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Selektif seratonin geri alım inhibitorü (SSRI) grubu ilaçlar düşük yan etkilerinden ve kolay tolere edilebilmelerinden dolayı günümüzde depresyon tedavisinde ilk tercih edilen ilaçlardır. Serotonin sendromunun tanısı serotonerjik bir ilacın alınmasını takiben gelişen ajitasyon, mental durum değişiklikleri, myoklonus, ishal, ateş, hiperreflexi, tremor, koordinasyon bozukluğu gibi belirtilerden en az üç tanesinin bulunması ile konulmaktadır. Yaklaşık 1 yıldır major depresyon ön tanısı ile tedavi gören ve suicid amaçlı 84 adet Citoles 20 mg tablet (essitalopram) alan 26 yaşındaki bayan hasta intoksikasyon nedeniyle yoğun bakım ünitesine yatırıldı. Bu olguda yüksek doz essitalopram alınmasından yaklaşık 2 saat sonra serotonin sendromu gelişen ve siproheptadin kullanılan bir hastanın sunulması amaçlanmıştır.

Purpose In this study, we evaluated the hypothesis that preoperative bilateral infraoptic nerve (ION) and infratrochlear nerve (ITN) blocks under general anesthesia with sevoflurane and remifentanil reduced the incidence of emergence agitation (EA), pain scores, and the analgesic consumption after the septorhinoplasty. Patients and Methods Our study was conducted as a prospective randomized, double-sided blind study. Fifty-two patients whose septorhinoplasty operation was planned under general anesthesia were included in the study. Patients were randomly distributed to either the ION and ITN blocks were performed. Group 1: Bilateral ION and ITN blocks were performed; Group 2: ION and ITN blocks were not performed. Duration of the surgery and anesthesia, Riker Sedation-Agitation Scale (RSAS) score, EA presence, duration of postoperative analgesia, numerical rating scale (NRS) scores, and cumulative dexketoprofen consumption were recorded. Results The RSAS score, NRS score and cumulative dexketoprofen consumption of the patients in Group 1 were statistically significantly lower than the patients in Group 2 (p

INTRODUCTION[|]Our aim is to compare magnetic resonance imaging and ultrasonography and optic nerve sheath diameter measurements in critical patients who do not have a known optic nerve disease, followed in intensive care, and to find correlations or significant differences between these two methods.[¤]METHODS[|]Our study was carried out prospectively observationally in the Anesthesiology and Reanimation Intensive Care Unit of TR Health Sciences University Diyarbakır Gazi Yaşargil Training and Research Hospital between May 2019 and December 2019. Critical patients aged ≥18 years, who were hospitalized in the intensive care unit, whose intracranial pressure increase was not known, and who were sedated with endotracheal intubation, ramsey sedation score 4-6, and magnetic resonance imaging were included in this study. Group 1: Optic nerve sheath diameter of 65 patients were measured by transorbital ultrasonography. 65 patients were included in the study. Group 2: Optic nerve sheath diameter of 65 patients were measured by magnetic resonance imaging method.[¤]RESULTS[|]When the optic nerve sheath diameters measured with ultrasonography and magnetic resonance imaging were divided into two groups, the mean of the optic nerve sheath diameter measurements in Group 1 was found to be statistically significantly lower than that of Group 2 (p = 0.016). When the relationship between ultrasonography-optic nerve sheath diameter measurements and magnetic resonance imaging-optic nerve sheath diameter measurements was examined by correlation tests, there was a statistically significant very high positive correlation between ultrasonography-optic nerve sheath diameter and magnetic resonance imaging-optic nerve sheath diameter (r = 0.811, p

Objective:The aim of this study was to determine the eye problems and risk factors encountered by patients in intensive care units and to evaluate the eye care awareness of healthcare workers in these units.Materials and Methods:In this study, 186 eyes of 93 patients without ophthalmological consultations were examined prospectively and observationally. The patients were evaluated for dry eye, hypertonic solution use, eyelid/eyelash hygiene, blink reflex, corneal pathology and eye care consultations. The ventilation type, length of hospitalization, Glasgow Coma scale score and sedation status were also evaluated. The presence of dry eye was evaluated according to gender, ventilation type, hypertonic solution use, Glasgow Coma scale score and hospitalization diagnosis. Additionally, patients were evaluated according to the risk factors of corneal pathologies.Results:The mean age of the patients was 63.53±22.06 (18-96) years and male/female ratio was 51/42. The mean length of hospitalization was 42.19±92.73 (7-203) days and the mean Glasgow Coma scale score was 9.35±4.34. Dry eye was detected in 30 (32.3%) patients. A higher rate of dry eye was detected in the mechanically ventilated and sedated patients, but the difference was not statistically significant (p=0.243 and p=0.384). Various corneal disorders were detected in 18 patients (19.35%). The sedation rate and length of hospitalization were higher in these patients, but the difference was not statistically significant (p=0.66 and p=0.126). However, Glasgow Coma scale score was significantly lower (p=0.027). The eyelid hygiene was adequate in 78 patients (83.9%) and inadequate in 15 patients (16.1%). Ophthalmological consultations were required for 29 patients (31.2%), but only 11 (37.9%) of these patients received consultations. Of 18 patients who were not consulted, 11 had punctate corneal epithelial defects, four had purulent conjunctivitis and three had keratitis.Conclusion:Eye disorders are quite common in intensive care unit inpatients. Increasing eye care awareness by providing eye care training to healthcare professionals focused on maintaining these patients’ vital functions will help prevent the emergence of eye diseases.

Introduction:The primary aim of our study was to investigate the relationship between hypertensive diseases of pregnancy (HDP) and blood groups. Our secondary aim is to determine the risk factors that play a role in the development of HDP.Methods:Pregnant women aged 15-49 years were included in this cross-sectional, observational, and prospective study. Pregnant women were divided into two groups. Group 1 (n=266) included patients admitted to the intensive care unit due to HDP. Group 2 (n=402) included normotensive patients without any complications during pregnancy. The groups were compared in terms of age, blood groups, Rh factor, gravida, parity, gestational week, and primiparity-multiparity.Results:There was no statistically significant difference between the groups in terms of ABO blood group and Rh factor. The mean age, gravida, and parity were significantly higher in Group 1 than in Group 2 (p=0.028; 0.001; 0.004, respectively), while mean gestational age was lower than Group 2 (p

Extracorporeal membrane oxygenation (ECMO) may be the last option in patients with severe acute respiratory distress syndrome (ARDS) in whom conventional methods have failed. The best results are obtained in patients with severe ARDS after trauma. Injured lungs can recover completely with ECMO therapy. A 44-year-old male patient was brought to the emergency department after sustaining severe thoracic gunshot injury. The patient was rushed into emergency surgery; however, pneumonectomy could not be performed due to morphological variation and widespread contusion in the lungs. The patient had flail chest with extensive damage of the ribs. Titanium plates could not be placed, as there was a major loss in the bone tissue. After cutting the fractured rib ends, the open chest wall was repaired with dual mesh and covered with serratus and latissimus dorsi muscles. However, the flail chest could not be corrected. During the follow-up in the intensive care unit, the patient developed ARDS and conventional therapies were unsuccessful. Thus, ECMO was used to allow lung healing. ECMO treatment was continued for seven days and was completed without any complications. The patient was transferred to the regular ward after 29 days. ECMO can be used as a life-saving treatment that allows lung healing in case conventional treatment methods have failed.

BACKGROUND: In this study, it was tried to determine the factors affecting the clinical process in patients who were followed up in hospital for coronavirus disease-2019 (COVID-19). METHODS: The study, which was designed as a single-center and retrospective cohort, included 658 patients admitted to the service due to COVID-19. The patients were grouped and compared as the patients followed up in the wards (Group 1) and those admitted to ICU (Group 2), between those who were intubated (Group I) in the ICU and those who were not (Group NI), and between patient groups who died (Group M) and survived (Group NM) among those who were intubated. RESULTS: Of the 658 patients hospitalized in the wards, 566 (86%) were discharged and 99 (14%) were later admitted to the ICU. The mortality rate for the 658 patients that were followed up was found to be 7.75%. When Groups 1 and 2 were compared, it was observed that the patients in Group 2 had more comorbidity and higher KDIGO stages (p

Background: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl. Results: There were no significant differences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1- and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO2, PO2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was significantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was significantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Pain on injection was present in 55% of patients (n = 81), mild in 36% (n = 54), and severe in 18% (n = 27). Myoclonies occurred in 4% of patients (n = 7) and local rash in 6% of patients (n = 10). Differences between formulations did not reach statistical significance. Conclusion: None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of effects on the neonate.

Background and objectives: AN69 and Oxiris are filters used in continuous renal replacement therapy. In this study, we aimed to research the effects of these filters on blood cell counts, blood biochemistry, inflammation indicators, clinical status and mortality of patients diagnosed with septic shock-related acute kidney injury. Method: Between March 2019 and October 2019, 42 adult patients (Group 1: Oxiris (n = 21) or Group 2: AN69 (n=21)) with septic shock-related acute kidney injury and received continuous venovenous hemodiafiltration (CVVHDF) in the intensive care unit were included in the study and their results were prospectively observed and compared. The data at the begining of CVVHDF (pre-CVVHDF) and 24 hours after the onset of CVVHDF (post-CVVHDF) were recorded.Results: In the comparison of the pre- and post-CVVHDF values in Group 1, there was a statistically significant decrease detected in the procalcitonin (p = 0.04) and noradrenaline infusion rate (p = 0.02) levels. In terms of the other data there was no statistically significant difference between pre- and post-CVVHDF values in Group 1. In the comparison of the pre- and post-CVVHDF values in Group 2, there was a statistically significant decrease detected in the urea (p = 0.04), platelet count (p = 0.02) and procalcitonin (p = 0.002) levels. There was no statistically significant difference between pre- and post-CVVHDF values in terms of the other data in Group 2. There was no statistically significant difference between the groups in terms of mortality. Conclusions: CVVHDF with Oxiris filter causes a statistically significant decrease in noradrenaline infusion rate. Therefore, we think that the use of CVVHDF with Oxiris filter applied for septic shock-related acute kidney injury will save us time and increase the improvement in the treatment.

Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery.Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated.Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001).To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

Introduction: Sedation is often needed for magnetic resonance imaging (MRI) in pediatric patients for diagnostic purposes. In this study, we aimed to present anesthesia techniques and complications that occurred during sedation in pediatric patients. Methods: A total of 337 pediatric patients, in whom MRI was performed with sedation between January 1, 2016 and December 31, 2016, were retrospectively reviewed. The procedure, anesthetic drugs used, complications, and the need for additional medications were recorded. The patients were divided into 3 groups. Group 1: MRI procedure lasted 15 minutes, group 2: MRI procedure lasted 15-30 minutes and group 3: MRI procedure lasted more than 30 minutes. Within the groups, subgroup evaluations were made according to the type of anesthetic drug used. Results: There was no statistically significant effect of drug types used on complication development (bradicardia, hypoxia) and additional drug requirements in binary comparisons among subgroups (p=0.655, p=0.655 and p=0.317). In comparison of the groups according to the duration of the MRI procedure, complication development and need for additional medication were found to increase with prolonged imaging time (p=0.008, p=0.012 and p=0.02). Conclusion: Combinations of anesthetic and sedative drugs used during MRI in the pediatric patient group have no effect on complication development (bradicardia, hypoxia) and additional drug need. However, as the duration of the imaging procedure increases, complications and need for additional medication increase.

We aimed to present the assessment of the Cushing reflex caused by intracranial haemorrhagia developing during mechanical thrombectomy in a case presenting with acute ischemic stroke. A 59-year old male patient was scanned by CT angio due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarction was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the anesthesiology team was warned and 1 mg IV atropine was administered for bradycardia. Acute infarction has to be removed because it is understood as mechanical thrombectomy has been performed to a patient with an infarction. Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed. As conclusion, anesthesia and operation team must be alert for vessel perforation when Cushing triad develops during navigation of the thromboaspiration catheter.

Amac: Biz bu calismada, opere edilen meningosel ve miyelomeningosel olgularina eslik eden komorbid durumlari ve bunlarin gebelikte kullanilan folik asitle iliskisini incelemeyi amacladik. Materyal ve Metot: Meningosel ve myelomeningosel tanisiyla opere edilen 81 yenidogan bu calismaya dahil edildi. Hasta dosyalari retrospektif olarak taranarak olgularin veriler kaydedildi. Olgular, gebelik doneminde folik asit kullanan ve kullanmayan grup olarak ikiye ayrildi. Iki grup arasinda yenidoganlarin agirlik, boy, hemogram, biyokimya, tani zamani, dogum sekli, maturite, lokalizasyon, tip, norolojik defisit, skolyoz, hidrosefali, cerrahi zamani, ventrikulomegali, tedavi sekli, ek patoloji, tetheredcord sendromu, dermal sinus trakti, maternal hastalik birlikteligi ve BOS fistulu gibi malformasyonlarin sayisi, karsilastirildi. Bulgular: Antenatal donemde folik asit kullanimi %44,4 olarak saptandi. Meningomiyelosel %40,7 lomber, ve %46,9 sakral bolgedeydi. Erken tanili yenidoganlarda (

The present study was designed to test the hypothesis that high dose dexmedetomidine would increase the duration of antinociception to a thermal stimulus in a rat model of sciatic nerve blockade without causing nerve damage. The rats were anesthetized with isoflurane. After electromyography (EMG) recordings, right sciatic nerves were explored and perineural injections were delivered: Group D (n = 7), 40 μg μg kg−1 dexmedetomidine administration, Group II (n = 6), (0.2 mL) saline administration, Group III (n = 2), only surgically exploration of the right sciatic nevre. Time to paw withdrawal latency (PAW) to a thermal stimulus for both paws and an assessment of motor function were measured every 30 min after the nerve block until a return to baseline. The compound muscle action potential (CMAP) of right and left sciatic nerves were recorded 10 times per each nerve once more after perineural injections at 14 day. After EMG recordings, right and the part of left sciatic nerve were excised at a length of at minimum 15 mm for histopathological examination. Comparison of right/left CMAP amplitude ratios before and 14 days after the procedure showed a statistically significant difference (p = 0.000). There were no differences in perineural inflammation between the Group D, Group S, and Group E at 14 days. Resumo: O presente estudo foi desenvolvido para testar a hipótese de que dexmedetomidina em dose alta aumentaria a duração da antinocicepção a um estímulo térmico em modelo de rato de bloqueio do nervo ciático sem causar danos ao nervo. Os ratos foram anestesiados com isoflurano. Após os registros da eletromiografia (EMG), os nervos ciáticos direitos foram explorados e injeções perineurais foram administradas: Grupo D (n = 7) recebeu 40 μg/kg−1 de dexmedetomidina, Grupo II (n = 6) recebeu 0,2 mL de solução salina, Grupo III (n = 2) recebeu apenas exploração cirúrgica do nervo ciático direito. O tempo de latência de retirada pata (LRP) a um estímulo térmico para ambas as patas e uma avaliação da função motora foram avaliados a cada 30 minutos após o bloqueio do nervo até o retorno à fase basal. O potencial de ação muscular composto (PAMC) dos nervos ciático direito e esquerdo foi registrado 10 vezes para cada nervo, mais uma vez, após as injeções perineurais no 14° dia. Após os registros da EMG, o nervo ciático direito e parte do esquerdo foram excisados com um comprimento de no mínimo 15 mm para exame histopatológico. A comparação das proporções da amplitude do PAMC direito/esquerdo antes e 14 dias após o procedimento mostrou uma diferença estatisticamente significativa (p = 0,000). Não houve diferenças em inflamação perineural entre os grupos D, S e E aos 14 dias. Keywords: Paw withdrawal latency testing, Analgesia meter, Sciatic nerve, Electromyography, Dexmedetomidine, Palavras-chave: Testes de latência de retirada da pata, Medidor de analgesia, Nervo ciático, Eletromiografia, Dexmedetomidina

BackgroundThe co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches.MethodsIn total, 58 study patients were randomly assigned to receive either anterior (group A, n = 29) or posterior (group P,n = 29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018.ResultsThe time to initiation of sensory block was significantly shorter in group P than in group A (7.70 ± 2.05 min and 12.88 ± 4.87 min, respectively;p = 0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00 ± 00.00 min for group P and 4.05 ± 7.47 min for group A;p p = 0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51 ± 2.87 μg for group P and 147.75 ± 22.30 μg for group A). Patient satisfaction (p p = 0.006), and surgical quality (p = 0.047) were significantly higher in group P.ConclusionsAnterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

BACKGROUND The aim of this study was to determine the correlation between inferior vena cava collapsibility index and changes in cardiac output measured during passive leg raising test in patients with spontaneous breathing and septic shock. MATERIAL AND METHODS Fifty-six patients were included in the study. All of these 56 patients were diagnosed with septic shock and had spontaneous breathing under continuous positive airway pressure. Patients exclusions included: patients with cardiac pathology, not septic shock, pregnant, spontaneous breathing, increased intra-abdominal pressure, inferior vena cava could not be visualized, arrhythmia and pulmonary hypertension. Exclusion criteria for the study were as follows: 1) left ventricular systolic dysfunction, 2) cardiomyopathy, 3) medium severe heart valve disease, 4) patients with arrhythmia; 5) pulmonary hypertension, 6) patients without spontaneous breathing (for inferior vena cava collapsibility index, it is not evaluated), 7) patients with >60 mmHg CO₂ in arterial blood gas; 8) pregnant patients; 9) patients with neurogenic shock, cerebrovascular incident or traumatic brain injury, 10) patients whose inferior vena cava and parasternal long axis cannot be visualized, and 11) patients with increased intra-abdominal pressure. Patients were placed in neutral supine position, and the inferior vena cava collapsibility index and cardiac output 1 were recorded. In passive leg raising test, after which the cardiac output 2 is recorded in terms of L/min. The percentage increase between the 2 cardiac outputs was calculated and recorded. RESULTS A moderately positive correlation was also observed between the inferior vena cava collapsibility index and delta cardiac output (r=0.459; r2=0.21), which was statistically significant (P

Background: The co-administration of sciatic nerve and femoral nerve blocks may provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to sciatic nerve block have been described, including anterior and posterior approaches. Methods: Our study included 58 patients, randomly assigned to receive either an anterior (Group A , n = 29) or posterior (Group P, n = 29) approach. After the blocks were performed, we determined sensory and motor block start and end times, first fentanyl requirement time after block and before operation starts, first fentanyl requirement time after the operation starts, the mean fentanyl dose administered per patient after block and before operation starts, the mean fentanyl dose administered per patient after the operation starts, the time to first diclofenac sodium administration, and the total dose of diclofenac sodium required. The date of trial registration was retrospectively registered in 11.07.2018 Results: Comparison of the two groups revealed that Group P exhibited significantly shorter times to starting the sensory block (12.88±4.87 min for Group A, 7.70±2.05 min for Goup P) p=0.01 and first fentanyl requirement time after block and before operation starts (00.00±00.00 min for Group A, 4.05±7.47 min for Group P) p=

The aim of the present study was to investigate the changes in intraocular pressures (IOP) in patients who underwent pulsatile and non-pulsatile cardiopulmonary bypass (CPB). A total of 42 patients operated for elective coronary bypass surgery (CABG) on CPB were randomly allocated to pulsatile (Group P) and non-pulsatile (Group N) groups. Pulsatile flow was applied to Group P patients during crops-clamp period. The IOP measurements were made before and after the induction of anesthesia, before the onset of CPB, on the 5th, 15th, 30th, 45th, and 60th min of CPB, after CPB and at the end of the operation. The results of repetitive measurements were analyzed at different intervals and in two groups. The second IOP measurements of right and left eyes displayed statistically significant decreases from the baseline level [11.9 ± 2.9 (p = 0.0001) and 12.5 ± 3.2 (p = 0.0001), respectively]. The significant decrease in the IOP values persisted in the repeated measurements except for the 5th min of CPB values [17.0 ± 3.5 (p = 0.346) and 16.7 ± 3.6 (p = 0.399)]. Comparison of two groups demonstrated significant differences at pre-CPB (right 12.8 ± 2.3 vs. 10.8 ± 2.4; p = 0.013 and left 13.3 ± 2.4 vs. 11.5 ± 2.5; p = 0.023), and 5th min of CPB measurements (right 18.5 ± 3.1 vs. 15.9 ± 3.4; p = 0.015; left 18.2 ± 3.0 vs. 15.7 ± 3.6; p = 0.019). We noted a steady decrease in repeated IOP measurements except for the transient increase in CPB values on 5th min. The IOP values were higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements; however, the difference was not significant in the repeated measurements.

Aim: Our aim in this study is to understand whether there is a correlation between IVC-CI, IJV-CI, CVP, and Delta-CO2 values in critical patients in the ICU and whether these values can be used interchangeably in monitoring intravascular fluid status.. Materials and Methods: Patients included in this study were selected from critical ICU patients between 18-90 years old with an unknown hypovolemic status that had spontaneous breathing and underwent invasive mechanical ventilation in CPAP mode. Patients’ parameters were consecutively measured by USG with the inferior vena cava collapsibility index (IVC-CI), internal jugular vein collapsibility index (IJV-CI), CVP, and Delta-CO2. The results were recorded, and any correlations were checked.Results: There was a statistically significant and moderately negative correlation (r = -0.428, p 0.001) between CVP and IVC-CI, and a statistically significant and weakly negative correlation between CVP and IJV-CI (r = -0.374, p = 0.001). There was a statistically significant and weakly positive correlation (r = 0.369, p = 0.001) between IVC-CI and IJV-CI. There was no statistically significant correlation between Delta-CO2 and IVC-CI, IJV-CI, and CVP.Conclusion: We think that CVP, IVC-CI and IJV-CI can be used interchangeably in the assessment of the intravascular volume status of critical patients, but Delta-CO2 cannot be used to assess intravascular volume status instead of these parameters.

Background. Diagnosis of lumbar facet joint disease is the sum of the combinations consisting of history, physical activity, and diagnostic imaging frequently including computed tomography and magnetic resonance imaging scans. Prevalence of facet-based chronic low back pain is 15–45%. Intra-articular injections with corticosteroid or medial branch block are traditionally used prevalently in the management of chronic low back pain due to lumbar facet joints. However, the evidence levels of these procedures are at either a low or a medium level. Radiofrequency neurolysis of the lumbar medial branch can be used as an alternative in the management of lumbar facet joint pain. There are two types of radiofrequency applications for radiofrequency neurolysis as pulsed radiofrequency and conventional radiofrequency. Materials and Methods. Patients with lumbar facet pain were separated into 2 groups. Group 1 (n=75): patients were given pulsed radiofrequency under fluoroscopy. Group 2 (n=43): patients were given conventional radiofrequency under fluoroscopy. Pre-op and post-op 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values of all patients were asked, recorded, and statistically compared. Visual Analogue Scale values of the groups in the same months were compared as well. At the end of the second year, Odom criteria of both groups were recorded and statistically compared. Results. Preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values were compared in Group 1 and Group 2, and there was a statistically significant difference between preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values in both groups. However, the number of repetitions of the operation was higher in Group 1. In the comparison of Odom criteria for both groups at the end of the second year, it was observed that the patients in Group 2 were more satisfied with the treatment. Conclusion. Conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurolysis effectively decreases Visual Analogue Scale values in both short and long term. The quality of life and daily activities of patients were better at conventional radiofrequency.

ResumoObjetivoDexmedetomidina é um agonista α2‐adrenérgico que tem uma ampla gama de efeitos, incluindo sedação do cérebro de mamíferos, e propriedades tanto analgésicas quanto simpatolíticas. Este estudo teve como objetivo comparar os efeitos de dexmedetomidina e propofol sobre as características da sedação em pacientes submetidos ao bloqueio combinado dos nervos ciático e femoral via abordagem anterior em procedimento ortopédico de membro inferior.MétodosQuarenta pacientes, entre 18 e 65 anos, submetidos a procedimento cirúrgico por causa de fraturas lateral e medial do maléolo foram incluídos neste estudo, conduzido no Departamento de Anestesiologia do Hospital de Ensino e Pesquisa Bağcılar de 8 de setembro de 2011 a 7 de junho de 2012. O bloqueio dos nervos ciático e femoral foi feito via abordagem anterior em todos os pacientes incluídos no estudo, com ultrassonografia. Os pacientes foram randomicamente divididos em dois grupos para as infusões de: dexmedetomidina (grupo D [n=20]; 0,5μgkg−1h−1) e propofol (grupo P [n=20]; 35mgkg−1h–1).ResultadosOs sinais vitais e os valores da escala de sedação de Ramsay no período intraoperatório foram semelhantes em ambos os grupos. Os tempos de início e término da sedação no grupo D foram significativamente maiores do que os do grupo P (p

Objective Prolonged ventilation (PV) after coronary artery bypass graft (CABG) surgery is a common postoperative complication. Preoperative and operative parameters were evaluated in order to identify the patients at risk for prolonged ventilation postoperatively in coronary artery bypass graft (CABG) patients. Design Retrospective. Setting Research and training hospital, single institution. Participants The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients. Interventions The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis. Measurements and Main Results Forty-six patients (5.6%) required PV postoperatively. Hospital mortality was significantly higher in this group (45.7% v 4.0%; p = 0.0001). Univariate analysis showed that these patients were older (65.6±9.3 v 60.4±9.9; p = 0.001), had higher incidences of cerebrovascular disease (21.7% v 10.5%; p = 0.032), advanced ASA (58.7% v 41.8%; p = 0.026) and NYHA classes (32.6% v 12.2%; p = 0.001), and chronic renal dysfunction (20.0% v 4.0%; p = 0.0001). Concomitant procedures were more commonly performed in these patients (30.4% v 7.8%; p = 0.0001), and total durations of perfusion were longer (147.2±69.1 v 95.7±33.9 minutes; p = 0.0001). In regression analysis, advanced NYHA class (odds ratio = 8.2; 95% CI = 1.5-43.5; p = 0.015), chronic renal dysfunction (odds ratio = 7.7; 95% CI = 1.3-47.6; p = 0.027), and longer perfusion durations (p = 0.012) were found to be independently associated with delayed weaning from the ventilator. Every 1-minute increase over 82.5 minutes of cardiopulmonary bypass increased risk of delayed extubation by 3.5% (95% CI = 0.8%-6.4%). Conclusions Postoperative prolonged ventilation is associated with advanced NYHA class, chronic renal dysfunction and longer perfusion times in CABG patients.

Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Associ­ated anomalies include hyperthelorism, ptosis, microgna­thia, downward sloping palpebral fissures, low-set ears, abnormal helix of ear, deeply grooved philtrum, short and/ or webbed neck, low hairline and cervical vertebral anom­alies. Patients with Noonan syndrome are known to pres­ent with challenging airways. Tracheal intubation can be difficult because of airway and cervical vertebral anoma­lies and bag mask ventilation may be difficult because of asymmetrical face. We present a case of anesthetic man­agement for Noonan syndrome. J Clin Exp Invest 2013; 4 (2): 238-241, Noonan sendromu değişik patofizyolojik düzensizlikler ve değişik anatomik anomalilerle görülen, otozomal domi­nant genetik geçişle karakterize bir hastalıktır. Bu send­romla ilişkili anomaliler, hipertelorizm, pitozis, mikrognati, aşağı dönük palpebral fissürler, düşük yerleşimli-anormal heliksli kulaklar, derin oluklu filtrum, kısa ve/veya yele bo­yun, düşük ense saç çizgisi şeklinde dismorfik bulgulardır. Noonan sendromu tanısı almış hastalar zor hava yolu ile karşımıza çıkar. Trakeal entübasyon hava yolu ve servikal vertebral anomalilere ve maske ile ventilasyon asimetrik yüz yapısına bağlı olarak zor olabilir. Biz Noonan send­romlu bir olguya anestezik yaklaşımımızı sunmak istedik.

Purpose: In the present study, we aimed to investigate the specific side-effects and effects of adjuvant agents used intrathecally on the properties of spinal anesthesia. Materials and methods: 100 cases were randomly divided into 5 groups of 20 cases. Saline group: 15 mg 0.5% hyperbaric bupivacaine + 0.5 mL saline, Bupivacaine Group: 17.5 mg 0.5% hyperbaric bupivacaine, Fentanyl Group: 15 mg 0.5% hyperbaric bupivacaine + 25 µg fentanyl, Sufentanyl Group: 15mg 0.5% hyperbaric bupivacaine + 2,5 µg sufentanyl, Neostigmine Group: 15 mg 0.5% hyperbaric bupivacaine + 250 µg neostigmine, The volume of the intrathecally administered drug was 3.5 mL in all groups. After spinal anesthesia, sensory block level was measured by pin-prick test every 5 minutes and motor block level was measured by Bromage scoring. Sensory and motor block durations of the groups were recorded. The side effects that occurred were recorded. Results: Effects of different adjuvant agents on the properties of spinal anesthesia differed. Fentanyl statistically significantly prolonged sensory block durations compared with other groups. Fentanyl and sufentanyl statistically significantly raised the 20th-minute sensory block level compared with other groups. In the bupivacaine group, the 5th-minute motor block level was detected to be statistically significantly higher than other groups. Specific side-effects occurred for each adjuvant agent. Occurrence of hypotension in the saline group was statistically significantly higher compared with other groups. Conclusion: Effects of different adjuvant agents on the properties of spinal anesthesia are different and they cause specific side-effects. Fentanyl prolongs sensory block level and duration. As the local anesthetic dose increases, the increase in the motor block level accelerates and as the quality of anesthesia decreases, occurrence of hypotension increases. Pam Med J 2013;6(2):44-51

OBJECTIVES This study aimed at determining the short-, mid- and long-term effects of a triple shoulder injection accompanied by fluoroscopy on Visual Analogue Scale (VAS) values in patients with chronic shoulder pain. METHODS The study was conducted by retrospective investigation of the files of 92 patients experiencing chronic shoulder pain, and on whom a triple shoulder injection with 40 mg methylprednisolone and 25 mg bupivacaine accompanied by fluoroscopy was applied between January 01, 2011 and August 31, 2012. RESULTS 1st week, 1st-6th month, and 1st year VAS values were significantly lower when compared to the basal VAS values from a statistical point of view (p

A seventy-seven year-old male patient had a stroke two years ago. Following the stroke, the patient had continuous, excruciating, severe pain between the left knee, which increased when standing and walking. We looked into the change in the character of the patient's pain after treatment. This study aimed to present our treatment approaches to the patients who develop central neuropathic pain, degenerative disk disease-related peripheral neuropathic pain and radicular nociceptive pain, and gonarthrosis-related nociceptive pain in the left leg following stroke.

Intensive care unit (ICU) readmissions after coronary bypass (CABG) operations occur in a significant number of patients, and the prognosis is poor. We analyzed the risk factors for ICU readmissions after CABG operations.We retrospectively analyzed the prospectively collected data of 679 coronary bypass patients operated in a single institution in order to evaluate the risk factors for readmittance to the ICU with logistic regression analysis. The outcome results of patients readmitted to the ICU (Group R) and others (Group N) were compared.Thirty-six (5.3%) patients were readmitted to the ICU. Postoperative in-hospital mortality and pulmonary and neurologic morbidity occurred in 43 (6.3%), 135 (19.9%), and 46 (6.8%) patients, respectively. The comparison of groups showed that mortality and morbidity were significantly higher in Group R compared to Group N (mortality 16.7% vs. 5.9, p=0.029; pulmonary morbidity 66.7% vs. 17.3%, p=0.0001; neurologic morbidity 38.9% vs. 5.0%, p=0.0001). Features associated with readmission included presence of left ventricular dysfunction preoperatively[odds ratio (OR)=4.1; 95% confidence interval (CI)=1.4-12.5; p=0.013], advanced NYHA Class (OR=5.3; 95% CI=1.3-21.7; p=0.022), pulmonary complications (OR=7.3; 95% CI=2.1-25.5; p=0.002), and neurologic complications (OR=4.6; 95% CI=1.3-16.7; p=0.021).Patients readmitted to the ICU postoperatively have higher rates of mortality and pulmonary and neurologic morbidity after coronary bypass operations. Left ventricular dysfunction, advanced NYHA class, and postoperative pulmonary and neurologic complications are significant risk factors for readmission to the ICU.

OBJECTIVE: To compare the postoperative analgesic characteristics and side effects of two different doses of intrathecal dexmedetomidine in combination with hyperbaric bupivacaine, and to evaluate the effects of these combinations on spinal anesthesia.METHODS: After obtaining approval from the local ethics committee, 60 male patients who were undergoing inguinal surgery and were classified as American Society of Anesthesiologists physical status class I were included in the study. The present study was conducted in 2003 in a military hospital with a capacity of 100 beds. The patients were randomly assigned to three groups of 20 patients: group 1, 0.5 mL saline added to 3 mL (15 mg) hyperbaric bupivacaine; and groups 2 and 3, 2 μg dexme-detomidine and 4 μg dexmedetomidine added to 3 mL (15 mg) hyperbaric bupivacaine, respectively. Medications were administered by intrathecal injection in a total volume of 3.5 mL. The postoperative analgesic characteristics, effects on spinal anesthesia and side effects were recorded.RESULTS: Demographic characteristics were similar among the groups. The mean (± SD) time to onset of pain was 220.75±112.7 min in group 1, 371.5±223.5 min in group 2 and 1042.50±366.78 min in group 3. Time to first pain sensation in group 3 was significantly longer than that in groups 1 and 2 (PCONCLUSION: Two different doses of dexmedetomidine, an α2-adrenoceptor agonist with analgesic effects, resulted in an increased duration of analgesia and efficacy, decreased postoperative analgesic use and was associated with no notable adverse effects.

Recent advances in surgical and anesthetic techniques have facilitated general anesthesia and surgical possibilities in the higher-risk patient group. Although general anesthesia is the only preferred approach for breast surgery, there have been many clinical trials about breast surgery that has been achieved with regional anesthesia techniques. It is known that regional anesthesia application decreases the preoperative stress, postoperative morbidity and mortality. Additionally, this application positively affects the early start of feeding and mobilization. Regional anesthesia techniques like high thoracic epidural anesthesia, cervical epidural anesthesia and paravertebral block have been applied successfully in mastectomy operations. Combined thoracic epidural anesthesia-interscalene block technique may also be a good alternative to general or cervical, high thoracic epidural anesthesia. We aimed herein to present a case who underwent successful mastectomy and axillary dissection under combined thoracic epidural anesthesia-interscalene block.

Objective: Dexmedetomidine is an α-2 adrenergic agonist having wide range of effects including sedation in mammalian brain, and has analgesic as well as sympatholytic properties. This study aimed to compare the effects of dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing combined sciatic nerve and femoral nerve block via anterior approach for lower limb orthopedic procedure. Methods: Forty patients, who were between 18 and 65 years old, this study was made at anesthesiology clinic of Bağcılar training and research hospital in 08 September 2011 to 07 June 2012, and underwent surgical procedure due to fractures lateral and medial malleol, were included. Sciatic nerve and femoral nerve block were conducted with an anterior approach on all patients included in the study, with an ultrasonography. The patients were randomly divided into dexmedetomidine [Group D (n = 20); 0.5 μg kg−1 h−1] and propofol [Group P (n = 20); 3 mg kg−1 h–1] infusion groups. Results: The vital findings and intra-operative Ramsay sedation scale values were similar in both groups. Time taken for sedation to start and time required for sedation to become over of Group D were significantly higher than those of Group P (p

Objective There is an increasing interest in reexamining the relationship between glucose levels and postoperative complications. Threshold levels of HbA1c below those currently recommended may be additional indicators of risk for renal and cardiovascular dysfunction. In this study, the authors analyzed the perioperative outcomes of coronary artery bypass graft (CABG) operations to evaluate the association of HbA1c levels and renal complications. Design Retrospective. Setting Research and training hospital, single institution. Participants The prospectively collected data of 510 coronary bypass patients with documented HbA1c levels were analyzed. Interventions The relationship of HbA1c with postoperative renal morbidity was evaluated with logistic regression analysis with lower threshold value (5.9%) for elevated levels. Measurements and Main Results Two hundred ninety-three patients (57.5%) had elevated HbA1c values. Patients with high HbA1c levels (>5.9%) had higher incidences of atherosclerotic vascular diseases. The incidence of acute kidney injury was higher in the high HbA1c group (11.9% v 1.8%; p = 0.0001). The high HbA1c group had higher incidence of renal morbidity (odds ratio = 4.608), and every 1% increase over 5.9% increased risk of renal complications by 23.6%. The other factors associated with renal morbidity were known history of diabetes, chronic renal disease, and performance of any concomitant procedure. Conclusions The elevated levels of HbA1c are associated with increased renal complications and the cut-off values of HbA1c could be lowered to the upper range of normal limits.