Extracavally Malpositioned Central Venous Catheter

WOS:000538941700032PubMed: 32513380[Özet Yok

Chiari’s Network as a Cause of Fetal and Neonatal Pathology

Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in “redundant” Chiari’s network, which may compromise cardiovascular function. This report describes a case with the novel finding of prenatal compromise due to redundant Chiari’s network and an uncommon case with significant postnatal symptoms. In both cases, the symptoms (fetal hydrops and postnatal cyanosis) resolved spontaneously. The variety of cardiovascular pathologies described in the literature is believed to be associated with persistence of a Chiari network. Knowledge about this not always harmless structure is important for perinatologists, pediatricians, and pediatric cardiologists alike. The clinical importance of this rare pathology is that prenatal counseling may anticipate a generally positive outcome and that surgical intervention generally should be avoided

Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery

Background: Levobupivacaine 0.5% and bupivacaine 0.5% were shown to be equally effective in spinal anaesthesia. In previous studies, low dose bupivacaine with an intrathecal opioid was used successfully in urological surgery. The aim of this study was to evaluate the clinical effectiveness and block quality of low dose levobupivacaine, and compare it with low dose bupivacaine when they are combined with fentanyl in transurethral resection of prostate surgery. Methods: Forty nine patients undergoing transurethral prostate surgery were enrolled in this prospective, randomized and double blind study. Patients in levobupivacaine group received 5 mg levobupivacaine + 25 μg fentanyl and bupivacaine group received 5 mg bupivacaine + 25 μg fentanyl. Demographic data, surgery times, hemodynamic parameters, block qualities and patient and surgeon satisfactions were recorded. Results: Demographic data, surgery times and patient and surgeon satisfactions were similar in both groups. Hemodynamic parameters were comparable and stable during the procedure in both groups. Sensory block characteristics were comparable and clinically effective in both groups. While 3 patients in bupivacaine group had Bromage score of 3 at the beginning of the surgery, no patient in levobupivacaine group had this score and this difference was significant (p = 0.042). Bromage scores at the end of the surgery were comparable in both groups. Conclusions: In conclusion, for transurethral prostate surgery 5 mg levobupivacaine with 25 μg fentanyl can provide stable hemodynamic profile, patient and surgeon satisfaction and effective sensorial blockade with less motor blockade in spinal anaesthesia; so it could be used at low doses as a good alternative to bupivacaine

Adding Remifentanil to Propofol and Etomidate in Cardioversion Anesthesia

Objectives: To compare their effects on cardiorespiratoy and recovery parameters and side effects. Methods: This study was performed in The Ministry of Health Ankara Numune Research and Training Hospital, Ankara, Turkey, from January to May 2005. The 40 American Society of Anesthesiology II/III patients were randomized into 2 groups. All patients received remifentanil 0.75 mu g.kg(-1); and then received either etomidate 0.1 mg.kg(-1) (group E, n=20) or propofol 0.5mg.kg(-1) (group P, n=20). Cardiorespiratory data, induction time, recovery parameters, pain scores, number of shocks (NS), total amount of energy used (TE), side effects, and patient/cardiologist satisfaction were recorded. Results: Induction time and recovery parameters were shorter in group P. No differences were seen between the groups in NS and mean TE required. In group P, a statistically significant decrease in mean blood pressure occurred after induction and returned to its baseline levels in 6 minutes. After cardioversion over 2 minutes, the respiratory rates were decreased significantly more in group P when compared with group E. Two patients in group P became apneic and needed assisted ventilation. Pain scores, side effects and patient/cardiologist satisfaction were similar in both groups. No patients in either group had myoclonus. Conclusion: We can induce hypnosis with propofol 0.5 mg.kg(-1) or etomidate 0.1 mg.kg(-1) by adding remifentanil 0.75 mu g.kg(-1) in cardioversion anesthesia. Although recovery parameters were longer in group E, and cardiorespiratory parameters were less stable in group P, their usage with remifentanil was both acceptable for cardioversion anesthesia.Wo

Raquianestesia com dose baixa da combinação de bupivacaína e fentanil: uma boa alternativa para a cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial

JUSTIFICATIVA E OBJETIVOS: Avaliar a eficácia, a duração do bloqueio, a permanência na sala de recuperação pós-anestesia e os efeitos adversos do uso por via intratecal de doses baixas de bupivacaína em combinação com fentanil e compará-los com a dose convencional de prilocaína e fentanil em cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial. MATERIAIS E MÉTODOS: Foram randomicamente designados 60 pacientes para dois grupos: o Grupo B recebeu 4 mg de bupivacaína a 0,5% + 25 µg de fentanil e o Grupo P recebeu 50 mg de prilocaína a 2% + 25 µg de fentanil intratecal. Qualidade e duração dos bloqueios, tempo de permanência na sala de recuperação pós-anestésica e efeitos adversos foram comparados. RESULTADOS: A duração do bloqueio e o tempo de permanência na sala de recuperação pós-anestésica foram menores no Grupo B do que no Grupo P (p < 0,001 para ambos). Hipotensão e bradicardia não foram observadas no Grupo B, que foi significativamente diferente do Grupo P (p = 0,024, p = 0,011, respectivamente). CONCLUSÃO: A administração intratecal de 4 mg de bupivacaína + 25 µg de fentanil forneceu raquianestesia adequada com menos tempo de duração do bloqueio e de permanência na sala de recuperação pós-anestésica com perfil hemodinâmico estável comparado à administração intratecal de 50 mg de prilocaína + 25 µg de fentanil para cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting

WOS: 000488808700001PubMed: 31580707Introduction: Postoperative nausea and vomiting (PONV) are frequent in patients undergoing laparoscopic cholecystectomy. The aim of this study is to evaluate the effectiveness of intraoperative laser acupuncture stimulation of Pericardium 6 (PC6) and Large Intestine 4 (LI4) acupoints combined with antiemetic drug prophylaxis on PONV. Methods: A total of 88 patients, scheduled for laparoscopic cholecystectomy, were assigned into 2 groups. Group I received bilateral laser acupuncture on PC6 and LI4 acupoints after induction of anesthesia and also received antiemetic drug (metoclopramide) prophylaxis. Patients in Group II received only antiemetic drug prophylaxis. Nausea and vomiting frequencies and need for rescue antiemetic drug (ondansetron) were recorded after extubation, at 30th minute at recovery room and at 6th hour at ward. Results: The incidence of nausea and rescue antiemetic drug need was higher at postoperative 6th hour in Group II. Vomiting was not different in groups at any time. Conclusion: Intraoperative laser acupuncture stimulation of PC6 and LI4 acupoints combined with antiemetic drug prophylaxis decreases nausea and rescue antiemetic drug need in late postoperative period in patients undergoing laparoscopic cholecystectomy

Lethal Very Long-Chain Acyl-Coa Dehydrogenase Deficiency with A Novel Mutation

WOS: 000472585000023Very long chain acyl-CoA dehydrogenase deficiency is an autosomal recessive genetic disorder in which the first step in the mitochondrial beta-oxidation of fatty acids for 14-20 carbons is defective. Clinical presentation is heterogeneous ranging from the severe neonatal form presenting with hypo-ketotic hypoglycemia, liver dysfunction and rapidly fatal cardiomyopathy with episodes of hypo-ketotic hypoglycemia in infants. Herein we report a patient with novel homozygous missense mutation c.1391C>A in exon 14 with a severe neonatal onset type who presented with hypoketotic hypoglycemia, cardiomyopathy and hepatomegaly.Çok uzun zincirli açil-KoAdehidrogenaz eksikliği, yağ asitlerinin mitokondriyalbeta-oksidasyonunda ilk basamak olan 14-20 karbonlu yağ asitoksidasyonunun defektif olduğu otozomal resesif geçiş gösteren genetik birhastalıktır. Klinik başvuru şekli hipoketotik hipoglisemi, karaciğer yetmezliği vehızlı seyirli fatal kardiyomyopatinin eşlik ettiği form ile hafif hipoketotikhipoliseminin eşlik ettiği infant form arasında heterojendir. Burada,hipoketotik hipoglisemi, hepatomegali ve kardiyomyopati ile başvuran, exon14’de c.1391C>A yeni tanımlanmış homozigot missense mutasyon saptanan,ciddi yenidoğan başlangıçlı bir çok uzun zincirli açil-KoA eksikliği vakasısunulmaktadır