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1. Nociception Monitoring

Author

Hülya Bilgin and Seda Cansabuncu

Subjects
Anesthesiology and Pain Medicine
Abstract

Tissue damage and inflammation-induced nociception during surgery are the primary reasons for administering general anesthesia to the patient. During general anesthesia, analgesics inhibit autonomic and somatic responses, hypnotic agents prevent awareness, and neuromuscular blocking agents inhibit reflex movements. Careful monitoring of the effects of general anesthesia is necessary to avoid over- or under-dosing of anesthetics and thus to prevent associated complications and adverse effects. In general, hemodynamic parameters have been used to guide the intraoperative administration of analgesics such as opioids, but hemodynamic parameters are not standardized and cannot always provide a clear assessment. There is growing interest in techniques that can objectively monitor the analgesic component of anesthesia to achieve an appropriate balance of nociception and anti-nociception and to guide analgesic administration. The purpose of this review is to provide information about nociception monitoring techniques, which are increasingly used in clinical practice. Keywords: General anesthesia, nociception, anti-nociception, monitoring

Published
2023

2. Isolated Cerebral Fat Embolism After Lower Extremity Fracture: Case Report

Author

Canan Yılmaz, Derya Karasu, Seda Cansabuncu, Yılmaz Apaydın, Hasan Özal, and Mine Aköz

Subjects
Cerebral fat embolism, trauma, methemoglobinemia, local anesthesia, Medicine, Internal medicine, RC31-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Fat embolism syndrome (FES) is characterized with petechiae, mental confusion, and respiratory failure, occurs generally after lower extremity long bone fractures or orthopedic surgery within 24-72 hours. Isolated cerebral fat embolism occurs at a rate of 0.9-2.2% that is a fatal event. The clinical diagnosis of isolated cerebral fat embolism is difficult since neurological symptoms are variable. On the other hand methemoglobinemia is a rare complication occurring after administration of local anesthetics. We aimed to present a case in whom isolated cerebral fat embolism and methemoglobinemia caused by intraoperative high dose of local anesthetic agents and who was taken to operation in the first 24 hours because of the left femoral diaphysis fracture in this study.

Published
2015
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3. The effect of pre-incisional wound site infiltration with multimodal analgesia on postoperative pain in total knee arthroplasty

Author

Derya Karasu, Seda Cansabuncu, Umit Caglayan, Canan Yilmaz, and Gökhan Cansabuncu

Subjects
Visual analogue scale, business.industry, Incision wound, Postoperative pain, Anesthesia, Group ii, Significant difference, Total knee arthroplasty, medicine, Osteoarthritis, medicine.disease, business, Infiltration (medical)
Abstract

Background: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insuffient postoperative pain management affects paitents satisfaction and functional results. To an effective postoperative pain management, several methods are used for analgesia. Aim of this study was to evaluate the effect of the application of pre-incisional wound site infiltration on postoperative analgesia, additional to multi-modal analgesia methods for the provision of analgesia following Total Knee Arthroplasty. Material and methods: Total of 80 patients aged ?55 years posted to undergo TKA were randomly separated into 2 groups. Pre-incisional injection was administered to the skin for the group I patients, wherreas patiemts of group II were not administered pre-incisional injection. For postoperative pain management additional multi-modal analgesia methods were applied in both groups. To evaluate the level of postoperative pain, a Visual Analog Scale (VAS) score at rest and dynamic VAS (DVAS) during activity were used. The time of requirement for first analgesia and the amount of analgesia required were recorded. The patients were monitored throughout the operation and in the postoperative period for side-effects. Results: Postoperative VAS scores of Group I were found to be statistically significantly lower than those of Group II (p

Published
2019

4. EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): study protocol for a multicentre, observational trial

Author

Weiss, Raphael, Saadat-Gilani, Khaschayar, Kerschke, Laura, Wempe, Carola, Meersch, Melanie, Zarbock, Alexander Hichem Makhloufi, Anis, Cherak, Lamine Lakhel Ghanem, Zohier, Gouaglia, Dina Nasrine Guadouri, Fayrouz Naouel Hama, Mustafa, Kara, Omayma, Saadi, Rachida, Sakhraoui, Fadila, Bourou, Abdelhadi, Cherifi, Rahmoune Ghania Sadaoui, Amel, Ouyahia, Ilhem, Ouahab, Souad, Bouaoud, Meriem, Abdoun, Anisse, Tidjane, Benali, Tabeti, Nabil, Boudjenan-Serradj, Carlos Jose Pérez Rivera, Paulo, Cabrer, Julián, Corso, Juan Pablo García, Sharon, Idarraga, Christopher, Montoya, Rafael, Figueroa, Eduar, Aldana, María Alejandra Torrado, Peng, Ke, Zheng-Min, Ma, Yu-Fan, Yang, Ya-Juan, Zhu, Peter, Sklienka, Michal, Frelich, Vojtech, Jarkulis, Pavel, Sevcik, Vojtech, Vodicka, Mohamed Gamal Elbahnasawy, Shady, Elsalhawy, Sara, Motawea, Zeinab, Othman, Mohamed, Sahma, Ahmed Mahmoud Nafea, Nermin, Ahmed, Doaa Ali Attia, Moataz Maher Emara, Mohamed Mamdouh Bonna, Mohamed Ahmed Gabr, Amany Ismail Tarbay, Ibrahim Abdelmonaem Abdehaleem, Esraa Elsayed Mohamed, Amr Mahmoud Eldeeb, Ahmed Mohamed Abbas, John Ashraf Magdy, Zyad Hassan Hamed, Hany Mostafa Esmaeil Osman, Mostafa Samy Abbas, Oliver, Joannes-Boyau, Nicolas, Barraud, Corentin, Berthelot, Thibault, Camus, Anissa, Dahmi, Mylène, Defaye, Sébastien, Derville, Younes, El-Boustani, Elsa, Deloge, Hélène, Jacob, Simon, Monziols, Fred, Priem, Jean-Jacques, Robin, Vincent, Legros, Therry, Floch, Salvatore, Muccio, Claire, Geneve, Marie Lim Legouge, Stéphanie Tao Mauny, Willy, Mfam, Léa, Pascot, Christophe, Aveline, Mireille, Chartier, Benjamin, Duteurtre, Jean Francois Gautier, Aidren Le Cousin, Pierre, Vautier, Julien, Nadaud, Nathalie, Begel, Claire-Annissa, Chekirine, Vincent, Derlon, Elodie, Grein, Marie-Annick, Lehair, Laurent, Magazzeni, Philippe, Magazzeni, Carsten, Potter, Catherine, Roth, Florence, Voivret, Thomas, Rimmelé, Valérie, Cerro, Stéphanie, Suria, Jamil, Elmawieh, Annabelle, Stoclin, Cédric, Cirenei, Gregoire, Andrieu, Sven, Couloumy, Jeremy, Falcone, Marion, Fajardy, Arsène, Gagneuil, Emeline, Girardet, Agnès, Mazereeuw, Sébastien, Ponsonnard, Pierre-Yves, Egreteau, Mélanie, Bertel, Simon, Bocher, Vanessa, Carn, Lenaïg Le Guen, Guillaume Le Loup, Montaine, Lefevre, Carole, Ichai, Amanita, Diop, Vanessa, Jean-Michel, Sylvie, Devlieger, Juliette, Duthoit, Mohamed El Kadiri, Maxime, Léger, Viviane, Cassisa, Sigismond, Lasocki, Charline, Masson, Emmanuel, Rineau, Pierre, Verrier, Axel, Coquerel, Philippe, Montravers, Enora, Atchade, Charles-Edouard, Rochon, Céline, Delerue, Vidal, Quentin, Vanessa, Latry, Nina, Queixalos, Vincent, Cottenceau, Thierry, Braun, Saad, Bouzoubaa, Basile, Christ, Audrey, Geiger, Joachim, Gomille, Vianney, Kieffer, Simone, Mangeant, Christelle, Prochilo, Christian, Schmitt, Stefan, Skwirba, Hubert, Grand, Frédérique, Boury, Nicolas, Mayeur, Marie, Pasquie, Pierre, Garçon, Vincent, Bruckert, Vincent, Arnould, Mona, Bonciu, Thibault, Chapelle, Luc, Facchino, Florence, Fagot-Gandet, Andrea, Iachim, Elena, Mannu, Olivier, Perus, Rémi, Plattier, Romain, Rozier, Gaël, Pradel, Michel, Boudinaud, Marie-Hélène, Hausermann, My Hue Nguyen, Andersen, Ramorasata, Amélie, Barreau, Anne-Hélène, Boivin, Céline, Ravry, Nicolas, Mottard, Johanne, Beuvelot, Florence Prunier Bossion, Olivier, Desebbe, Alexander, Zarbock, Christian, Dörr, Thilo Caspar von Groote, Mira, Küllmar, Christina, Massoth, Melanie, Meersch, Khaschayar, Saadat-Gilani, Raphael, Weiss, Carola, Wempe, Sebastian, Ziemann, Linda, Grüßer, Ana, Kowark, Pia, Wittig, Timo, Brandenburger, Thomas, Dimski, Niklas, Döhmen, Laura, Huthmann, Daniela, Kaierle, Claude, Pelletier, Manon, Schleß, Andreas, Hohn, Sebastian, Cleophas, Stephanie, Haunhorst, Marina, Jansen, Alexandra, Schmitt, Julia, Soisch, Kilian, Sturm, Peter, Rosenberger, Alexander, Bendig, Lena, Flohr, Helene, Häberle, Pascal, Hofmann, Jonathan, Kuhle, Nora Michaela Leser, Kathrin, Pfister, Stefanie, Prohaska, Franziska, Sennholz, Lena, Stetz, Kathrin, Weber, Sebastian, Stehr, Stephan, Klaus, Marco, Sadlo, Matthias, Boschin, Christian, Sengelhoff, Ulrich Michael Göbel, Jan Gerrit Haaker, Carina-Kristin, Göttker, Matthias, Gründel, Matthias, Heringlake, Romina, Baumgärtel, Astrid, Berggren, Madeleine, Gülzow, Lennart, Muras, Hauke, Paarmann, Serge, Thal, Alexander, Bentley, Dschamil, El-Masri, Anne, Sebastiani, Eleni, Arnaoutoglou, Maria, Ntalouka, Paula, Stratigopoulou, Anastasia, Analytis, Efthymios, Mavrommatis, Petros, Tzimas, Agathi, Karakosta, Danai, Pantazi, Antonia, Dimakopoulou, Katerina, Dimitropoulou, Orestis, Ioannidis, Humam, Jalaawiy, Aeshah, Anwar, Hashim Talib Hashim, Hogir Imad Rasheed Aldawoody, Andrea, Cortegiani, Giulia, Catalisano, Gilia, Ingoglia, Mariachiara, Ippolito, De Rosa, Silvia, Lucia, Cattin, Andrea, Bianchin, Marisa, Barone, Gianluca, Paternoster, Salvatore Lucio Cutuli, Andrea, Russo, Liliana, Sollazzi, Laura, Cascarano, Massimo, Antonelli, Paola, Aceto, Bruno, Romanò, Savino, Spadaro, Vincenzo Francesco Tripodi, Michele, Rossi, Rosamaria, Scappatura, Maria Cristina Vadalà, Diego, Fiume, Maria Teresa Strano, Giulia, Oddo, Clemente, Santorsola, Bilal Abu Hussain, Adnan Raed Alnaser, Anas Hassouneh Ghassan, Khaled, Hasanein, Mohammed, Theab, Seokyung, Shin, Seungho, Jung, Kyuho, Lee, Sung Mee Jung, Jongyoon, Baek, Muhammed, K Elhadi, Issa, Abuzeid, Mohammed, Albaraesi, Sarah, Aldressi, Wegdan, Khalel, Eman, Abdulwahed, Akram Abdulhamid Ashur Abujrad, Amer, Almaghrabi, Muhand Mohammed Alteleeb, Entisar Ahmed Ali Alshareea, Marwa Isa Biala, Abdulqudus, Deeknah, Dooua Ali Gheddim, Reem, Ghmagh, Nawras Salih Ali AbuIkhrays, Marwa, Sinan, Enas, Soula, Sumayyah Ghayth Bahroun, Khawla, Derwish, Aya Munir Mohamed, Eman Sayed Younes, Rayet Al Islam Benjouira, Mohamed, Aliwa, Najwa Abdullah Altashani, Mohammed Omar Alteb, Ahmed, Msherghi, Fatima, Alagelli, Sufyan, Albarouni, Ahmed, Albishti, Sarah, Aljamal, Mohamed, Alsori, Taha, Ekhuja, Suha, Elzwai, Mohammed, Ghula, Tahani, Mustafa, Ahmed, Tuwaib, Haifa, Zriba, Hamza Mahmoud Agilla, Toky Andriamahefa Rafanomezantsoa, Anne Marie Camilleri Podesta, Denise Mifsud Bonnici, Tiziana, Pirotta, Gilberto Adrián Gasca López, Maja Mojsova Mijovska, Tatjana, Davitkovska, Aleksandra, Gavrilovska, Sanja, Lukikj, Marija, Vesova, Dina, Zafirova, Sarah, Amro, Baraa N, F Hajjaj, Muawia, Alkhazendar, Yousuf, Barakat, Sewar Abdulaziz Elejla, Ahmed, Elhissi, Ahmed, Khader, Ali, Salem, Rita de Freitas Regufe, André Filipe de Oliveira Eloy, Lisbete Marisa Neto Cordeiro Perdigão, Evgeny, Grigoriev, Artem, Ivkin, Roman, Kornelyuk, Michael, Yaroustovsky, Marina, Abramyan, Ekaterina, Komardina, Nataliya, Lesteva, Medina, Aybazova, Elmira, Kumykova, Svetlana, Lesina, Gennady, Rybakov, Alexey, Shestov, Abdulnaser Ahmad Ahmad Barmou, Bushra Lotfi Altayeb Ahmed, Aisha Mohammad Eliyas, Yousra, Emadeldin, Alexander, Kaserer, Clara, Castellucci, Julian, Rössler, Samira, Akbas, Andreja Möller Petrun, Irena, Gregorcic, Vesna, Sok, Roman, Čičak, Elizabeth, Bárcena, Antonio, Guisado, Ismail, Wi, Javier Ripollés Melchor, Ángel, Becerra-Bolaños, Sergio, Cabrera-Doreste, Ancor, Domínguez-Arbelo, María Candelaria Delgado-Alonso, Virginia, Muiño-Palomar, Aurelio, Rodríguez-Pérez, Javier Mata Estévez, Maria Begona Covas Munoz, Juan Mulet Matas, Sara Perez Palao, Maria Dolores Mira Quirós, Alisia Cezara Teslev, Mercedes Garcia Alvarez, Marga, Argilaga, María, Campos, Albert, Bainac, Astrid, Batalla, Marta, Giné, Gracia, Herránz, Ignacio, Hinojal, Margarita Logroño Ejea, Noelia de la Rosa Ruiz, María Gastaca Abasolo, Carla Rosario Houhton Acuna, Ibai Iriarte Zaranton, Ana, Mendigurenmurua, María José Munoz Sanz, Erika Olea de la Fuente, María Pilar Pérez Vaquero, Ana Soto Iglesias, Ana Ugarte Mieres, Alaitz Urtiaga Urrestizala, Lourdes, Ferreira, Félix, Lobato, Marta Aguado Sevilla, Andres, Erazo, Pere, Miró, Sergi, Sabaté, Diana, Vernetta, Berta Castellano Paulis, Anabel Adell Perez, Marta Aseguinolaza Pagola, Elena delVal Peciña, Ainhoa Garmendia Odriozola, Amaia Lopetegi Aizpurua, Olatz Pavón Piquer, Pilar Plou Garcia, Paula Ortega Rezola, Antia Osorio Lopez, Isabel de la Calle Gil, Rosalía Navarro Casado, Peter, Adamove, Roser Bayona Domenge, Francho Miguel Blasco Blasco, Adriana Alexandra Rueda Villamizar, Maria Antonia Perelló Llaneras, Jose Ignacio García-Sánchez, Laura Fernandez Téllez, Sara García Zamorano, Natalia Gijón Herreros, Andrea Rodriguez Esteve, Pablo Monedero Rodríguez, Isabel García Trigo, Agustín, Alcaraz, Andrea Lara Jiménez, Iñigo, Rubio, Nuria, García, Raquel, Callejas, Angel Manuel Candela Toha, Eli, Claros, Pilar, Cobeta, Pascual, Crespo, Trini, Dorado, Elena, Elías, Javier, Felices, Diego, Gil, María, Gómez, Nuria, Mané, María, Martín, Adolfo, Martínez, Lucía, Pereira, Alberto Balvis Noemí Samaranch, Ana, Serrano, Carlos, Tiscar, Judith, Villahoz, Patricia Galán Menéndez, Elena, Cardona, Anna, Conesa, Veronica, Estepa, Patricia, Galán, Laura Llinares Espí, Yuri Loaiza Aldeán, Susana, Manrique, Víctor Morales Ariza, Laura Villarino Villa, Elfayadh Saidahmed Mohamed Amed Suliman, Hytham, Hamid, Ahmed Mohamed Ibrahim, Modather Mohamed Saeed, Orhan Sungur Mukadder, Demet, Altun, Nur, Canbolat, Müşerref Beril Dinçer, Tulay Özkan Seyhan, Serap Aktaş Yıldırım, Müzeyyen, İyigün, Davut, Yapıcı, Levent, Özdemir, Aslinur, Sagun, Neval, Boztug, Yesim, Cetintas, Bora, Dinc, Emel, Gündüz, Hakkı, Ünlügenç, Demet Lafli Tunay, Deniz, Karakaya, Burhan, Dost, Ozgur, Komurcu, Özlem Korkmaz Dilmen, Eren Fatma Akcil, Yusuf, Tunali, Gülay, Ok, Eda Tok Alsina, Özge, Hakli, Cengiz, Polat, Namigar, Turgut, Nurcan, Kızılcık, Özge, Köner, Öznur, Şen, Nurdan, Aydin, Burcu, Basaran, Emre Sertac Bingul, Yavuz, Gürkan, Kamil, Darcin, Semra, Ugur, Kemal Tolga Saracoglu, Asli, Demir, Özgök, Aysegül, Eda, Balci, Behic, Girgin, Aygun, Guler, Ümit, Karadeniz, Nihal, Özaslan, Yigit Özay Hülya, Namik, Ozcan, Aysun, Postaci, Mehmet, Sahap, Nevriye, Salman, Özlem, Sağır, Bulent, Atik, Murat, Bicakcioglu, Hafize Fisun Demir, Ugün, Fatih, Nazan, Kocaoglu, Hüseyin Ilksen Toprak, Duygu Demiröz Aslan, Yusuf Ziya Colak, Mustafa Soner Ozcan, Mehmet, Yilmaz, Umran, Karaca, Sevtap Hekimoglu Sahin, Özlem Ersoy Karka, Gizem Demir Şenoğlu, Süheyla Erkoç Karadağ, Neslihan, Alkis, Volkan, Baytaş, Engin, Erturk, Ali, Akdogan, Ahmet, Besir, Dilek, Kutanis, Sedat, Saylan, Ersagun, Tugcugil, Pinar, Ayvat, Berrin, Günaydın, Beyza Mehri Büyükgebiz, Omer Faruk Boran, Feyza, Calisir, Yavuz, Orak, Bahar Kuvaki Balkan, Sibel, Büyükcoban, Erol, Gökel, Sakize Ferim Günenc, Sule, Özbilgin, Suna, Göre, Selcan, Akesen, Seda, Cansabuncu, Natalia, Momot, Anna, Panchenko, Jean-Francois, Pittet, Kristen, Rutledge, Tıp Fakültesi, Weiss, R, Saadat-Gilani, K, Kerschke,L, Wempe,C, Meersch, M, Zarbock, A, Cortegiani, A, and Ippolito, M

Subjects
Epidemiology, urologic and male genital diseases, acute renal failure, Adult Intensive & Critical Care, Anaesthesia, Cohort Studies, surgery, chronic renal failure, Humans, Multicenter Studies as Topic, Prospective Studies, adult intensive & critical care, urogenital system, Incidence, General Medicine, Acute Kidney Injury, female genital diseases and pregnancy complications, critical care, Renal Replacement Therapy, Observational Studies as Topic, epidemiology, Acute Renal Failure, Surgery, adult intensive &amp, Chronic Renal Failure
Abstract

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Published
2021

5. A comparison of peri-articular injection and femoral block for pain management after total knee arthroplasty: A prospective cohort study

Author

Seda Cansabuncu and Gökhan Cansabuncu

Subjects
total knee arthroplasty, Medicine (General), medicine.medical_specialty, total diz artroplastisi, RD1-811, Total knee arthroplasty, ağrı yönetimi, R5-920, medicine, Prospective cohort study, Peri-articular injection,Femoral nerve block,Total knee arthroplasty,Pain management, Gynecology, femoral nerve block, business.industry, Pain management, Periartiküler enjeksiyon,Femoral sinir bloğu,Total diz artroplastisi,Ağrı yönetimi, periartiküler enjeksiyon, Orthopedics, pain management, peri-articular injection, Ortopedi, Medicine, femoral sinir bloğu, Surgery, business
Abstract

Aim: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insufficient postoperative pain control negatively affects patients’ satisfaction and functional results. The aim of this study is to compare the effects of intraoperative peri-articular injection and postoperative single-dose femoral nerve block on functional results, the need for analgesia, and pain in the short-term following total knee arthroplasty (TKA).Methods: Thirty-one patients who received peri-articular injection (PAI) during TKA and 38 who were administered a single dose of femoral nerve block (FNB) postoperatively were evaluated. In both groups, an intravenous patient-controlled analgesia (PCA) device was utilized for postoperative analgesia. Analgesia demand and the amount administered from the PCA in the first 24 hours were recorded. For the evaluation of the level of postoperative pain, a visual analog scale (VAS) was used at rest at 2nd, 4th, 8th, 12th, and 24th hours, and dynamic VAS was used at the 24th hour to assess pain with mobilization. Range of movement (ROM) was recorded with the measurements of active flexion and extension angles at the first, second and third postoperative days.Results: The resting VAS scores at the 2nd, 4th, 8th, and 24th hours were significantly lower in the PAI group than in the FNB group (P=0.032, P=0.037, P=0.014, P=0.004, respectively). The number of patients’ demands on the PCA for pain relief and the number of doses administered were higher in the FNB group. The ROM values measured on postoperative days 1, 2, and 3 were insignificantly greater in the PAI patients (P=0.956, P=0.103, P=0.162, respectively).Conclusion: The peri-articular injection technique, when used appropriately, is easy to apply with a low-side effect profile. Therefore, it can be considered a safe and effective analgesia method providing a higher level of patient comfort and greater range of movement., Amaç: Total diz artroplastisi (TDA) diz osteoartriti için etkili bir tedavi yöntemi olmasına rağmen, postoperatif yetersiz ağrı kontrolünün uygulanması hastaların memnuniyetini ve fonksiyonel sonuçları etkiler. Bu çalışmanın amacı intraoperatif periartiküler enjeksiyon ile postoperatif tek doz femoral sinir bloğunun total diz artroplastisi sonrası erken dönemde ağrı, analjezik gereksinimi ve fonksiyonel sonuçlar üzerine olan etkilerini karşılaştırmaktır.Yöntemler: Total diz artoplastisi sırasında intraoperatif periartiküler enjeksiyon uygulanan (PAG) 31 hasta ve postoperatif tek doz femoral sinir bloğu uygulanan (FBG) 38 hasta çalışmada değerlendirildi. Postoperatif iki gruba da analjezi için intravenöz hasta kontrollü analjezi (PCA) cihazı takıldı. 24 saatlik analjezik talebi ve PCA’dan verilen miktar kaydedildi. Postoperatif ağrı düzeyini değerlendirmek için istirahatte vizüel analog skala (VAS) skoru 2., 4., 8., 12. ve 24. saatlerde, mobilizasyon ile değerlendirmeye başlanan dinamik VAS (DVAS) ise 24. saatte değerlendirildi. 1.gün, 2.gün ve 3.günde aktif fleksiyon ve ekstansiyon dereceleri ölçülerek eklem hareket açıklıkları (EHA) kaydedildi.Bulgular: Postoperatif sırasıyla 2., 4., 8. ve 24. saatteki istirahat VAS skorları PAG’ta FBG’na göre anlamlı şekilde daha düşük bulundu (sırasıyla P-değerleri: P=0,032, P=0,037, P=0,014, P=0,004). Ağrı kontrolü için kullanılan PCA’ya basma miktarı ve PCA tarafından verilen doz sayısı PAG’ndaki hastalarda FBG’undaki hastalara göre daha az olduğu görüldü. PAG’ndaki hastaların eklem hareket açıklıklarının 1. 2. ve 3. günlerde daha fazla ölçülmesine rağmen iki grup arasındaki bu fark anlamlı bulunmadı (sırasıyla P-değerleri: P=0,956, P=0,103, P=0,162).Sonuç: Periartiküler enjeksiyon tekniğine uygun olarak uygulandığı zaman kolay uygulanabilir, düşük yan etki profili ile ameliyat sonrası daha yüksek düzeyde hasta konforu ve daha fazla hareket açıklığı sağlayan etkili ve güvenilir bir analjezi yöntemidir.

Published
2020

7. Isolated Cerebral Fat Embolism After Lower Extremity Fracture: Case Report

Author

Yılmaz Apaydin, Mine Aköz, Canan Yilmaz, Seda Cansabuncu, Hasan Özal, and Derya Karasu

Subjects
medicine.medical_specialty, methemoglobinemia, lcsh:Internal medicine, business.industry, lcsh:R, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Cerebral fat embolism, lcsh:Medicine, lcsh:RC86-88.9, medicine.disease, Surgery, trauma, Medicine, Radiology, Fat embolism, Lower extremity fracture, business, local anesthesia, lcsh:RC31-1245
Abstract

Fat embolism syndrome (FES) is characterized with petechiae, mental confusion, and respiratory failure, occurs generally after lower extremity long bone fractures or orthopedic surgery within 24-72 hours. Isolated cerebral fat embolism occurs at a rate of 0.9-2.2% that is a fatal event. The clinical diagnosis of isolated cerebral fat embolism is difficult since neurological symptoms are variable. On the other hand methemoglobinemia is a rare complication occurring after administration of local anesthetics. We aimed to present a case in whom isolated cerebral fat embolism and methemoglobinemia caused by intraoperative high dose of local anesthetic agents and who was taken to operation in the first 24 hours because of the left femoral diaphysis fracture in this study.

Published
2015

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