Ahmet Sen

Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Intracranial Midline Shift in Patients with Head Trauma

OBJECTIVE Measurement of the optic nerve sheath diameter (ONSD) by using sonography is a straightforward, noninvasive technique to detect an increased intracranial pressure, which can even be conducted at the bedside. However, the correlation between ONSD and intracranial midline shift has not been studied. METHODS The authors performed a prospective, blinded observational study in an intensive care unit. Forty-five patients were divided into groups. Of those, 19 patients had a midline shift, whereas 26 had no intracranial pathology or shift and served as control individuals. RESULTS Spearman rank correlation coefficient of difference of ONSD and midline shift was 0.761 (P < 0.0005), demonstrating a significant positive correlation between patients with midline shift and control group. CONCLUSIONS Despite small numbers and selection bias, this study suggests that bedside ultrasound may be useful in the diagnosis of midline intracranial shift by measurement of ONSD.

Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility.

STUDY OBJECTIVE To compare sugammadex with conventional reversal of neuromuscular block in terms of postoperative gastrointestinal motility. DESIGN Double blinded, randomized, controlled clinical trial. SETTING Operating room, postoperative recovery area. PATIENTS Seventy-two patients with ASA physical status I or II, scheduled for total thyroid surgery were studied. INTERVENTIONS When 4 twitches were observed on train-of-four stimulation, neuromuscular block was reversed conversatively in the control group, and with sugammadex in the study group. MEASUREMENTS Time to first flatus and feces, incidence of postoperative nausea, vomiting, diarrhea and constipation were collected. MAIN RESULTS Median time of first flatus was 24 hours (18-32 [10-36]) in the neostigmine group, and 24 (18-28 [12-48]) in the sugammadex group (P > .05). Median (IQR) time of first feces was 24 hours (18-36 [10-48]) in neostigmine group, 32 hours (28-36 [12-72]) in sugammadex group (P > .05). There were no occurrences of nausea, vomiting, diarrhea, or constipation. CONCLUSIONS Sugammadex may be safely used in cases where postoperative ileus is expected.

Cardiac arrest following butane inhalation

Butane is a commonly misused volatile agent, and a cause of intoxication. We present a case, who had a syncope and persistent ventricular fibrillation during the course of resuscitation. We discussed the management of this case in the intensive care unit and the accompanying difficulties in the light of the current literature.

Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section

Study Design Retrospective. Purpose This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia. Overview of Literature Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia. Methods We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS). Results Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months. Conclusions Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

BACKGROUND AND OBJECTIVES We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. METHODS A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. RESULTS AND CONCLUSIONS First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p>0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4s, p<0.001), and time to intubation (95% CI 3-4.6s, p<0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4s, p<0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p<0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Complication of Peribulbar Block: Brainstem Anaesthesia

Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.

Combined spinal and epidural anesthesia for ovarian cancer in a patient with muscular dystrophy

İletişim Bilgisi / Correspondence 195 Yard. Doç. Dr. Başar Erdivanlı, Recep Tayyip Erdoğan Üniversitesi Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İslampaşa Mahallesi, Şehitler Caddesi, No: 74 53100 Rize Türkiye E-mail: berdivanli@gmail.com Geliş tarihi / Received: 18.07.2013 Kabul tarihi / Accepted: 15.08.2013 Çıkar Çatışması / Conflict of Interest: Yok / None Musküler distrofi (miyotonik distrofi) tanılı over kanseri vakasında