Hülya Çelebi

Effect of high-dose lidocaine treatment on superoxide dismutase and malon dialdehyde levels in seven diabetic patients

Background and Objectives: We report on the use of intravenous (IV) high‐dose lidocaine to relieve diabetic neuropathic pain, and the techniques effects on clinical measures of lipid peroxidation. Methods: Under continuous electrocardiogram monitoring, IV lidocaine (5 mg kg−1 in 100 mL saline) was administered over 30 minutes to 7 non‐insulin‐dependent diabetic patients suffering from neuropathic pain who reported increased pain within the preceding 6 months. This treatment was performed once a week for 1 month. Blood samples were collected from the contralateral limb to determine plasma superoxide dismutase (SOD) and malondialdehyde (MDA) levels on admission and following the final lidocaine administration. Results: Plasma MDA concentrations significantly decreased after the final IV lidocaine treatment (P < .05, paired t‐test), whereas SOD levels did not show a statistically significant difference compared with baseline levels. Conclusions: High‐dose lidocaine treatment lessens MDA levels, a marker of free‐radical‐mediated cell damage. This suggests that one of lidocaines mechanism of action may be its effect on oxygen free radicals, which in turn impacts lipid peroxidation.

A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval

OBJECTIVE: To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval. METHODS: Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effect-site concentration of 1.5 µg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded. RESULTS: Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea. CONCLUSION: Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.

Anesthetic management of a child with Rubinstein-Taybi syndrome for cervical dermoid cyst excision

which are characteristics of this syndrome (Fig. 1). Thyroid ultrasonography showed a multilocular cystic 33 3 20mm mass anterior to the thyroid gland. There was no mass activity on thyroid scintigraphy. The total blood count and other laboratory test results were within normal ranges. No gastroesophageal reflux was observed on esophagogastrography. The right testis had not descended, and the left testis was retractile. The results of cranial computerized tomography and chromosomal analysis were normal. He had no cardiac defects. He was diagnosed as having the autosomal dominant mutagenic form of RTS. There was an uneventful history of operation and anesthesia for a midline neck mass diagnosed as a thyroglossal cyst that was performed at another center 1 year previously. On this occasion, the midline neck mass was above the previous one and was thought to be a recurrent thyroglossal cyst preoperatively. The patient’s height was 90cm (,3 percentile), and his weight was 14kg (3–10 percentiles). He fasted for 8h and was not premedicated before induction of anesthesia. His heart rate was 130 beats·min21 and his SpO2 was 99%. After preoxygenation, anesthesia was induced by 50% N2O/O2 mixture in sevoflurane via a face mask. After intravenous access had been obtained, 0.5mg kg21 of atracurium was injected, and endotracheal intubation was performed without difficulty with an uncuffed tube that had an internal diameter of 4.5mm. Anesthesia was maintained with 50% N2O/O2 mixture in sevoflurane. The neck mass was excised. At the end of anesthesia, spontaneous ventilation was promptly reestablished. After reversal of residual muscle paralysis with 0.5mg of neostigmine and 0.25mg of atropine, the endotracheal tube was removed. Rectal paracetamol was administered for postoperative pain. No significant problem was encountered during induction, maintenance, and extubation. The pathologic diagnosis of the mass was dermoid cyst.

Comparison of Parasacral and Posterior Sciatic Nerve Blocks Combined with Lumbar Plexus Block.

OBJECTIVE The aim of this study is to compare the effects of parasacral and posterior Winnie approaches when combined with the inguinal paravascular approach for lumbar plexus block. METHODS After the approval of the Ethics Committee, 40 patients scheduled to undergo arthroscopic knee surgery were enrolled. The patients were randomly assigned into two groups in a double-blind manner to perform sciatic nerve block either by the parasacral technique (Group I) or by the posterior approach (Group II). RESULTS The obturator nerve motor block success rate was found to be 80% (16/20) in Group I, whereas it was 10% (2/20) in Group II (p<0.05). CONCLUSION Inguinal paravascular block with parasacral sciatic nerve block led to a much higher incidence of obturator nerve motor block when compared to the inguinal paravascular block with posterior sciatic nerve block during knee arthroscopies.

Anesthesia for correction of esophageal stricture in a patient with epidermolysis bullosa: a case report

different surgical procedures. We could find only two cases of colonic interposition for esophageal stricture with EBD [2,3]. The anesthetic methods were different, and the procedures were shorter than those used in our case. There was only one patient with EBD who underwent a reconstructive operation of 12h duration [4]. Because of the paucity of the literature on anesthesia of long duration in patients with EBD, we report the anesthetic technique employed in a 12-year-old girl with EBD who underwent a colonic interposition operation of more than 10 h duration.

Acute Phase Reaction after Femur Fracture in a Child with Griscelli Syndrome

Griscelli syndrome (GS) is an autosomal recessive disorder that is characterized by partial albinism of the skin and hair shaft. Prompt and early diagnosis is a crucial step for the follow up and management of GS, which would otherwise dramatically decrease the life expectancy of the patients. This case report presents the clinical course of a femoral fracture treated with closed reduction and pelvic-pedal cast, and progression of acute phase reaction during the follow up period.

An unmasked neurological pathology (schwannoma) following spinal anesthesia.

A neurological deficit occurred following spinal anaesthesia that unmasked a relatively important neurological pathology. Spinal anesthesia was performed between L3 and L4 by midline approach at the first attempt. Postoperative clinical examination of the patient showed sensory loss below the T5 segment. Whenever new neurological signs are seen after regional anesthesia, further investigations should be done immediately for differential diagnosis.

Comparison of the effects of neuroleptanesthesia and enflurane or sevoflurane anesthesia on neuromuscular blockade by rocuronium.

Forty-five unpremedicated ASA class I or II patients scheduled to undergo either orthopedic or ear, nose, and throat surgery under general anesthesia with an anticipated duration of approximately 1.5–3 h were enrolled in this study after approval of the hospital ethics committee and written informed consent from the patients had been obtained. All patients were free from neuromuscular, endocrine, liver, or renal diseases and were not receiving drugs known to interact with neuromuscular blocking agents. They required muscle relaxation only for endotracheal intubation. An intravenous infusion of 0.9% sodium chloride solution was given initially via the basilic vein on one of the arms, while the other arm was kept for monitoring neuromuscular block. The heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) (Odam Physiogard SM 785, Wissenbourg, France), and end-tidal concentrations of CO2 and volatile anesthetics (Artema MM 256, Sundbyberg, Sweden) were monitored. Each patient was allocated to one of three groups: enflurane (group E, n 15), sevoflurane (group S, n 15), and neuroleptanesthesia (group NA, n 15). The induction of anesthesia was performed with i.v. fentanyl 2μg · kg 1 and thiopentone 5–7 mg·kg 1, followed by a volatile anesthetic, either enflurane or sevoflurane, with assisted ventilation by mask in groups E and S, respectively. The volatile anesthetics (enflurane or sevoflurane) were administered in 66%/33% : nitrous oxide/oxygen at the endtidal concentration corresponding to 1 minimum alveolar concentration (MAC) in the present study. One MAC of enflurane and sevoflurane was assumed to be 0.57% and 0.66% in approximately 66% nitrous oxide, respectively [13]. In group NA, anesthesia was induced with i.v. droperidol 0.2mg · kg 1, fentanyl 5μg · kg 1, and thiopentone 1–2mg · kg 1 during inhalation of 66%/33% : N2O/O2. Stable end-tidal anesthetic concen