Neurolysis for Treatment of Infraorbital Neuropathy

Two patients, a woman aged 34 and a man aged 56, were included in the study. They reported the existence of pain in the areas of the infraorbital nerve, which, over the last four to five years, aggravated by the stimuli of eating, laughing, and being touched. 2 ml of 0.5% lidocaine was administered to these patients six times percutaneously. It was observed that the ease of pain lasted until the local anesthesia lost its effect, and the pain resumed its original intensity. Neurolysis with 0.5 ml of 50% ethanol was applied to the infraorbital nerve. This procedure was applied to the first patient twice and three times to the second. Thereafter, the patients were cured completely. For the treatment of idiopathic chronic infraorbital neuropathy, the neurolysis of the infraorbital nerve using 50% ethanol could be considered as an effective treatment alternative

The Use of Linezolid in the Treatment of Ventilator-Associated Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus

Introduction: Hospital-acquired pneumonia, especially ventilator-associated pneumonia (VAP), caused by methicillin resistant Staphylococcus aureus (MRSA) is considered among the important nosocomial infections. In the current guidelines, linezolid or vancomycin treatment is recommended in the empirical treatment of VAP when suspected from MRSA. Patients and Methods: In our retrospective study, we analyzed the patients that have been applied mechanical ventilation in the anesthesiology and reanimation, neurology, and neurosurgery intensive care units between October 2005 and January 2008. The patients were diagnosed as VAP evidenced by MRSA isolation from the endotracheal aspirate cultures. Results: Among the 32 patients, 3 of them died in the first 24 hours, and 2 of them succumbed to underlying diseases before the completion of treatment. Clinical improvement was observed in 48-72 hours in all of the 27 patients who completed 14-day linezolid treatment. Microbiological eradication was the case in 23 of 25 patients according to the endotracheal culture results obtained in the 48- 72 hours of treatment. When all the patients are taken into consideration, clinical success was the result in 84.4% of the patients, and microbiological eradication was 71.8%. Conclusion: In Turkey, the data about clinical experience of linezolid treatment in MRSA-VAP cases is very limited, and our study provides some data in this field. Our results suggest that linezolid is effective in the treatment of MRSA-VAP cases due to its high clinical and microbiological effectiveness, however, these observations need to be supported with well planned controlled clinical studies

Target-controlled infusion of remifentanil with propofol or desflurane under bispectral index guidance: quality of anesthesia and recovery profile

Background: Our objective was to examine the clinical properties of two anesthetic regimens, propofol target-controlled infusion (TCI), or desflurane using remifentanil TCI under bispectral index (BIS) guidance during ear, nose, and throat (ENT) procedures. Methods: Forty consenting patients who scheduled for ENT procedures were prospectively studied and were included in one of the two groups: TCI group or desflurane (DES) group. General anesthesia was induced with 3 ng mL -1 and 4 μg mL -1 effect site concentrations (Ce) of remifentanil and propofol, respectively, with TCI system. After intubation, while propofol infusion was continued in the TCI group, it was ceased in the DES group and desflurane with an initial delivered fraction of 6% was administered. The Ce of propofol infusion and inspired fraction of desflurane was adjusted in order to keep BIS as 50 ± 10. Results: General mean values of mean arterial pressure (MAP) and heart rate (HR) for the TCI group was significantly higher than DES group (89.3 mmHg and 72.4 bpm vs. 77.1 mmHg and 69.5 bpm). Early emergence from anesthesia did not significantly differ between the groups. The rate of patients′ Aldrete score (ARS) to reach 10 was found to be 100% at the 15 th min in both groups. Conclusions: Bispectral index guided combinations of remifentanil TCI either with propofol TCI or desflurane anesthetic regimens are both suitable for patients undergoing ENT surgery. The lower blood pressure in the remifentanil TCI with desflurane anesthetic regimens may be a significant advantage