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Background Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Methods Patients with osteoarthritis were randomly allocated to two groups. Group I (n = 26) received 7 mL 0.5% lidocaine and group II (n = 26) received 7 mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30 minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Results Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P = 0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P = 0.006, P = 0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P = 0.035, P = 0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P = 0.002, P Conclusions Intra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period.

Amaç: Bu retrospektif çalışmada hastanemizde laparaskopik bariatrikcerrahi uygulanan hastalardaki anestezi deneyimimizin aktarılması veperioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç veYöntem: Obezite cerrahisi geçiren ASA risksınıflaması II-III olan 62 hasta retrospektif olarak değerlendirilmiştir.Hastaların demografik özellikleri, cerrahinin süresi, peroperatif dönemdegörülen komplikasyonlar, hastanede kalış süresi kaydedilmiştir.Bulgular: Hastaların yaş aralığı 19 ile 59 arasında değiştiği ve %72.6’sının kadınolduğu tespit edildi. Ortalama operasyonsüresi 167 dakika, hastanede kalış süresi 5 gündür. İntroperatif dönemdegörülen komplikasyonlar arasında taşikardi, hipertansiyon ve aritmi yeralmaktadır. Takiplerde 6 (%9.7) hastanın tekrar operasyona alındığı, hastalarıntamamının sağlıklı şekilde hastaneden taburcu edildiği tespit edildi.Sonuç:Laparaskopik obezite cerrahisinde oluşabilecekkomplikasyonların önlenmesinde donanımlı bir ekip ve takım çalışması ilebirlikte iyi bir preoperatif hazırlık, tromboemboli proflaksisi, sıkıhemodinami ve kan gazı takibi güvenli bir anestezi için gereklidir., Purpose: The aim of this study was topresent our experience in patients who underwent laparoscopic bariatric surgery and to discuss the current literature on theperioperative management.Material andMethods: Sixty two patients with ASA riskclassification II-III were evaluated retrospectively who underwent obesity surgery inour hospital. Demographiccharacteristics of the patients, surgical time, complications that seen in theperioperative period and the length of hospital stay were recorded.Results: The age of thepatients ranged from 19 to 59 years and 75.9% of them were female. Meanoperation time was 167 minutes and the length of hospital stay was 5 days. Complications seen during intraoperative period were tachycardia,hypertension and arrhythmia. In the following days, 6 (9.7%) patients were re-operated and there was no mortality.Conclusion: The prevention of complications that may occur inlaparoscopic obesity surgery is required with a equipped team and teamwork, agood preoperative preparation, thromboembolism prophylaxis, tight hemodynamicsand blood gas monitoring for safe anesthesia.

Amaç: Bu retrospektif çalışmada hastanemizde intrakranial kitle cerrahisiuygulanan hastalardaki anestezi deneyimimizin değerlendirilmesi ve perioperatifyönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç veYöntem: 2015-2016 tarihleri arasında intrakranialkitle cerrahisi geçiren yaşları 3 ile 78 arasında ASA risk sınıflaması I-IIIolan 112 hasta retrospektif olarak değerlendirildi. Veriler içinanestezi kayıt formları, hasta dosyaları ve hastane bilgisayar sistemikullanıldı.Hastaların demografik özellikleri, anestezi yönetimi ve postoperatif bilgilerikaydedildi.Bulgular: Hastaların yaş aralığı 3 ile78 arasında değiştiği ve %57.1’ninerkek olduğu tespit edildi. 98 (%87.5) hastanın kitlesi supratentorialbölgede iken 14 (%12.5)’nin infratentorial bölgede lokalize olduğusaptandı. Ortalama operasyon süresi 184dakika, ortalama yoğun bakımda kalış süresi 3 gün, hastanede kalış süresi 7gündür. İntroperatif dönemde görülen komplikasyonlar arasındataşikardi (%5.4), bradikardi(%3.6), hipertansiyon (%3.6) ve hipotansiyon (%1.8) yer almaktadır.Takiplerde 13 (%11.6) hastanın tekrar operasyona alındı. Preoperatifve postoperatif dönemde ölüm ile karşılaşılmadıSonuç: İntrakranial kitle cerrahisi için nöroaanesteziuygulamalarında çeşitli anestezi teknikleri başarıyla kullanılabilir. İnvazivmonitorizasyon, sıkı hemodinami ve kan gazı takibi ile olası komplikasyonlarerken fark edilerek mortalite ve morbidite azaltılabilir., Purpose: The aim of this retrospectivestudy was to present our evaluate anesthesia experience in patients whounderwent intracranial tumor surgery and to discuss thecurrent literature on the perioperative management.Material and Methods: ASA risk classificationI-III 112 patients between the ages of 3-78 were evaluated retrospectively whounderwent intracranial mass surgery between the years 2015-2016. Anesthesia registration forms, patientfiles and hospital computer system was used.for data. The demographic characteristics ofpatients, anesthetic management, and postoperative data were recorded.Results: The age of patientsranged from 3-78 years and 57.1% of them were men. Masses were localized insupratentorial area in 87.5% (98) of cases. Mean operation time was 184 minutes,mean length of intensive care unit was 3 days and length of hospital stay was 7days. Common vomplications seen during intraoperative period were tachycardia (5.4%),bradycardia (3.6%), hypertension (3.6%) and hypotension (1.8%). In thefollowing days, 13 (11.6%) patient received repeated operation. There was notmortality.Conclusion: Several anesthetic techniques may be usedsuccessfully to provide anesthesia for resection of intracranial mass surgery. To reduced morbidity and mortality, the possiblecomplications must be recognized and treated early with invasive monitoring,strict hemodynamics and blood gas monitoring.

Objective: To assess flexible laryngeal mask airway (F-LMA) use during pediatric adenoidectomies in terms of patient safety, comfort, complication rates and surgeon satisfaction levels. Methods: Patients who had undergone an elective adenoidectomy after receiving general anesthesia using F-LMA from June 2012 to November 2015 were included. Patients' demographics and the incidence of perioperative complications were investigated. The surgeon's satisfaction level was also evaluated by questionnaire. Results: Eight hundred fourteen patient were included in the study. Conversion from F-LMA to an endotracheal tube was carried out in two patients (0.2%). Airway complications were identified in two patients. The mean duration of stay in the postoperative anesthesia care unit was 17 minutes. All patients were discharged the same day. According to the otolaryngologists F-LMA applications provide a significant reduction in the processing time (100%), postoperative patient comfort is better than when using endotracheal intubation (83.3%) and the consensus was that there should be a complete continuation of the use of the F-LMA (100%) in subsequent adenoidectomies. Conclusion: Our data show that the use of F-LMA for pediatric adenoidectomies has well tolerability profile and resulted in a lower incidence of complications. We think that the use of F-LMA for pediatric adenoidectomy is safer, simpler and speeder method.

This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries.Prospective, randomized clinical trial.University Teaching and Research Center.Seventy-one American Society of Anesthesiologists (ASA) I-III patients between 48 and 70 years of age who underwent total knee arthroplasty were randomized.Tenoxicam (20 mg) was administered intramuscularly to both groups of patients 30 minutes before surgery. Patients were randomized into two groups to receive fascia iliaca block before the induction of anesthesia (Group FI) or periarticular drug injection during the surgery (Group PI). All surgeries were performed under general anesthesia using standard techniques. Postoperative analgesia was provided with patient-controlled intravenous morphine.Total morphine consumption was the primary outcome measure and was recorded postoperatively at 1, 2, 6, 12 and 24 hours. Pain levels at rest and on movement (knee flexion) were evaluated using the Visual Analogue Scale (VAS) and recorded at the same time points. Patients' demographics, rescue analgesic demands, side effects, hemodynamics, and satisfaction scores were also recorded.The groups had similar VAS scores both at rest and on movement (P.05). However, the amount of cumulative morphine and use at each follow-up period was higher in Group PI (P.0001). The groups did not differ significantly in rescue analgesic use or side effects, such as nausea/vomiting, hemodynamic variables, and patient satisfaction scores (P.05).Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.

WOS: 000406051800002, Curcumin has remarkable anti-inflammatory and antioxidant properties. The aim of this study was to investigate the protective effects of curcumin on a rat model of carbapenemresistant Escherichia coli-induced acute lung injury (ALI). Thirty-two rats were randomly allocated to 4 groups to induce an ALI: negative control group (rats not infected with E coli with no antibiotic treatment), positive control group (rats infected with E coli with no antibiotic treatment), imipenem group (rats infected with E coli that received intraperitoneal injection of imipenem), and the imipenem+curcumin group (rats infected with E coli that received intraperitoneal injection of imipenem and were fed on curcumin). The rats were killed, and lung tissues samples were harvested for biochemical analyses and histopathologic examination. Total antioxidant status (TAS), total oxidant status (TOS), tumor necrosis factor alpha (TNF alpha), and interleukin-6 (IL6) were measured. TOS increased in the positive control group (P < 0.001) and decreased in the imipenem and imipenem+curcumin groups (P < 0.001 and P < 0.001, respectively). TAS decreased in the positive control group (P = 0.005). Imipenem treatment did not increase TAS, but the imipenem+curcumin group increased TAS (P = 0.014). TNF alpha and IL6 increased in the positive control group compared with the negative control group (P < 0.001 and P = 0.010, respectively). Imipenem decreased TNF alpha (P < 0.001), but did not decrease IL6 (P = 0.418). Imipenem+curcumin decreased TNF alpha (P < 0.001); this decrease was more pronounced compared with the imipenem group (P = 0.008). IL6 decreased in the curcumin group compared with the positive control group (P = 0.011). Curcumin combined with imipenem can be an alternative therapeutic agent to overcome the resistance of E coli strains., Baskent University [DA 15/05], This study was supported by the Baskent University Research Fund (Project DA 15/05).

Background/aim We report the analysis of ketamine doses needed and the recovery times in pediatric oncology patients undergoing repeated radiotherapy sessions. Materials and methods In a single-blind prospective study design, thirty-three pediatric patients undergoing radiotherapy due to oncologic disorders received 2 mg/kg ketamine and 10 μg/kg atropine intravenously and the rescue drug to be administered was ketamine at 0.5 mg/kg when the sedation level was inadequate. Total ketamine consumption, additional doses, and recovery time were recorded. Results Data of 635 consecutive radiotherapy sessions were evaluated. There was no significant alteration in total ketamine consumption required to complete the radiotherapy periods during consecutive procedures (P > 0.05). However, the recovery times started to decrease by the fourth session (P = 0.02) and continued to decrease onwards during the whole study period (P = 0.001). The mean of the first recovery time was 13.68 ± 3.99 min, whereas the mean of the last recovery time was 7.66 ± 6.35 min. Conclusion A requirement for an incremental increase in ketamine dose after subsequent administrations was not detected, despite a significant decrease in recovery times being anticipated when ketamine is used repeatedly for sedative purposes in consecutive radiotherapy sessions.

Background and Objective: Septoplasty operations are associated with moderate to severe postoperative pain which has unfavourable effects on patient's recovery and postoperative outcome. The aim of this study was to compare effects of intravenous paracetamol and dexketoprofen on postoperative analgesia, tramadol consumption and side effects after septoplasty. Methods: In total 72 patients (aged 18-65 years) who had undergone an elective septoplasty from August 2013 to January 2015 in Baskent University Faculty of Medicine, in the Department of Anesthesiology and Reanimation Clinics were included in this study. The patients were randomised into one of two groups: those who received intravenous paracetamol; and those who received intravenous dexketoprofen. All patients were treated with tramadol for 24 hour postoperatively. The primary endpoint was pain intensity as measured by a visual analogue scale (VAS). Tramadol consumption and drug related side effects were also recorded. Results: The pain scores in the dexketoprofen group were significantly lower at recovery, 15 and 30 minutes and two hour (p< 0.05). The pain scores had no difference at other time points. Tramadol consumption in the recovery period was significantly lower in the dexketoprofen group, but cumulative tramadol consumption did not differ between the groups. The incidence of nausea was lower but not statistically significant in the dexketoprofen group at 15 and 30 minutes and two hour. Conclusions: Compared with paracetamol, preemptive dexketoprofen is associated with lower VAS scores and tramadol consumption in the early postoperative period after septoplasty. However, the cumulative tramadol consumption did not significantly differ between the groups.

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy. JUSTIFICATIVA E OBJETIVO: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. MÉTODOS: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada com uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, uma, duas, quatro, seis, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg-1) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 horas de pós-operatório e os efeitos adversos relacionados ao tratamento foram registrados. RESULTADOS: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em seis horas (p < 0,05) e no grupo dipirona em comparação com o grupo placebo em 30 minutos e seis horas (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de uma, duas, quatro, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). CONCLUSÕES: Paracetamol e dipirona têm um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia.

ResumoJustificativa e objetivoA sedação em paciente dependente de diálise com doença renal em estágio terminal (DRET) requer cautela como resultado da administração de altas doses de sedativos e suas complicações. Os regimes de sedação com múltiplas drogas podem ser superiores e vantajosos em relação ao consumo menor de drogas e aos eventos adversos que ocorrem facilmente em pacientes com DEET. Avaliamos os efeitos da pré‐medicação com dexmedetomidina sobre o consumo de propofol, os níveis de sedação com os escores da Observer's Assessment of Alertness and Sedation (OAA/S) e do índice bispectral (BIS), as alterações hemodinâmicas e os potenciais efeitos colaterais em pacientes geriátricos com DRET submetidos à cirurgia para fratura de quadril sob raquianestesia.MétodoNeste estudo randômico, controlado e duplo‐cego, 60 pacientes idosos (idade≥65 anos), com DRET e fratura de quadril, agendados para fixação intramedular de haste femoral anterógrada foram designados para grupos para receberam infusão intravenosa de solução salina (Grupo C) ou pré‐medicação com infusão de 0,5mg kg/10min de dexmedetomidina (DEX) (Grupo D). Todos os pacientes receberam infusão de propofol após a indução da raquianestesia.ResultadosO consumo total de propofol, a dose de propofol necessária para os níveis‐alvo de sedação de acordo com os escores da OAA/S, os valores do BIS e os tempos de recuperação foram significativamente menores no Grupo D (p

Patients with isolated peripheral branch neuralgia of trigeminal nerve usually receive traditional treatment such as medical therapy and interventional procedures targeting the entire trigeminal nerve or related ganglions. However, if the intractable pain is limited to a certain branch, the patient may also benefit from a peripheral and nerve-targeted interventional approach. Here, we report the management of a patient with isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with steroid and local anesthetic combination. 48years-old male patient diagnosed with trigeminal neuralgia was resistant to medical therapy for 3years. The pain site was isolated to the area of the right nasal wing, right lateral incisor, the upper right canine and the first premolar teeth. His pain was an electric shock-like, throbbing and stabbing with a pain score of 8-9 according to numeric rating scale (NRS) and 18 according to the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS). Following a diagnostic ultrasound-guided infraorbital nerve block with 1% lidocaine, the block was repeated twice with 15mg lidocaine and 1.5mg dexamethasone in a total volume of 1.5mL in a month. The patient's NRS and LANSS scores decreased to 2 and 8, for approximately 21months until this report was written. We suggest that ultrasound-guided infraorbital nerve block with dexamethasone and lidocaine combination may present as an initial interventional treatment option in patients with isolated infraorbital neuralgia.

Ozmete O, Sener M, Bali C, Caliskan E, Aribogan A. Congenital insensitivity to pain: How should anesthesia be managed? Turk J Pediatr 2017; 59: 87-89. Congenital insensitivity to pain syndrome is a rare, sensorial and autonomic neuropathy characterized by unexplained fever, insensitivity to pain and anhidrosis. Patients may require anesthesia even for minor surgical procedures due to mental retardation and trauma arising from self- mutilating behavior. A child diagnosed with congenital insensitivity to pain syndrome was scheduled for gastric endoscopy under sedation due to suspected ingestion of a household cleaning disinfectant. Deep sedation was achieved, and spontaneous respiration was maintained. We did not encounter any complications. There is limited data regarding the safe anesthesia management in these patients because of the rarity of the disease. Therefore, we think that more clinical experience, case reports and studies are needed to establish the appropriate anesthesia management.

OBJECTIVE Adequate pain management following day-case surgery allows early ambulation of patients. In this study, we aimed to compare postoperative analgesic efficacy of intravenous (iv) dexketoprofen vs. iv paracetamol following day-case operative hysteroscopy. METHODS One hundred and fourteen American Society of Anesthesiologists (ASA) I-II patients scheduled for day-case operative hysteroscopy were recruited and randomized to three groups in the study. Group D received 50 mg iv dexketoprofen trometamol, Group P 1000 mg iv paracetamol and Group C normal saline solution. Visual Analogue Scale (VAS) pain intensity, pain relief, sedation, nausea-vomiting, other side effects, and additional opioid analgesic requirement were noted at postoperative 15 minutes (min), 30 min, 1 hour (h), 2 h, and 3 h. Patients with VAS>=40 mm received meperidine 0.25 mg/kg as rescue analgesic medication. RESULTS VAS scores at 15 min, 30 min, 1 h, and 2 h were significantly lower in Group D compared to Group C. VAS scores at 15 min and 30 min were significantly lower in Group D compared to Group P. The percentages of patients who required opioid treatment were 34%, 60%, and 63% in Groups D, P and C, respectively (p

Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Dear Editor, Edwards’ syndrome is the most common autosomal trisomy after Down syndrome (1). It is a syndrome in which multiple malformations such as structural heart defects, microcephaly, micrognathia, low-set ears, limbs, gastrointestinal and genitourinary system defects are observed (1). Death often occurs in the first year of life because of reasons such as severe heart defects, central apnoea, aspiration, respiratory failure and upper airway obstruction, found in more than 90% of patients (1, 2). Both serious heart problems and the possibility of a difficult airway due to micrognatia makes anaesthetic management special for patients to undergo surgery. There are few reports in the literature regarding the anaesthetic management of these patients. A 2-month-old baby boy weighing 3030 g was evaluated for intervention because of a right inguinal hernia. It was found out that he had perimembraneous outlet ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tricuspid valve malformation, pulmonary hypertension, horseshoe kidney and, in the cranial system, ventriculomegaly and mega cisterna magna. Physical examination revealed that the baby with microphthalmia, micrognathia, short neck and ‘club foot’ deformity in lower extremities was low-weighted and apathetic (Figure 1). Findings of laboratory tests were normal. It was decided to place a laryngeal mask without using muscle relaxant in the patient in whom routine monitoring was conducted. Number 1 laryngeal mask was placed on the patient, who received 3 mg kg−1 thiopental sodium and 2%–3% concentration of sevoflurane intravenously in the induction. In the anaesthesia maintenance, 50%/50% oxygen/nitrogen mixture was applied with 1%–2% concentration of sevoflurane. In the patient who remained haemodynamically stable, the intervention was completed smoothly, and no perioperative complications developed. Figure 1 Appearance of the baby with Edwards’ syndrome Edwards’ syndrome is a complex syndrome for anaesthesiologists, with many aspects. In these patients, in whom cardiac malformations are at the forefront, it is important to prepare an anaesthesia plan that will not affect the haemodynamics. Because Edwards’ syndrome may cause muscle rigidity, it is stated that succinylcholine should be avoided in cases where the use of muscle relaxants is required (3). Considering the possibility of difficult intubation that may occur because of micrognathia, we believe that it would be appropriate to use the supraglottic airway tools that require the use of lower doses of anaesthetic drugs in appropriate cases and cause less haemodynamic response.

Study Objective To evaluate the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in infant patients. Design Retrospective observational study. Setting University teaching hospital. Patients Twenty-six infants (2-12 months of age; 3-11 kg) with an American Society of Anesthesiologists classification I, II, or III who were scheduled to undergo neurosurgical procedures were included in the study. Interventions Anesthesia was induced with 5 mg/kg thiopental, 1 μg/kg fentanyl and 0.6 mg/kg rocuronium. Sevoflurane was administered to all patients after intubation. Methods The neuromuscular block was monitored with acceleromyography using train-of-four (TOF) stimuli. Patients received additional doses of rocuronium to maintain a deep block during surgery. If profound neuromuscular block (TOF, 0) persisted at the end of the surgery, 3mg/kg sugammadex was administered. Measurements The demographic data, surgeries, and anesthetic agents were recorded. The time from sugammadex administration to recovery of neuromuscular function (TOF ratio, >0.9) and complications during and after extubation were also recorded. Main results Twenty-six infants who had a deep neuromuscular block (TOF, 0) at the end of surgery received 3 mg/kg sugammadex. The mean recovery time of the T4/T1 ratio of 0.9 was 112 seconds. No clinical evidence of recurarization or residual curarization was observed. Conclusions The efficacy and safety of sugammadex were confirmed in infant surgical patients for reversal of deep neuromuscular block induced by rocuronium.

Objective To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery. Design A prospective, randomized, single-center study. Setting A university hospital. Participants One hundred ninety-five patients scheduled for open-chest cardiac surgery. Interventions The study population consisted of patients for whom central vein catheterization was intended during cardiac surgery. Patients were randomized to 3 groups according to the route of central vein catheterization: the supraclavicular group: the supraclavicular approach for the subclavian vein (n = 65); the infraclavicular group: the infraclavicular approach for the subclavian vein (n = 65); and the jugular group: the internal jugular vein approach (n = 65). After the induction of anesthesia, central venous catheterization was performed according to the assigned approach. Measurements and Main Results The success rates for the assigned approach were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). The success rates in the first 3 attempts in patients who were catheterized successfully according to the assigned approach were 96%, 100%, and 96% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). There was no difference among groups in catheter insertion time (p > 0.05). After sternal retraction, central venous pressure trace loss and difficulty in fluid infusion were significantly more frequent in the infraclavicular group (21%) when compared with the supraclavicular (3%) and jugular groups (0%) (p = 0.01). There was no difference among groups in terms of catheter malposition, complications during catheterization, and rate of catheter-related infection. Conclusion The supraclavicular approach for subclavian vein catheterization is an acceptable alternative for central venous access during cardiac surgery in terms of procedural success rate, ease of placement, rate of complications, and usability after sternal retractor expansion.

Objectives The aim of this study was to evaluate the characteristics of spinal anesthesia, including its efficacy, adverse effects and complications, in order to determine if it can be applied safely in pediatric patients at high-risk for general anesthesia. We emphasize our positive outcomes in children undergoing lower abdominal surgery in our previous experience. Methods The perioperative data of 86 pediatric patients who received spinal anesthesia between 2007 and 2008 were scanned retrospectively. Demographic data, operation types, anesthetic applications, duration of surgery, motor blockade degree, two dermatomes regression time, postoperative analgesic requirements, adverse effects, and complications were recorded. Results The operation time and two dermatomes regression times were found as 49.8 ± 24.1 minutes and 73.0 ± 21.9 minutes, respectively. At the end of the operation, motor blockade had disappeared in 17 patients and persisted in 68 patients. Block time was measured as 67.3 ± 16.2 minutes in these patients. During the intraoperative period, hypotension was observed in two patients, and bradycardia occurred in one patient. Except for these, hemodynamic parameters did not change more than 20% from control values at any time. In three children, surgery was continued under general anesthesia. Forty-six patients required additional analgesic doses in the postoperative period. The time to first analgesic requirement was 2.3 ± 1.2 hours. During the postoperative period, no hemodynamic or respiratory complications were observed. Conclusion Spinal anesthesia continues to gain acceptance as an alternative to general anesthesia in children. However, we conclude that accumulated experience is required in order to apply this technique safely in pediatric patients. We emphasize the positive outcomes, adverse events and complications observed in our experience.

Objective: Tracheostomy is one of the most frequent interventions for ICU patients. The current trend in performing a tracheostomy is a percutaneous approach because of its popularity and significant advantages. In this study, certain indications of surgical tracheostomy (ST) are suggested and furthermore, ST is compared with percutaneous tracheostomy (PT).Patient and Methods: We performed a U-shaped ST in 121 patients and PT in 85 patients between March 2003 and December 2006. All of the STs were opened U-shaped in the operating room. In this technique; instead of removing the tracheal ring, it was used to create a flap. The tracheal flap was hung with a suture from middle of the 2nd or the 3rd cartilage rings, as a guide. Also, the PT procedure “Griggs dilatation technique” was performed in the ICU.Results: PT and ST had similar complication rates: 4.1% for ST [bleeding in 2 patients, stenosis in 2, and stomal infection in 1] versus 3.6% for PT [bleeding in 2 patients, and pneomothorax in 1] (p = 0.08). No significant difference was found regarding mean operation time between ST [12 min (9–18)] and PT [8 min (6–16)] (p = 0.09) Conclusions: Staff utilization and cost seem like the major advantages of PT. However, our surgical technique has similar complication rates with PT and moreover, using ST still remains favorable for select patients with thyroid hyperplasia, short neck, tracheaomalacia, obesity, neck operation history and for children.

We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia.A total of 82 patients were studied in two groups. Group 1 (n = 45) consisted of the patients who underwent general anesthesia, and group 2 (n = 37) comprised those who received combined spinal-epidural anesthesia.The mean ages of patients in groups 1 and 2 were 45 +/- 15 and 44 +/- 15 years, respectively. The mean areas of the stones in groups 1 and 2 were 734 +/- 386 mm(2) and 731 +/- 394 mm(2), respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operative time, irrigation fluids, fluoroscopy time, delta hemoglobin, and hospitalization time (P = 0.439). At the end of the surgery, stone-free rates were 76% in group 1 and 81% in group 2; clinically insignificant residue fragments rates were 24% in group 1 and 19% in group 2. The difference was statistically insignificant between the groups (P = 0.543).We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.

Duchenne's muscular dystrophy (DMD) is a neuromuscular disease with a progressive course. It is the most common and most severe muscular dystrophic disorder for which the application of anesthesia is critical, due to muscle weakness, and cardiac and pulmonary involvement. Successful application of spinal anesthesia in a 2-year-old boy with DMD undergoing bilateral inguinal hernia repair is described in the present report. It is proposed that spinal anesthesia is an effective alternative to general anesthesia in certain pediatric patients, including those with DMD, for whom general anesthesia poses increased risk.

in this study we controlled the efficiency and safety of using remifentanil combined with two different supplementary background infusions for labor analgesia in nulliparous patients.60 subjects were allocated to two groups. After programming the patient-controlled analgesia device to deliver a fixed load and demand doses of intravenous remifentanil for all subjects, group r (n = 30) received a background infusion of remifentanil 0.1 microg/kg/min and group R (n = 30) received a supplementary infusion of remifentanil 0.15 microg/kg/min. Visual analogue scale for analgesia, hemodynamic parameters, sedation scales and fetal heart rates were recorded at the 5th, 10th, 20th and 30th min of the study and measurements continued every 15 min during 90 min of labor and delivery. Side effects, Apgar and satisfaction scores were obtained for every subject.visual analogue scale scores of group R were significantly lower than those of group r throughout labor and delivery (p0.05). Hemodynamic parameters and fetal heart rates of the two groups were not different (p0.05). Most subjects were awake and only nausea was obtained (p0.05). The increase in the Apgar and satisfaction scores was not statistically significant (p0.05).it was determined that remifentanil with a 15-mug demand dose and 0.15 mug/kg/min supplementary continuous infusion is an effective choice for patient-controlled analgesia during labor in nulliparous subjects.

The purpose of the paper was to assess and to compare the effectiveness and safety of patient controlled epidural analgesia using tramadol or morphine for postoperative analgesia after major urological surgeries. For patient-controlled epidural analgesia; in group I (n = 30) a loading dose of 20 mg tramadol 0.1% with a continuous infusion of 1 mg/ml at a rate of 8 ml/h was administered preemptly and in group II (n = 30) a loading dose of 2 mg morphine in 20 ml normal saline was administered and a supplemental infusion of 0.2 mg/h morphine was begun at a rate of 2 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 minutes and a background infusion of 8 ml/h in tramadol 0.1% group and 2 ml/h in morphine 0.01% group were administered. VAS for pain intensity, vital signs, sedation scale and side effects were monitored at 0, 15, 30 minutes and 1, 2, 3, 4, 8, 12, 24 hours during the postoperative period. Adequate analgesia was provided in all patients. VAS values were significantly lower in group II than in group I after the fourth hour measurement (p < 0.05). The incidence of nausea, vomiting and pruritius was lower in the tramadol group (p < 0.05). In conclusion we decided that, after major urologic surgery, patient-controlled epidural administration of tramadol with a continuous background infusion might provide a safe and effective analgesia with limited side effects, even though there is increased drug consumption.

Purpose:Renal transplantation significantly improves quality of life compared to hemodialysis in patients with end-stage renal failure. In end-stage renal failure anesthetic technique should be planned carefully, due to changes in volume distribution, drug metabolism, excretion. Results of total intravenous anesthesia, inhalation anesthesia, regional techniques are being investigated. Aim of this study was to present our experience in total intravenous anesthesia in 77 patients, who underwent live and cadaveric donor renal transplantation at Baskent University Faculty of Medicine Adana Teaching and Research Center. Material and Methods:Induction of anesthesia was performed with propofol(2mg/kg) and fentanyl(1μg/kg), and rocuronium bromide(0.4-0.5mg/kg) was given before intubation. Anesthesia was maintained with total intravenous anesthesia(propofol,50 mcg/kg/min; remifentanil,0.25 mcg/kg/min infusion). Intraoperative fluid, urine volumes were recorded. For preemptive multimodal analgesia, pre-incisional intravenous paracetamol(15mg/kg), intramuscular morphine(0.1mg/kg) were given. Postoperative analgesia was maintained with intravenous patient-controlled analgesia(meperidine 10 mg bolus, with a lockout time of 20 minutes). Postoperative pain was recorded using Visual Analogue Scale, level of sedation was assessed by Ramsey Sedation Scale. Results:Study included 64(83.1%) live donor transplantations and 13(16.9%) cadaveric donor transplantations. Mean total fluid administration was similar between live and cadaveric donor kidney transplantation patients however mean intraoperative urine output was significantly higher in live donor kidney transplantation patients(p, Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Background and objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid “codeine” to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. Methods: Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. Results: The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p 0.05). Conclusions: The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects. Resumo: Justificativa e objetivos: Os anti-inflamatórios não esteróides (AINEs) são frequentemente usados para controlar a dor após artroscopia. A adição de um opiáceo oral eficaz (codeína) aos AINEs pode ser mais efetiva e diminuir o consumo de opiáceo parenteral no pós-operatório. O objetivo deste estudo foi comparar a eficácia e os efeitos colaterais de naproxeno sódico e uma nova preparação, naproxeno sódico-fosfato de codeína, quando administrados preventivamente para meniscectomia artroscópica. Métodos: Sessenta e um pacientes foram randomicamente divididos em dois grupos para receber naproxeno sódico por via oral (Grupo N) ou naproxeno sódico-fosfato de codeína (Grupo NC) antes da cirurgia. A cirurgia foi realizada sob anestesia geral. Meperidina intravenosa foi iniciada por meio de analgesia controlada pelo paciente (ACP) para todos os pacientes. O desfecho primário foi o escore de dor na primeira hora de pós-operatório, avaliada com a Escala Visual Analógica (EVA). A sedação foi avaliada usando a Escala de Sedação de Ramsey. A primeira demanda de ACP, o consumo de meperidina no pós-operatório, os efeitos colaterais e os dados hemodinâmicos também foram registrados. Resultados: Os grupos foram demograficamente comparáveis. As medianas dos escores EVA tanto em repouso quanto em movimento foram significativamente menores no Grupo NC comparado ao Grupo N; exceto para movimento na avaliação de18 horas (p 0,05). Conclusões: A combinação de naproxeno sódico-fosfato de codeína forneceu analgesia mais efetiva que naproxeno sódico, sem aumentar os efeitos colaterais. Keywords: Arthroscopy, Postoperative analgesia, Naproxen sodium, Codeine phosphate, Palavras-chave: Artroscopia, Analgesia pós-operatória, Naproxeno sódico, Fosfato de codeína