Erkan Cem Celik

Tetanus is still a deadly disease: a report of six tetanus cases and reminder of our knowledge:

We analysed the data in the medical records of six patients admitted for tetanus in the intensive care unit (ICU) of the anaesthesia department in the Medical Faculty of Ataturk University from 1 January 2010 to 31 December 2012. All patients received the generalized form of treatment for tetanus in the ICU. The average age of the patients was 65.33 ± 13.45 years. Treatment modalities were administered to the patients in accordance with the literature. Four patients died despite all therapeutic interventions and two patients were discharged uneventfully. All those who died had chronic disease and infected wounds on their head, but only one patient had an infected wound on his leg. The surviving patients had no chronic illnesses but did have injuries on their legs. The presence of chronic disease increases tetanus-related mortality. More information about the disease must be made available in order to make it preventable with regular vaccinations.

The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

STUDY OBJECTIVE The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination. DESIGN Randomized controlled clinical trial. SETTING Operating rooms of university hospital of Erzurum, Turkey. PATIENTS Sixty-four 18- to 45-year-old American Society of Anesthesiologists I-II patients scheduled for cesarean delivery under spinal anesthesia having hardly palpated anatomic landmarks on vertebral column. INTERVENTIONS Palpation difficulty of vertebral column landmarks was scored as 0, 1, 2, or 3 from easy to difficult for all patients in sitting position. The patients with score 2 or 3 were randomly allocated into 2 groups as group C (conventional, n=32) and group U (ultrasound, n=32) in which ultrasound guidance was used. MEASUREMENTS The number of skin punctures, the number of needle steering, the number of puncture tried vertebral levels, and procedure time were all recorded. MAIN RESULTS The number of skin punctures was significantly lower in group U (P<.001). Successful subarachnoid puncture on first attempt was also significantly higher in group U (P<.01). The duration of procedure in the patients with score 2 was determined to be significantly longer in the ultrasound-guided group (P<.001). CONCLUSIONS Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.

Excisão de lipoma axilar gigante em paciente acordado sob bloqueio do plano serrátil

the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567--81. 6. Holm JH, Frederiksen CA, Juhl-Olsen P, Sloth E. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg. 2012;115:1029--32. 7. Schnobrich DJ, Olson AP, Broccard A, Duran-Nelson A. Feasibility and acceptability of a structured curriculum in teaching procedural and basic diagnostic ultrasound skills to internal medicine residents. J Grad Med Educ. 2013;5:493--7. 8. Ramsingh D, Rinehart J, Kain Z, et al. Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents. Anesthesiology. 2015;123:670--82. 9. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:921--64. Fábio de Vasconcelos Papa a,b,c

O bloqueio contínuo do quadrado lombar tipo 3 fornece analgesia pós‐operatória efetiva para cirurgia do quadril

INTRODUCTION Hip surgery is a major surgery that causes severe postoperative pain. Although pain during rest is usually considerably reduced mobilization is important in terms of thromboembolic complications. The quadratus lumborum block is a regional analgesic technique that blocks T6-L3 nerve branches. This block may provide adequate analgesia and reduce opioid consumption after hip surgery. CASE REPORT We performed continuous quadratus lumborum type 3 block in two patients who underwent hip arthroplasty. Postoperative 24-h pain scores, local anesthetic consumptions on patient-controlled analgesia and additional analgesic requirement were recorded. In two patients, postoperative pain scores were less than 6 during rest and physiotherapy. Patient was mobilized in the early postoperative period without additional opioid analgesic requirement and without muscle weakness. DISCUSSION Continuous quadratus lumborum block may be used to relieve postoperative acute pain in hip surgery because it provides one-sided anesthesia without muscle weakness.

Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study

STUDY OBJECTIVE The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN Randomized controlled clinical trial. SETTING Operating rooms of university hospital of Erzurum, Turkey. PATIENTS One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.

Effects of Anthropometric Measurements on Spinal Anaesthesia Block Characteristics and Hemodynamics

We aimed to determine the effects of some anthropometric values on sensorial block characteristics of spinal anesthesia and hemodynamics in patients unergoing elective cesarean sections performed under spinal anesthesia. Weight, length, body surface area, and body mass index, abdominal, waist, and hip circumferences of 50 patients were measured. Spinal anesthesia was applied while the patient was sitting erect. The time of sensorial block to reach the T4 level and the maximum sensorial block level were recorded in each case. Cases who developed hypotension and bradycardia during the spinal anesthesia were recorded. In this study hypotension was observed in 54% of patients and it was determined that the prevalence of hypotension increased in patients with a shorter height, larger abdominal circumference, higher body mass index, lower body surface area and a higher waist/hip ratio. It was found that the prevalence of bradycardia increased in patients with a shorter height, higher body mass index, lower body surface area and a higher waist/hip ratio. This study also determined a positive correlation between the values of height, weight and body surface area and the time of sensorial block to reach the T4 dermatome; and a positive correlation between the body mass index and the dermatome area of the maximum sensorial block In line with the values provided by simple and non-time consuming anthropometric measurements the patients who are planned to receive a spinal anesthesia may be priorly prepared against advers effects of bradycardia and hypotension that may develop, and to estimate the sensorial block characteristics of the spinal anesthesia.

Clinical Outcomes and Mortality Analysis of Patients with COPD Admitted to an Intensive Care Unit: Retrospective Analyses of Five-Year Data

Received: 16.06.2016 Accepted: 26.07.2016 1Sabuncuoğlu Şerafeddin Training Hospital, Department of Anesthesia 2Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation 3Palandöken State Hospital, Department of Anesthesia 4Harakani State Hospital, Department of Anesthesia Yazışma adresi: Ali Ahıskalıoğlu, Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation, Erzurum e-mail: aliahiskalioglu@hotmail.com GİRİŞ