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The majority of patients who undergoes lower extremity surgery are elder patients with higher risks. In these patients, regional anesthesia is usually preferred to general anesthesia however with this technique the risk of hypotension and bradycardia increases. The position of spinal anesthesia might also provoke pain. The intravenous analgesic agents applied before the procedure or regional anesthesia might improve patient comfort. In this case report, we aimed to present a semi-spinal anesthesia procedure with low dose heavy bupivacaine and opioid, after femoral block in a high-risk patient who underwent surgery for femoral neck fracture. [ABSTRACT FROM AUTHOR]

Objective: We aimed to demonstrate to what extent do the right information in patients' inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded. Results: Of all the patients, 17 of them (44.7%) were male and 21 of them (55.3%) were female. Of the people who informed the patients 50% were research assistants, 34.2% of them were medical specialists and 15.8% were paramedics. The most common causes of transfer were found to be invasive hemodynamic monitoring (52.6%), mechanical ventilation (36.8%) and the need for dialysis (10.5%). As the patients were evaluated after admission to ICU, the 71.1% of the information about patients was found to be incomplete and/or misleading. The most common health problems that found to be not reported during acceptance were chronic systemic diseases (25.8%), emergent cardiac pathologies (16.1%), malignancy (12.9%), active infection (12.9%), psychiatric disorders (12.9%) and neurological deficiencies (%9,7). Conclusion: This study revealed that the most of the patient transfers were made improperly with incomplete or misleading information and without the tertiary care ICU indication. In order to use ICU effectively, we believe that an efficient system which provides correct information should be used during inter-hospital patient transfer. [ABSTRACT FROM AUTHOR]

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

In this case report a patient with septic arthritis who developed impaired consciousness that responded to amantadine sulfate treatment was presented. A 67 years old male patient who had high fever, leukocytosis, hypotension, and generalized organ failure findings after knee prosthesis revision surgery was accepted to intensive care unit. Patient was intubated and connected to mechanical ventilation as he lost consciousness during non-invasive mechanical ventilation. In the follow-up he was diagnosed with bone abscess and was started penicillin according to culture results. Despite of clinical and laboratory resolving of sepsis finding, patient had tonic-clonic seizures especially on the right upper extremity with normal cranial computerized tomography findings. Septic course of the patient improved with antibiotic treatment, while impaired consciousness and seizures continued. Radiological evaluation of the patient was within normal ranges; however he was diagnosed as organic neurological dysfunction that developed secondary to sepsis. Amantadine sulfate 200 mg/day was initiated after neurology department consultation. Neurological suppression and seizures started to improve after the 6th day and completely resolved after the 10th day of the treatment. Patient was discharged from intensive care unit after resolution of septic clinic after 57 days. As a result we believe that amantadine is an efficient agent in treatment of neurological patients with coma and significantly decrease rehabilitation duration. [ABSTRACT FROM AUTHOR]

Background and objective: Spinal anesthesia is a preferred method in daily practice as it provides muscle relaxation and maintains spontaneous respiration during surgical procedures. Opioids, midazolam, ketamine, propofol and dexmedetomidine are the generally preferred sedoanalgesic agents. Ketofol, a mixture of ketamine and propofol, is a good analgesic and also provides sedation even at low doses. Methodology: 54 inguinal hernia surgery patients were included and divided into two groups: propofol group (Group P, n: 27) and ketofol group (Group KP, n: 27). The ketofol mixture was obtained by mixing 2 ml of ketamine (50 mg/ml) with 8 ml saline and then adding 10 ml of propofol (%1, 10 mg/ml) to acquire a solution of 5mg/ml ketamine and 5 mg/ml propofol. The Ramsay sedation scale (RSS) and bispectral index (BIS) were used to determine the response to sedation and analgesia. Intraoperative hemodynamic parameters and medication dosages were recorded. At postoperative 12th hour visual analog scale (VAS) was performed to measure patient satisfaction and pain. Results: Although the duration of surgery was similar in both groups, the duration in intensive care unit was significantly longer in Group P (p:0.002, Table 1). The time taken to reach Ramsay 3 value was significantly shorter in Group KP than in Group P (6.8 ± 5.1 vs 9.6 ± 7.2 minutes, p:0.042). Group KP patients were also highly satisfied and experienced less pain in postoperative period according to VAS evaluation (p: 0.04). Conclusions: Ketofol is a good alternative for propofol in spinal anesthesia for regional surgeries with higher postoperative patient satisfaction, lower pain rates and shorter intensive care requirements. [ABSTRACT FROM AUTHOR]

Local anaesthetic (LA) toxicity is the most fatal complication of peripheral nerve block techniques. Accidental intravascular application or use of doses above the safety range are the most common cause of toxicity. Bupivacaine is a long-acting LA frequently used for long procedures or those associated with significant post-procedural pain. Fatal central nervous system and cardiovascular system toxicity are described. In this paper, we reported a young patient who showed LA toxicity symptoms 7 h after an infraclavicular peripheral block. [ABSTRACT FROM AUTHOR]

Delirium is a clinical syndrome that develops acute or subacutely, due to physical and organic problems and characterized by variable symptoms of diffuse cerebral dysfunction. In this report we want to share our experience of a delirium case that developed in an elderly patient after orthopedic surgery that was complicated by a myocardial infarction. [ABSTRACT FROM AUTHOR]

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

By inhibiting sodium channels, local anesthetics (LAs) prevent sodium entering the cell and inhibit cellular depolarization. Although undesired drug reactions caused by LA usage are common, real allergic reactions are rare. The objective of this study was to discuss allergic reactions developing after application of spinal anesthetic.