JOURNAL OF CLINICAL ANESTHESIA

Serotonin syndrome occurs with selective serotonin reuptake inhibitors, opioids, and other serotonergic agents. We describe a possible serotonin syndrome related to intrathecal fentanyl in a patient taking multiple drugs and substances such as ergot alkaloids, marijuana, methylenedioxy-N-methylamphetamine, and ephedrine. (c) 2008 Elsevier Inc. All rights reserved

Comparison of effects of preoperatively administered lornoxicam and tenoxicam on morphine consumption after laparoscopic cholecystectomy

Background and objective: The efficacy, tolerability and the morphine-sparing effects of lornoxicam were compared with those of tenoxicam when used preoperatively in patients undergoing laparoscopic cholecystectomy. Methods: In this prospective, double-blind study, 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomized equally to receive intravenous tenoxicam 40 mg (Group T) or lornoxicam 16 mg (Group L), preemptively. Three patients withdrew from the study, so 57 patients were included in the analysis. In the postoperative period, the first morphine demand times, pain scores, side-effects and cumulative morphine consumptions were evaluated during the first 24h. Results: The patient characteristics data and the duration of surgery were similar between two groups, except for body weights (P = 0.002). The first morphine demand time was significantly longer in Group L (P = 0.037), but the pain levels did not differ. The mean pain scores were higher in Group T in the 15 min (P = 0.036), 1 h (P = 0.020), 2 h (P = 0.001) and 4 h (P = 0.0042) after extubation. A statistically significant difference between two groups was found in calculated cumulative morphine consumptions per kilogram in the 15 min (P = 0.037), 30 min (P = 0.016), and 1 h (P = 0.004) and 2 h (P = 0.013) between two groups. There was no difference in the severity of nausea but 13 patients in Group T and five patients in Group L had vomiting (P = 0.018). Patient satisfaction was similar in the two groups. Conclusions: Preoperatively administered lornoxicam 16 mg significantly prolonged the first morphine demand time, reduced postoperative morphine consumption during the first 4 h and caused significantly fewer adverse effects when compared with tenoxicam after laparoscopic cholecystectomy

Evaluation of education, attitude, and practice of the Turkish anesthesiologists in regional block techniques

Background: The demand for regional blocks from both patients and surgeons has significantly increased in anesthesia practice during the last 30 years. Although the studies show that the complications are rare, regional blocks still have serious difficulties which can be prevented by training programs. Objectives: The purpose of this study was to determine the factors affecting the educational methods, attitude and practice of the Turkish anesthesiologists in regional blocks during and following residency programs. Patients and Methods: Anesthesiologists were asked to answer a questionnaire. Educational proficiency was determined by at least 50 spinal, 50 epidural and 50 peripheral block applications during residency. Specialists were asked for the numbers of spinal, epidural and peripheral blocks (PBs) they applied in 2009. The mean and median values were calculated. Results: One hundred and eighty-eight anesthesiologists (84.3 %) agreed to participate in the study. While all participants had made their first attempts in neuraxial blocks (NBs) when they were residents, this ratio was detected as 96.8% for PBs. All participants learned neuraxial and PBs on patients in the operating theater. Education proficiency ratios for spinal, epidural and PBs were 98.1 %, 92.5 % and 62.3 %, respectively. Age, perception of adequate training, nerve block rotation, adequate application in education, following innovations were the factors which significantly affected the number of PBs in practice according to univariate analysis. The participants who consider their applications on NBs were adequate (P = 0.029) and the ones working in state or private hospitals (P = 0.017), applied NBs significantly above the median number. Conclusions: Anesthesiologists had adequate education and practice of NB applications but a significant proportion of participants (51.8%) lacked both in PBs applications. We believe that NBs are more easily learned than PBs during residency training program. © 2013 Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM); Published by Kowsar Corp

Effects of blood products on nosocomial infections in liver transplant recipients

PubMed ID: 23901878Objectives: Infection is the most severe complication after an organ transplant. Blood cell transfusion is an independent risk factor for adverse events, including infection in the recipient. This study sought to evaluate the effect of blood product transfusions on nosocomial infections in liver transplant patients. Materials and Methods: Patients who underwent a liver transplant at our hospital between 2003 and 2010 were recruited for this study. Exclusion criteria were incomplete records, patients who were hospitalized for more than 48 hours during the 4 weeks before transplant, and pediatric transplants. Incidence of nosocomial infections, which were defined as infections occurring within 30 days after transplant was the primary endpoint. Results: The incidence of nosocomial infections was 28.7%. The number of transfusions of packed red blood cells and fresh frozen plasma was significantly higher in patients with nosocomial infection compared with patients without nosocomial infection (P =.018 and P =.039). Blood products dose-dependently contributed to nosocomial infections. Transfusions of ? 7.5 units of red blood cells (odds ratio: 2.8) or ? 12.5 units of fresh frozen plasma (odds ratio: 3.27) were associated with nosocomial infections (P =.042 and P =.015). The infection-related mortality rate was 10.3%. Conclusions: Blood product transfusions are associated with an increased rate of nosocomial infections, which contributes to higher morbidity and mortality. © Başkent University 2013. Printed in Turkey. All Rights Reserved

Comparison of Patients With and Without Anterior Sector Venous Drainage in Right Lobe Liver Transplantation From Live Donors in Terms of Complications, Rejections, and Graft Survival: Single-Center Experience

Aim. The issue of performing an anastomosis of the anterior sector veins to the vena cava in living donor liver transplantation is still controversial. We aimed to research whether there was any difference in terms of complications, rejections, and graft survival between patients with and without anterior sector venous drainage to the vena cava

Anesthesia-related complications in living liver donors: The experience from one center and the reporting of one death

Living donor liver transplantation has become an alternative therapy for patients with end-stage liver disease. Donors are healthy individuals and donor safety is the primary concern. The objective of this study was to evaluate the anesthetic complications and outcomes for our donor cases; we report one death. The charts of the patients who underwent donor hepatectomy from February 1997 to June 2007 were retrospectively reviewed. Right hepatectomy (resection of segments 5-8) was done in 101 donors, left lobectomy (resection of segments 2-3) in 11 donors, and left hepatectomy (resection of segments 2-4) in one donor. Minor anesthetic complications were shoulder pain, pruritus and urinary retention related to epidural morphine, and major morbidity included central venous catheter-induced thrombosis of the brachial and subclavian vein, neuropraxia, foot drop and prolonged postdural puncture headache. One of 113 donors died from pulmonary embolism on the 11th postoperative day. This procedure has some major risks related to anesthesia and surgery. Although careful attention will lower complication rate, we have to keep in mind that the risks of donor surgery will not be completely eliminated

Comparison of the haemodynamic effects of interscalene block combined with general anaesthesia and interscalene block alone for shoulder surgery

Interscalene brachial. plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. Heart rate and oxygen saturation remained stable throughout the study in both groups. Mean arterial pressure was significantly decreased when the patient moved into the sitting position in those given combined anaesthesia, whereas in those given ISB alone mean arterial pressure did not change significantly. Neither pain scores nor patient satisfaction scores differed significantly between the two groups. All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results

Comparison of the Haemodynamic Effects of Interscalene Block Combined with General Anaesthesia and Interscalene Block Alone for Shoulder Surgery

Interscalene brachial. plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. Heart rate and oxygen saturation remained stable throughout the study in both groups. Mean arterial pressure was significantly decreased when the patient moved into the sitting position in those given combined anaesthesia, whereas in those given ISB alone mean arterial pressure did not change significantly. Neither pain scores nor patient satisfaction scores differed significantly between the two groups. All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results

Risk Factors for Early Bacterial Infections in Liver Transplantation

Objective. Our aim was to determine perioperative risk factors for early bacterial infection after liver transplantation