Yüksek riskli hastada karotis endarterektomi cerrahisi için ultrason eşliğinde karotis kılıf bloğu ve literatür taraması

Carotid endarterectomy (CEA) surgery is generally performed for patients who under the risk of ischemic cerebral stroke due to the critical obstruction of the carotid artery. Ischemic complications may occur during the surgery. So, the awakeness of the patient is very important during the surgery. Regional anesthesia techniques may be performed instead of general anesthesia for shunt placement during CEA surgery. Herein, we aimed to share our successful US-guided carotid sheath block experience for anesthesia management during CEA surgery.Karotid endarterektomi cerrahisi genellikle karotis arterin tıkanıklığından dolayı iskemik serebro-vaskuler olay riski altındaki hastalara uygulanır. Cerrahi sırasında iskemik komplikasyonlar gelişebilir. Bu nedenle cerrahi sırasında hastanın uyanıklığı çok önemlidir. Cerrahi sırasında şant yerleşimi için genel anestezi yerine rejyonal anestezi teknikleri tercih edilebilir. Bu makalemizde karotid endarterektomi cerrahisi sırasında anestezi yönetimi için ultrason eşliğinde uyguladığımız başarılı karotis kılıf bloğu deneyimimizi paylaşmayı amaçladık

Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: A randomized, blinded study

Background: Adductor canal block (ACB) provides effective analgesia management after arthroscopic knee surgery. However, there is insufficient data about performing ACB before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB when it is performed before and after thigh tourniquet and evaluate motor weakness. Methods: ACB was performed before the tourniquet inflation in the PreT group, it was performed after the inflation of the tourniquet in the PostT group. In the PO group, ACB was performed at the end of surgery after disinflation of the tourniquet. Results: There were no statistical differences between the groups in terms of demographic data. Opioid consumption showed no statistically significant differences (for total consumption; p = 0.5). The amount of rescue analgesia administered and patient satisfaction were also not significantly different between groups. There was no significant difference in terms of static and dynamic VAS scores between groups (for 24 hours; p = 0.3, p = 0.2 respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and in the PO group (only one patient) (p = 0.005). Conclusions: Using a tourniquet before or after ACB may not result in any differences in terms of analgesia; however, applying a tourniquet immediately after ACB may lead to muscle weakness

Sequential Application of Oxygen Therapy via High-flow Nasal Cannula and Non-invasive Ventilation in COVID-19 Patients with Acute Respiratory Failure in the Intensive Care Unit: A Prospective, Observational Study

Objective:Non-invasive mechanical ventilation (NIV) and high-flow nasal oxygen therapy (HFNO) are the most frequently used methods for treating hypoxemia in those diagnosed with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU). In this prospective study, we compared the effects of these two treatment modalities applied alternately in the same patient.Materials and Methods:Standard oxygen therapy (SOT) was administered for 1 hour to patients hospitalized in the ICU with a diagnosis of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) due to COVID-19. HFNO and NIV were applied alternately to patients who met the inclusion criteria, and we evaluated the effects of HFNO and NIV applied to the same patient.Results:Thirty of forty-five patients admitted to the ICU for COVID-19 ARDS met the inclusion criteria for the study. According to the first and second arterial blood gas (ABG) values, the PaO2/FiO2 (P/F) ratio was significantly higher during NIV compared to both baseline and HFNO. In addition, the ROX index was significantly higher during NIV than HFNO, and SpO2 in NIV increased significantly compared with the baseline value. In both methods, patient satisfaction according to the visual analog scale was better than that of SOT. Eighty percent (24/30) of the patients were orotracheally intubated; 13 patients were transferred to the ward (43.3%), 2 patients were discharged home (6.7%), and 15 patients died (50%).Conclusion:Starting respiratory support with HFNO and/or NIV rather than SOT is more effective in improving oxygenation in patients with AHRF and ARDS due to COVID-19 and other causes. NIV is more effective than HFNO in increasing the SpO2 and P/F ratio

Complex regional pain syndrome type I: efficacy of stellate ganglion blockade

PubMed ID: 19888550Background: This study was performed to evaluate the treatment of complex regional pain syndrome (CRPS) type I with stellate ganglion blockade. Materials and methods: We performed three blockades at weekly intervals in 22 patients with CRPS type I in one hand. The patients were divided into two groups depending on the time between symptom onset and treatment initiation. Group 1and 2 patients had short and long symptom-onset-to-treatment intervals, respectively. Pain intensity, using a visual analog score (VAS), and range of motion (ROM) for the wrist joint were assessed before and 2 weeks after treatment and were compared using nonparametric statistical analysis. Results: Treatment produced a statistically significant difference in wrist ROM for all patients (P < 0.001). VAS values showed an overall decrease from 8 ± 1 to 1 ± 1 following treatment, and there was a significant difference in VAS value between groups 1 and 2 (P < 0.05). Conclusions: We concluded that stellate ganglion blockade successfully decreased VAS and increased ROM of wrist joints in patients with CRPS type I. Further, the duration between symptom onset and therapy initiation was a major factor affecting blockade success. © 2009 Springer-Verlag

Effects of inadvertent perioperative mypothermia on metabolic and inflammatory mediators

Objective: The aim of the present study was to investigate the effects of perioperative undesirable hypothermia on inflammatory (interleukin (IL)-8, IL-10, IL-18, IL-23 and pentraxin (PTX)-3) and metabolic responses (cortisol and insulin) and recovery time.Methods: A total of 60 patients between the ages of 18 and 65 years who were in the lumbar stabilisation operation were included in the study. In this prospective, randomised controlled study, two groups were constituted as with warmed (Group N) and not warmed (Group C) patients before and during the operation. Diuresis, blood loss, body temperature and side effects were recorded with IL-8, IL-10, IL-18, IL-23, PTX-3, cortisol and insulin levels.Results: Perioperative diuresis was significantly higher in Group C. Aldrete score was significantly higher in Group N with less shivering and vom-iting in the postoperative period. IL-10, PTX-3 and cortisol levels were found to be significantly higher in Group C in the first postoperative hour. PTX-3 and cortisol were found to be significantly higher in Group C after 24 h of the operation. Insulin was significantly higher in Group N. In 72 h, IL-8 in Group N and cortisol level in Group C were significantly higher.Conclusion: Positive effects of heating the patients in the perioperative period on haemorrhage, diuresis, complications and recovery time were observed in our study. In addition, maintenance of normothermia appeared to modulate the biomarkers that indicate the inflammatory and met-abolic responses

Ultrasound-guided single-shot preemptive erector spinae plane block for postoperative pain management

WOS: 000463691000052PubMed ID: 30477888Thoracotomy is a procedure that causes severe pain as a result of muscle incision, retraction of the ribs, and damage to the intercostal nerves. Postoperative analgesia management is very important for respiratory functions, and successful pain management reduces postoperative complications and length of hospital stay.1 A variety of procedures have been described for the first-step treatment of thoracic analgesia, including intercostal nerve blocks, thoracic epidural analgesia (TEA), and thoracic paravertebral blocks.2 However, their usage is limited because of complications and failure rates (up to 15% in TEA).3 The other option for analgesia is intravenous opioid medications that can be used in combination with nonsterioidal anti-inflammatory drugs.4 Adverse effects such as sedation, hypoventilation, nausea, and vomiting can occur, especially in systemic high opioid doses used for severe pain such as after thoracotomy

Endoskopik girişimlerde sedasyon

Today endoscopic examination is the best diagnostic method for the visualization of the upper and lower gastrointestinal system. In many countries endoscopic interventions have become better tolerated and more comfortable using sedoanalgesia and because it causes amnesia in patients repeated examinations are easier. Sedation during endoscopy is a conscious sedation that provides patient cooperation to verbal and and tactile stimuli. In gastroenterology sedation is applied in diagnostic and therapeutic endoscopic interventions for esophagus, stomach, duodenum and colon and during cholangiopancreaticography. The procedure of gastrointestinal endoscopy contains multiple standardized diagnostic and therapeutic procedures and has provided a perfect source for IV sedation studies. In gastrointestinal endoscopy sedation is applied safely by endoscopists that are experienced in sedation and analgesics. Especially in the pediatric group, in the presence of cardiac and pulmonary diseases and prolonged duration of the procedure, that the sedation is applied by anesthetists using standard maniterization is most appropriate

ERAS and geriatric patient

Geriatrik hastalar genellikle perioperatif dönemde daha genç hastalara göre farklı bir bakım seviyesi gerektirir. Postoperatif komplikasyonlar, fonksiyonel düşüş, bağımsızlık kaybı ve diğer istenmeyen sonuçların gelişmesine eğilimlidirler. ERAS (Enhanced recovery after surgery) perioperatif yönetimi optimize etmeyi amaçlayan multimodal bir yaklaşımdır. ERAS, organ disfonksiyonunu ve cerrahi stres yanıtını azaltmak için preoperatif, intraoperatif ve postoperatif bakımdaki değişikliklerin bir bütünüdür ERAS protokollerinin uygulandığı geriatrik hastaların peroperatif ve postoperatif bakımlarının ve taburculuk sürelerinin uygulanmayanlara göre daha iyi olduğu gözardı edilmemelidir.Geriatric patients often require a different level of care in the perioperative period from younger patients. They are prone to the development of postoperative complications, functional decline, loss of independence, and other undesirable outcomes. ERAS (Enhanced Recovery After Surgery) is a multimodal approach which aims to optimize perioperative management. ERAS is a combination of changes in preoperative, intraoperative and postoperative care to reduce organ dysfunction and surgical stress response. It should not be overlooked that peroperative and postoperative care and discharge time of geriatric patients for whom ERAS protocols have been applied are more improved than those who lacked such an opportunity

Subcutaneous effusion resulting from an epidural catheter fragment

WOS: 000236251900017PubMed: 16476696The breakage of an epidural catheter within a patient is uncommon, but troublesome, complication of epidural block, and its cause is rarely discovered. In this case report, our aim was to present an effusion between s.c. tissue and fascia in the lumbar region because of a broken fragment of epidural catheter which was unnoticed during its removal