Gökçe Gişi

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial

Background and Objectives Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. Methods Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block. All blocks were performed under general anesthesia before surgery. Pain levels were assessed using an FLACC (Face, Legs, Activity, Cry, Consolability) scale. Results The study included 50 patients, after excluding 3 patients who were not eligible. The number of patients who required analgesia in the first 24 hours postoperatively was significantly lower in the quadratus lumborum block group (P < 0.05). In the quadratus lumborum block group, the postoperative 30-minute and 1-, 2-, 4-, 6-, 12-, and 24-hour FLACC scores were lower compared with those of the transversus abdominis plane block group (P < 0.05). Parent satisfaction scores were higher in the quadratus lumborum block group (P < 0.05). Conclusions The results of this study showed that in pediatric patients undergoing unilateral inguinal hernia repair or orchiopexy the quadratus lumborum block provided longer and more effective postoperative analgesia compared with the transversus abdominis plane block. Clinical Trials Registration: The trial was registered prospectively at clinicaltrials.gov (NCT02715999).

Effects of Epidural-and-General Anesthesia Combined Versus General Anesthesia Alone on Femoral Venous Flow During Laparoscopic Cholecystectomy

BACKGROUND AND OBJECTIVEnThe pneumoperitoneum has been shown to decrease femoral blood flow, resulting in venous stasis. We analyzed the effects of the pneumoperitoneum and epidural analgesia on femoral vein diameter and the peak flow rate of femoral vein during laparoscopic cholecystectomy.nnnPATIENTS AND METHODSnForty patients were randomly allocated to receive either combined epidural analgesia (EA) and general anesthesia (GA) (group EA/GA) or GA alone (group GA). Laparoscopic cholecystectomy was the standard operation for the selected patients. Then, 10 mL of 1% lidocaine in group EA/GA or physiologic serum in group GA was injected via epidural catheter. Peak flow rates (PFRs) of femoral vein cross-sectional areas (CSAs) were measured from the right femoral vein at three different times: after induction of anesthesia, during the pneumoperitoneum, and after abdominal deflation, but prior to reversal of anesthesia.nnnRESULTSnThe two groups were similar in age, sex, body mass index, and duration of operation. The CSA slightly increased after the induction of anesthesia, compared with the previous measurements, although there was no statistical significance between them for both groups (P > 0.05). The PFR decreased, whereas the CSA increased during the pneumoperitoneum in each group. The PFR values after basal measurements were significantly higher in the EA/GA than in the GA group (P < 0.05). Group EA/GA had significantly lower heart-rate and blood-pressure levels during surgery than those in group GA (P < 0.05).nnnCONCLUSIONSnAbdominal insufflation during laparoscopic cholecystectomy results in dilation and decreased flow in the common femoral vein. Epidural analgesia added to the GA partially compensated for the reduction in femoral PFR.

Frequency-dependent effects of sequenced pulsed magnetic field on experimental diabetic neuropathy

Purpose: Pulsed magnetic field (PMF) as an important non- invasive alternative therapeutic option has been investigated in several pre-clinical and clinical studies. We also hypothesized that sequenced PMF formed with different frequencies can modulate the diabetes-induced neuropathic signs differently. Materials and methods: Therapeutic actions of sequenced PMF including 1, 5, 1, 5 Hz (low (L)-PMF) or 30, 40, 30, 40 Hz (high (H)-PMF) were examined on improving signs and symptoms of diabetic neuropathic pain in the streptozotocin-induced diabetic rat models by measuring nociceptive parameters such as hyperalgesia and allodynia, and various cytokine levels (tumor necrosis factor [TNF]-alpha, interleukin [IL]-1 beta, IL-6 and IL-10) of spinal cord and sciatic nerve tissues. Results: Ameliorating potential of L-PMF application on signs of diabetes is significantly higher than those of H-PMF. L-PMF partially attenuated the diabetes-induced increase in the blood glucose level, enhanced the decreased thresholds and latency during the experiments. Diabetes enhanced the pro-inflammatory cytokine, TNF-alpha, IL-1 beta and IL-6, levels in spinal cord and sciatic nerve of rats. L-PMF treatments to diabetic rats decreased these, but enhanced the production of anti-inflammatory cytokine, IL-10. Conclusions: The present results demonstrated that sequenced L-PMF treatment can relieve neuropathic signs of diabetes in rats. Anti-hyperglycemic, anti-allodynic and anti-hyperalgesic effects of L-PMF treatment can be closely correlated with each other. Furthermore, decreasing actions of L-PMF on pro-inflammatory/anti-inflammatory cytokine ratio can suggest that the therapeutic potential of L-PMF in diabetes induced neuropathy may involve the regulation of the neuroinflammatory/neuroimmune processes.

Low-flow anaesthesia with a fixed fresh gas flow rate

During the wash-in period in low flow anaesthesia (LFA), high fresh gas flow is used to achieve the desired agent concentration. In this study, we aimed to evaluate the safety of fixed 1xa0L/min fresh gas flow desflurane anaesthesia in both the wash-in and maintenance periods in patients including the obese ones. 104 patients undergoing surgery under general anaesthesia were included. After endotracheal intubation, fresh gas flow was reduced to 1xa0L/min and the desflurane vaporizer was set at 18%. The time from opening the vaporizer to end-tidal desflurane concentration reaching 0.7 MAC was recorded (MAC 0.7 time). Throughout the surgery, hemodynamic variables, FIO2, MAC and BIS values were observed. MAC 0.7 time, BIS and MAC values at the start of surgery, number of adjustments in vaporizer settings, desflurane consumption were recorded. The average MAC 0.7 time was 2.9u2009±u20090.5xa0min. MAC and BIS values at the start of the surgery were 0.7 (0.6–0.8) and 39u2009±u20098.5 respectively. No individual patient had a BIS value above 60 throughout the surgery. Hemodynamic variables were stable and FIO2 did not fall below 30% in any patient. The number of adjustments in vaporizer settings was 56. Average desflurane consumption was 0.33u2009±u20090.05xa0mL/min. We demonstrated that LFA without use of initial high fresh gas flow during the wash-in period is an effective, safe and economic method which is easy to perform.

Anesthesia Procedure for Congenital Insensitivity to Pain in a Child with Anhidrosis Syndrome: A Rare Case

Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a neuropathy characterized by insensitivity to pain, impaired thermoregulation, anhidrosis, and mental retardation. A 9-year old boy with CIPA syndrome, underwent 2 operations for a calcaneal ulcer. During the first operation standard monitorization was performed. In the second operation, Bispectral Index (BIS) monitoring was added and temperature was monitored with an esophageal probe. In the first operation, in which anesthesia induction was applied with ketamine and midazolam, extremity movements with surgical stimuli were seen. Despite pain insensitivity, as extremity movements were seen with surgical stimuli, propofol was administered in the second operation. Throughout the operation, the BIS values varied from 19-58 and body temperature was measured as 36.1°C-36.9°C. In conclusion, despite the absence of pain sensitivity in CIPA syndrome cases, there is an absolute need for the administration of anesthesia in surgical procedures because of tactile hyperesthesia.

KOLESİSTEKTOMİ SONRASI NADİR İZOLE EDİLEN BİR BAKTERİ RAOULTELLA (KLEBSİELLA) ORNİTHİNOLYTİCA: OLGU SUNUMU

OZET Klebsiella turu bakteriler, Enterobacteriaceae familyasina ait Gr(-), aerobik basillerdir. K. ornithinolytica’nin insanlarda cig balik tuketilmesiyle, yuksek oranda histamin salinimina neden olarakxa0 ‘Histamin balik atesi’ adi verilen zehirlenme tablosunu yaptigi bildirmistir. Burada farkli olarak elektif kolesistektomi sonrasi kolon perforasyonu dusunulerek yeniden operasyona alinan ve operasyon sirasinda batin ici materyalden alinan kulturde Gr(-) R. ornithinolytica tespit edilen bu nadir olgunun sunulmasi amaclanmistir. Elektif kolesistektomi operasyonu sonrasi,xa0 takiplerinde batin drenlerinden pu ve gaita gelen, yuzde ve ust ekstremitelerde eritem ve makulopapuler dokuntuleri olusan 62 yasinda erkek hastada, batin ici kulturde R. ornithinolytica tespit edilmis, imipenem tedavisi sonrasi duzelen hasta 3.gun yogun bakimdan servisine gonderilmistir. Sonuc olarak, histamin desarji ile ilgili ani makulopapuler dokuntu ve diger histamin salinimi bulgularinin goruldugu hastalarda bu bakteri akla getirilmelidir. Boylece gerek tedavide zaman kaybinin onlenmesi gerekse antibiyotik direnci ile iliskili olarak gereksiz kullanimin sinirlandirilmasi mumkun olabilir. Anahtar kelimeler : Raoultella(Klebsiella) ornithiniolytica, Histamin balik atesi, elektif kolesistektomi

HELLP Sendromu Olan Hastada Uzun Süren Ciddi Sepsis: Bir Olgu Sunumu

Preeklampsi; hipertansiyon ve proteinuri ile karakterize, gebeligin ikinci yarisindan sonra gorulen bir hastaliktir. Tum dunyada gebelerin %5 ile %7’sini etkileyen, maternal ile fetal mortalite ve morbiditenin birinci nedenidir. HELLP sendromu (Hemolysis-Elevated Liver enzymes-Low Platelets) ise preeklamtik gebelerin yaklasik %4-20’sinde gorulen, yuksek maternal ve perinatal morbidite ve mortalite ile iliskili bir tablodur. HELLP sendromlu hastalarda akut sikintili solunum sendromu (ARDS), intraserebral kanama, akut bobrek yetersizligi (ABY), hepatik ruptur, yaygin damar ici pihtilasma bozuklugu (YDIPB) ve septik sok gibi komplikasyonlar maternal morbidite ve mortalite artmasi nedeniyle yogun bakim ihtiyaci ortaya cikabilmektedir. Sezeryan sonrasi postoperatif donemde yogun bakim unitesinde takip ettigimiz ve uzun suren ciddi sepsis nedeniyle tedavi ettigimiz HELLP sendromlu bir hastanin sunulmasi amaclanmistir.Preeclampsia is a disease manifesting itself in the second half of pregnancy, and characterised by hypertension and proteinuria. It affects 5% to 7% of pregnant women all over the world making it the most common cause of maternal and fetal morbidity and mortality. HELLP syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets) occurs in about 4%-20% of the preeclamptic pregnant women and it is often associated with high maternal and perinatal morbidity and mortality rates. HELLP syndrome may require monitoring in the intensive care unit because of the increased morbidity and mortality rates it brings about as a result of potential complications such as acute respiratory distress syndrome (ARDS), intracerebral hemorrhage, acute renal failure, hepatic rupture, disseminated intravascular coagulation, and septic shock. We aim to present the case story of a long-lasting but successful postoperative treatment for severe sepsis of a patient with HELLP syndrome who was monitored in our intensive care unit after a caesarean section

Postoperative Sudden Hypotension Due to Relative Adrenal Insufficiency.

Systemic blood pressure is regulated by three mechanisms: the sympathetic nervous system, the renin-angiotensin system, and the arginine-vasopressin system. Hypotension is a condition that can occur at any stage of management of general anaesthesia, including induction, extubation, and maintenance. Many of the medications used for anaesthesia produce a mild to moderate decrease in systemic vascular resistance (SVR) with a subsequent decrease in arterial blood pressure. Profound and sustained hypotension, however, can have a global impact, resulting in a failure to adequately perfuse systemic capillary networks. The following report describes the case of a 69-year-old man undergoing surgery for total hip replacement who had hypotension that was refractory to fluid administration and inotropic agents at the end of the surgery. In this case study, the role of methylprednisolone therapy in catecholamine-resistant hypotension is also discussed.