Search

Istanbul, home to numerous historical treasures, houses one of the oldest fully constructed hospitals.This 50-bed hospital was built in the early 12Although it was built in the 12

Over the past 30 years, the treatment of deep and eloquent arteriovenous malformations (AVMs) has moved away from microneurosurgical resection and towards medical management and the so-called minimally invasive techniques, such as endovascular embolization and radiosurgery. The Spetzler-Martin grading system (and subsequent modifications) has done much to aid in risk stratification for surgical intervention; however, the system does not predict the risk of hemorrhage nor risk from other interventions. In more recent years, the ARUBA trial has suggested that unruptured AVMs should be medically managed. In our experience, although these eloquent regions of the brain should be discussed with patients in assessing the risks and benefits of intervention, we believe each AVM should be assessed based on the characteristics of the patient and the angio-architecture of the AVM, in particular venous hypertension, which may guide us to treat even high-grade AVMs when we believe we can (and need to) to benefit the patient. Advances in imaging and intraoperative adjuncts have helped us in decision making, preoperative planning, and ensuring good outcomes for our patients. Here, we present several cases to illustrate our primary points that treating low-grade AVMs can be more difficult than treating high-grade ones, mismanagement of deep and eloquent AVMs at the behest of dogma can harm patients, and the treatment of any AVM should be tailored to the individual patient and that patient's lesion.

For individuals who form the society to live in harmony, they need to acquire a set of values such as love, respect, tolerance and honesty. To create a society with individuals having these characteristics, value education should be carefully planned and implemented. Students who study in the Distance Learning MA Program on Character and Value Education, are expected to stimulate various feelings, thoughts, values and behaviours in their families, friends, colleagues and immediate environments, starting from themselves. The aim of this qualitative study is to reveal to what extent the students reflected the outcomes they gained in the program to themselves, their families, immediate environments and the society. The participants were 22 students studying in the Distance Learning MA Program on Character and Value Education at Anadolu University, Turkey. The data were collected through a data-collection form consisting of openended questions. Descriptive analysis was performed for data analysis. The results of the study showed that the students who attended the Distance Learning MA Program on Character and Value Education gained certain benefits for themselves, which were also reflected to their families and immediate environments as well as the country and the world. Various suggestions were offered in accordance with the results of the study.

The surgical approach to the atrium of the lateral ventricle remains a challenge because of its deep location and close relationship to important neurovascular structures. We present an alternative and safer approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. We demonstrate this approach through cadaveric anatomical microdissection and a case series. Five formalin-fixed brain specimens (10 hemispheres) were dissected with the Klingler technique. Transillumination was used to show the trajectory of the approach in cadaveric specimens. Clinical data from five patients who underwent this approach were reviewed. This data included intraoperative ultrasound images, operative images, pre- and postoperative magnetic resonance imaging, MR tractography, and visual field examination. The parieto-occipital fissure is a constant, uninterrupted fissure that can be easily identified in cadavers. Our anatomical dissection study revealed that the atrium of the lateral ventricle can be approached through the parieto-occipital fissure with minor damage to the short association fibers between the precuneus and cuneus, and a few fibers of the forceps major. In our series, five patients underwent total resection of their atrial lesions via the posterior interhemispheric transparieto-occipital fissure. No morbidity or mortality was observed, and the disruption of white matter was minimal, as indicated on postoperative tractography. The postoperative visual fields were normal. The posterior interhemispheric transparieto-occipital fissure approach is an alternative to remove lesions in the atrium of the lateral ventricle, causing the least damage to white matter tracts and preserving visual cortex and optic radiation.

In the social studies course, which has the function of preparing individuals for social life, it is very important to benefit from social resources. The family is an important social resource that can be used to channel the lives of students into the social studies classroom environment. This study explores how family involvement can be utilized in a social studies course, and examines the views of students, families and teachers for the use of family involvement activities in a social studies course. In the study, action research design, which is a recognized qualitative research method, was employed. The study was conducted with the participation of 5th grade students of a public middle school in the fall semester of the 2016–2017 academic year, along with the parents and social studies teachers of these students. The data for the study were collected from personal information forms, semi-structured interviews, focus group interviews, observations, student anecdote notebooks, family cooperation notebooks, a research diary and voice records of the validity committee, and was subjected to a descriptive data analysis. As a result of the research, it was found that it is possible to teach social studies lesson with activities based on various family participation at home, school and outside school. In the research, it was concluded that teaching social studies lesson with activities based on family participation provides various benefits to students, families and social studies teachers. Family involvement activities at home, at school and outside school as part of such were course were found to strengthen family-child relationships, to help family members spend quality time together, to strengthen relationships between the family, the student and the teacher, and to give families the opportunity to observe the classroom environment. Based on these findings, the study was concluded by making various recommendations for further research and implementation., Bireyleri toplumsal yaşama hazırlama işlevine sahip olan sosyal bilgiler dersinde toplumsal kaynaklardan yararlanmak büyük önem taşımaktadır. Aile de sosyal bilgiler dersinde öğrencilerin günlük yaşamlarını sınıfa taşımada yararlanılabilecek etkili bir toplumsal kaynaktır. Araştırmanın amacı sosyal bilgiler dersine aile katılımının nasıl sağlanabileceğini ve aile katılımına dayalı etkinliklerle işlenen sosyal bilgiler dersine ilişkin öğrenci, aile ve öğretmen görüşlerini ortaya koymaktır. Araştırma kapsamında nitel araştırma yöntemlerinden olan eylem araştırması deseni benimsenmiştir. Araştırma 2016-2017 öğretim yılı güz döneminde bir Devlet Ortaokulu’nun 5. sınıf şubelerinin birinde öğrenim gören öğrenciler, bu öğrencilerin aileleri ve sosyal bilgiler öğretmeninin katılımı ile gerçekleştirilmiştir. Araştırmanın verileri kişisel bilgi formu, yarı yapılandırılmış görüşme, odak grup görüşmeleri, gözlemler, öğrenci anekdot defterleri, aile iş birliği defterleri, araştırmacı günlüğü ve geçerlik komitesi ses kayıtları aracılığıyla toplanmıştır. Veriler betimsel analiz yoluyla çözümlenmiştir. Araştırma sonucunda sosyal bilgiler dersinin evde, okulda ve okul dışında çeşitli aile katılımına dayalı etkinlikler ile işlenmesinin olanaklı olduğu görülmüştür. Araştırmada sosyal bilgiler dersinin aile katılımına dayalı etkinliklerle işlenmesinin öğrencilere, ailelere ve sosyal bilgiler öğretmenine çeşitli kazanımlar sağladığı sonucuna ulaşılmıştır. Sosyal bilgiler dersinde evde, okulda ve okul dışında gerçekleştirilen aile katılımlı etkinliklerin aile-çocuk ilişkilerinin güçlenmesini, aile üyelerinin birlikte iyi zaman geçirmesini, aile-öğrenci-öğretmen ilişkilerinin güçlenmesini ve ailelerin sınıf ortamını görmesini sağladığı ortaya çıkmıştır. Araştırma sonunda, sonuçlara dayalı olarak uygulamaya ve araştırmaya yönelik çeşitli öneriler sunulmuştur.

The quality of teachers, who are the practitioners of the education system, is an issue that needs to be emphasized. Today, accreditation studies are of great importance in terms of determining the problems experienced in teacher education programs, taking forward measures, and improving the quality of teacher education and teachers. In this study, it was aimed to understand how pre-service social studies teachers who participated in the accreditation evaluation process perceive the evaluation process and their experiences regarding the phenomenon. Therefore, one of the qualitative research designs, the "phenomenology" was employed. Within the scope of the research, semi-structured interviews were conducted with 10 pre-service social studies teachers who participated in the accreditation process, and the data obtained were analyzed with an inductive data analysis approach. As a result of the research, it was found that the perceptions of the pre-service social studies teachers perceived the accreditation process as reviewing the education currently given in the program, improving the program, controlling it, bringing it into compliance with the standards and evaluating it. It has also been found that pre-service social studies teachers have gained experience in participating in the accreditation process, this experience helped them to make self-evaluation and self-assessment and gain a multi-faceted perspective. Pre-service social studies teachers also made suggestions about some issues came up during the meetings held by the accreditation team with students such as environment where the interviews took place, meeting one-on-one, meeting in a quiet environment, meeting students without dividing them into groups, spending more time on student meetings, and including questions for socio-cultural activities. In addition, the pre-service social studies teachers who participated in the research explained their expectations regarding the accredited Social Studies Teacher Education Program as being more encouraged in reading more books as a preparation for the courses, in participating in scientific activities and research projects, and being guided by academicians more effectively. Based on the findings obtained from the research, there were implications in terms of the accreditation team, interview questions, and social environment., Eğitimin büyük bir yaşamsal öneme sahip olduğu günümüzde eğitim sisteminin uygulayıcıları olan öğretmenlerin kalitesi üzerinde durulması gereken bir konudur. Günümüzde öğretmen eğitim programlarında yaşanılan sorunları belirlemek, ileriye dönük önlemler almak, öğretmen eğitiminin ve öğretmenlerin kalitesini artırmak bakımından akreditasyon çalışmaları büyük önem taşımaktadır. Bu araştırmada akreditasyon değerlendirme sürecine katılmış öğretmen adaylarının akreditasyon sürecini nasıl algıladıklarını ve akreditasyon sürecine ilişkin deneyimlerini ortaya koymak amaçlanmıştır. Bu amaçla nitel araştırma desenlerinden biri olan “olgu bilim” deseni işe koşulmuştur. Araştırma kapsamında akreditasyon sürecine katılmış 10 sosyal bilgiler öğretmen adayı ile yarı yapılandırılmış görüşme gerçekleştirilmiş, elde edilen veriler tümevarımsal analiz yaklaşımı ile çözümlenmiştir. Araştırma sonucunda sosyal bilgiler öğretmen adaylarının akredite olma sürecine ilişkin algıları programda verilen eğitimin gözden geçirilmesi, programın iyileştirilmesi, denetlenmesi, standartlara uygun duruma getirilmesi ve değerlendirilmesi olarak belirlenmiştir. Sosyal bilgiler öğretmen adaylarının akredite olma sürecine katılım sağlamaları ile özeleştiri ve özdeğerlendirme yapmalarına, çok yönlü bakış açısı kazanmalarına destek olmasına yönelik deneyimler edindikleri bulguları elde edilmiştir. Sosyal bilgiler öğretmen adayları akreditasyon ekibinin öğrencilerle gerçekleştirdiği akreditasyon görüşmelerine ilişkin bölüme ait bir ortamda görüşme, birebir görüşme, sessiz bir ortamda görüşme, öğrencileri gruplara ayırmadan görüşme, öğrenci görüşmelerine daha uzun zaman ayırma, sosyo-kültürel etkinliklere yönelik sorulara yer verme gibi öneriler sunmuşlardır. Bununla birlikte araştırmaya katılan sosyal bilgiler öğretmen adayları akredite olmuş Sosyal Bilgiler Öğretmenliği Programı’na ilişkin beklentilerini ders içeriğine yönelik kitap okumaya teşvik etme, bilimsel etkinliklere katılıma teşvik etme, öğrencilere yönelik projeler üretme ve öğrencilere rehberlik etme olarak açıklamışlardır. Araştırmadan elde edilen bulgulara dayalı olarak akreditasyon ekibine, görüşme soruları ve ortamına ilişkin çeşitli öneriler sunulmuştur.

OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions.METHODSThis is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort.RESULTSIn the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1–137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%–100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma).CONCLUSIONSEndoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done.

Objective: The virus pandemic called Covid-19 pandemic, has spread from Wuhan city of People’s Republic of China to the whole world in December 2019 It poses a risk to healthcare professionals due to patients and asymptomatic cases carrying the disease In particular, operating theaters are among the most risky work areas in terms of aerosol forming processes and possible contact For this reason, the establishment of perioperative operation protocols conveys importance In this review;our “preoperative patient preparation and operating room operation protocols” including preoperative patient preparation, operating room organization and personal protection equipment which have particular importance are presented Method: For this purpose, existing protocols and literature scanning have been made and the protocol created in the light of current information includes 3 subtitles as preoperative patient preparation, regulation of operating room procedures, and operating room cleaning at the end of the operation Results: The protocol created was being used between March 15, and May 10, 2020 When the perioperative management is meticulously implemented in line with our protocols created in accordance with the internal functioning of our institution, it has been observed that the surgical process does not fail, besides safety of patients and employees may be reinforced Conclusion: In the light of clinical protocols, COVID-19 suspected-infected patients can be identified in the preoperative period, and perioperative risks can be reduced and the safety of the patient, healthcare professionals and other patients can be increased

Purpose: Despite developments in the treatment of pain, the availability of new drugs or increased knowledge of pain management, postoperative pain control after different surgeries remains inadequate. We aimed to compare the postoperative analgesic efficacy of tramadol versus tramadol with paracetamol after lumbar discectomy. Design, Setting, Participants: Sixty patients undergoing lumbar discectomy were randomly assigned into two groups. Methods: Patients in Group T (n = 30) received tramadol (1 mg/kg), and patients in Group TP (n = 30) received tramadol (1 mg/kg) with paracetamol (1 g) 30 minutes before the end of surgery and paracetamol was continued during the postoperative period at 6 hours intervals for the first 24 hours. Patient-controlled analgesia with tramadol was used during the postoperative period. Main Outcome Measures: Duration, postoperative pain scores, Ramsay sedation scores, analgesic consumption, and side effects were recorded in all patients during the postoperative period. Continuous random variables were tested for normal distribution using the Kolmogorov-Smirnov test, than Student's t-test was used for means comparisons between groups. For discrete random variables chi-square tests and McNemar test was used. Results: Demographic data, mean duration of anaesthesia and surgery were similar in both groups. Postoperative pain scores were significantly higher in Group T than Group TP at 5; 15; 20; and 30 minutes (P =.021, P =.004, P =.002, P =.018). Late postoperative pain scores were similar. Total tramadol consumption in Group T (106.12 ± 4.84 mg) was higher than Group TP (81.20 ± 2.53) during the 24 hours postoperative period. However, continuing the paracetamol at 6 hours interval did not change late postoperative pain scores. Conclusion: The administration of tramadol with paracetamol was more effective than tramadol alone for early acute postoperative pain therapy following lumbar discectomy. Therefore, while adding paracetamol in early pain management is recommended, continuing paracetamol for the late postoperative period is not advised. © 2019 John Wiley & Sons Ltd

Günümüzde en çok kullanılan mobil cihazlar akıllı telefonlardır. Akıllı telefonları öğrenme-öğretme ortamlarında kullanmak okul ile yaşamın birbirine yaklaştırılmasında önemli katkılar sağlayabilecektir. Çok disiplinli yapısı sayesinde sosyal bilgiler dersi, akıllı telefonların kullanılabilmesi açısından zengin bir ortam ve çeşitlilik sunmaktadır. National Council for the Social Studies (NCSS) gibi sosyal bilgiler dersine yön veren toplulukların raporları ve bu alanda yapılan akademik çalışmalar, teknolojinin önümüzdeki yıllarda eğitim alanında ve sosyal bilgiler dersinde daha etkin kullanılmaya başlanacağına dikkat çekmektedir. Araştırmada “sosyal bilgiler öğretmen adaylarının sosyal bilgiler dersinde akıllı telefonlarda kullanılan uygulamalardan yararlanmaya ilişkin görüşleri ve deneyimleri nelerdir?” sorusuna yanıt aranmaktadır. Nitel araştırma yaklaşımına dayalı olarak gerçekleştirilen bu araştırma olgubilim deseninde tasarlanmıştır. Araştırmanın katılımcıları ölçüt örnekleme tekniğine göre belirlenmiştir. Araştırma verileri yarı-yapılandırılmış görüşme tekniği ile toplanmıştır. Verilerin çözümlenmesinde tümevarım analizi tekniği kullanılmıştır. Araştırma sonucunda öğretmen adaylarının akıllı telefon uygulamalarından günlük yaşamlarında gündemi takip etme, bilgiye ulaşma ve bilgi depolama, müzik dinleme, fotoğraf ve video çekme amacıyla yararlandıkları ortaya çıkmıştır. Araştırmada öğretmen adaylarının, sosyal bilgiler dersinde öğretmenlerin akıllı telefon uygulamalarından etkili bir biçimde yararlanabileceğini vurguladıkları sonucuna ulaşılmıştır. Araştırma sonunda, araştırma bulgularına dayalı öneriler sunulmuştur., Smartphones are the most used mobile devices today. Using smartphones in teaching and learning environments could make important contributions to bringing school and life closer. The multidisciplinary structure of the social studies course offers a rich environment and diversity in terms of the use of smartphones. Reports of the societies leading the social studies field, such as the National Council for the Social Studies (NCSS), and academic studies in this field indicate that technology will be used more effectively in the field of education and social studies in the future. The current study seeks to answer the question “what are the social studies teacher candidates' views and experience on benefiting from the applications used in social studies course on smartphones?" The current study adopts the qualitative phenomenological research design. The participants of the study were selected according to the criterion sampling technique. Data were collected by semi-structured interviews. Induction analysis technique was used to analyze the data. Results showed that teacher candidates used smartphone applications to follow the agenda in their daily lives, to access information and to store information, to listen to music, to take photos and videos. In conclusion, teacher candidates emphasized that social studies teachers could benefit from smartphone applications effectively in the social studies course. Suggestions based on the research findings were presented.

We present a case of invasive monitoring of a patient while he was being surgically treated in the status state. Our patient was a 27-year-old male who was hospitalized for frequent seizures, which began after a head trauma at the age of 3 years. Video electroencephalography was performed, and 25 clinical seizures were observed in 24 hours. Cranial magnetic resonance imaging (MRI) revealed a right frontal lesion which was hyperintense in T2-weighted and hypointense in T1-weighted images, and a subependymal nodule. For invasive monitoring, subdural electrodes were placed on the cortex surface via a right frontal craniotomy. The patient was re-operated, and the epileptic zone resection was performed. There was no sign of neurological deficit. Histopathological examination revealed cortical tuber, and the patient was scanned for tuberous sclerosis. There was no sign of tuberous sclerosis in other organs. The diagnosis of our patient was tuberous sclerosis, cortical tuber, subependymal nodule, epilepsy, and intermediate mental retardation. Radiological diagnosis should also be considered. Cortical tuber can be confused with focal cortical dysplasia. Finally, staged resection may be performed as a surgical treatment in some cases.

Amac: Postoperatif bulanti ve kusma (POBK) bircok nedenden kaynaklanan ve sik karsilasilan bir problemdir. POBK ve nitroz oksit arasindaki ilisi yeterince arastirilmistir.Bu calismada laparoskopik kolesistektomi geciren hastalarda, nitroz oksitin POBK`ya etkisinin arastirilmasi amaclanmistir. Yontem: Premedikasyon yapilmis, ASA I-II, 18-60 yas arasinda, 50-80 kg agirliginda, elektif laparoskopik kolesistektomi operasyonu gecirecek 40 kadin hasta calismaya dahil edildi. Hastalar randomize olarak 2 gruba ayrildi. Tum hastalara tiyopental sodyum, remifentanil ve atrakuryum ile anestezi induksiyonu uygulandi. Anestezi idamesinde, grup I`de sevofluran ve nitroz oksit-oksijen karisimi,grup II`de sevofluran ve hava-oksijen karisimi kullanildi. Tum hastalara peroperatif remifentanil infuzyonu verildi. Hastalarin POBK ve agri skorlari 24 saat sure ile takip edildi. Bulgular: POBK skorlari, grup I`de 1. ve 4. saatlerde diger saatlere gore yuksekti, ancak grup II`de saatler arasinda istatistiksel fark saptanmadi. Gruplar arasinda, POBK ve agri skorlari, antiemetik ilac ihtiyaci olan hasta yuzdesi acisindan fark saptanmadi. Hastalarin POBK ve agri skorlari arasinda iliski saptanmadi. Sonuc: Calismamiz sonucunda, laparoskopik kolesistektomi operasyonu geciren hastalarda, peroperatif kullanilan nitroz oksidin, postoperatif bulanti ve kusmanin sikligi ve siddetini arttirmadigi sonucuna varilmistir. Anahtar Kelimeler: Nitroz oksit, Postoperatif, Bulanti, Kusma

Objective A challenging step of the paramedian supracerebellar-transtentorial approach is to expose the anterior portion of the mediobasal-temporal region (MTR), a step that seems most affected by the steepness of the tentorium. The objective of this study was to define magnetic resonance imaging measurements that can predict the level of challenge in exposing the anterior portion of the MTR. Methods Cranial magnetic resonance imaging studies of 100 healthy individuals were examined. The tentorial and occipital angles were measured, and the amount of brain tissue that remained hidden on the microscopic view in front of the petrous apex was indirectly estimated. These measurements were statistically compared with the cephalic index of each person. Results The mean values for the tentorial and occipital angles were 42° (range 25°–53°) and 98° (range 69°–122°), respectively. The results proved that the higher the tentorial angle, the higher the occipital angle and the greater the amount of hidden brain tissue. Of 100 persons, 3 (3%) were found to be dolichocephalic, 23 (23%) were mesocephalic, and 74 (74%) were brachycephalic. Statistical analysis proved that individuals with a dolichocephalic cranial shape have lower tentorial and occipital angles. Conclusions The results provide strong evidence proving that the lesser the tentorial and occipital angles, the easier the exposure of the anterior portion of the MTR during the paramedian supracerebellar-transtentorial approach. The tendency of the cranial shape toward dolichocephaly seems to have the same practical value in choosing the approach. It is easier to expose the anterior portion of the MTR in these individuals.

OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position.METHODSOne hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient’s head was elevated 30° during surgery, and in Group 2, each patient’s head elevation was 45°. Patients were assigned to their group according to the location of their lesion. During surgery, the standard anesthetic protocol was used with total intravenous anesthesia, and transesophageal echocardiography was used to detect air in the blood circulation. Any air embolism seen on the echocardiography screen was classified as Grade 0 to 4. If multiple events occurred, the worst graded attack was used for statistical analysis. During hemodynamic changes caused by emboli, fluid and vasopressor requirements were recorded. Surgical and anesthetic complications were recorded also. All results were compared statistically, and a p value of < 0.05 was considered statistically significant.RESULTSThere was a statistically significant difference between groups for the total rates of venous air emboli detected on transesophageal echocardiography (22.0% [n = 11] in Group 1 and 62.5% [n = 30] in Group 2; p < 0.0001). The rate and severity of air embolism were significantly lower in Group 1 than in Group 2 (p < 0.001). The rates of clinically important venous air embolism (Grade 2, 3, or 4, venous air embolism with decreased end-tidal carbon dioxide levels and/or hemodynamic changes) were 8.0% (n = 4) in Group 1 and 50.0% (n = 24) in Group 2 (p < 0.0001). There was no association between the rate and severity of venous air embolism with patient demographics (p > 0.05). An association was found, however, between the rate of venous air embolism and the type of surgical pathology (p < 0.001); venous embolism occurred more frequently in patients with a meningioma. There were no major surgical or anesthetic complications related to patient position during the postoperative period.CONCLUSIONSFor patients in the semisitting position, an increase in the degree of head elevation is related directly to a higher rate of venous air embolism. With a 30° head elevation and our standardized technique of positioning, the semisitting position can be used safely in neurosurgical practice.

Introduction: Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone–dimenhydrinate and dexamethasone–ondansetron combinations in prevention of nausea and vomiting in postoperative patients. Method: Sixty 18–65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone–dimenhydrinate group (group DD) and dexamethasone–ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air–oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated. Observations: Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups. Result: Our study revealed that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron in prevention of nausea and vomiting after rhinoplasty operations. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2016, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

Problem: Tolerance is one of the values which citizens should have in today's multicultural and democratic society. Educational system should teach tolerance to the individuals in a democratic society. Tolerance can be given through curricula in educational process. Social studies is one of the courses for conducting tolerance education. Skills and perspectives of teachers are important for tolerance education in social studies. The purpose of this study is to understand social studies teachers' perceptions of tolerance. Method: In the study, qualitative research method and phenomenology that is one of the qualitative research designs was employed. The participants were determined using criterion sampling. 10 social studies teachers graduated from social studies education departments working at schools of Eskisehir Provincial Directorate of National Education participated in the study. The research process consisted of two phases. The data were gathered through semi-structured interviews. The interviews were conducted in two steps in order to make an in-depth analysis. In Phase I of the study, semi-structured interviews were conducted with 10 teachers in December and January months during the 2012-2013 school year. The data obtained from the first interviews were also the base for the questions in the second interviews. In Phase II of the study, semi-structured interviews were again conducted with 10 teachers who participated in the first interviews in April and May months during the 2012-2013 school year. Teacher Interview Form-1 in the first interviews and Teacher Interview Form-2 in the second interviews were used for data collection. As for data analysis, thematic analysis technique was used. The data were analysed, the findings were defined and interpreted based on the research questions. Findings: The findings of the study revealed that the social studies teachers described tolerance as respecting ideas, values, beliefs and behaviors, accepting differences such as gender, race and developmental characteristics, being considerate, accepting one's faults, caring about people and being objective, and emphasized the religious aspect of tolerance. The social studies teachers described the limits of tolerance as damaging freedom, country and individuals. Most of them stated that tolerance was important to live together in a community. They also asserted that families were effective in their children's tolerance development. Besides, according to them, age, experience and reading habits could also affect tolerance. The findings also showed that the social studies teachers pointed out that prejudices, pressure and media such as television and Internet inhibited tolerance.

Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 – 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and severity of metabolic acidosis.

Summary This study was performed to evaluate the histopathological effects of epidural drug injection given either by intermittent bolus or continuous infusion through a catheter on epidural tissue. Fourteen ewes received intermittent bolus injections of morphine with bupivacaine, or a bolus of the same drugs followed by continuous infusion for 5 days. After 5 days, histopathological examination of the epidural space revealed mild to moderate inflammatory changes, and focal fibrosis surrounding the catheter in all ewes. The similarity of the inflammatory reaction in the control and drug treated groups seems to indicate that neither intermittent bolus or continuous infusion after a bolus dose caused histopathological changes in the epidural space beyond that caused by the catheter itself.

Gabapentin is an anticonvulsant drug that has analgesic properties for acute postoperative pain. However, the analgesic effect of gabapentin as an antiepileptic prophylactic drug on patients undergoing craniotomy is unclear. In this study, we evaluated the postoperative effectiveness of gabapentin on acute postoperative pain when it is used for antiepileptic prophylaxis in patients undergoing craniotomy for supratentorial tumor resection.Eighty patients undergoing craniotomy for supratentorial tumor resection were randomly assigned into two groups. Patients in Group G (n = 40) received oral gabapentin (3 x 400 mg), and patients in Group P (n = 40) received oral phenytoin (3 x 100 mg) for 7 days before the operation and postoperatively. An identical anesthesia protocol was performed for both the groups. Anesthesia was maintained with propofol and remifentanil infusion. Patient-controlled analgesia with morphine was used, and pain levels were measured. The antiepileptic-related side effects, anesthetic consumption, duration of anesthesia and surgery, tracheal extubation time, postoperative pain scores, morphine consumption, and sedation scores were recorded.Thirty-seven patients in Group G and 38 patients in Group P completed the study. During the preoperative period in Group G, one patient had severe fatigue, one had severe dizziness, and one patient's surgical procedure was changed. The median plasma levels of gabapentin were 34 micromol/mL (range, 23-51 micromol/mL) in 34 patients. In Group P, one patient withdrew from the study preoperatively and one developed transient neurological symptoms postoperatively. The demographic data and mean duration of anesthesia and surgery were similar in both the groups. The total propofol and remifentanil consumption in Group G (1847 +/- 548 mg/3034 +/- 1334 microg) was significantly less than that of Group P (2293 +/- 580 mg/4287 +/- 1282 microg) (P = 0.01). However, tracheal extubation could be done earlier in Group P (4.5 +/- 2 min) than in Group G (16.6 +/- 22 min) (P0.001). Pain scores were significantly higher in Group P at 15 min, 30 min, and 1 h (P0.001). The total morphine consumption was also significantly higher in Group P (33 +/- 17 mg vs 24 +/- 19 mg) (P = 0.01). The postoperative sedation scores were significantly higher in Group G at 15 min, 30 min, 1 h, and 2 h (P0.001).The administration of gabapentin to patients undergoing craniotomy for supratentorial tumor resection was effective for acute postoperative pain. It also decreased analgesic consumption after surgery. However, it may lead to side effects such as delayed tracheal extubation and increased sedation postoperatively.

The role of intraoperative monitoring of lower cranial nerves is not well established. In this study, the authors retrospectively analyzed the intraoperative monitoring data and the clinical outcome of the spinal accessory nerve (SAN) in patients who have undergone posterior fossa surgery. SAN was monitored in 19 patients. Subcutaneous needle electrodes were placed in the trapezius, and any abnormal spontaneous activity was documented for duration and amplitude. A bipolar stimulation probe was used for triggered electromyogram, with a maximum stimulation intensity of 3 mA. All patients were clinically evaluated for SAN dysfunction postoperatively 24 hours and 7 days. Neurotonic discharges, lasting between 3 and 90 minutes were seen in 84% of the patients. Continuous discharges lasting longer than 5 minutes were seen in 36% of the patients. The SAN was stimulated in 57.8% of the patients. With clinical examination, none of our patients had postoperative SAN dysfunction. Long lasting dense neurotonic discharges and high stimulation thresholds have been correlated with postoperative facial nerve injury; however, this does seem be true in the case of SAN monitoring. Neurotonic discharges are commonly false-positive and stimulation intensity up to 3 mA can be related with a good outcome. The intraoperative monitoring of SAN may not be valuable as much as facial nerve monitoring. Copyright © 2008 American Clinical Neurophysiology Society.

Summary Aim: This study investigates whether the diameters of right internaljugular vein (RIJV) are suitable for the use of ‘big radius curved J-tip’Seldinger wires in pediatric patients.Methods: One-hundred and thirty-five children, 1 month to 15 yearsof age, scheduled for pediatric surgery were divided into foursubgroups according to their age (0–12 months, 1–2 years, 2–6 yearsold, and >6 years). Patients in the 0–12 months group were furtherdivided into two groups as 0–6 months and 7–12 months of age toevaluate RIJV characteristics in detail. Following anesthesia induction,depth, diameter, and area of RIJV were measured with ultrasound atthe level of cricoid cartilage and sterno-clavicular junction in supineand Trendelenburg position.Results: Infants in the 0–6 months of age group had the least meandiameter of RIJV at both the cricoid cartilage and the sternoclavicularjunction level (0.484 ± 0.132 and 0.499 ± 0.136 cm). The aforemen-tioned diameter was significantly lower than the values of other agegroups (P < 0.05). Trendelenburg position did not increase RIJVdiameter in children below 6 and cross-sectional area below 2 yearsold. Correlations between age, height, weight, head circumference andRIJV diameter, cross-sectional area, depth from the skin were weak.Conclusion: The diameter of the IJV in pediatric patients, especiallyinfants, is often smaller than the diameter of the J-tip guidewire curve.We speculate that this may lead to impeded guidewires and failedcannulation. It must also be kept in mind that the Trendelenbergposition might not facilitate IJV cannulation in children

WOS: 000247128200009 PubMed: 17531730 Study Objective: To compare the case of cannulation, success/failure rate, and complication rate between ulnar and radial arteries. Design: Randomized, controlled study. Setting: Operating room. Patients: 100 ASA physical status I, II, and III patients undergoing general anesthesia and requiring arterial cannulation. Interventions: Patients were divided randomly into two separate groups of 50 patients each according to cannulation site: ulnar artery (group U) or radial artery (group R) group. Measurements: The presence and fullness of the arterial pulses (strong/weak/absent), ease of cannulation (cases in which cannulation was successful on the first attempt and those that which required more than one cannulation attempt), success rate of cannulation, and complications (early/late) were all recorded. Main Results: The radial artery was stronger in pulse (83% vs 73%). The success rates of cannulations for the ulnar and radial arteries were 82% and 90%, respectively (P > 0.05). The overall success rate of cannulation in the ulnar group with a strong pulse was 100%. There were significant differences in the success rate of cannulation between the patients with strong and weak pulses in the ulnar group (P < 0.0001). Ease of cannulation and complication rates of cannulations were not statistically different in both groups. Conclusions: The success rate of an arterial cannulation in a patient with a strong ulnar pulse is the same as for radial artery cannulation. (C) 2007 Elsevier Inc. All rights reserved.

The purpose of this study is to understand social studies teachers' perceptions of tolerance education and their practices. The participants were 10 social studies teachers who were determined using criterion sampling. The data were gathered through semistructured interviews and analysed thematically. According to the results of the study, most of the teachers emphasized that tolerance could be gained through education, educated people were more tolerant, and teachers should be tolerant. The social studies teachers emphasized that values and diversities should be taught for tolerance. The teachers also pointed out that after receiving tolerance education, the students should have empathy, be respectful for diversities, confident, patient, obey the rules, be objective, have developed communication skills and have a broad perspective. They stated that with regard to tolerance, they mostly talked about events emerging in the classroom during their lessons. Moreover, the teachers, as the guidance teachers, talked about tolerance outside the classroom, and organized book activities and competitions towards tolerance. They indicated that tolerance was not included in the Social Studies curriculum sufficiently. Educational activities which will improve teachers’, families’ and students’ perceptions of tolerance can be arranged. Qualitative and quantitaive researchs can be conducted about families’ and students’ perceptions of tolerance, Bu araştırmanın amacı, sosyal bilgiler öğretmenlerinin hoşgörü eğitimine bakışını ve hoşgörü eğitimine ilişkin uygulamalarını anlamaktır. Araştırmaya ölçüt örneklem ile belirlenen 10 sosyal bilgiler öğretmeni katılmıştır. Araştırmanın verileri yarı- yapılandırılmış görüşme yoluyla toplanmış ve tematik olarak analiz edilmiştir. Araştırma sonucunda sosyal bilgiler öğretmenlerinin çoğu hoşgörünün eğitimle kazandırılabileceğini, eğitimli insanların daha hoşgörülü olduklarını ve öğretmenin hoşgörülü olması gerektiğini vurgulamışlardır. Sosyal bilgiler öğretmenleri, hoşgörü için değerlerin ve farklı kültürlerin öğretilmesi gerektiğine vurgu yapmışlardır. Sosyal bilgiler öğretmenleri, hoşgörü eğitimi aldıktan sonra öğrencilerin empati becerisine sahip, farklılıklara saygı gösteren, özgüvenli, sabırlı, kurallara uyan, nesnel, iletişim becerileri gelişmiş ve geniş bir bakış açısına sahip bireyler olmaları gerektiğini belirtmişlerdir. Sosyal bilgiler öğretmenleri hoşgörü eğitimine yönelik olarak derslerinde daha çok sınıfta gelişen olaylarla ilgili konuştuklarını belirtmişlerdir. Sosyal bilgiler öğretmenleri, ders dışında ise sınıf rehber öğretmeni olarak hoşgörüye değindiklerini, hoşgörüye yönelik kitap kampanyası ve yarışma düzenlediklerini de belirtmişlerdir. Sosyal bilgiler öğretmenleri, Sosyal Bilgiler Öğretim Programı’nda hoşgörüye yeterince yer verilmediğini belirtmişlerdir. Öğretmen, öğrenci ve ailelerin hoşgörü algısını geliştirecek eğitim etkinlikleri düzenlenebilir. Ailelerin ve öğrencilerin hoşgörü algısını belirleyecek nicel ve nitel çalışmalar yapılabilir.

Bu araştırmanın amacı, Sosyal Bilgiler öğretmenlerinin hoşgörü algısını belirlemektir.Bu araştırmada, nitel araştırma desenlerinden olgubilimden yararlanılmıştır. Araştırmaya 10 Sosyal Bilgiler öğretmeni katılmıştır. Araştırmada veriler yarı-yapılandırılmış görüşme yoluyla toplanmış ve tematik olarak analiz edilmiştir. Araştırma sonucunda,Sosyal Bilgiler öğretmenlerinin hoşgörüyü; düşünce, değer, inanç ve davranışlara saygı duymak, cinsiyet, ırk ve gelişim özellikleri gibi farklılıkları kabul etmek, hataları kabul etmek, insana değer vermek ve nesnel olmak olarak tanımladıkları ortaya çıkmıştır. Sosyal Bilgiler öğretmenleri hoşgörünün sınırlarını, bireylere ve ülkeye zarar verme olarak vurgulamışlardır. Sosyal Bilgiler öğretmenleri hoşgörü algılarının gelişiminde ailesinin, yaşının, deneyimlerinin ve okuduğu kitapların etkili olduğunu belirtmişlerdir.

Objective: Dexmedetomidine has been reported to produce analgesia after intrathecal administration. In the present study the α2-adrenoceptor agonist dexmedetomidine was evaluated for its potential spinal neurotoxic effects. Material and Methods: Three days after intrathecal cannulation, rats were administered either dexmedetomidine (3 μg/30 μL, i.t.) or saline (30 μL, i.t.). Antinociceptive, sedative and motor effects of intrathecal administrations of dexmedetomidine or saline were evaluated during 90 min. The tail-flick and hot plate tests were used to assess the thermal nociceptive threshold. Seven days after drug administration, animals were sacrified and spinal cords were evaluated for histopathological changes by light microscopy. Results: Dexmedetomidine administered intrathecally produced antinociception. Antinociception was accompanied by immediate sedation and loss of placing-stepping reflexes that lasted over 40 min in all dexmedetomidine administered rats. In all rats, microscopic examination revealed mild gliosis and minimal infiltration of inflamatory r cells in posterior white matter. Mild (total score 4-6) histopathologic lesions were seen in four animals in dexmedetomidine adminisered rats, but there was no statistically significant difference when compared with the saline administered rats. Conclusion: We observed that intrathecal injections of dexmedetomidine at the dose of 3 μg/30 μL produce antinociception but did not cause any histopathological sign of injury in the spinal cord. Turkish Başlık: Ratlarda Intratekal Deksmedetomidin Antinosiseptiv ve Nörotoksik Etkilerinin Değerlendirilmesi Amaç: İntratekal deksmedetomidin uygulaması ile analjezi elde edildiği gösterilmiştir. Bu çalışmada bir α2-reseptör agonisti olan deksmedetomidinin olası spinal nörotoksik etkilerinin değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Ratlara intretekal kanülasyondan 3 gün sonra ya deksmedetomidin (3 μg/30 μL, i.t.) veya salin (30 μL, i.t.) uygulandı. İntratekal deksmedetomidinin veya salinin antinosiseptif, sedatif ve motor etkileri uygulamadan 90 dk sonra değerlendirildi. Termal nosiseptif eşiği değerlendirmek için kuyruk-çekme (tail-flick) ve sıcak-zemin (hot-plate) testleri kullanıldı. İlaç uygulamalarından yedi gün sonra, ratlar sakrifiye edildiler ve spinal kord spesmenleri ışık mikroskopisi ile histopatolojik değişiklikler açısından değerlendirildiler. Bulgular: İntratekal deksmedetomidin uygulaması antinosiseptif etkiye sahiptir. Tüm deksmedetomidin uygulanan ratlarda 40 dk süren adımlama (placing-stepping) refleksi kaybına sedasyon eşlik etmekteydi. Tüm ratlarda, mikroskopik inceleme sonucunda, beyaz madde posterior bölümünde hafif gliozis ve az sayıda iltihabi hücre infiltrasyonu gözlendi. Deksmedetomidin uygulanan dört ratta hafif (total skor 4-6) histopatolojik lezyonlar izlendi, ancak salin uygulanan ratlarla karşılaştırıldığında istatistiksel anlamlılık tespit edilmedi. Sonuç: İntratekal 3 μg/30 μL dozda deksmedetomidin uygulaması ile antinosiseptif etki elde ettik, ancak medulla spinaliste injuriye ait herhangi bir histopatolojik bulguya rastlamadık.

Objective One significant drawback during a cranial reoperation is the presence of meningocerebral adhesions. The appearance of connective tissue bridges between the inner surface of the dura and the pia-arachnoid is mostly related to dural closure and the condition in which the surgical field was left in the previous surgery. This study was done to determine the benefit of placing a thin-layer gelatin sponge of polypeptides subdurally to prevent meningocerebral adhesions. Methods From September 2005 through May 2012, 902 craniotomies were performed for various lesions by the senior author (U.T.). Beginning in February 2009, we began placing a gelatin sponge under the dural flap to isolate the dural healing process from the cortical surface. To compare the degree of meningocerebral adhesions statistically, reoperation cases between February 2009 and May 2012 were divided into 2 groups as group G (gelatin) and group C (Control) in which the dural closure was made with and without subdural application of the gelatin sponge, respectively. Results In all patients of group G (n = 15), a neomembrane was found when the dura was opened. This layer was easily dissected and showed no or minimal attachment to the underlying cerebral cortex. However, in group C (n = 14), meningocerebral adhesions in various degrees were detected. Adhesion scores were significantly greater in group C than in group G ( P Conclusion This study proves that, during the dural closure, placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningocerebral adhesions.

BACKGROUND AND AIM: Anaesthesia with sevoflurane leads to a high prevalence of emergence agitation in paediatric patients. This study investigates the effects of combining hydroxyzine and midazolam on sevoflurane-induced emergence agitation in paediatric patients undergoing infraumbilical surgery with a caudal block. PATIENTS AND METHODS: Eighty-four children 1-7 years of age undergoing general anaesthesia with sevoflurane and caudal block were assigned to two groups. Children in group M (n = 42) were premedicated with 0.5 mg kg oral midazolam and children in group MH (n = 42) were premedicated with 0.5 mg kg oral midazolam and 1 mg kg hydroxyzine given 30 min before anaesthesia induction. A caudal epidural block was performed following anaesthesia induction. Induction quality, parental separation scores and emergence agitation were evaluated. Emergence agitation was evaluated with the PAED score (Paediatric Anesthesia Emergence Delirium) every 5 min during the first 30 min after admission to recovery room. Induction quality and parental separation were assessed with 4-point scores. Postoperative pain was evaluated with the 10-point Children's and Infants' Postoperative Pain Scale. RESULTS: Median parental separation (3 vs. 2; P = 0.01), induction quality (2 vs. 2; P = 0.03) and sedation scores (3 vs. 2; P = 0.003) were significantly better in the MH group compared to the M group. Median PAED score of group M (15) was higher than that of group MH (11; P < 0.001) and the number of children with PAED scores more than 16 was also higher in group M (n = 16) compared to group MH (n = 2; P < 0.001). None of the children had a pain score more than 3 throughout the study period. CONCLUSION: The incidence of sevoflurane-induced emergence agitation was significantly lower in children premedicated with a midazolam and hydroxyzine combination compared to those premedicated with midazolam only. Furthermore, the midazolam and hydroxyzine combination provided better premedication quality than midazolam alone.

This study was performed to evaluate the histopathological effects of epidural drug injection given either by intermittent bolus or continuous infusion through a catheter on epidural tissue. Fourteen ewes received intermittent bolus injections of morphine with bupivacaine, or a bolus of the same drugs followed by continuous infusion for 5 days. After 5 days, histopathological examination of the epidural space revealed mild to moderate inflammatory changes, and focal fibrosis surrounding the catheter in all ewes. The similarity of the inflammatory reaction in the control and drug treated groups seems to indicate that neither intermittent bolus or continuous infusion after a bolus dose caused histopathological changes in the epidural space beyond that caused by the catheter itself.

During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

BACKGROUND: In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-base status compared with baseline values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis. METHODS: In this prospective clinical study, we measured the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), ?-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg • kg • d phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1, 3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation (2nd and 4th h), just after extubation, and 1, 2, 6, and 12 h after extubation. RESULTS: Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with baseline with a peak value on postoperative Day 1 and returned to normal values within a week. Base excess levels after extubation were significantly decreased compared with baseline. They were in the normal range, however, and returned to baseline values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4-6 mo after surgery. CONCLUSIONS: Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clinical effect on the acid-base status or pancreas or liver enzymes. Copyright © 2009 International Anesthesia Research Society.

WOS: 000260134200010 PubMed: 18929287 The use of unilateral spinal block with a specific hyperbaric mixture of bupivacaine and fentanyl in two centenarian women is presented. This technique was very effective in restricting sympathetic block, and it provided satisfactory analgesia and hemodynamic stability. (C) 2008 Elsevier Inc. All rights reserved.

WOS: 000226069300053 PubMed: 15617601 WE REVIEWED MANY of the essential Greek myths to identify the methods used at that time to relieve the pain of both illness and surgery, and we discovered many pioneering methods. Both gods and demigods implemented these methods to ease pain, to conduct surgery, and, on occasion, to kill mythological beings. The myths describe the three most common components of anesthesia: hypnosis, amnesia, and (an)algesia. Drugs and music-aided hypnosis were two of the most common methods use to treat emotional and surgical pain. This article identifies highlights in the development of concepts to treat pain in Greek mythology. The examples found in the Greek myths remind us of the historical significance of pain treatment.