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Purpose Newborns are often sedated during MRI but sedation itself creates adverse events and management is more challenging in this environment. Oral glucose/sucrose administration has been studied in newborns during painful procedures; however, its effectiveness in keeping newborns sleepy and motionlessness during painless procedures has not been demonstrated. The objective of this study was to describe effectiveness of oral 30% glucose administration by comparing with intravenous midazolam sedation for newborns during MRI. Methods One hundred twelve ASA II-III newborns who required care in the ICU and were scheduled for MRI with sedation were included. Group I received 30% glucose solution orally with 0.5-1 ml increments up to 2 ml/3 kg doses and group II received intravenous 0.1 mg/kg midazolam with 0.05 mg/kg repetition. The procedure was considered satisfactory when MRI images were not disturbed by patient movement after oral glucose or intravenous midazolam administration. The efficiency of the techniques, additional dose and rescue sedation requirements, blood glucose levels following oral 30% glucose suckling and presence of adverse events were recorded. Results Demographic data was similar between groups. The efficiency of the procedures were similar between groups (78.9%, in group I and 66.1%, in group II). The blood glucose levels were within normal range in group I whereas transient desaturation and apnea occurred in 8 neonates in group II (p = 0.006). Conclusion Oral 30% glucose administration for newborns during MRI is as effective as standard sedation protocol with midazolam. Thereby, we recommend and support the integration of this safe and reliable technique into routine practice for newborns during MRI., Author(s): H. Evren Eker [sup.1] , Oya Yalcin Cok [sup.1] , Bilin Çetinkaya [sup.2] , Anis Aribogan [sup.3] Author Affiliations: (1) grid.411548.dDepartment of Anesthesiology, Baskent University School of Medicine, Adana [...]

Purpose We investigated whether inserting an intrathecal catheter and leaving it in place for 24 h after an unintentional dural puncture in orthopedic patients reduced the incidence of post-dural puncture headache (PDPH). Methods The study consisted of 427 patients in whom a total of 21 unintentional dural punctures had occurred during orthopedic surgery performed between 2002 and 2006. Seven patients (phase I; evaluated retrospectively) each underwent placement of an epidural catheter at another level after dural puncture during the period January 2002 to February 2004. Fourteen patients (phase II; evaluated prospectively) received an epidural catheter through the dural tear after an unintentional dural puncture during the period February 2004-March 2006 Results In phase I, 5 of the 7 patients experienced PDPH, and one required an epidural blood patch. In phase II, only one of the 14 patients complained of PDPH, which resolved after 48 h of medical therapy. No patient experienced paresthesia, neurologic or hemorrhagic complication, or infection. Conclusion Inserting an epidural catheter through the dural tear following an unintentional dural puncture and leaving it in place for 24 h significantly reduces the incidence of PDPH. Keywords Unintentional dural puncture * Intrathecal catheter * Postoperative 24 h, Introduction Total hip and knee replacements are common orthopedic surgeries. A combination spinal epidural technique is still a reasonable choice for use in patients treated with this type of surgery [...]

Thoracic injury is a common type of trauma. The mechanics of chest injury are complex and varied. Morbidity and mortality are primarily determined by associated injuries and severe pain is one of the component. Associated pulmonary complication would be decreased with acute pain management modalities and development of chronic pain would be prevented. The pain management setting at the site of scene of accident and continuing at emergency unit, intensive care unit, during and after surgery is very important to decrese the percentage of morbidity and mortality. Opioids, adjuvant agents, regional techniques, operations would be performed to manage acute pain and prevent chronic pain according to the clinical situation of the patient. The success rate of pain management would be increased by combined management modalites and using imaging devices like ultrasonography during regional techniques. [ABSTRACT FROM AUTHOR]

Amaç: Servikal epidural nöroplasti servikal diskopati tedavisinde olduğu gibi akciğer kanserinin apeks tutulumlarında özellikle dermatomal ekstremite yayılımlarının tedavisinde uygulanabilir. Servikal lokal anestezik uygulamaları sırasında sistemik toksik reaksiyon gelişebilir. Bu durumda hızlı müdahalenin, etiyolojik nedenlerin göz önünde bulundurulmasının hasta sağaltımı açısından önemini vurgulayan bir olgu aktarılmaktadır. Olgu: Metastatik akciğer kanseri nedeniyle takip edilen hasta (61 yaş, erkek) sağ boyunda, sırtta, omuza ve kola yayılan ağrı şikayeti nedeni ile algoloji bölümüne konsülte edildi. Öyküsünde 15 gündür bıçak saplanır tarzda sürekli ağrısı olup fizik muayenede nörolojik defisit bulgularına rastlanmadı. PET/BT’de sağ akciğer üst lobda primer tümör ve yaygın metastazı olan hastanın servikotorakal MRG’de bası bulgusu yoktu. Medikal tedavi ile VAS 8’den 6’ya gerileyen hastaya servikal epidural nöroplasti için "prone" pozisyon verilerek iv sedoanaljezi uygulandı. C7-T1 seviyesinden sağ lateral interlaminar yaklaşım ile epidural aralığa girim yapılarak epidural kateter C3-4 sağ lateral foraminal seviyesine ilerletildi. Seviye ve epidural aralık kontrolü kontrast madde yayılımı ile skopi görüntüleriyle kontrol edildikten sonra %0,125 bupivakain ve 16 mg deksametazon içeren 10 mL solüsyondan 2 mL uygulandı. Epidural kateter sırasıyla C4-5, C5-6, C6-7 seviyelerine çekilerek kontrast yayılımı kontrol edildikten sonra her bir seviyeye 2 mL enjeksiyon uygulandıktan sonra işlem sonlandırıldı. İşlemin ardından kardiyak arrest gelişen hastada hava yolunu da güven altına almak üzere "supine" pozisyona çevrilerek KPR’ye başlandı. Sistemik toksik reaksiyon öntanısı ile hastaya iv lipid emülsiyon 100 mL uygulandı ve 4 saat boyunca 0,25 mL/kg/saat ile devam edildi. Resüsitasyon sonrası bakımı reanimasyon ünitesinde devam ettirilen hasta nörolojik muayenesi normal (GKS:15), hemodinamisi stabil olarak 4. saatte ekstübe edildi. Sonuç: Servikal epidural alana uygulanan algoloji girişimlerinde, kateter yerinin kontrolüne rağmen lokal anestetik kullanımına bağlı spinal blok ve kardiyupulmoner arrest gelişebilir. Bu durumda vital bulguların yakın takibi ile hızlı müdahalenin, sistemik toksik reaksiyon nedeniyle iv lipid emülsiyon uygulamasının resüsitasyon başarısını artırdığı kanaatindeyiz. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate and report perioperative clinical experience in patients undergoing bilateral sympathectomy with video-assisted thoracoscopic approach for the management of hyperhidrosis. Material and Methods: After the approval of the ethics committee all patients undergoing bilateral video-assisted thoracoscopic sympathectomy for the management of hyperhidrosis between 01/01/2007-01/07/2010 were included in the study. Associated data were obtained from patient files and anaesthesia records. Results: Mean age of thirty-five patients operated with bilateral video-assisted thoracoscopic sympathectomy for the management of hyperhidrosis was 25.1±5.9 years, and 22 of them were female. All patients were intubated with double-lumen endotracheal tube and managed with one-lung ventilation. In the early postoperative period, after extubation, two of three patients who were diagnosed with pneumothorax were treated with percutaneous approach. The last patient who was a heavy-smoker and persistently demonstrated low oxygen saturation values despite bronchodilator therapy required thorax drainage tube. Three patients diagnosed as pneumothorax with chest x-ray examination recovered spontaneously. During the first 24 hours, all patients' pain scores remained less than 3 according to verbal analogue scale. After a week, 80 % of the patients had pain scores of < 3. The patients (n=7) whose pain scores were more than three were those who had clipping during sympathectomy. Conclusion: Although this kind of surgery was performed on low-risk patients and its known superiorities over open thoraco­tomy, VATS requires a particular ventilation management during intraoperative period and very close monitoring of postoperative complications and effective postoperative analgesia. Therefore, in planning anaesthesia, indications of thoracic surgery, and patients' characteristics should be evaluated in the same context. [ABSTRACT FROM AUTHOR]

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Arterial cannulation is a common intervention in anesthesia practice. However, the success rates and complications of radial arterial cannulation with 20-G or smaller catheters in patients with atherosclerosis have been underevaluated. The aim of this prospective randomized study was to compare the efficacy of and complications with 20- and 22-G catheters for radial arterial cannulation in atherosclerotic patients. Thirty patients with atherosclerosis, American Society of Anesthesiologists (ASA) III–IV, undergoing general anesthesia were enrolled in the study. Radial artery cannulation was performed in group 20G ( n = 15) with a 20-gauge (20 × 1.1 × 33 mm; flow, 61 ml·min−1) catheter and in group 22G ( n = 15) with a 22-gauge (22 × 0.9 × 25 mm; flow, 36 ml·min−1) catheter. Radial artery systolic blood flow (SBF) and radial artery diameter (RAD) were assessed by a Doppler ultrasound probe before cannulation and 24 h after decannulation for vascular complications. The number of puncture attempts, arterial blood gas samples, and manual flushes; total heparinized solution consumption; duration of cannulation; decannulated radial arterial systolic blood flow; postcannulation RAD; and vascular complications such as occlusion, hematoma, pseudoaneurysm, bleeding, and thrombosis were noted. The Mann Whitney U-test, χ2 test, and one-sample t-test were used. Values are expressed as medians and quartiles and P < 0.05 was considered as significant. The number of puncture attempts was greater in group 20G (range, 1 to 4) than in group 22G (range, 1 to 2; P = 0.02). In group 20G patients, postoperative RAD was larger than preoperative RAD ( P = 0.02) and postoperative SBF was lower than preoperative SBF ( P = 0.03). In group 22G patients postoperative SBF was higher than preoperative SBF ( P = 0.03), while there was no significant difference between preoperative and postoperative RAD. The occlusion rate of atherosclerotic radial arteries was 6% with the 22-gauge catheter and 26% with the 20-gauge catheter ( P = 0.02). A 22-gauge catheter for radial arterial cannulation in patients with atherosclerosis provides unchanged postcannulated radial artery diameter, decreases postcannulation complications, and improves the first-attempt success rate. [ABSTRACT FROM AUTHOR]

Acute herpes zoster (AHZ) causes postherpetic neuralgia (PHN) in 48-75% of patients. Nerve blocks performed in the acute phase of HZ may treat the pain and prevent PHN development. Here, we present pain relief with modified van-Lint block in two cases with AHZ involving vesicles on the traces of the supraorbital and supratrochlear nerves. Two female patients, 72 and 66 years old, with AHZ involving vesicles on the traces of the supraorbital and supratrochlear nerves starting from the right periocular region to the scalp presented with symptoms such as hypoesthesia, dizziness, burning, throbbing, and severe pain. Their initial visual analogue scale (VAS) scores for pain were 9 and 10, respectively. Supraorbital and supratrochlear nerve blockade with modified van-Lint technique was planned, as the classical nerve block sites were covered with active vesicles. Following the nerve blocks, VAS scores of both patients decreased to 1 immediately. Vesicles were faded and scabbed, symptoms such as hypoesthesia, burning and throbbing had recovered, dizziness was relieved, and VAS scores were 4 and 5, respectively, after one week. VAS scores were 1 and 2, respectively, after the second injection, and all symptoms were resolved, and no additional analgesic was required during a three-month follow-up. Modified van-Lint block with 5 mL 1% lidocaine may provide successful pain relief in AHZ involving vesicles on the traces of the supraorbital and supratrochlear nerves.

Background: Accidental intraneural injection induced nerve injury is an iatrogenic tragedy and intramuscular injection (IM) is the most common injury mechanism affecting the sciatic nerve. The most frequent presentation of sciatic nerve injury includes radicular pain and paresthesia with almost immediate onset of variable motor and sensory deficit., Objectives: Intraneural injection is a common injury mechanism of the sciatic nerve and generates neuropathic pain with inflammatory neuritis. Steroids inhibit the production of inflammatory mediators and reduce ectopic discharges on damaged neural membranes. The results of transsacral steroid injection on neuropathic pain in 5 patients with accidental sciatic nerve injury due to intraneural injection were presented in this report., Design: Report of 5 cases., Description of Cases: Five patients, 32, 34, 45, 54 and 70 years old respectively, complaining of severe neuropathic pain, paresthesia and progressive weakness of the lower extremity with difficulty in walking secondary to gluteal injection were admitted to the clinic. The symptoms were resistant to drug therapies. Electromyography disclosed axonal damage of the sciatic nerve. The initial examination of the patients revealed a Numeric Rating Scale (NRS) of 10, 10, 9, 9, and 10 respectively., Results: Diagnostic block was performed through the unilateral S1-S2-S3 sacral foramina with 22-G spinal needle by 5 mL 1% lidocaine into each foramen. NRS scores decreased to 1, 2, 2, 2 and 1, respectively. One week later, the patients were administered 80 mg methylprednisolone with 1% lidocaine in 15 mL solution shared equally in each foramen. The patients were checked one month after therapeutic block and a full recovery was achieved in all patients., Conclusion: The neuropathic pain due to accidental intraneural injection of the sciatic nerve would be an acceptable indication for transsacral nerve block with corticosteroids in the treatment of sciatic neuropathic pain symptoms.