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Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline. Resumo A Distrofia Miotônica (DM) tipo-1 (Doença de Steinert) é uma doença multissistêmica progressiva autossômica dominante em que a crise miotônica pode ser desencadeada por vários fatores, incluindo dor, estresse emocional, hipotermia, tremores e estímulo mecânico ou elétrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinação com peridural torácica para colecistectomia laparoscópica em paciente com Doença de Steinert. Para evitar laringoscopia, a intubação traqueal foi realizada utilizando cateter de intubação Aintree guiado por broncofibroscopia óptica. Os efeitos anestésicos prolongados do propofol foram revertidos e a recuperação anestésica foi acelerada pelo uso de infusão intravenosa de teofilina.

Pregnant women undergo non-obstetric surgeries as well as cesarean operations. Airway management can be complicated due to physiological changes which occur in the respiratory system of labors. The most common causes of pregnancy-specific hypoxic respiratory failure are eclampsia, preeclampsia, and pulmonary edema that develops secondary to tocolytics. Approximately 10–15% of pregnant women undergo emergency cesarean section. Regional anesthesia is a preferred technique worldwide most commonly, and general anesthesia is applied with rapid sequence induction for the rest of the patients. Difficult Airway Society Master Algorithm for Obstetric Patients is a useful method to manage the airway in labors.

Introduction: The aim of the study is to determine the duration of action and ideal effective doses of bupivacaine-lidocaine combination in different concentrations for infraclavicular brachial plexus block. Methods: The Ethics Committee of Istanbul Bilim University approved this study. Patients were randomized into 3 groups, consisting of 20 patients and applied 15 mL 0.5% bupivacaine- 15 mL 2% lidocaine to the first, 15 mL 0.5% bupivacaine- 15 mL 2% lidocaine with 30 mL saline to the second, 10 mL 0.5% bupivakain- 10 ml 2% lidocaine with 40 mL saline to the third group. Onset and duration of motor and sensory blocks, additional analgesic requirements, postoperative Visual Analogue Scale scores were recorded.Results: Groups were similar according to demographics, time until operation after block, operation time, perioperative and postoperative mean arterial pressure, heart rates, SpO2 values. Initiation of sensory block time was significantly longer in Group 1 than the others. Motor block initiation time was significantly longer in Group 1 than the other groups. Postoperative sensory and motor block performance time was significantly shorter in group 1 than the other groups. Additional analgesic requirement and Visual Analogue Scale scores were highest in Group 1 (p

Background: Opioid and local anesthetic infusion by an epidural catheter is widely used as a postoperative pain management method after major abdominal surgeries. There are several agents nowadays to provide sufficient analgesia. The agents which cause less side effects but better quality of analgesia are more valuable. We aimed to postoperatively compare the analgesic, hemodynamic and arrhythmogenic effects of epidural levobupivacaine-fentanyl and bupivacaine-fentanyl solutions. Methods: Fifty patients were scheduled to undergo major abdominal surgery in this clinical trial. The parameters were recorded pre- and post-operatively. In Group I (n=25), bupivacaine with fentanyl solution and in Group II (n=25), levobupivacaine with fentanyl solution was infused via epidural patient-controlled analgesia (PCA). According to the preoperative and postoperative holter recording reports, the arrhythmogenic effects were examined in four catagories: ventricular arrhythmia (VA), supraventricular arrhythmia (SVA), atrioventricular conduction abnormalities and pauses longer than two seconds. Results: Mean visual analog scale (VAS) values of groups did not differ at all time. They were 6 at the end of the surgery (0. Min, p = 0.622). The scores were 5 in Group I and 4 in Group II in 30. min (p = 0.301). The frequency of SVA was higher in bupivacaine group. Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

OBJECTIVE: : Fear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital METHODS: Anesthesiologists, nurses and nurse anesthetists were invited to fill out the survey The survey was consist of questions from ''The Fear of COVID-19 Scale'', ''Patient Health Questionnaire'' and ''Pittsburgh Sleep Quality Index'' (PSQI) Each question was worth a point RESULTS: The data of 208 participants were analyzed Mean age was 29 ± 7 748 years, 72 1% were male, 67 3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone Moderate depression was the most frequently detected outcome (n = 90, 43 3%) Mean The Fear of COVID-19 Scale for all participants was 18 56 ± 7 731 The mean PSQI of patients was 6 18 ± 4 356 with a 45 7% rate of poor sleep quality PSQI was found significantly higher in nurses (7 1 ± 4 7, p = 0 000) Nurses were the group with the highest deterioration in sleep quality (53 6%, p = 0 003) The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0 018) PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7 02 ± 4 59 vs 4 81 ± 3 57 respectively, p = 0 001) A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0 005) CONCLUSION: Depression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak Intensive care unit nurses were at highest risk

Objective: Regional anaesthesia is mostly preferred for elective caesarean delivery. This study aimed to compare general, epidural and spinal anaesthesia techniques in terms of their foetal and maternal effects. Methods: Parturients undergoing elective caesarean delivery were randomly divided into three groups: general anaesthesia (GA), epidural anaesthesia (EA), and spinal anaesthesia (SA). The APGAR score, foetal blood gas level, free O-2 requirement and positive-pressure ventilation, phototherapy requirement, bilirubin level and weight loss were recorded. The time to the first breastfeeding, perioperative bleeding, crystalloid requirement, ephedrine consumption, first analgesic requirement, the time of defaecation and mobilization were also measured. Results: The APGAR scores and SpO(2) were lower in the GA group (p

Background: In this study, we aimed to evaluate the long-term outcomes of monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery in patients with atrial fibrillation. Methods: We retrospectively evaluated a total of 167 patients (67 males, 100 females; mean age 56.8 +/- 6.9 years; range, 48 to 65 years) with atrial fibrillation who underwent monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery between September 2001 and January 2015. The patients were divided into two groups according to the procedure applied as those undergoing monopolar ablation (group 1, n=68) and those undergoing bipolar ablation (group 2, n=99). All patients were followed by electrocardiogram and 24-h Holter monitoring. Echocardiography was performed before discharge, at three and 12 months postoperatively, and annually thereafter. Left atrial volume index, left atrial diameter, and left ventricular ejection fraction were recorded. Results: There was no significant correlation between the procedure applied and hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, history of the cerebrovascular events (p>0.05). The mean preoperative left atrial diameter decreased from 5.3 +/- 0.5 cm to 4.9 +/- 0.5 cm postoperatively in all patients (p=0.0001). The mean preoperative left atrial volume index decreased from 53.8 +/- 0.4 mL/m(2) t o 43.7 +/- 6.2 mL/m(2) in t he postoperative period (p=0.0001). During follow-up, 61.8% (n=42) of the patients in group 1 and 62.6% (n=62) of the patients in group 2 remained in sinus rhythm. One patient (1.5%) in group 1 and two patients (2.0%) in group 2 developed early postoperative cerebrovascular accident. Conclusion: Monopolar and bipolar ablation methods are safe and effective methods to ensure long-term sinus rhythm. Both procedures do not increase the morbidity risk with very low thromboembolic complication rates.

We aimed to analyze the use of blood products in cardiac surgery and to investigate its effect on clinical outcomes. Perioperative transfusion requirement, survival and complication rates and the duration of hospitalization were noted. Patients were divided into two groups considering the duration of hospital and intensive care unit (ICU) stay. The cardiopulmonary bypass time and the cross clamp time, and the amount of used cryoprecipitate, fresh frozen plasma, platelet, red blood cell and the bleeding amount were significantly higher in groups that stayed at the hospital for > 7 days and at the ICU for > 2 days (p > 0.05). In the univariate model, to predict the patients who might stay at the hospital for more than 1 week and who might stay at the ICU for more than 3 days, we considered the significant efficacy of postoperative blood transfusion, bleeding amount, and the cardiopulmonary bypass time (p

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls.

WOS: 000302753000007, PubMed ID: 22580860, Background. Intravenous patient-controlled analgesia (IV PCA) using opiods is an accepted method for delivering postoperative analgesia. The aim of this study was to compare fentanyl and tramadol with IV PCA after spinal anesthesia (SA) and general anesthesia (GA) following cesarean section (C/S). Methods. Ninety women were randomly assigned to three groups (n=30). Group 1 was treated with IV fentanyl PCA after SA. Groups 2 and 3 were treated with IV fentanyl PCA and IV tramadol PCA after GA. Outcome measures were recorded for the first 24 h post-anesthesia. Results. PCA use was significantly lower after SA (P0.05). 638.4 +/- 179.1 mu g fentanyl was consumed by patients of Group 2, 356.3 +/- 87.0 mu g fentanyl and 559.5 +/- 207.0 mg tramadol was consumed by Group 1 and Group 3 respectively. There was no significant difference in the overall severity and incidence of nausea, drowsiness or pruritus. Conclusion. Our study shows that analgesic consumption and post-operative pain scores after SA in C/S decreased, without increase in adverse reactions.