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Objective: We compared the air or saline insufflated endotracheal tube (ETT) cuff pressures and their effects on postoperative respiratory complications in gynecological laparoscopic surgeries in the Trendelenburg position (TP). Patients and Methods: This prospective study was carried out on a total of 60 patients, whose ages ranged from 18 to 65 years and who were classified by the American Society of Anesthesiologists (ASA) as I-III. They were scheduled for gynecological laparoscopic surgery in TP. Patients included in the study were randomly divided into two groups as the saline (Group S, n=30) and air (Group A, n=30) groups. ETT cuff pressures and peak airway pressures were recorded immediately after intubation and at 10-minute intervals during the intraoperative period. Results: The cuff pressure and maximum cuff pressure values in the saline group were significantly lower than in the air group in the 50-minute (p

One-lung ventilation may cause negative changes in the oxygenation of cerebral tissue which results in post-operative cognitive dysfunction. We compared the potential effects of total intravenous anesthesia and inhalation general anesthesia techniques on cerebral tissue oxygenation.In this prospective double-blind trial, patients whose standard anesthesia induction was done were randomly divided into two groups as group total intravenous anesthesia using propofol (Group T, n = 30) and group inhalation general anesthesia using sevoflurane (Group I, n = 30) based on anesthesia maintenance. The intraoperative cerebral oxygen saturation and pre-post-operative mini-mental status test scores of the patients were monitored and recorded.Baseline characteristics were similar between the two groups. The decrease of cerebral oxygen saturation more than 20% in total intravenous anesthesia group was significantly higher than inhalation group (p0.05). In both groups, the mini-mental status test values at the post-operative 3Inhalation general anesthesia provided better cerebral tissue oxygenation in thoracic surgery with one-lung ventilation compared to total intravenous anesthesia. However, there was no significant correlation between the presence of desaturation and post-operative cognitive dysfunction.La ventilación unipulmonar puede provocar cambios negativos en la oxigenación del tejido cerebral que se traduce en una disfunción cognitiva postoperatoria. Comparamos los efectos potenciales de la anestesia total intravenosa y las técnicas de anestesia general por inhalación en relación con la oxigenación del tejido cerebral.En este ensayo prospectivo doble ciego, los pacientes en los que se realizó una inducción estándar de anestesia se dividieron aleatoriamente en dos grupos: grupo de anestesia intravenosa total con propofol (Grupo T, n = 30) y grupo de anestesia general por inhalación con sevoflurano (Grupo I, n = 30) basados en el mantenimiento de la anestesia. Se controlaron y registraron la saturación de oxígeno cerebral intraoperatoria y las valoraciones de la miniprueba de estado mental preoperatoria de los pacientes.Las características de base fueron similares entre los dos grupos. La disminución de la saturación de oxígeno cerebral de más del 20% en el grupo de anestesia intravenosa total fue significativamente mayor que en el grupo de inhalación (p0.05). En ambos grupos, los valores de la mini prueba del estado mental al cabo de la 3La anestesia general por inhalación facilitó una mejor oxigenación del tejido cerebral en la cirugía torácica con ventilación unipulmonar en comparación con la anestesia intravenosa total. Sin embargo, no hubo una correlación significativa entre la presencia de desaturación y la disfunción cognitiva posoperatoria.

Craniosynostosis (CS) is associated with increased intracranial pressure (ICP) and this elevation is of vital importance in children. Bedside optic nerve sheath diameter (ONSD) on ocular ultrasonography has begun to be increasingly used in recently. A patient who was diagnosed with CS, standard anesthesia monitoring and anesthesia were performed. Before and after the surgery, ONSD measurement was performed to follow the changes in ICP. ONSD measurement can be used as an effective, non-invasive, repeated, and easy-to-apply method to monitor the changes in the ICP in pediatric patients with CS who are planned to undergo craniectomy.La craneosinostosis (SC) se asocia con un aumento de la presión intracraneal (PIC) y esta elevación es de vital importancia en los niños. El diámetro de la vaina del nervio óptico al lado de la cama (ONSD) en la ecografía ocular ha comenzado a usarse cada vez más recientemente. A un paciente al que se le diagnosticó SC, se le realizó seguimiento anestésico estándar y anestesia. Antes y después de la cirugía, se realizó la medición ONSD para seguir los cambios en la PIC. La medición ONSD se puede utilizar como un método eficaz, no invasivo, repetido y fácil de aplicar para monitorear los cambios en la PIC en pacientes pediátricos con SC que se planea someter a craniectomía.

Background Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. Methods This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. Results Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. Conclusion Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations.Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kgEdema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p 0.017).We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.

Objective: The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cut-off value for TT or TP. Materials and Methods: Patients who underwent elective orthopedic lower-extremity surgery under general anesthesia were randomized into 2 groups: group A (inflation with a pneumatic TP of systolic blood pressure + 100 mm Hg; n = 30) and group B (inflation using the arterial occlusion pressure formula; n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic-nerve sheath diameter (ONSD) and end-tidal CO2 values were taken at specific time points (15 min before the induction of anesthesia, just before, and 5, 10, and 15 min after the tourniquet was deflated). Results: The initial and maximum TPs were found to be significantly higher in group A than in group B. At 5 min after the tourniquet deflation, there was a significant positive correlation between TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥5 mm was taken as a standard criterion, the safe cut-off value for the optimal TT was found to be < 67.5 min (sensitivity 87% and specificity 59.5%). Conclusion: The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. TT of ≥67.5 min was found to be the cut-off value and is considered the starting point of the increase in ICP after tourniquet deflation.

Aim In this study, we aimed to compare the effects of standard verbal information in the preoperative period and the information by visual expression and physical applications in the development of agitation, edema and ecchymosis in the postoperative period. Materials and methods The study was carried out in 60 ASA I-II patients who were going to undergo open rhinoplasty by plastic surgery. In the Preoperative Anesthetic Assessment the patients were divided into two groups as the patients given standard verbal information (Group S; n = 30) and those informed with a catalog which contains visuals (Group V; n = 30) In the preoperative period, anxiety levels of the patients were evaluated. Standard anesthesia induction was performed in both groups after standard monitoring. Patients were monitored in the post-anesthesia care unit and ward. Patient's extubation quality, presence of postoperative agitation and periorbital edema and ecchymosis at the 6th, 12th, 18th, and 24th hours were evaluated. Results No significant difference was found between the groups in terms of intraoperative and postoperative MAP, HR, extubation quality, presence of recovery agitation, postoperative pain, development edema and ecchymosis (P > 0.05). Significant positive correlation was found between post-extubation MAP and edema scores at the 16th and 24th hours postoperatively and between the post-anesthesia care unit entry MAP and ecchymosis at the 24th postoperative hours independently of the groups (r = 0.27; P = 0.038, r = 0.302; P = 0.019, r = 0.345; P = 0.007, respectively). Result In our study, it was concluded that detailed visual information and physical application in the preoperative period among rhinoplasty patients had no effect on the incidence of postoperative agitation, development of edema and ecchymosis.

Background/aim: The aim of this study was to evaluate changes in intracranial pressure following tourniquet deflation using noninvasiveultrasonographic optic nerve sheath diameter (ONSD) measurements.Materials and methods: Our study included 59 adult patients between the ages of 18 and 65 years from the American Society ofAnesthesiologists (ASA) I/II risk groups who were scheduled to undergo elective orthopedic surgery of the lower extremities usinga tourniquet under general anesthesia. ONSD and end-tidal CO2 (ETCO2) were measured 5 times: 15 min prior to the anesthesiainduction; just prior to the deflation of the tourniquet; and at 5, 10, and 15 min after the deflation. Additionally, age, sex, weight, height,ASA score, and duration of operation and tourniquet usage were recorded.Results: The ONSD value measured 5 min after the deflation was significantly higher than all of the remaining measurements. Therewas a significant correlation between the ONSD and ETCO2 measurements at 5 and 10 min after deflation (r = 0.61, 95% CI 0.42-0.75,P < 0.0001 and r = 0.30, 95% CI 0.04-0.51, P < 0.05, respectively).Conclusion: The ultrasonographic ONSD measurements, which were obtained using a simple and noninvasive approach, increasedsignificantly following tourniquet deflation, and this increase was correlated with an increase in ETCO2.

Amac: Entube hastalarda nitrik oksitli (N2 O) dusuk akimli genel anestezide (DAA) inspire edilen nitroz oksit fraksiyonundaki (Fi N2 O) artisa bagli olarak N2 O’nun endotrakel tup (ETT) kafi icine diffuzyonu kaf basinclarinda artisa neden olur. Biz calismamizda N2 O’lu DAA’de hava ve salin ile sisirilen ETT kaf basinclarini ve bunun ameliyat sonrasi donemdeki bogaz agrisina olan etkisini karsilastirdik. Yontemler: Calismaya ASA I/II toplam altmis eriskin hasta dahil ettik. Anestezi induksiyonu sonrasi endotrakeal entubasyon yapilan hastalarin ETT kaflari hava (Grup A, n=30) ve salin (Grup S, n=30) ile 25 cmH2 O olacak sekilde sisirilerek rastgele iki gruba ayrildi. Anestezi N2 O’li DAA ile surduruldu. ETT kaf basinclari bir basinc manometresi ile surekli olarak olculdu ve inspire edilen oksijen ve N2 O seviyeleri operasyon boyunca her 10 dakikada bir kaydedildi. Hastalarin cerrahi sonrasi 2. ve 24. saatlerde yutkunurken ve yutkunma olmaksizin bogaz agrilari numerical rating scala (NRS) ile degerlendirildi. Bulgular: Gruplar arasinda demografik ve intraoperatif acisindan anlamli bir fark yoktu. Tum takip donemlerindeki kaf basinclari Grup S ile kiyaslandi- ginda Grup A’da maksimum olarak yuksekti (p10.dk=0,02, deger donemlerde p

Aim: Local anesthetics are commonly used in surgical interventions and anesthesia applications. The aim of this study was to increase the sensitivity of local anesthetic toxicity to the presence of symptoms, precautions to be taken and the use of 20% lipid infusion for treatment. Material and Methods: The questionnaire was applied on 160 of 205 physicians who were prescribed local anesthetics.Results: Of the 160 participants included in the study, 108 (67.5%) were research assistants, 47 (29.4%) were faculty members and the remaining 5 (3.1%) were expert medical practitioners. 63 of the participants (39.4%) had been working in the medical profession for more than 5 years. While 42.5% of the participants administered local anesthetics every day, 33.1% had not received any training in the area. On the basis of their training status, it was the anesthetists among specialist doctors who were the most trained in anesthetics with a statistically high rate of 86.3%. Thirty-three of the surveyed physicians (20.6%) who responded stated that they had experienced a case of local anesthetic toxicity previously. The most frequent answer to the question in early findings concerning local anesthetic toxicity was anaphylaxis (74.4%). 38.1% of the participants had not heard the use of 20% lipid solution in local anesthetic toxicity. Although there was 20% lipid solution in the university hospital where the research was conducted, 31.9% of the participants knew this.Conclusion: Although local anesthetic toxicity is rare, it frequently occurs in clinical practice. Therefore, physicians should have general knowledge regarding local anesthetic drugs, maximum doses, side effects, toxicity symptoms and the required treatment in the case of toxicity. We also think local anesthetic toxicity should be included in annual training programs and practical applications by other clinical branches that apply local anesthetic drugs as we currently do at our Clinic and physicians should be given appropriate guidance.

Resumen Durante la anestesia general pueden lesionarse los nervios en la region faringola-ringea. Los nervios mas a menudo lesionados son el hipogloso, lingual y laringeo recurrente.Las lesiones puedensurgir como resultado de varios factores que ser, durante la larin-goscopia, intubacion endotraqueal e insercion deltubo y por presion balon, ventilacion conmascarilla, maniobra aereatriple, via orofaringea, modo de insercion del tubo, posicionde la cabeza ydel cuello, aspiracion.Las lesiones nerviosas en esa region pueden comprometer un solo nervio aislado o causar laparalisis de 2 nervios en conjunto, como la del nervio laringeo recurrente hipogloso (sindromede Tapia). Sin embargo, la lesion combinada de los nervios lingual e hipogloso, despues de laintubacion para la anestesia, es una condicion mucho mas rara. El riesgo de una lesion se puedereducir con medidas preventivas. A continuacion describimos un caso de paresia unilateralcombinada de los nervios hipogloso y lingual despues de la intubacion para la anestesia.© 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. Todos losderechos reservados.

BACKGROUND This randomized, double-blind study was designed to assess the effect of perioperative remifentanil with controlled hypotension on intraoperative bleeding, postoperative edema, and ecchymosis. METHODS Fifty-two patients undergoing rhinoplasty were divided into 2 groups. The remifentanil group received 1 µg · kg(-1) intravenously as a bolus before induction of anesthesia, 0.5 to 1 µg · kg(-1) · h(-1) by continuous intravenous infusion during the operation. After anesthesia induction with propofol (2-3 mg · kg(-1)) and fentanyl (1-15 µg · kg(-1)), muscle relaxation was achieved with rocuronium (0.45-0.90 mg · kg(-1)). Mean arterial pressure was maintained at 50 to 60 mm Hg in controlled hypotensive anesthesia achieved using remifentanil infusion. Perioperative hemodynamics and bleeding; early postoperative pain and agitation scale; postoperative first, third, and seventh day edema; and ecchymosis were evaluated. Edema and ecchymosis were evaluated using graded scale from 0 to 4. RESULTS Remifentanil reduced mean arterial pressure during the entire operative period and the first 30 minutes postoperatively (P < 0.05 for these comparisons). Intraoperative bleeding also decreased (P < 0.001). There was a significant decrease in edema in both upper and lower eyelid edema on the first and third days in the remifentanil group, although this difference was not detected on the seventh day (P(1upper) = 0.000, P(1lower) = 0.000, P(3upper) = 0.008, and P(3lower) = 0.002). Ecchymosis decreased significantly in both upper and lower eyelids on the first, third, and seventh days in the remifentanil group (P(1upper) = 0.000, P(3upper) = 0.000, P(3upper) = 0.002, P(3lower) = 0.002, P(7upper) = 0.049, and P(7lower) = 0.038). There were no differences in postoperative pain and agitation between 2 groups. CONCLUSIONS Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

The aim of this study was to compare the effects of wound infiltration with levobupivacaine and tramadol in reducing postoperative pain in children undergoing unilateral inguinal hernia and undescended testis surgery. Under general anesthesia for elective unilateral inguinal hernia and undescended testis underwent surgery, ASA I-II, 80 children between the ages of 1-6 records in the patient's file was reviewed. The patients who were given 2mg.kg-1 tramadol in saline solution as prepared 0,2 ml.kg-1 into the surgical incision area by the surgeon at the end of the operation were accepted as Group T, who were given 0.25% levobupivacaine as 0.2 ml.kg-1 were accepted as Group L. Hemodynamic parameters, CHEOPS pain scores, additional analgesic consumption, adverse effects were recorded from the files. Patients\' CHEOPS were significantly higher in Group L compared to Group T at 4 and 6 hours (p, Biz çalışmamızda inguinal herni ve inmemiş testis operasyonu geçiren çocuklarda levobupivakain ile tramadolun yara yeri infiltrasyon yöntemiyle postoperatif ağrıyı azaltmadaki etkinliklerini karşılaştırmayı amaçladık. Genel anestezi altında elektif inguinal herni ve inmemiş testis operasyonu geçiren, ASA I-II risk grubunda, 1-6 yaş arası 80 çocuk hastanın dosya kayıtları retrospektif olarak incelendi. Cerrahi bitiminde, cilt kapanmadan önce yara dudaklarına 2 mg/kg tramadol içeren solusyondan 0.2 ml/kg olacak şekilde yapılanlar T Grubu, %0.25’ lik levobupivakain solusyondan 0.2 ml/kg olacak şekilde yapılanlar L Grubu olarak kabul edildi. Hemodinamik parametreler, CHEOPS ağrı skoru, ek analjezik tüketimi ve yan etkiler dosyalardan incelenerek kaydedildi.Hastaların CHEOPS skoru L grubunda T grubu ile kıyaslandığında 4. ve 6. saatte daha yüksek saptandı (p

Purpose: The purpose of this study is to evaluate the contribution, efficacy and safety of preemptive intravenous lornoxicam 8 mg on postoperative analgesia in patients who shall undergo spinal surgery and instrumentation. Materials and Methods: 50 adult (18-65) patients from ASA I-II risk group, scheduled for elective spinal surgery were included in clinical prospective, randomized, double blind, placebo controlled study. Lornoxicam 8 mg (in 100 ml physiological serum iv) was administered to the first group (Group L; n=25) and 100 ml physiological serum iv was administered by perfusor to the second group (Group P; n=25) 30 minutes before surgical incision. General anesthesia was applied after standard monitorization. Postoperative analgesia was performed with tramadol (iv) in 2 mg/ml concentration via patient controlled analgesia (PCA); bolus: 20 mg, lock time: 60 minutes and application time: 24 hours. Numerical Rating Scale (NRS) (0-10 points), tramadol used by PCA, frequency of drug request, additional analgesic amount consumed and effective analgesia times were recorded at the end of operation, 2nd, 4th, 6th, 12th and 24th hours. Results: Total PCA tramadol consumption during 24 hours period and frequency of PCA drug request at the end of operation, 2nd and 12th hours was significantly lower than the values for placebo (p

Aim: The aim of this study was to investigate the effects of extravasated fluid on the airway pressure of the patients in different surgical positions.Material and Methods: This prospective observational study included 50 arthroscopic shoulder surgery patients (18-65 years) placed in lateral decubitus (Group L) and beach chair (Group B) positions under general anesthesia. Peak airway pressure (Ppeak) and internal PEEP (iPEEP) measurements were recorded after intubation. The neck, chest, and shoulder circumferences were measured before induction and after operation.Results: The increases in Ppeak and iPEEP values were not statistically significant between the groups (p> 0.05). The total amount of irrigation fluid was significantly higher in Group L (p=0.042), not significantly correlated with Ppeak but positively correlated with the surgery time (r=0.51099; p=0.001 0.05). The neck circumference measurements were statistically significant between the groups. No respiratory complications were observed during the follow-up period.Conclusion: The lateral decubitus and beach chair positions do not cause a clinically significant compromise on the airway pressure in arthroscopic shoulder surgery but a longer operation duration will cause a higher amount of irrigation fluid to be used, leading to an increased circumference of the neck in the postoperative period.Keywords: Shoulder arthroscopy; airway pressure; lateral decubitus position; beach chair position

To investigate the effects of propofol and caffeic acid phenethyl ester (CAPE) on prevention of lung injury as a remote organ after performing hindlimb ischaemia-reperfusion (IR) in a rat model.The animals were divided randomly into one of four groups: sham, no IR (n = 8), control, IR, (n = 8), CAPE group, IR with CAPE, (n = 8), propofol group, IR with P, (n = 8). After the rats were anaesthetised, the animals in the CAPE group received CAPE of 10 micromol, in the propofol group received propofol 50 mg/kg, in the control group received a similar volume of saline solution by means of intraperitoneal injection 1 h before reperfusion. After 4 h of ischaemia the tourniquet was removed and the animals were released for reperfusion for 4 h thereafter. At the end of the reperfusion period, a median sternotomy was performed. A blood sample was obtained for plasma malondialdehyde (MDA). The lung tissues were also removed for MDA assays, myeloperoxidase (MPO) activity, and histopathological examination.Plasma and lung MDA levels, and lung MPO activity were significantly higher in the control group compared to the other groups (p0.0005). In the CAPE group, these were significantly lower compared to the control group (p0.0005). Also, propofol caused a marked reduction in the MDA levels and MPO activity compared with control group (p0.0005), with no significant difference compared to that of the sham group. Histopathologically, the scores resulted in a grade zero (8/8) in the sham group, 3 (3/8) or 4 (5/8) in the control group, 1 (2/8) or 2 (6/8) in the CAPE group, and 1 (3/8) or 2 (5/8) in the propofol group.Propofol and CAPE seem to be effective in protecting against lung injury caused by increased oxidative stress and neutrophil accumulation after hindlimb IR in a rat model.

Pulmonary artery sling (PAS) is a rare congenital anomaly frequently accompanied by focal or long-segment tracheal stenosis. We presented a 34-year-old female patient with severe long-segment tracheal stenosis associated with PAS which was assessed with Multi Slice Computed Tomography (MSCT) consisting of axial, three dimensional and virtual bronchoscopic images of the airway. This case report discussed the management of her difficult airway condition during surgical cholecystectomy and thyroidectomy by using proseal- LMA and I-gel, respectively (Fig. 4, Ref. 10).

Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy.Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient’s analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient’s demands from the pump, pump’s delivery, and additional analgesic requirement were also recorded.Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient’s demand and pump’s delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C.Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration.Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia. Keywords: Hypoglossal paralysis, Lingual paralysis, Intubation anesthesia

WOS: 000323912900041 PubMed: 23601417 Objectives: To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia-reperfusion (I/R) injury in rat ovarian tissue. Study design: Animals were randomized into three groups: Group S (n = 8), no pneumoperitoneum; Group C (n = 8), pneumoperitoneum; and Group D (n = 8), 100 mu g intraperitoneal dexmedetomidine 30 min before pneumoperitoneum. Ovarian tissue was collected from all rats 30 min after desufflation, and fresh frozen for histological and biochemical evaluation. Results: Body weight was similar in all three groups (202.62 +/- 28.86, 211.00 +/- 14.45 and 212.87 +/- 15.71 g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p < 0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p < 0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p < 0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p > 0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p < 0.05). Conclusion: Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Peripheral nerve blocks can provide a number of advantages in high-risk patients and may sometimes be preferred despite relative contraindication. Our first case had relative contraindication due to being confused, with a