Canan Yilmaz

Unilateral Horner Syndrome Following Epidural Anaesthesia in a Morbidly Obese Parturient

Horners syndrome is rarely observed in epidural anaesthesia; it is characterized by ptosis and enophthalmos on the affected side; miosis, anisocoria, and conjunctival hyperemia in the affected eye and anhydrosis, flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anaesthesia, stellate, cervical and brachial plexus block, thoracic, lumbar and caudal epidural anaesthesia and intrapleural analgesia are the main causes associated with Horners syndrome in anaesthesia. Among the other causes of Horners syndrome are head and neck surgery, trauma and puncture of the internal jugular vein. We aimed to present a case with unilateral Horners syndrome, which appeared in the morbidly obese parturient after lumbar epidural anaesthesia.

Effects of Different Anesthetic Agents on Surgical Site Hemorrhage During Circumcision

PURPOSE To investigate the effects of ketamine+midazolam and propofol+sevoflurane anesthesia on surgical site hemorrhage during circumcision procedures. MATERIALS AND METHODS The boys undergoing circumcision surgery were included in the study. The patients were divided into two groups. In Group 1 (n = 50), 0.01 mg/kg midazolam and 2 mg/kg IV ketamine were administered. In Group 2 (n = 50), 1 ?g/kg fentanyl, 1 mg/kg lidocaine 2%, and 2-3 mg/kg IV propofol were administered, and patency of airway was ensured with a laryngeal mask airway. The intraoperative bleeding scale was recorded during the procedure to evaluate surgical site bleeding. Hemorrhage was checked for the first three hours using the postoperative bleeding scale to follow the amount of hemorrhage. RESULTS Intraoperative bleeding scores were significantly higher in Group 1 as compared to Group 2. However, there was no significant difference between the groups regarding frequency of postoperative hemorrhage. Themean blood pressure values measured at 5th, 10th, 15th minutes and recovery room were significantly higher in Group 1. CONCLUSION The intraoperative bleeding scores were significantly higher with ketamine+midazolam compared to propofol+sevoflurane. On the other hand this hemorrhage can be controlled easily with appropriate hemostasis, and the amount of blood loss was not clinically significant. We think that our study makes a positive contribution to the literature about the effects of anesthetics on the surgical site bleeding during circumcision. CLINICAL TRIALS REGISTRATION ACTRN12616000189426.

Relação entre consumo de tabaco e concentração de monóxido de carbono na expiração com complicações respiratórias perioperatórias

BACKGROUND The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies. METHODS One hundred and fifty two patients (smokers, Group S and non-smokers, Group NS), who underwent laparoscopic cholecystectomies under general anesthesia, were studied. Patients completed the Fagerstrom Test for Nicotine Dependence. The preoperative carbon monoxide level in the exhaled breath levels were determined using the piCO+Smokerlyzer 12h before surgery. Respiratory complications were recorded during induction of anesthesia, intraoperatively, during extubation, and in the recovery room. RESULTS Statistically significant increases were noted in group S with respect to the incidence of hypoxia during induction of anesthesia, intraoperative bronchospasm, bronchodilator treatment intraoperatively, and bronchospasm during extubation. The carbon monoxide level in the exhaled breath and the Fagerstrom Test for Nicotine Dependence, and number of cigarettes smoked 12h preoperatively were designated as covariates in the regression model. Logistic regression analysis of anesthetic induction showed that a 1 unit increase in the carbon monoxide level in the exhaled breath level was associated with a 1.16 fold increase in the risk of hypoxia (OR=1.16; 95% CI 1.01-1.34; p=0.038). Logistic regression analysis of the intraoperative course showed that a 1 unit increase in the number of cigarettes smoked 12h preoperatively was associated with a 1.16 fold increase in the risk of bronchospasm (OR=1.16; 95% CI 1.04-1.30; p=0.007). While in the recovery room, a 1 unit increase in the Fagerstrom Test for Nicotine Dependence score resulted in a 1.73 fold increase in the risk of bronchospasm (OR=1.73; 95% CI 1.04-2.88; p=0.036). CONCLUSIONS Cigarette smoking was shown to increase the incidence of intraoperative respiratory complications while under general anesthesia. Moreover, the estimated preoperative carbon monoxide level in the exhaled breath level may serve as an indicator of the potential risk of perioperative respiratory complications.

The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P (n = 66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n = 64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.

Cerebral Vein Thrombosis after Spinal Anaesthesia with Pregnancy

Thrombosis of cerebral veins or thrombosis of cortical and deep veins that empty into the sinuses can cause serious neurological syndromes. Cerebral vein thrombosis is seen, especially between the ages of 20-35. The predisposing factors in 80% of patients can be determined. Pregnancy, postpartum period and spinal anaesthesia are among the predisposing factors. Diagnosis of the disease is difficult due to the variety of clinical signs and symptoms. Headache is the most common reason for admission to the hospital. Thromboembolic events in pregnancy are an important reason of maternal morbidity and mortality. Most cases of cerebral venous thrombosis in pregnancy occur in the postpartum period. Confusion, convulsions and respiratory arrest occurred in 37-year-old female patient after 3 hours from operation. Cerebral vein thrombosis was diagnosed, owing to laboratory and neuroradiological findings. In this article, we have emphasised the importance of clinical evaluation of pregnant patients with cerebral vein thrombosis after spinal anaesthesia.