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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

To prevent hemodynamic and respiratory changes that are likely to occur during cementation in partial hip prosthesis by prophylactic use of pheniramine maleate and dexamethasone.The study included 40 patients aged between 60 and 85 years with an American Society ofAnesthesiologists (ASA) grade of II-III who underwent partial hip prosthesis. Just after spinal anesthesia, 4 mL normal saline was pushed in patients in Group S, whereas 45.5 mg pheniramine maleate and 8 mg dexamethasone mixture was pushed intravenously in a total volume of 4 mL in patients in Group PD.Amounts of atropine and adrenaline administered after cementation were significantly higher in Group S than in Group PD (P0.05). There was a significant difference between SpO2 values before and after cementation in Group S; SpO2 value was lower after cementation (P0.05) except for 1. min after cementation. SpO2 value increased 1 min after cementation (P = 0.031) CONCLUSION: Prophylactic use of pheniramine maleate and dexamethasone in partial hip prosthesis led to an increase in SpO2 value and a decrease in the utilization of adrenaline and atropine after cementation.

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.

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.