Search

Giriş ve Amaç: Travmatik vertebra cerrahisi(TVC); intraoperatif kan kaybının en önemli sebeplerinden biridir ve genellikle allojenik kan transfüzyonu gereklidir. Biz bu çalışmada intraoperatif allojenik kan transfüzyonlarını(IOAKT) etkileyen faktörleri belirlemek ve IOAKT' nin kısa vadeli postoperatif sonuçlar üzerindeki etkilerini gözlemlemek istedik. Yöntem: Bu retrospektif çalışmada TVC uygulanan 203 hasta belirlenmiştir ve verileri eksik olan 58 hasta çalışma dışı bırakılmıştır. Preoperatif ve intraoperatif değişkenlerin IOAKT insidansı üzerine etkilerini, IOAKT ile postoperatif mekanik ventilasyon(MV) süreleri, Yoğun Bakım Ünitesi(YBÜ) kalış süreleri ve taburculuk süreleri arasındaki ilişki değerlendirilmiştir. Bulgular: 145 hasta değerlendirildi. İOAKT+(n=25) ve İOAKT-(n=120) olan iki grup arasında yaş (p= 0,171), cinsiyet (p=0,471 ), ASA sınıflaması, cerrahi yapılan segment sayısı (p=0,068), cerrahi yaklaşım şekli arasında istatistiksel olarak anlamlı fark bulunmamıştır. Preoperatif hemoglobin düzeyleri sırasıyla 12,25 ± 1,78 g/dL ve 12,97 ± 1,84 g/dL idi(p = 0,076). İOAKT+ grubun ortalama operasyon süresi anlamlı derecede uzun bulunmuştur(p ˂ 0,022). İOABT+ grubun hastaneden taburculuk süresi anlamlı derecede uzun bulunmuştur(14 ve 9 gün). İki grup arasında YBÜ’ de kalma süreleri(p=0,624) ve MV süreleri(p=0,555) arasında anlamlı fark bulunmamıştır. Sonuç: Allojenik kan transfüzyonu, hastaların preoperatif hemoglobin seviyeleri ve ameliyatın büyüklüğünden bağımsız olarak; daha uzun hastanede yatış süresi için bağımsız bir risk faktörü olabilir. Kan kaybını ve kan transfüzyonunu önleme stratejileri, maliyetlerin düşmesi ile sonuçlanabilir. Anahtar Kelimeler: Transfüzyon , Komplikasyon , Spinal Kord , Vertebra Cerrahisi

The children with Pierre Robin Sequence (PRS) have anatomical and physiological challenges of airwaymanagement. The children with PRS have difficult airway caused by micrognathia, glossoptosis, andcleft palate. The patients’ airway management who have PRS is dificult and requires attention. Herewe present a 5-year-old girl with PRS, admitted to our hospital for cleft palate repair surgery. She alsohad a history of traсheostomy. Otholaryngologists had to perform trachestomy for this operation. Thepatient had an uneventful operative and postoperative period. We wanted to discuss the difficulties ofairway management of the children with PRS with this case report. Anaesthesiologists must be readyfor the challenges and otholaryngologists, must also be ready to manage these difficult airways. Inaddition, bronchospasm and airway obstruction after extubation are very common complications, socareful postoperative monitoring should be performed., Pierre Robin Sendromlu (PRS) çocukların hava yolu yönetiminde anatomik ve fizyolojik zorluklarvardır. PRS’lu çocuklarda, zor havayoluna sebep olan, mikrognati, glossopitozis vardır. PRS’luhastalarda havayolu yönetimi zordur ve dikkat gerektirir. Burada PRS’lu 5 yaşında bir kız çocuğu,yarık damak onarımı için hastanemize başvuran bir hastayı sunuyoruz. Ayrıca hastanın trakeostomiöyküsü de vardı. Bu operasyon için, kulak-burun-boğaz uzmanlarının trakeostomi açması gerekti.Hastanın operasyon ve operasyon sonrası dönemi sorunsuz geçti. Bu olgu sunumu ile PRS’luhastaların havayolu zorluklarını gözden geçirmek istedik. Anestezistler, zorluklar için hazır olmalıdırve kulak burun boğaz uzmanları da bu zorlukların üstesinden gelinmesi için hazır bulunmalıdırlar. Ekolarak, bronkospazm ve havayolu tıkanıklıkları ekstübasyon sonrası sık görülen komplikasyonlardır, bunedenle dikkatli postoperatif monitörizasyon uygulanmalıdır.

PLOS ONE 17(1), e0262110 (2022). doi:10.1371/journal.pone.0262110, Published by PLOS, San Francisco, California, US

Objective:Especially in large surgical procedures, it is recommended that the fluid treatment be performed according to the needs of the patient in the presence of hemodynamic monitoring during the operation. We aimed to review intraoperative fluid treatments and to increase awareness of intraoperative fluid management.Methods:The patients (393) who underwent general anesthesia were included in the study. According to the information of intraoperative fluid applications, the demographic characteristics of the patients and the amount and type of fluid that should be given according to the type of operation performed were determined.Results:In our study, the mean amount of fluid given to patients was found to be 2677.61 ml. The mean intraoperative fluid volume was higher in patients who were treated with IV vasopressors than in untreated patients (3477.27 ml). When compared with patients with ASA 1-2 group, the amount of fluid given to the patients in the ASA-3 group was high (2795 ml). Comparing the type of surgery and the amount of fluid given intraoperatively, we observed that the amount of intraoperative fluid was significantly higher in the high-risk surgical group (3601.65 ml). We can say that we are close to liberal practices as a liquid strategy. The use of balanced crystalloid with the closest content to plasma is the most preferred liquid type in our clinical practice.Conclusion:Due to the variability of the concepts of liberal and restrictive fluid regimen and the lack of standardized targeted clinical and physiological parameters, no specific evidence-based guideline or procedure specific fluid treatment could be demonstrated. In our study, we see that fluid replacement is performed under standard fluid treatment, which still can be considered liberal. We think that it can be useful to use hemodynamic monitoring methods more frequently in patients who need them, also in selected patient groups.Key Words: Fluid, Liberal, Restrictive, Perioperative, Crystalloid, Colloid, ÖZGiriş/Amaç:Büyük cerrahi işlemlerde, hemodinamik monitörizasyon ve hastanın ihtiyacına göre sıvı tedavisinin yapılması önerilmektedir. Biz intraoperatif sıvı tedavilerini gözden geçirmeyi ve intraoperatif sıvı ilkelerine farkındalığı arttırmayı amaçladık.Gereç ve Yöntemler:Genel anestezi uygulanan hastalar (393) çalışmaya dahil edildi. İntraoperatif sıvı uygulamaları, hastaların demografik özellikleri ve yapılmış olan operasyonun türüne göre verilmesi gereken sıvı miktarları ve türü belirlendi. Hastaların mevcut kayıtlarından verilmiş olan sıvı miktarlarına ait verilerle karşılaştırılma yapılarak sonuçlar analiz edildi.Bulgular:Çalışmamızda hastalara verilen ortalama sıvı miktarı 2677,61 ml (11,3 ml/kg/saat) olarak bulunmuştur. IV vazopressör kullanılan hastalarda intraoperatif verilen ortalama sıvı miktarlarının kullanılmayan hastalara göre daha yüksek olduğu görüldü (3477,27 ml). ASA-3 grubu hastalar ASA1-2 grubu hastalarla kıyaslandığında, ASA-3 grubu hastalara intraoperatif dönemde verilen sıvı miktarı yüksekti (2795 ml). Cerrahi tipi ve intraoperatif verilen sıvı miktarları karşılaştırıldığında; yüksek riskli cerrahi grubunda intraoperatif verilen sıvı miktarının anlamlı olarak daha yüksek olduğunu gözlendi (3601,65 ml). Sıvı yönetiminde liberal uygulamalara yakın değerlerde olduğumuzu söyleyebiliriz. Kristaloid kullanımı klinik pratiğimizde en sık tercih ettiğimiz sıvı tipi olarak karşımıza çıkmaktadır.Sonuç:Liberal ve restriktif sıvı rejimi kavramlarının değişkenliği, hedeflenen klinik ve fizyolojik parametrelerin standart olmaması nedeniyle kanıta dayalı kılavuz veya prosedüre özel bir sıvı tedavisi ortaya konamamıştır. Yüksek riskli hastalarda sıvı yönetimi için tek tip yaklaşım uygun olmayacaktır. Bizim çalışmamızda standart sıvı tedavisi uygulamaktayız, sonuçlarımız liberal sayılabilir. Hemodinamik monitorizasyon yöntemlerine ve hastanın sıvı gereksinimlerine dikkat edilerek replasman yapılmasının faydalı olacağını düşünmekteyiz.Anahtar Sözcükler: Sıvı, Liberal, Restriktif, Perioperatif, Kristalloid, Kolloid

Objective: Intraoperative blood loss during scoliosis surgery often leads to blood transfusion. Allogenic blood transfusion affects outcomes negatively in several patient populations. Our primary aim was to determine the influence of intraoperative blood transfusion on the postoperative blood transfusion rate and early postoperative outcomes in scoliosis surgery.Material and Methods: A total of 202 patients who had undergone scoliosis surgery between 2009 and 2014 were included in this retrospective study. Postoperative red-blood cell usage, postoperative mechanical ventilation, İntensive Care and Post Anesthesia Care Unit stay, and postoperative hospital discharge times were compared between intraoperatively-transfused and intraoperativelynon-transfused patients. Only intraoperatively-transfused, both intraoperatively and postoperatively transfused, only postoperatively transfused and patients with no transfusion were also compared. Results: Postoperative blood transfusion rates and hospital discharge times were significantly higher in intraoperatively transfused patients than intraoperatively-non-transfused patients p, Amaç: Skolyoz cerrahisi sırasında intraoperatif kan kaybı sıklıkla kan transfüzyonuyla sonuçlanmaktadır. Allojenik kan transfüzyonunun bazı hasta populasyonunda sonuçları olumsuz etkilediği gösterilmiştir. Çalışmamızdaki primer amacımız skolyoz cerrahisinde intraoperatif kan transfüzyonunun postoperatif kan transfüzyon oranına ve erken dönem postoperatif sonuçlara etkisini belirlemektir.Gereç ve Yöntemler: 2009-2014 yılları arasında skolyoz cerrahisi geçiren 202 hasta retrospektif olarak incelendi. İntraoperatif transfüzyon yapılan ve intraoperatif transfüzyon yapılmayan hastalarda postoperatif eritrosit süspansiyonu kullanımı, postoperatif mekanik ventilasyon süreleri, Yoğun Bakımda ve Anestezi Sonrası Bakım Ünitesinde kalış ve hastaneden taburculuk süreleri karşılaştırıldı. Sonra sadece intraoperatif transfüzyon yapılan, hem intraoperatif hem de postoperatif transfüzyon yapılan, sadece postoperatif transfüzyon yapılan ve transfüzyon yapılmayan hastalar karşılaştırıldı. Bulgular: Postoperatif kan transfüzyon oranları ve hastaneden taburculuk süreleri intraoperatif transfüzyon yapılan hastalarda intraoperatif transfüzyon yapılmayan hastalara göre anlamlı derecede yüksekti p

Background and aims Brain cortex controls movement but the influence of peripheral component of movement on cortex is not known. functional magnetic resonance imaging(fMRI) studies in volenteers, investigate cortex areas activated during execution and imagination of complex movements. We hypothesized that cortex areas activated to remember, organize and order to do a movement can be isolated from areas activated during performing the motor component of movement when the limb is peripherally blocked. We also aimed to show if there is bilateral cortex activity during acute peripheral motor block as seen in stroke patients and amputated patients. Methods We performed brain fMRI in 3 right-handed patients scheduled to undergo right-hand surgery with peripheral block anaesthesia as a pilot-study. Ethics approval and written informed consent from all patients were obtained. fMRI screening was performed before the surgery day and just before surgery after the block. Patients were screened when executing the task (figure 1) (after the block they just attempt), during rest and during they imagine doing the task. Results The activation areas decreased after right-hand block during both blocked and intact hand execution trials (figure 2) and imagination trials (figure 3). We propose that the difference between the areas of right hand represent the motor component of movement. Conclusions In this report, we describe a model that shows the activation areas during the effort of execution and imagery of complex hand movements during peripheral-nerve-block. There are many unknowns in the interactions between the brain-peripheral organ during movement. Identification of motor activation areas will help to perform more effective stroke rehabilitation and neurophatic pain therapies.

ObjectivesTo compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged ≥65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M).MethodsPatients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded.ResultsThe study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine.ConclusionThese current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥65 years of age undergoing elective TUR-P or TUR-M operations.

Objective The effectiveness of axillary brachial plexus block (ABPB) performed using peripheral nerve stimulation (PNS) alone was compared with PNS preceded by nerve localization using a pen device, enabling nerve mapping without puncturing the skin. Methods Patients undergoing unilateral hand or forearm surgery suitable for ABPB were randomly assigned to receive either PNS alone (pen − group) or PNS preceded by nerve localization using a pen device (pen + group). Parameters related to the block procedure and patient comfort were assessed. Results Thirty patients were included in each group. The block performance time was longer in the pen + group than the pen − group despite a reduced number of needle insertions. The complete block rate was higher and intraoperative analgesic usage lower in the pen + group compared with the pen − group. Patient satisfaction and complication rates were similar in the two groups. Conclusion The pen device seems to be a helpful addition to PNS for ABPB, with improved results in terms of block success and patient comfort, but further studies are needed to confirm these findings.

ResumenJustificativa y objetivosEvaluamos los efectos de la administración epidural de levobupivacaína o solución salina en BCRE para cesárea.MétodosSe incluyeron en este estudio 138 pacientes con embarazo a término de 37-42 semanas programadas para cesárea. El Grupo 1 (n = 48) recibió raquianestesia con una dosis única (RADU), el Grupo 2 (n = 45) recibió BCRE-EVE con una solución salina y el Grupo 3 recibió BCRE-EVE con levobupivacaína. Las características del bloqueo motor y sensorial y los efectos en las alteraciones hemodinámicas maternas y en los recién nacidos fueron comparados.ResultadosEl tiempo para alcanzar el bloqueo sensorial máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de regresión del bloqueo sensorial en dos segmentos fue significativamente menor en el Grupo 1, siendo significativamente mayor en el Grupo 3 con relación al Grupo 2 (p < 0,05). El tiempo de inicio del bloqueo motor fue significativamente mayor en el Grupo 1 que en los grupos 2 y 3 (p < 0,05). El tiempo para alcanzar el bloqueo motor máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de recuperación del bloqueo motor fue significativamente mayor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo para el primer analgésico fue significativamente mayor en el Grupo 3 (p < 0,05).ConclusionesEl bloqueo sensorial-motor rápido y adecuado se obtuvo en todas las pacientes del presente estudio. Sin embargo, el bloqueo sensorial-motor se inició más rápidamente y se extendió más, alcanzando un nivel más alto en los grupos 2 y 3. Esos efectos fueron más acentuados en el Grupo 3.

Objectives: The aim of this study is to decrease scar discomfort and pillar pain of carpal tunnel syndrome surgery results which were performed with mini invasive surgery. We preferred to use mini invasive method to preserve the pillar area which is one of the most intensive area for subcutaneous nerve and which is containing most contact area within the hand. Methods: The study included 200 hands of 160 patients with carpal tunnel syndrome at Akdeniz University in between January 2006 - December 2010. All hands were operated by the same surgeon with mini incision which was made through distal of transvers carpal ligament at midpalmar region. Two-hundred hands evaluated with Boston symptom severity and functional state scale, grip and pinch strength, patient satisfaction results. Results: We achieved statistically significant improvement with grip and pinch strength .In postoperative period we achieved significant improvement according to Boston symptom severity and functional state scale. Patient's satisfaction of the procedure was 96.5%. Conclusion: Successful results can be achieved with midpalmar mini-incision method which is a reliable, cheap and effective method. [Hand Microsurg 2013; 2(1.000): 23-27]

Introduction: In this report we present two cases of gunshot injury related midfoot defects, reconstructed with a chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap. The first case, a 14 years old male, had 10 × 8 cm medial plantar and 6 × 4 cm dorsal foot defects and the second case, a 55 years old female, had only 8 × 6 cm dorsal foot defect. In both cases the defects were associated with fractures, one with lateral cuneiform and cuboid with 90% bone loss and the other with navicular bone, respectively. After 6 months, the patients could walk well without support, and radiographs confirmed bony union. A chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap may be used for the reconstruction of combined bony and soft tissue defects of the midfoot and to promote bone healing. © 2016 Wiley Periodicals, Inc. Microsurgery 36:598–603, 2016. © 2016 Wiley Periodicals, Inc.

Conventional procedures can usually prevent cerebrospinal fluid ( CSF ) leakages, but they may not work for complicated cases. In this case presentation we demonstrated the effectiveness of combined omental and latissimus dorsi musculocutaneous flaps for management of difficult CSF fistula. A reverse turnover latissimus dorsi musculocutaneous flap and omental flap were transferred for reconstruction of the back wound and CSF leakage. The omental flap component was used to CSF absorption and the latissimus dorsi muscle component was used to obliterate the dead space, to cover the exposed bone and for tension-free closure of the wound. The wound healed dramatically. We haven't seen severe donor site morbidity. The patienthas been followed for 30 months with no evidence of CSF leakage and no pseudomeningocele formation which was confirmed by magnetic resonance imaging (MRI) . Although this is a case presentation, we can say that the combination of the omental and musculocutaneous flaps allow effective treatment and prevention of CSF fistulas in selected high-risk patients and provide durable coverage of complex spinal wounds.

To compare the effects of intrathecal ropivacaine with bupivacaine in a dose ratio of 2:1 for outpatient arthroscopic knee surgery.Randomized, single-blinded study.University-affiliated hospital.90 patients scheduled for outpatient arthroscopic knee surgery.Patients were randomized and assigned in single-blinded fashion to receive a 3-mL solution of either 15 mg of isobaric ropivacaine (group R; n = 45) or 7.5 mg of isobaric bupivacaine (group B; n = 45) through a 27-gauge Quincke spinal needle at the L(3) to L(4) interspace, while placed in the lateral decubitus position.Onset and offset times for sensory and motor block; highest level of sensory block; duration of the sensory and motor block; first ambulation, urination, and discharge time; mean arterial pressure; and heart rate were all recorded.Onset time for sensory block (mean +/- SD) to L1 and time until sensory block regressed to L2 were shorter in group R. Complete motor block occurred in 40 patients with ropivacaine and 45 patients with bupivacaine. First ambulation and first urination and discharge times were similar between the two groups. Cephalad spread of sensory block was higher with ropivacaine (P0.05). The median (range) upper sensory level obtained with bupivacaine was T11 (T6-L1) and T8 (T6-T10) with ropivacaine. Hemodynamic changes were similar between the groups (P0.05).Isobaric ropivacaine 15 mg provided a higher sensory block level and shorter sensorial onset and offset times than did 7.5 mg of isobaric bupivacaine.

Background. To provide postoperative analgesia by spinal anesthesia, we compared the quality of analgesia and side effects of two doses of morphine added to ropivacaine in kidney donors. Materials and Methods. Thirty renal donors underwent nephrectomy under standard general anesthesia. After the operation, the patients were randomly allocated into two groups of intrathecal doses for spinal anesthesia: the 0.5 group (n = 15) received a total volume of 4 mL including 0.5 mg morphine, 10 mg ropivacaine, and 0.9% NaCl, and the 0.3 group (n = 15), a total volume of 4 mL including 0.3 mg morphine, 10 mg ropivacaine, and 0.9% NaCl. After extubation, an intravenous (IV) morphine protocol was initiated by a patient-controlled analgesia pump to provide sufficient spinal analgesia. Results. In the 0.3 group, the IV morphine consumption was significantly higher, namely, 14.60 ± 7.57 times versus 4.60 ± 10.14 times for the 0.5 group (P = .005). The total amount of morphine was 7.80 ± 5.40 mg in the 0.5 group and 13.53 ± 5.30 mg in the 0.3 group (P

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91-10.08] min, LD = 13 [6.76-20.19] min, LDc = 6 [4.44-8.43] min) and sensory block (L = 7 [5.21-10.30] min, LD = 12 [6.11-19.40] min and LDc = 6 [4.2-8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.

Background: To evaluate the clinical efficacy and safety of unilateral spinal anaesthesia with 0.66% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine for arthroscopic knee surgery. Patients and methods: Forty patients with American Society of Anesthesiology physical status grade I–II were randomly and double blindly allocated to one of two groups. Spinal anaesthesia was performed from the L3-4 or L4-5 interspace with the patient in the lateral decubitus position and with the operative side below. Group B (n = 20) received 7.5mg of 0.5% hyperbaric bupivacaine and group R (n = 20) received 10mg of 0.66% hyperbaric ropivacaine. Patients stayed in the lateral decubitus position for 10 minutes and were then turned to the supine position. The characteristics of spinal block, intraoperative quality of spinal anaesthesia, adverse effects and recovery times were recorded. Results: The onset of sensory block and motor block were significantly earlier in group B compared with group R (p < 0.05). The duration of sensory block and motor block were significantly shorter for group R compared with group B (p < 0.05). Bilateral sensory block occurred in 85% of patients in group B and in 40% of patients in group R (p < 0.05). Bilateral motor block occurred in 70% of patients in group B and in 25% of patients in group R (p < 0.05). Conclusion: For outpatient knee arthroscopy, 10mg of 0.66% hyperbaric ropivacaine is preferred to 7.5mg of 0.5% hyperbaric bupivacaine because it provides a more selective unilateral block and a faster recovery.

The combination of advances in microsurgery and the improvement of anesthetic management with increased understanding of the physiology of preoperative and postoperative care has significantly raised the upper age limit for free-flap transfer in elderly patients. Despite pessimistic opinions regarding elderly patients who have poor recovery potential and decreased physiological reserves, the unique feature of free-tissue transfer is that it allows the transfer of well-vascularized tissue to defects in a single-stage procedure, and leads to improved quality of life. In this report, a retrospective analysis of 55 patients aged 50 and older who underwent microsurgical tissue transfer is presented. Hospital and our own records were used to review various parameters. The preoperative medical status of each patient was assessed using the American Society of Anesthesiologists (ASA) Classification of Physical Status. Each patient's preoperative medical records, age, sex, transferred tissue type, and length of operation were outlined. Postoperative recorded parameters were the fate of flaps and the short-term postoperative outcome, including surgical complications, medical morbidity, and death within 30 days of surgery. Fifty-eight microvascular tissue transfers were performed in 55 consecutive patients. The study comprised 38 male and 17 female patients, with a mean age of 64.8 years. ASA classification status was class 1 for 15 patients, class 2 for 26 patients, and class 3 for 14 patients. Twenty-five flaps were used for lower extremity reconstruction, 32 flaps were used for head and neck reconstruction, and 1 was used for breast reconstruction. The average operative time was 5.7 h, ranging between 2-13 h. There were 14 major medical complications, resulting in an overall medical complication rate of 25%. There were 3 deaths within 30 days postoperatively. Thus, the overall surgical mortality rate was 5.4%. The longer operation times were associated with the development of postoperative total medical and surgical complications (P = 0.008). While the relationship between ASA class and medical complications was significant (P = 0.0007), no significant relation was determined between ASA class and surgical complications (P = 0.66). It was revealed that the greater the age group, the greater the occurrence of postoperative medical complications (P = 0.0001). The relationship between postoperative surgical complications and age groups was not significant (P = 0.07). It was also demonstrated that the advanced age of patients was associated with a higher ASA class (P = 0.0017). Eleven flaps required reoperation for vascular compromise. While 10 of these were salvaged with vascular anastomosis revisions, one flap was lost. Thus the overall flap success rate was 98.3%. In conclusion, if a patient's medical problems do not constitute a handicap, age itself should not be considered a barrier to free-flap transfer. It is important to be familiar with preoperative medical problems and possible postoperative medical complications in order to achieve a successful outcome. Contrary to what is generally suggested, surgical complications do not constitute a special consideration in older patients.

Anaphylaxis is defined as a severe, life threating, generalized or systemic hypersensitivity reaction. The most common agent involved in intraoperative anaphylactic reactions is muscle relaxant (61-70%); natural rubber latex (NRL) is the second most implicated agent and the incidence of latex-related anaphylactic reactions is increasing despite increasing awareness and preventive measures taken. Latex is a ubiquitous part of life today. Medical products which contain latex are present in our environment, especially in the hospital setting. This study focuses on our experience with two different anaesthetic techniques performed on the same patient who had latex hypersensitivity reaction and underwent surgery for myomectomy twice in 5 years. This case report aims to point out to latex hypersensitivity on health workers. The patient described had latex allergy and strategy of management during perioperative period is detailed.

Objective Complications after vertebroplasty are rare. There are few reported infectious complications requiring surgical management such as corpectomy with anterior reconstruction and posterior stabilization, although we have not seen any reports about epidural abscess in the literature. We present a patient in whom posterior epidural abscess developed after vertebroplasty in which drainage and antibiotherapy were required for treatment. Methods A 70-year-old female with a painful T12 osteoporotic compression fracture underwent percutaneous vertebroplasty using polymethylmethacrylate without complication. One week after vertebroplasty, however, she had fever and increased back pain. On clinical examination, soft tissue abscess formation was determined at the vertebroplasty site. This was drained surgically and antibiotic treatment was started. At follow-up, she had progressive neurological deterioration (paraparetic) on the 18th day after abscess drainage. MRI of the thoracolombar spine revealed posterior spinal epidural abscess at the T11/12 level. Partial laminectomy and drainage were performed. She had complete neurological recovery in the follow-up period. Conclusion An epidural abscess, which is an unusual complication of vertebroplasty, represents a medical and surgical emergency. Treatment is generally urgent surgical drainage combined with antibiotics. The patient should be evaluated in detail for systemic infectious disease and comorbid conditions before the vertebroplasty procedure.

Resume Objectif Les complications apres vertebroplastie sont rares. Quelques complications infectieuses ont ete rapportees, necessitant une prise en charge chirurgicale par corporectomie avec reconstruction anterieure et stabilisation posterieure, mais nous n'avons pas trouve dans la litterature de cas rapportes d'abces epidural. Nous rapportons le cas d'un patient ayant developpe un abces epidural posterieur apres vertebroplastie, necessitant un traitement par drainage et antibiotherapie. Methode Une femme de 70 ans ayant un tassement vertebral osteoporotique douloureux de T12 a subi une vertebroplastie percutanee avec du polymethacrylate de methyle sans complication. Toutefois, une semaine apres la vertebroplastie, elle etait febrile avec augmentation de la douleur dorsale. A l'examen clinique, il existait un abces des parties molles en regard du site de la vertebroplastie. Ce dernier a ete draine chirurgicalement et des antibiotiques ont ete debutes. Lors du suivi, elle a developpe une deterioration neurologique progressive (paraparesie) au 18e jour apres le drainage de l'abces. L'IRM de la colonne dorsolombaire a revele un abces epidural spinal posterieur a l'etage T11/12. Une laminectomie partielle et un drainage ont ete realises. Elle a presente une recuperation neurologique complete dans la periode du suivi. Conclusion L'abces epidural, qui est une complication inhabituelle de la vertebroplastie, represente une urgence medicale et chirurgicale. Le traitement combinant un drainage chirurgical et des antibiotiques est generalement urgent. Les patients doivent etre evalues en detail avant une procedure de vertebroplastie, a la recherche de maladies infectieuses systemiques et de comorbidites.

The search for markers releated to pain was involved a variety molecules assayed from plasma and cerebrospinal fluid. Cystatin C is low molecular weight proteinase inhibitor. Its role n pain was investigated. In this clinical study was investigated that the relationship between the cystatin C levels in cerebrospinal fluid and pain. Our results suggested that cystatin C concentrations in cerebrospinal fluid is unreliable diagnostic marker for pain.

Introduction The appropriate anesthesia for renal transplantation requires minimal toxicity for patients and for the transplanted organ, as well as sufficient pain relief and maintenance of vital functions. The aim of this study was to determine how the anesthetic technique influences the outcome in patients after renal transplantation in terms of preoperative and intraoperative hemodynamic changes and blood gas changes. Methods Fifty adult patients undergoing renal transplantation were randomly divided into two groups receiving standardized general anesthesia or combined spinal and epidural anesthesia. Results Demographically both groups were similar. Total anesthesia time (202 ± 53 vs 186 ± 37 minutes) and surgical time (191 ± 52 vs 162 ± 31 minutes) did not differ between the groups. The heart rate and systolic blood pressure values of the groups as measured before induction and 5, 15, 20, 30, as well as 60 minutes thereafter did not differ between the groups. Neither the frequency of bradycardia (four vs two) nor of hypotension (six vs four) during anesthesia differed between regional versus general anesthesia groups. Conclusion Regional is an important alternative to general anesthesia during renal transplantation surgery in adult patients.

Spinal anaesthesia is the method of choice for elective caesarean delivery. Levobupivacaine may produce a sensory and motor block that is different from that produced by bupivacaine, the most popular local anaesthetic for parturients undergoing caesarean section (CS). We present a case of unexpectedly prolonged spinal anaesthesia following a successful spinal block with levobupivacaine. There was no evidence of any neurological injury in this patient during injection.

JUSTIFICATIVA E OBJETIVOS: Avaliamos os efeitos da administração peridural de levobupivacaína ou solução salina, extensão do volume peridural (EVE), em bloqueio combinado raqui-peridural (BCRP) para cesariana. MÉTODOS: Foram incluídas no estudo 138 pacientes com gravidez a termo de 37-42 semanas programadas para cesariana. O Grupo 1 (n = 48) recebeu raquianestesia com dose única (RADU), o Grupo 2 (n = 45) recebeu BCRP-EVE com solução salina e o Grupo 3 recebeu BCRP-EVE com levobupivacaína. As características do bloqueio motor e sensorial os efeitos nas alterações hemodinâmicas maternas e nos recém-nascidos foram comparados. RESULTADOS: O tempo para atingir o bloqueio sensorial máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de regressão do bloqueio sensório em dois segmentos foi significativamente menor no Grupo 1, enquanto foi significativamente maior no Grupo 3 em relação ao Grupo 2 (p < 0,05). O tempo de início do bloqueio motor foi significativamente maior no Grupo 1 do que nos grupos 2 e 3 (p < 0,05). O tempo para atingir o bloqueio motor máximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de recuperação do bloqueio motor foi significativamente maior no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo para o primeiro analgésico foi significativamente maior no Grupo 3 (p < 0,05). CONCLUSÃO: Bloqueio sensório-motor rápido e adequado foi obtido em todas as pacientes do presente estudo; no entanto, o bloqueio sensório-motor teve início mais rapidamente, foi mais prolongado e atingiu um novel mais alto nos grupos 2 e 3; esses efeitos foram mais acentuados no Grupo 3. BACKGROUND AND OBJECTIVES: We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS: One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n = 48) received single-shot spinal anesthesia (SSS), group 2 (n = 45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS: Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p < 0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p < 0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p < 0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p < 0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p < 0.05). The time to first analgesic was significantly longer in group 3 (p < 0.05). CONCLUSIONS: Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3. JUSTIFICATIVA Y OBJETIVOS: Evaluamos los efectos de la administración epidural de levobupivacaína o solución salina en BCRE para cesárea. MÉTODOS: Se incluyeron en este estudio 138 pacientes con embarazo a término de 37-42 semanas programadas para cesárea. El Grupo 1 (n = 48) recibió raquianestesia con una dosis única (RADU), el Grupo 2 (n = 45) recibió BCRE-EVE con una solución salina y el Grupo 3 recibió BCRE-EVE con levobupivacaína. Las características del bloqueo motor y sensorial y los efectos en las alteraciones hemodinámicas maternas y en los recién nacidos fueron comparados. RESULTADOS: El tiempo para alcanzar el bloqueo sensorial máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de regresión del bloqueo sensorial en dos segmentos fue significativamente menor en el Grupo 1, siendo significativamente mayor en el Grupo 3 con relación al Grupo 2 (p < 0,05). El tiempo de inicio del bloqueo motor fue significativamente mayor en el Grupo 1 que en los grupos 2 y 3 (p < 0,05). El tiempo para alcanzar el bloqueo motor máximo fue significativamente menor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo de recuperación del bloqueo motor fue significativamente mayor en el Grupo 3 que en los grupos 1 y 2 (p < 0,05). El tiempo para el primer analgésico fue significativamente mayor en el Grupo 3 (p < 0,05). CONCLUSIONES: El bloqueo sensorial-motor rápido y adecuado se obtuvo en todas las pacientes del presente estudio. Sin embargo, el bloqueo sensorial-motor se inició más rápidamente y se extendió más, alcanzando un nivel más alto en los grupos 2 y 3. Esos efectos fueron más acentuados en el Grupo 3.

This paper is the first step of a multi-sensor fusion system for control of dept of desflurane anesthesia. In this study, depth of desflurane anesthesia was examined through cardiovascular-based an adaptive neuro-fuzzy system according to changing in the blood pressure and heart rate taken from the patient. The second step, in the next paper will be based on auditory evoked responses. The system designed for anesthetic agent, desflurane, because it is very popular and among the first choices of anesthesiologist for inhalation anesthesia. Intraoperative awareness resulting from inadequate anesthetic is a rare but serious complication during general anesthesia. In order to prevent possible intraoperative awareness, anesthesiologists usually apply anesthetics at level much above the minimal necessary. Anesthetic overdosing prolongs the recovery period, which may cause severe hemodynamic depression and a life-threatening scenario in critically ill patients. To increase patient safety and comfort is one of the most important potential benefits of the system. The second important aim of the study is to relase the anesthesiologist so that he or she can devote attention to other tasks that can’t yet be adequately automated. Also, to make the optimum in the area of anesthetic agent and to economize by lessening the costs of an operation are included the benefits which are coming with this system.

We investigated the role of potassium channels in vasodilatory effect of levosimendan in human internal thoracic arteries.Samples of redundant internal thoracic arteries obtained from patients undergoing a coronary artery bypass graft surgery were cut into 3 mm wide rings and suspended in 20 ml organ baths. Isometric tension was continuously measured with an isometric force transducer connected to a computer-based data acquisition system.Levosimendan (10(-8)-10(-5) M) or cromakalim (10(-8)-10(-5) M) produced concentration-dependent relaxation responses in human internal thoracic arteries precontracted by 10(-6) M phenylephrine. The relaxant responses to levosimendan did not differ significantly between endothelium-intact and endothelium-denuded preparations. Incubation of human internal thoracic artery rings with adenosine 3',5'-triphosphate (ATP)-dependent potassium channel blocker glibenclamide (10(-6) M) for 30 min significantly inhibited the relaxant responses to both levosimendan and cromakalim. The Ca2+-activated potassium channel blocker iberiotoxin (10(-7) M) also caused a significant but smaller inhibition on relaxant responses to levosimendan. Incubation of the rings with the voltage-dependent potassium channel blocker 4-aminopyridine (5 mM) for 10 min did not cause significant alterations in relaxant responses to levosimendan.The findings of this study suggested that levosimendan-induced relaxation responses in human internal thoracic arteries were depended on the activation of ATP-dependent and Ca2+-activated potassium channels.

One of the aims of neuroanesthesia is to provide early postoperative recovery and neurologic examination in patients undergoing supratentorial surgery. Our aim was to investigate the role of using the bispectral index (BIS) in recovery from anesthesia and altering drug administration in patients undergoing craniotomy. Fifty American Society of Anesthesiologists' (ASA) physical status I-II patients undergoing craniotomy were included in the study. The patients were randomly divided into two groups, and all patients received standard induction drugs, and 0.8%-1.5% sevoflurane was used for maintenance of anesthesia. In the BIS-guided group, the concentration of sevoflurane was titrated to maintain BIS at 40-60. In the control group, the anesthesiologist was blind to BIS, and the concentration of sevoflurane was changed according to the patients' hemodynamic changes. The hemodynamic data, BIS values, and sevoflurane concentrations were recorded every 15 minutes. In addition, the BIS value was recorded by the primary anesthetist in the BIS-guided group and by another independent anesthetist in the control group. At the end of the study, recovery criteria and Aldrete recovery scores were recorded every 15 minutes. Neurologic assessments were performed when the Aldrete score was 9-10. BIS values were higher, and sevoflurane concentrations (P < 0.05) and total doses of fentanyl (P < 0.01) were lower, in the BIS-guided group. Times to first spontaneous breathing, eye opening, and extubation (P = 0.035, P = 0.001, and P = 0.0001, respectively) were significantly shorter in the BIS-guided group. Time to an Aldrete score of 9-10 and adequate neurologic assessment were similar between the groups. In conclusion, BIS monitoring by supratentorial craniotomy under general anesthesia reduced the maintenance anesthetic concentration and narcotic drug usage and lowered the recovery times from general anesthesia.

In this study, we studied 45 healthy parturients with singleton vertex presentation. Patients were allocated randomly to receive either 0,125 % bupivacaine with 2 micro g/ml fentanyl or 0,125 % bupivacaine with 1,5 micro g/ml clonidine for epidural labour analgesia. A patient controlled epidural analgesia (PCEA) pump was programmed as follows: basale infusion rate: 6 ml/h, demand bolus: 5 ml, lockout interval: 10 min. Efficacy of analgesia was evaluated using visual analogue scale. Maternal and fetal cardiovascular variables, Apgar scores of the newborn at 1-5 min and umbilical arterial blood gas measurements were recorded. The duration of stages of labour and total analgesic consumption were also noted. Systolic blood pressure decreased significantly at 3rd h in bupivacaine plus fentanyl group. Although all patients experienced a good analgesia, pain scores in bupivacaine plus clonidine group were lower than bupivacaine plus fentanyl group. The analgesic requirement in bupivacaine plus clonidine group was less than the other group. There were no significant differences in fetal heart rate, Apgar scores or umbilical blood gases. In conclusion, the addition of clonidine to epidural bupivacaine for PCEA was superior to bupivacaine plus fentanyl for analgesia and analgesic requirement during labour.