: Perioperative hypothermia (POH) emerges as an important problem in increasing the morbidity and mortality rates of geriatric patients. The purpose of this study was to determine the incidence of POH in geriatric patients undergoing elective surgery. In addition, to determine the risk factors associated with POH in geriatric patients, to contribute to the improvement of temperature monitoring awareness and body temperatures. Methods: Patients over 65 years of age who would undergo elective surgery under sedoanalgesia, general and regional anesthesia were included in the study. Demographic and operative data of the patients, body temperatures at the time of entering the waiting room and exiting the waiting room in the pre-operative period, at the 0th min (min), 60th min, 120th min, 180th min, and 240th min in the intraoperative period and in the post-operative period, and body temperatures at the time of entry and exit from the recovery unit were measured from the tympanic membrane and recorded. Body temperatures below 36°C were accepted as hypothermia. Results: A total of 178 patients, including 75 females (42.1%) and 103 males (57.8%), were included in the study. The mean age of the patients was 73±7.44 years. While the pre-operative mean body temperature of the patients was 36.8±0.46°C, the mean body temperature at the entrance and exit of the postoperative recovery unit was 35.61±0.89°C and 36.11±0.63°C, respectively. In the intraoperative period, the mean value of body temperature at the 0th min was found to be higher than the 60th, 120th, and 180th min, which was statistically significant (p<0.01). A statistically significant difference was found in all time frame comparisons of prolonged operation time and decrease in body temperature (p<0.01). Discussion and Conclusion: In our study, POH emerges as an important problem in geriatric patients. We suggest that routine monitoring of body temperature and warming of patients are necessary to prevent hypothermia in geriatric patients. Especially in operations that are planned to take a long time; improvements should be implemented quickly to avoid hypothermia

An Example Waqfiyya of a Non-Muslim in 18Th Century in Ottoman Period: Edirneli Lumberman Agop’S Waqfiyya

DergiPark: 326043trakyasobedEven though there are many different opinions about how the waqfs has been developed for the first time, it is Islam religion that has encouraged by its signs and teaching of the prophet Muhammed. Also it is possible to say the waqfs were the foundations wich were based according to Islamic law. Ottoman Empire has followed Islamic law as other Islamic countries when they founded the waqf. According to Islam religion the main aim to found a waqf is, to gain Allah’s consent, spiritually near to Allah. Therefore it is not relevant who founds the waqf regardless to their race, religion and nationalitiy. There are many waqfs founded in Ottoman Empire both by müslims and nonMüslims. However non-muslims were not allowed to found a waqf which would help directly to churches, monasteries and synagogues to be repaired or built and to print or distribute Bible and Torah. Nevertheless non-muslims were alloved to give waqf to the poor of the churches, monasteries and synagogues. Therefore non-muslims were able to give charity to their worship places. Apart from this the non-muslims in Ottoman Empire, were allowed to found waqfs for social aim and building fountains, roads, bridges etc. Edirneli Lumberman Agop’s waqf is about fountain, road and poor and ill people of a church in the 18th century. His waqf’s aims were social and community affairs. In Agop’s foundation’s waqfiyya; donated properties, who will work in the fouindation, how much the workers will be paid, where and how much the foundation income will be distributed and the legal side of the foundation etc. are elaborately included. Agop’s foundation gives information about 18th century socio-cultural and economic life in Ottoman EmpireVakıf müessesesinin menşei hakkından birçok görüş olmakla birlikte vakfın, İslam dininin yardımlaşmaya teşvik edici âyet ve hadislerinden ilham alan, hukûkî prensipleri İslam dininin kurallarına göre şekillenen bir İslam müessesesi olduğunu söylemek mümkündür. Osmanlı Devleti de diğer İslam devletlerinde olduğu gibi vakıf sisteminin temelini İslam hukukuna dayandırmıştır. İslam dinine göre vakıf kurmadaki en önemli unsur Allah’a yakın olma yani Allah’ın rızasını kazanma gayesidir. Dolayısıyla vakıf kurmada kişinin dini, mezhebi ve milliyeti önemli değildir. Osmanlı devletinde Müslüman ve gayrimüslimlerin kurduğu birçok vakıf vardır. Ancak gayrimüslimler doğrudan kiliselere, manastırlara veya havralara, bunların tamir ve inşası ile Tevrat ve İncil’in basım ve dağıtımına yönelik vakıflar kuramazlardı. Ancak gayrimüslimler kilise, manastır ve havraların fukarasına harcanmak üzere vakıflarda bulunabilirlerdi. Gayrimüslimler bu şartı kullanmak suretiyle dolaylı yollardan mabetlerine vakıflarda bulunmuşlardır. Bunun dışında Osmanlı devletinde gayrimüslimler sosyal gaye ve beledî hizmetler (çeşme-yol vb.) amacıyla vakıflar kurabilmişlerdir. XVIII. yüzyılda yaşamış olan Edirneli Keresteci Agop’un vakfı, sosyal ve beledî hizmet amaçlı bir vakıf olup, çeşme, yol, kilise fukaraları ve hastaları konu almaktadır. Agop tarafından kurulan vakfın vakfiyesinde vakfedilen mallar, vakıfta kimlerin çalışacağı, çalışan kişilerin ne kadar ücret alacağı, vakıf gelirlerinin nerelere hangi miktarda dağıtılacağı, vakfın hukukî yönü vb. hususlar detaylı bir şekilde yer almaktadır. Edirneli Keresteci Agop’un vakfiyesi bu yönüyle Osmanlı Devleti’nin XVIII. yüzyıl sosyo-kültürel ve ekonomik hayatı hakkında bilgi vermektedi

A Waqfiyya That Belongs To Cevrî Usta

Osmanlı Devleti’ni medeniyet seviyesine taşıyan önemli unsurlardan birisi de hiç şüphesiz vakıf sistemidir. Başta padişah, hânedân üyeleri ve devlet adamları olmak üzere pek çok kimse imkânları ölçüsünde vakıf kurmuştur. Vakıf kuranlardan biri de Sultan II. Mahmud’un şehzâdeliği sırasında onun hayatını kurtararak Osmanlı Devleti’nin geleceğini etkileyen Cevrî Usta’dır. Cevrî Usta, bu olaydan sonra Sultan II. Mahmud’un taltifiyle Hazînedâr Ustalık görevine getirilmiştir. Cevrî Usta bu görevi yürüttüğü 1808 yılından vefat ettiği 1819 yılına kadar geçen kısa süre içinde vakıflar kurmuştur. Cevrî Usta’nın 1231 (1816) tarihli vakfiyesi Tophane (İstanbul) Semti’nde Sefer Kethüda Mahallesi’nde inşa ettirdiği bir çeşmeyi ve bu çeşmenin su yollarını konu almaktadır. Cevrî Usta’nın kurduğu bu vakfın gelir kaynağı ise daha sonra akâra dönüştürülecek bir miktar paradır. Vakfiye, vakfiyede anılan çeşme, bu çeşmenin su yolları, vakfın geliri ve bu gelirlerin nerelere harcanacağı hakkında bilgi vermesi açısından önem taşımaktadır.One of the important elements carrying the Ottoman Empire to a high level of civilization of its era is undoubtedly the waqf system. The Sultans being at the fore front, the dynasty members and dignitaries, many people established waqfs the attributes of which were dependent upon the extent of their wealth. One of the people setting up a charity was Cevrî Usta who saved şehzade Mahmud’s life and affected Ottoman Empire’s future. As a result of his outstanding favour, Cevrî Usta was rewarded by Sultan Mahmud II and appointed as Hazînedâr Usta. While being Hazinedar, Cevrî Usta founded many charities between 1808-1819. She died in 1819. Her waqf contains a fountain and its water ways which was built by Cevrî Usta in 1231 (1816) in Tophane (Istanbul) Sefer Kethuda Street. The source of income of the foundation was amount of money which was later used to buy real estate. The waqfiyya of the foundation provides important information about fountains and their waterways, the revenues and the expenditures of the waqf

Mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and early postoperative anesthesia complications in pediatric patients scheduled for adenoidectomy, tonsillectomy, and adenotonsillectomy

Amaç: Çalışmanın amacı, adenoidektomi, tonsillektomi ve adenotonsillektomi geçiren çocuklarda sık kullanılan sistemik inflamasyon belirteçlerinden ortalama trombosit hacmi (OTH), nötrofil/lenfosit oranı (NLO), trombosit/lenfosit oranı (TLO) ve ortaya çıkan erken postoperatif anestezi komplikasyonlarını incelemektir. Yöntem: Bu çalışmada 2-16 yaş, ASA1 adenoidektomi/adenotonsillektomi operasyonu uygulanan 203 (Grup I) ve farklı nedenlerle opere edilmiş olan 200 (kontrol grubu- Grup II) pediatrik hasta dahil edildi. Hastalara ait yaş ve cinsiyet gibi demografik veriler, erken postoperatif anestezi komplikasyonları, preoperatif beyaz küre sayısı, lenfosit sayısı, trombosit sayısı, hemoglobin ve hematokrit düzeyi NLO, TLO ve OTH parametreleri incelendi. Bulgular: Ortalama yaş, tonsillektomi grubunda kontrol grubuna göre anlamlı olarak daha yüksekti (p=0,001). Her iki grup arasında cinsiyet dağılımı açısından istatistiksel olarak anlamlı fark saptanmadı (p=0,720). Nötrofil sayısı Grup I’de Grup II’ye göre istatistiksel olarak anlamlı derecede yüksekti (p=0,000). Lenfosit sayısı Grup I’de Grup II’ye göre istatistiksel olarak anlamlı derecede düşük saptandı (p=0,011). Nötrofil/lenfosit oranı ve TLO oranları Grup I’de Grup II’ye kıyasla anlamlı derecede yüksek saptandı (p=0,000 ve p=0,002). Ortalama trombosit hacmi açısından gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p>0,05). Erken postoperatif anestezi komplikasyonlarında hipoksi oranlarının Grup I’de Grup II’ye göre yüksek olması istatistiksel olarak anlamlı bulundu (p=0,001). Nötrofil/lenfosit oranı değerinin kesme noktası 0,68 ve TLO değerinin kesme noktası 89,6 olarak belirlendi. Sonuç: Adenoidektomi veya tonsillektomi planlanan pediatrik hasta grubunda preoperatif NLO ve TLO değerleri yüksek bulundu. Nötrofil/lenfosit oranı ve TLO değerleri akut veya kronik inflamatuvar yanıt ve obstrüktif uyku apnesi kliniğinin de eşlik edebildiği bu hasta grubunun tanınarak artan erken postoperatif anestezi komplikasyonları açısından dikkatli bir takip planı oluşturulmasında yol gösterici olabilirObjective: In our study, we aimed to examine the mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (TLR), and early postoperative anesthesia complications, which are frequently used systemic inflammation markers in children who have undergone adenoidectomy, tonsillectomy, and adenotonsillectomy. Method: Our study included 203 (Group I) pediatric patients aged 2–16 years who underwent ASA1 adenoidectomy/adenotonsillectomy operation and 200 (control group-Group II) pediatric patients who were operated for different reasons. Demographic data such as age and gender of the patients, early postoperative anesthesia complications, preoperative white blood cell count, lymphocyte count, platelet count, hemoglobin and hematocrit levels, NLR, TLR, and MPV parameters were examined. Results: The mean age was significantly higher in the tonsillectomy group than in the control group (p=0.001). There was no statistically significant difference between the two groups in terms of gender distribution (p=0.720). The number of neutrophils was statistically significantly higher in Group I compared with Group II (p=0.000). The lymphocyte count was found to be statistically significantly lower in Group I compared with Group II (p=0.011). NLR and TLR rates were found to be significantly higher in Group I compared with Group II (p=0.000 and p=0.002). The difference between the groups in terms of MPV was not statistically significant (p>0.05). It was found statistically significant that the rates of hypoxia in early postoperative anesthesia complications were higher in Group I compared with Group II (p=0.001). The cut-off point of the NLR value was determined as 0.68 and the cut-off point of the TLR value was determined to be 89.6. Conclusion: Preoperative NLR and TLR values were found to be high in the pediatric patient group scheduled for adenoidectomy or tonsillectomy. NLR and TLR values can be a guide in creating a careful follow-up plan in terms of increasing early postoperative anesthesia complications by recognizing this patient group, which can also be accompanied by acute or chronic inflammatory response and obstructive sleep apnea clinic

Comparison of the effects of minimal and high-flow anaesthesia on cerebral perfusion during septorhinoplasty

Objective: The aim of this study was to analyse the effects of minimal-and high-flow anaesthesia on cerebral oxygenation during septorhinoplasty with controlled hypotension using near-infrared spectroscopy. Methods: Eighty patients scheduled for septorhinoplasty under general anaesthesia with controlled hypotension were randomised into two groups: minimal-flow (MF) or high-flow (HF). Both groups received desflurane anaesthesia to maintain bispectral index values at 40%-50% and 0.25-0.5 µg kg?1 min?1 i.v. remifentanyl infusion to maintain mean arterial blood pressure between 55 and 65 mmHg. The MF group received 5 L min?1 of fresh gas flow for the first 10 mins then the gas flow was reduced 0.4 L min?1. The HF group received 2 L min?1 of fresh gas flow throughout. Haemodynamic parameters and cerebral oxygen saturation were measured. Results: There were no statistical differences in demographic variables, duration of anaesthesia and surgery, time to extubation and proceeding to an Aldrete score of 9. There were no statistical differences in haemodynamic parameters, end-tidal CO2 and cerebral oxygen saturation. The amount of desflurane used in the MF group was significantly lower than that used in the HF group (30.5±9.8 mL vs. 48.5±12.1 mL; p<0.05). Conclusion: MF and HF anaesthesia did not lead to any difference in cerebral oxygen saturation in patients undergoing septorhinoplasty with controlled hypotension. MF anaesthesia may thus be used as safely as HF anaesthesia is

Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients

Background: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 ?g/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs

A case of primary hypoparathyroidism presenting with acute kidney injury secondary to rhabdomyolysis

Hypoparathyroidism is the most common cause of symmetric calcification of the basal ganglia. Herein, a case of primary hypoparathyroidism with severe tetany, rhabdomyolysis, and acute kidney injury is presented. A 26-year-old male was admitted to the emergency clinic with leg pain and cramps, nausea, vomiting, and decreased amount of urine. He had been treated for epilepsy for the last 10 years. He was admitted to the emergency department for leg pain, cramping in the hands and legs, and agitation multiple times within the last six months. He was prescribed antidepressant and antipsychotic medications. He had a blood pressure of 150/90 mmHg, diffuse abdominal tenderness, and abdominal muscle rigidity on physical examination. Pathological laboratory findings were as follows: creatinine, 7.5 mg/dL, calcium, 3.7 mg/dL, alanine transaminase, 4349 U/L, aspartate transaminase, 5237 U/L, creatine phosphokinase, 262.000 U/L, and parathyroid hormone, 0 pg/mL.There were bilateral symmetrical calcifications in basal ganglia and the cerebellum on computerized tomography. He was diagnosed as primary hypoparathyroidism and acute kidney injury secondary to severe rhabdomyolysis. Brain calcifications, although rare, should be considered in dealing with patients with neurological symptoms, symmetrical cranial calcifications, and calcium metabolism abnormalities

Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

Objective We aimed to investigate the effects of hypotensive anaesthesia on oxidative stress with serum thiol/disulphide balance in patients undergoing elective septoplasty procedures under general anaesthesia. Methods Seventy-two patients between the ages of 18-60, with a physical condition I -II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anaesthesia, patients were divided into the groups as Hypotensive Anaesthesia (n = 40) and Normotensive Anaesthesia (n = 32). Serum thiol/disulphide levels were measured by the method developed by Erel & Neselioglu. Results The native thiol and total thiol values of both groups measured at the 60th min intraoperatively were significantly lower than the preoperative values (both P 40 years and female gender were found to have a significant effect on dynamic oxidative stress (P = .002 and .001, respectively). Conclusion This pilot study has found that hypotensive anaesthesia had no adverse effect on dynamic thiol/disulphide balance in elective surgeries