Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade

Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block

Anesthetic Approach for a Patient with Jeune Syndrome

Jeune syndrome (JS) is an autosomal recessive disease also known as asphyxiating thoracic dystrophy. A narrow bell-shaped thoracic wall and short extremities are the most typical features of the syndrome. Prognosis in JS depends on the severity of the pulmonary hypoplasia caused by the chest wall deformity. Most patient deaths are due to respiratory problems at early ages. Herein, we report a case of JS patient, who was scheduled for femoral extension under general anesthesia. The severity of respiratory problems in JS patients is thought to diminish with age. Our case supported this theory, and we managed the anesthetic process uneventfully

The relationship between neutrophil to lymphocyte ratio and postoperative pain in total knee and hip arthroplasty

Background and objectives: Neutrophil to lymphocyte ratio is a simple, cost-effective and easily applicable inflammation indicator that is being used frequently in mortality, morbidity and prognosis studies in the recent years. We evaluated the relationship between neutrophil to lymphocyte ratio and postoperative pain in patients undergoing total hip arthroplasty and total knee arthroplasty. Material and methods: We included 101 patients who preferred spinal anesthesia and intravenous patient-controlled analgesia in accordance and divided them into two groups, total hip arthroplasty and total knee arthroplasty. We recorded demographic information, duration of operation, length of hospital stay, analgesics consumption, neutrophil to lymphocyte ratio results and postoperative pain using Visual Analog Scale. Results: The morphine consumption of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 7.38 mg, 7.80 mg; 8th hour: 12.19 mg, 13.29 mg; 12th hour: 16.94 mg, 19.18 mg; 24th hour: 25.97 mg, 27.98 mg; 48th hour: 36.38 mg, 39.59 mg. The Visual Analog Scale scores of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 4.10, 4.51; 8th hour: 3.02, 3.43; 12th hour: 2.29, 2.55; 24th hour: 1.90, 1.87; 48th hour: 1.08, 1.13. In group total hip arthroplasty, we found a statistically significant association between postoperative neutrophil to lymphocyte ratio and the Visual Analog Scale values on the 48th hour in a positive direction (r = 0.311; P = 0.031; P < 0.05). Conclusion: Neutrophil to lymphocyte ratio can be accepted as a relatively objective method for the diagnosis of postoperative pain. Resumo: Justificativa e objetivos: A proporção entre neutrófilo/linfócito é um indicador de inflamação simples, custo-efetivo e de fácil aplicação que vem sendo utilizado com frequência em estudos de mortalidade, morbidade e prognóstico nos últimos anos. Avaliamos a relação entre a proporção neutrófilo/linfócito e a dor pós-operatória em pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho. Material e métodos: No total, 101 pacientes que preferiram a raquianestesia e a analgesia venosa controlada pelo paciente foram incluídos e divididos em dois grupos neste estudo: artroplastia total de quadril e artroplastia total de joelho. Os dados demográficos e os tempos de operação, internação hospitalar e consumo de analgésicos e os resultados da proporção neutrófilo/linfócito e da dor pós-operatória foram registrados usando uma escala visual analógica. Resultados: O consumo de morfina dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 45 foi de, respectivamente: 7,38 mg e 7,80 mg; 12,19 mg e 13,29 mg; 16,94 mg e 19,18 mg; 25,97 mg e 27,98 mg; 36,38 mg e 39,59 mg. Os escores obtidos na escala visual analógica dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 48 foram, respectivamente, os seguintes: 4,10 e 4,51; 3,02 e 3,43; 2,29 e 2,55; 1,90 e 1,87; 1,08 e 1,13. Na artroplastia total do quadril, uma associação estatisticamente significativa foi encontrada entre a proporção neutrófilo/linfócito no pós-operatório e os valores da escala visual analógica na 48ª hora em uma direção positiva (r = 0,311; p = 0,031; p < 0,05). Conclusão: A proporção neutrófilo/linfócito pode ser aceita como um método relativamente objetivo para o diagnóstico da dor pós-operatória. Keywords: Neutrophil to lymphocyte ratio, Postoperative pain, Lower extremity arthroplasty, Total knee arthroplasty, Total hip arthroplasty, Palavras-chave: Relação neutrófilo/linfócito, Dor pós-operatória, Artroplastia de extremidade inferior, Artroplastia total de joelho, Artroplastia total de quadri

Brachial Plexus Injury Associated With Subclavian Vein Cannulation: A Case Report.

We documented brachial plexus injury by electromyography and magnetic resonance imaging secondary to needle sticks for central line insertion. This type of complication is rare in the literature, as few case reports exist. Brachial plexus injury can happen because of anatomic variations. Nevertheless, multiple attempts or introducer needle rotations should be avoided during subclavian vein catheterization. Pain that emerges in the ipsilateral arm after subclavian catheter placement should be taken into serious consideration. It is important to identify the cause of pain as soon as possible so that the correct treatment can be efficiently provided. Use of an ultrasound-guided catheterization may be a better choice for preventing complications

Postoperative analgesia for arthroscopic rotator cuff surgery: a comparison between subacromial and interscalene levobupivacaine

Objectives: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery

Two-year experience with cell salvage in total hip arthroplasty

ABSTRACT BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53 ± 111.88 mL) than that in the control group (170.14 ± 116.79 mL; p < 0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37 ± 193.33 mL) than the control group (152.22 ± 208.37 mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n = 29; 43.2%) was also significantly lower than control group (n = 56; 73.6%; p < 0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible

Postoperative Analgesia for Arthroscopic Rotator Cuff Surgery: A Comparison Between Subacromial and Interscalene Levobupivacaine

Objectives: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery

Postoperative analgesia after arthroscopic shoulder surgery: A comparison between single-shot interscalene block and single-shot supraclavicular block.

Objectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks

SINGLE-CENTERED QUESTIONNAIRE STUDY: PROFESSIONAL ASSESSMENT AMONGST ANESTHESIOLOGY RESIDENTS

Objective: Anesthesiology is a special branch which requires different practice places, necessity for collaboration with various teams and frequently taking fast and right decisions. In this respect, stress is frequently experienced. It has been reported that unmanaged stress has become a worldwide concern for the anesthesiologists. In this study, we aimed to investigate the reasons for anesthesiology residents' professional satisfaction and stress during their training period and we have tried to identify the qualifications which a good anesthesiologist should have

THE COMPARISON OF LIDOCAINE WITH LIDOCAINE AND MAGNESIUM COMBINATION FOR REGIONAL INTRAVENOUS ANESTHESIA

Objectives: RIVA (Regional Intravenous Anesthesia) is frequently preferred during distal upper extremity operations (hand, wrist and forearm) compared to general anesthesia because of the following reasons: lower operational cost, simplicity, surgical operation environment stability, quick implementation and faster recovery time. Deeper anesthesia, prolonged effective time, hemodynamic stabilization, reduced intraoperative complications and longer postoperative analgesia are aimed by using adjunct drugs. Main objective of our study is to investigate the effectiveness of magnesium as an adjunct in RIVA