Ahmet Can Senel

A Patient with Glanzmann's Thrombasthenia for Emergent Abdominal Surgery

Glanzmann’s thrombasthenia is a rare autosomal recessive disease characterized by potentially major mucocutaneous complications and nose bleeds. It is considered hazardous for these surgical patients to conceive, with a high risk of urgent surgery. The treatment of bleeding or prevention of hemorrhage for surgery or invasive procedures is based on platelet transfusion. However, platelet transfusions may be responsible for the development of alloimmunization, with a high risk of future platelet refractoriness. We report a surgical case of Glanzmann’s thrombasthenia complicated by nasopharyngeal bleeding and managed with platelet transfusions, recombinant activated factor VII, and postoperative airway management in the intensive care unit.

Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications

OBJECTIVES This study evaluated the failure and complication rates of sedation in ambulatory patients undergoing oral and maxillofacial surgery. MATERIALS AND METHODS This retrospective cohort study was carried out among 619 patients who had undergone maxillofacial surgical procedures under intravenous sedation with midazolam and fentanyl. Each patients age, American Society of Anesthesiologists (ASA) classification, systemic condition, surgical procedure, complications, and failures were recorded for evaluation. RESULTS A total of 400 patients with ASA I, 199 with ASA II, and 20 with ASA III between the ages of 9 months and 84 years were included in the study. The most common systemic disorders in our patients were mental retardation (35%), hypertension (19%), and epilepsy (15%). Evaluation of the cases revealed 9 complications (1.4%) and 9 sedation failures (1.4%). The complications were bradycardia, postoperative agitation and hallucination, drug reaction, vomiting and nausea, desaturation, and hypotension. CONCLUSIONS Our results in the oral and maxillofacial surgery clinic revealed low complication and failure rates.

Premedication with midazolam prior to caesarean section has no neonatal adverse effects

Like all surgical patients, obstetric patients also feel operative stress and anxiety. This can be prevented by giving patients detailed information about their operation and with preoperative pharmacological medications. Because of depressive effects of sedatives on newborns, pharmacological medications are omitted, especially in obstetric patients. The literature contains few studies concerning preoperative midazolam use in Caesarian section (C/S) patients. Our aim in this study was to help patients undergoing C/S surgery. One group scheduled for elective C/S received midazolam 0.025 mg kg(-1) intravenously, the other received saline. Maternal anxiety was evaluated using Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores, and newborns were evaluated using Apgar and the Neonatal Neurologic and Adaptive Capacity Score (NACS). In conclusion, patients receiving midazolam 0.025 mg kg(-1) as premedication had significantly low anxiety scores, without any adverse effects on the newborns. Midazolam can therefore safely be used as a premedicative agent in C/S surgery.

Retropharyngeal hematoma secondary to minor blunt neck trauma: case report

BACKGROUND AND OBJECTIVES The development of a retropharyngeal hematoma following a blunt trauma is a rare occurrence. However, a space-occupying lesion in this area can be life-threatening and requires rapid assessment and treatment. This is clinically important because of the close proximity of the retropharyngeal space to the upper airway. Any swelling in the the posterior pharyngeal space may prompt it to bulge anteriorly into the airway and cause its obstruction. CASE REPORT A 86-year-old woman fell from a height of 1.5m and hit her neck on stairs and was admitted to our trauma department. A computerized tomography scan and a lateral neck x-ray to observe the soft tissue revealed a large retropharyngeal mass extending from the base of the skull down to the level of the lung. The patient was kept under observation and the hematoma reduced spontaneously in the following seven days although the patient died on the tenth day from pulmonary infection. The report emphasizes that early drainage of a retropharyngeal hematoma should be considered in similar cases. Although rarely encountered, retropharyngeal hematoma is a problem that can be faced in an emergency department.

Hematoma retrofaríngeo secundário a pequeno trauma contuso no pescoço: relato de caso

JUSTIFICATIVA E OBJETIVOS: O desenvolvimento de hematoma retrofaringeo apos trauma contuso e uma ocorrencia rara. Porem, uma lesao ocupando espaco nessa area pode ser fatal, o que exige rapida avaliacao e tratamento. Esse tipo de hematoma e clinicamente importante devido a proximidade entre o espaco retrofaringeo e a via aerea superior. Qualquer edema nesse espaco pode causar uma protuberância da parede posterior da faringe de encontro as vias aereas e obstrui-las. RELATO DE CASO: Paciente do sexo feminino, 86 anos, que caiu de uma altura de 1,5 m e bateu o pescoco na escada, foi admitida em nosso Departamento de Traumatologia. Tomografia computadorizada e radiografia dos tecidos moles do pescoco foram feitas e mostraram uma grande massa retrofaringea que se estendia da base do crânio ate o nivel dos pulmoes. A paciente ficou em observacao e o tamanho do hematoma diminuiu espontaneamente nos sete dias subsequentes; contudo, devido a uma infeccao pulmonar, a paciente foi a obito no decimo dia. Este relato enfatiza que a drenagem precoce do hematoma retrofaringeo poderia ter sido considerada neste caso. Embora seja de ocorrencia rara, o hematoma retrofaringeo e um problema que pode ser encontrado em servicos de emergencia.