Burhanettin Usta

Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients.

The aim of this study was to investigate the usefulness of sonography for verifying tracheal tube placement within 3 seconds in adult surgical patients.

Dexmedetomidine for the prevention of shivering during spinal anesthesia

PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection. RESULTS: Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207). CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study

STUDY OBJECTIVE To determine whether magnesium sulfate (MgSO(4)) infusion during surgery reduces shivering during spinal anesthesia. DESIGN Double-blinded placebo-controlled, randomized trial. SETTING Operation room of a university hospital. PATIENTS 60 patients, aged 40 to 70 years, scheduled for elective transurethral resection of the prostate (TURP) during spinal anesthesia. INTERVENTIONS Subarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5% was injected using a 25-G Quincke spinal needle. Patients received either saline (Group C, n = 30) or MgSO(4) (Group Mg, n = 30). Group Mg received an intravenous (IV) bolus of MgSO(4) 80 mg/kg via syringe pump over a 30-minute period, followed by a two g/hr infusion during the intraoperative period. Group C received an equal volume of saline. MEASUREMENTS Motor blockade was evaluated by Bromage motor scale. Sensory block level was assessed by pinprick test. Shivering was assessed after the completion of subarachnoid drug injection. Side effects were recorded. MAIN RESULTS Hypothermia was observed in all patients (100%) in Group Mg and in 24 patients (80%) in Group C (P = 0.024). The decrease in core temperature in Group Mg was significantly greater (P < 0.005). Shivering was observed in two patients (6.7%) in Group Mg and 20 patients (66.7%) in Group C (P = 0.0001). CONCLUSIONS MgSO(4) infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia. MgSO(4) infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia.

Patient-controlled analgesia and sedation with alfentanyl versus fentanyl for colonoscopy: a randomized double blind study.

Study Objective The aim of this study was to evaluate whether sedo-analgesia with alfentanyl/fentanyl, using a patient-controlled analgesia (PCA) pump, may have positive outcomes in terms of safety, postprocedural workload, and expectations of the colonoscopist, nurse, and patients in elective colonoscopy. Patients One hundred American Society of Anesthesiology physical status I and II adult patients. Interventions Patients were randomized in a double-blind trial to receive either alfentanyl (n=50) or fentanyl (n=50) by PCA, and incremental doses of midazolam. Measurements Patient expectations were assessed using hemodynamic variables, willingness to have a repeat colonoscopy in the same way, adverse events, discomfort scores, and patient/operator/nurse satisfaction associated with sedo-analgesia. Result All patients in both groups had adequate sedo-analgesia with high satisfaction and willingness scores. There were no serious adverse effects and except for a few events, no required medication. The total sedation times were shorter in the alfentanyl group compared with the fentanyl group. Conclusions PCA and sedation with alfentanyl and fentanyl for colonoscopy are safe, feasible, and acceptable to most patients. However, shorter sedation times make alfentanyl more attractive for postprocedural workload.

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

Background: Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double‐blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.

Remifentanil-propofol in vertebral disk operations : Hemodynamics and recovery versus desflurane-N2O inhalation anesthesia

The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N2O/O2. A constant infusion of remifentanil was provided at 0.125 μg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/ 50% N2O/O2, with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O2 saturation, and end-tidal CO2 data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33–3.53 min), extubation (3.13–3.88 min), eye opening (4.06–6.23 min), and being able to give name and date of birth (5.4–7.9 min) compared with times in the desflurane group (P<.05). In theTIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In theTIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.

Generalized Seizure in Patient Receiving Epidural Meperidine During Cesarean Section

transplant recipients switched froma calcineurin inhibitor to sirolimus. AmJ Transplant 2005;5: 1392-6. 5. Morelon E, StemM,Israel-Bier D,et al. Characteristic of sirolimus-assodated interstitial pneumonitis in renal transplant patients. Transplantation 2001;72:787-90. 6. Naranjo CA,Busto U,Sellers EM,et al, A method forestimating theprobability ofadverse drugreactions. ClinPharmacal Ther1981;30:239-45. 7. Champion L, Stem M, Israel-Bier D, et al. Sirolimus-associated pneumonitis: 24 casesin renaltransplant recipients. AnnInternMed2006; 144:505-9.

The comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain.

Purpose: Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain. Methods: Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic. Results: In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs. Conclusions: Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.

SEDATION DURING CERVICAL VS. LUMBAR TRANSLAMINAR EPIDURAL STEROID INJECTIONS

To the Editor:papr_315_1 480..481 We have read the article entitled “Vasovagal Reactions and Other Complications of Cervical vs. Lumbar Translaminar Epidural Steroid Injections” by Terrence et al. We congratulate the authors and wish to offer some remarks about this article. A few complications are associated with Cervical Epidural Steroid Injection (CESI), and vasovagal reactions are often among them. Vasovagal reactions, characterized by hypotension, bradycardia, nausea and vomiting, and loss of consciousness, are associated with anxiety-provoking events. The higher rate of cervical vasovagal reactions may result from a combination of anxiety, the prone and upright positions with the neck flexed, drapes covering the head, and/or the stimulus from a procedure on the neck. Terrence et al. suggest conscious sedation to prevent these reactions. We do not agree on this point. Sedation is often used in interventional procedures to minimize discomfort, improve the patient’s experience, and reduce the risk of procedural complications by assuring no mobility and compliance of the patient. However, there is variability in sedation levels that may in part relate to differing goals among patients. That is, in some patients a higher level of sedation may be desirable, yet this level might not be achieved without a loss of patient cooperation. Furthermore, sedation, especially with benzodiazepines, may carry the potential for cognitive complications, such as paradoxical reactions including agitation, talkativeness, confusion, disinhibition, and loss of impulse control in some subjects. These reactions may cause failure of CESI or serious complication. On the other hand, in a systematic review, Howard et al. concluded that there is no significant evidence of the influence of sedation in cervical and lumbar interventional procedure. This raises 2 questions: What effect does the mode of sedative administration have on safety? What is the relationship between subjective and objective sedation scales? These handicaps might be addressed using Bispectral Index (BIS) monitoring and using the Sedation–Agitation Scale. On the other hand, these procedures would make the process more complex and might not prove to be cost effective. Therefore, we suggest effective local anesthesia with a small needle and gaining the patient’s cooperation to prevent these reactions by counseling in the operating room with standard monitoring, adequate equipment for resuscitation, and intravenous access.

Successful treatment of a resistance trigeminal neuralgia patient by acupuncture

A 66-year-old woman was referred with a typical TN pain on the left side of her face for 25 years. She was diagnosed with TN after evaluation and work-up by a neurologist. She used medications, including phenytoin (200 mg per day) and carbamazepine (600 mg per day). The pain was triggered by speaking, eating or touching. The pain was evaluated using a visual analog scale (VAS), which ranged from 0 (no pain) to 10 (worst pain imaginable). According to the VAS, the patient rated her pain as 10. She had, to date, experienced no beneficial effects from several therapeutic methods, including medication (carbamazepine, gabapentin and valproic acid), nerve block and radiofrequency rhizotomy of the infraorbital branch of the trigeminal nerve. Acupuncture treatment was initiated without making any change to her drug regime. Acupuncture needles (0.20 x 13 mm needles for the face and 0.25 x 25 mm needles for the other regions) were inserted on the typical areas that are used for trigeminal neuralgia (4). For facial neuralgia, the protocol utilized local points of TH 17 and 21, GB2, SI 18, ST 2, 3 and 7, GV 26 and LI 20; systemic points included TH 5, LI 4, ST 36, ST 44, ST 45 and LIV 3. Auricular acupuncture points were also used (Shen Men, neuro, face and lung points). Needles were not manipulated, and no attempt was made to elicit De-Qi. Every treatment session lasted about forty-five minutes, three times a week. After the fourth session, she reported that she had been relieved almost pain free. By the sixth week (14 sessions), the patient was completely free of pain (VAS = 0) and was still pain free at the end of sixth month.