Gözen Öksüz

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).

The Knowledge of Eye Physicians on Local Anesthetic Toxicity and Intravenous Lipid Treatment: Questionnaire Study

Objectives: To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue. Materials and Methods: A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals. Results: The study included 104 ophthalmologists (25% residents, 67.3% specialists, 7.7% faculty members) with a mean age of 35.71±6.53 years. The highest number of participants was from state hospitals (65.4%), and 34.6% of the physicians had been working in ophthalmology for more than 10 years. Seventy-six percent of the participants reported using LA every day or more than twice a week, but 56.7% had received no specific training on this subject. No statistically significant difference was observed between different education levels and the rates of training (p=0.419). Bupivacaine was the most preferred LA and the majority of respondents (97.1%) did not use a test dose. Allergy (76%) and hypotension (68.3%) were the most common responses for early findings of LATS, while cardiac arrest (57.4%) and hepatotoxicity (56.4%) were given for late findings. The most common responses concerning the prevention of LATS included monitorization (72.4%) and use of appropriate doses (58.2%). Symptomatic treatment was selected by 72.4% of respondents and cardiopulmonary resuscitation and antihistamine treatment by 58.8%. Of the ophthalmologists in the study, 62.5% had never encountered LATS. The use of 20% intravenous lipid emulsion therapy for toxicity was known by 65% of the physicians, but only 1 participant stated having used it previously. Conclusion: The importance of using 20% lipid emulsion in LATS treatment and having it available where LA is administered must be emphasized, and there should be compulsory training programs for ophthalmologists on this subject.

Efficacy of bispectral index monitoring for prevention of anestheticawareness and complications during oocyte pick-up procedure

Background/aim: This study was planned by considering that the use of bispectral index (BIS) monitoring ensures sufficient depth of anesthesia and avoids anesthetic awareness and patient movement in the oocyte pick-up (OPU) procedure.Materials and methods: Ninety-eight patients undergoing OPU were randomly divided into 2 groups as the control group (n = 48) and BIS group (n = 50). After propofol and remifentanil induction, the control group was given additional propofol according to reaction response, while the BIS group was given propofol at BIS values of 60 and above with the aim that BIS values be 40?60. Total procedure time, recovery time, patient movement, additional propofol consumption, total number of oocytes, and awareness during anesthesia were recorded. Results: Demographic data were similar in the two groups (P > 0.05 for all). The recovery time in the BIS group was significantly shorter compared to the control group (P < 0.001) while additional propofol consumption was found to be significantly lower (P < 0.001). Baseline BIS values fell compared to all other times after induction significantly (P < 0.001). No patient had anesthesia awareness.Conclusion: During the OPU procedure BIS monitoring is considered to prevent anesthesia awareness, intraoperative movement, and complications caused by insufficient anesthetic use as it ensures optimal doses of anesthetic agents used and early recovery.

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.

Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants

Abstract Difficulties in the palpation of anatomical landmarks in pregnancy due to obesity may create problems in the regional anaesthesia. Objective of this study was to compare ultrasound examination carried out before the procedure with conventional spinal anaesthesia method with papation of bony landmarks in caesarean sections performed under spinal anaesthesia in obese pregnants. Ninety-seven obese pregnants having pre- and post-pregnancy body mass index > 30 kg/m2 were prospectively examined. Patients were randomised to two groups as landmark group (n = 49) and ultrasound group (n = 48). The needle insertion point was determined at L4–L5 level before the procedure through palpation in the landmark group and with the examination in the ultrasound. The numbers of skin punctures and needle passes, total procedure time (TPT) and spinal block occurrence time (SBOT) were recorded. TPT was significantly longer in the ultrasound than in the landmark group (p < 0.001) (8 ± 2 and 5 ± 1; respectively). Whereas SBOT values were similar (p = 0.063). The numbers of skin punctures and needle passes were significantly fewer in the ultrasound than in the landmark group (p < 0.001). We believe that, accurate determination of the needle introducing site before the procedure by viewing the vertebral structures through ultrasound examination in obese pregnants could increase the success rate.

Anaesthetic management of a patient with Michels syndrome

Michels Syndrome,whichwasfirst defined in 1978, is anuncommon syndrome seen with craniosynostosis, blepharophimosis, ptosis, epicanthus inversus, cleft lip/palate, abnormal supra umbilical abdominal wall defect and mental deficit, hearing loss, spina bifida occulta, abnormalities in the kidneys, bladder and genital system [1]. To the best of our knowledge, this is the first report in literature of the anaesthesia method used in Michels syndrome. A 4-year old boy, weighing 11 k was admitted to our clinic for surgery for bilateral undescended testes. In the physical examination on presentation, the patient with the diagnosis of Michels syndrome was determined with mental retardation, hypertelorism, previously operated cleft lip/palate, unilateral cochlear implant (Fig. 1). After obtaining written, informed consent from the parents, the patient was admitted to the operating room and a vascular route was opened in the left hand with a 22-gauge needle while sevoflurane (sevorane) was administered with inhalation. After administration of 2 mg/kg propofol and 0.1 mcg fentanyl and the disappearance of the eyelash reflex, mask ventilation was provided. A no. 2 Proseal Laryngeal Mask Airway (PLMA; Intravent Orthofix, Maidenhead, UK) was applied to the patient. By positioning the patient laterally, the coccyxwas examined. A sacral dimple was observed and as it was considered that there could be occult spina bifida, caudal block that is used as routine postoperative analgesia in our clinic, was not applied. As it was considered that there could be umbilical, abdominal wall deficit, transversus abdominis plane and quadratus lumborumblocks that are applied in lower abdominal surgery for postoperative analgesia, were not applied. Postoperative analgesia for the patient was provided with 15 mg/kg paracetamol. After the 80-min operation, the patient was woken with no problems. As Michels Syndrome is characterised by many deficits such as craniosynostosis, blepharophimosis, cleft lip/palate, hearing loss, there is a high possibility that these caseswill require surgery because of thesedeficits [1]. In operations requiring general anaesthesia, preparations must be made for difficult intubation because of facial deformities and there is insufficient information on this in literature. No reports of the anaesthesia method used in cases of Michels syndrome could be found in literature. The only casewith a similar genemutationwas a report by Fiona et al. of the anaesthesia method used with Malpeuch syndrome. Adenectomy and tonsilectomy were applied to a 4-year old patient with Malpeuch syndrome and it was reported that general anaesthesia was applied successfully and intubation was difficult [2]. The case presented here had previously undergone surgery twice, for cleft lip/palate and for a cochlear implant. There were no anaesthesia difficulties written in the patient records, and the family did not give any such information. Nonetheless, preparations were made for difficult airway.