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Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: We aimed to discuss the successful treatment of cerebrospinal fluid (CSF)-cutaneous fistula which is caused by combined spinal epidural anesthesia (CSE), with an autologous epidural blood patch (EBP), further investigation and antibiotherapy. Case: CSE was applied for a total hip replacement. Since CSF was seen in the first attempt, CSE was achieved in the second attempt using the same Tuohy needle. Postoperatively epidural catheter was used for analgesic purposes for 2 days. After the catheter removal, anesthesia consultation was requested due to the patient's wet back. A clear fluid leak at the needle insertion point was observed. A sample was taken and the differential diagnosis of CSF-skin fistula was made biochemically with the presence of glucose and chloride. The patient denied headaches. Neurological examination was normal. With patient's consent, EBP was performed. During the injection CSF leak was slowed down, the last drops were macroscopically hemorrhagic and eventually the leak stopped. Headache, dizziness, and nausea occurred on the 2nd day after EBP. Neurological examination was normal. No dural defect or CSF collection was observed in brain CT, brain diffusion MR and contrast-enhanced MR myelography. Ceftriaxone, metronidazole and a pneumococcal vaccine were added for meningitis prophylaxis in consensus with infection and neurology consultants. 1-month follow-up was performed telephonically and the patient was completely cured. Conclusion: Cerebrospinal fluid (CSF)-cutaneous fistula is a rare complication of neuraxial anesthesia techniques. Since there are no sufficient guidelines for management, the decision on the treatment method depends on the clinician's aspect. We consider that it would be advantageous to prefer EBP primarily in cases with CSF-skin fistula and that the benefit/harm ratio is higher than the complications to be caused by a subarachnoid space that is fistulized to skin and opened out to cutaneous flora. In the literature, the development of meningitis has been reported in some cases followed up under conservative treatment or skin sutures. Although prophylactic use should be avoided as possible due to increasing antibiotic resistance, our opinion is that clinicians should decide for each case, taking into account the conditions such as hospital infection surveillance and the flora of inpatient service. [ABSTRACT FROM AUTHOR]

Background: Surgical trauma may affect immunity and pave the way for septic complications. In our case, the intensive care follow-up of a patient who developed spondylodiscitis and diagnosed with immunodeficiency and ARDS-Sepsis was presented, and the literature was reviewed. Case: A 36-year-old male patient became immobile with severe pain after a lumbar disc hernia repair twenty-eight days ago. Antibiotherapy was started after the diagnosis of Spondylodiscitis by MRI (Figure 1). Due to his clinical deterioration, he was transferred to our intensive care unit with the preliminary diagnosis of ARDS-sepsis and acute renal failure. There were tachycardia, hypotension, hypoxia, anuria, with no infective findings in the operation area. Continuous venovenous hemodialysis and cytokine filter were applied to the patient. The cytokine filter was terminated on the third day with the regression of ARDS and infective parameters (Table 1), and the patient was followed up with high flow (fiO²: 100 flow: 60L/min). Hypoxia became evident on the seventh day, and the patient had to be intubated on the tenth day. Antibiotherapy was expanded due to acinetobacter and hyphae in deep tracheal aspirate. Deepening of thrombocytopenia was thought to be related to antibiotics. IgG level was 569 mg/dL (700-1600 mg/dL). Intravenous Ig (IVIG) was administered. As the cytopenia continued, it was thought that infection-related immune thrombocytopenia might have been added, and IVIG was planned again, the treatment was completed with clinical response. After sixty days of intensive care follow-up, the patient was removed from the intensive care unit by closing the tracheotomy. Conclusion: Spondylodiscitis is usually bacterial and occurs after surgery. Complications, constant source of infection, and prolonged antibiotic therapy may lead to multiple organ dysfunction syndrome (MODS) due to uncompensated excessive and prolonged proinflammatory responses in patients. Long-term hospitalization after surgery, immobility, malnutrition are predisposing factors to sepsis; it also reveals the imbalance of inflammatory and anti-inflammatory processes. Thus, prolonged immunodeficiency findings can be observed. The patient, who developed MODS and secondary immunodeficiency, was discharged after meticulous multidisciplinary follow-up. In conclusion, it should be kept in mind that the immune system may be suppressed in young and low-risk patients and the resulting sepsis may cause multi-organ damage. [ABSTRACT FROM AUTHOR]

Introduction Cesarean section is a widely performed procedure and its rate varies among countries. Although spinal and/or epidural block are often the preferred anesthetic method in Cesarean delivery, the use [...], Purpose The aim of the present study was to investigate whether levobupivacaine and tramadol wound infiltration decreases postoperative pain following Cesarean section and reduces the need for analgesics in the immediate postdelivery period. Methods Ninety patients (aged 18-40 years) scheduled for elective Cesarean section under general anesthesia were randomly allocated to one of the three groups: the placebo group (group P) received 20 mL local wound infiltration with 0.9 % saline solution; the levobupivacaine group (group L) received 20 mL local wound infiltration with levobupivacaine 0.25 %; and the tramadol group (group T) received 20 mL local wound infiltration with 1.5 mg/kg tramadol within 0.9 % saline solution. Following the closure of the uterine incision and the rectus fascia, 20 mL solution was infiltrated subcutaneously along the skin wound edges. The primary outcome was 24-h tramadol consumption. Secondary outcomes were recorded VAS scores, diclofenac requirement, fever, vomiting, and wound infection. Results At 15 min postoperatively, VAS values were lower in groups T and L than group P (P = 0.0001). The mean 24-h tramadol consumption was lowest in group T (P = 0.0001) and it was lower in the group L compared to group P (P = 0.007) (401.6, 483.3, and 557.5 mg for T, L, and P groups, respectively). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (P > 0.05). Conclusions We conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia. Keywords Levobupivacaine * Tramadol * Postoperative analgesia * Infiltration

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents the authors' ultrasound (US)-guided CSB experience for anesthesia management during carotid endarterectomy (CEA) surgery. Topics discussed include comorbidities of patients that underwent CEA surgery, reason regional anesthesia is the favorite technique for CEA surgery, and information on the case of a 72-year-old patient who underwent CEA surgery due to the obstruction of the carotid artery.

Objective Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia. Design Randomized prospective double-blind study. Setting Academic university hospital. Subjects Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. Methods Patients were equally divided into two groups—either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients. Results There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P =0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P =0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group. Conclusions ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery. [ABSTRACT FROM AUTHOR]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)