Kamer Dere

A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation.

Objective The intent of our study was to compare the effects of dexmedetomidine versus midazolam on perioperative hemodynamics, sedation, pain, satisfaction and recovery scores during colonoscopy. Material and methods A total of 60 ASA I–II patients, between 20 and 80 years of age were included in the study. Patients were randomly assigned to two groups. Midazolam 0.05 mg kg−1 and fentanyl citrate 1 μg kg−1 were administered intravenously to cases in Group I (n = 30). An initial loading dose of 1 μg kg−1 dexmedetomidine was administered intravenously in 10 min to cases in Group II (n = 30) before the procedure and as a continuous infusion dose of 0.5 μg kg−1 h−1 just before the procedure started. Also 1 μg kg−1 fentanyl citrate was administered intravenously immediately before the procedure. Peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS), Numeric Rating Scale (NRS) scores and colonoscopist satisfaction scores of the cases were recorded. Results Although statistically significant values were not detected between the two groups with regard to mean arterial pressure, in Group I heart rates were higher and Spo2 scores were lower in a statistically significant manner. When the groups were compared with regard to RSS, the RSS scores of Group I at the 10th and 15th minutes were significantly lower than Group II. There was no statistically significant difference between the two groups when compared with regard to NRS scores. Satisfaction scores were significantly lower in Group II. Conclusion Dexmedetomidine provides more efficient hemodynamic stability, higher Ramsay sedation scale scores, higher satisfaction scores and lower NRS scores in colonoscopies. According to our results we believe that dexmedetomidine can be used safely as a sedoanalgesic agent in colonoscopies.

Efficacy of pulsed radiofrequency treatment on the saphenous nerve in patients with chronic knee pain.

BACKGROUND AND OBJECTIVE We studied the long-term efficacy of pulsed radiofrequency treatment (PRF) on the saphenous nerve in 115 patients with chronic knee pain. MATERIALS AND METHODS 115 patients with chronic knee pain were investigated in a period of 22~months retrospectively. All patients had pulsed radiofrequency to the saphenous nerve. The mean age was 59 (range, 51-67). All patients were accessed with the visual analog scale (VAS) and WOMAC score pain at rest, pain on movement, and pain in flexion at 10th day, 3rd and 6th~months post procedure. RESULTS All patients showed improvement in their VAS scores as well as in their WOMAC scores after ten day, three month, and 6 months (p=0.001). No side effects were reported. CONCLUSION PRF application to the saphenous nerve for eight minutes showed remarkable amount of patient satisfaction. Application of PRF for the second time could be recommended if it shows some benefit after the sixth month. But none of our patients needed a second application of PRF after six months period.

The Comparison of the Effects of Different Doses of Levobupivacaine Infiltration on Wound Healing

Introduction-Aim: The easiest method in postoperative analgesia is the infiltration of the wound with local anesthetic drugs. Although many local anesthetic drugs have been used for this type of infiltration, studies on levobupivacaine are rare. The aim of this study was to investigate the effects of different concentrations of levobupivacaine infiltration on wound healing. Method: Forty female Wistar-Albino rats (280–300 g) were included in the study, which were randomly separated into four groups. Rats were infiltrated with 1.25 mg/mL levobupivacaine in group L1.25 (n = 10), with 2.50 mg/mL levobupivacaine in group L2.5 (n = 10), with 3.75 mg/mL levobupivacaine in group L3.75 (n = 10), and with normal saline in control group (n = 10). Breaking-strength measurements, levels of hydroxyproline, and fibrotic index were evaluated in the tissue samples taken from the rats. Results: When the breaking-strength measurements were evaluated, we have found a significant difference between the control and the study groups (p < 0.05). In the intergroup comparison the difference between groups L1.25 and L3.75 was statistically significant (p < 0.05). In all of the levobupivacaine groups the levels of hydroxyproline were higher compared to the control group. Also significant differences were observed between groups L1.25 and L2.5 and groups L1.25 and L3.75 (p < 0.05). The levels of tissue fibrotic index were higher in all of the levobupivacaine groups compared to the control group (p < 0.05) and also a difference was observed between groups L1.25 and L3.75 in terms of tissue fibrotic index (p < 0.05). Conclusion: We have concluded that levobupivacaine used in clinical doses have a significant effect on the fastening of wound healing and this effect increases with an increase in the concentration of the levobupivacaine. We believe that levobupivacaine will be more widely preferred in the near future in the postoperative analgesia.

Ecthyma-gangrenosum-like lesions associated with methicillin-resistant Staphylococcus aureus infection.

Ecthyma gangrenosum (EG) manifests as a skin lesion and is commonly associated with Pseudomonas aeruginosa septicemia in immunocompromised patients. Other viral, fungal and bacterial agents can also cause EG. The first clinical observation is grouped vesicles with surrounding erythema. Within a few days, they evolve into a gangrenous ulcer with a black/gray eschar surrounded by an erythematous halo. Herein, we present a patient with chronic obstructive pulmonary disease who developed EG-like lesions due to methicillin-resistant Staphylococcus aureus infection while he was in the intensive care unit.

A complication during caudal steroid injection

BACKGROUND AND OBJECTIVE Epidural injections in the lumbar spine are provided by caudal, lumbar interlaminar or transforaminal routes. Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this case report, we demonstrate the importance of fluoroscopic guidance during caudal epidural injection. CASE REPORT A 60 years old male patient was admitted to our Algology Department for low back pain. After physical examination caudal epidural steroid injection was planned. The caudal space was identified under fluoroscopic control initially using an anteroposterior projection. After the resultant epidurogram demonstrated vascular spread along the caudal epidural space the needle was withdrawn and the procedure was completed after reinserting the needle. CONCLUSION A careful real time fluoroscopic monitoring should be applied with the injection of opaque material to minimize the risk of vascular injection.

Anesthesia in a child with massive thyroid enlargement

SIR—‘Cretinism’ is a congenital deficiency of thyroid hormones, retarding mental and physical growth. The tongue is large and the neck is short and thick. Intubation can be difficult. Tracheomalacia and hematoma formation can complicate the postoperative course, but can be minimized by an experienced surgical team. A 19-year-old, mentally and growth retarded girl who was 1.27 m high and weighed 31 kg was scheduled for elective thyroidectomy for giant diffuse goiter (Figure 1). The right thyroid lobe was 16 · 15 · 8 cm and the left lobe was 20 · 15 · 8 cm. In her preoperative examination, difficulty in breathing, tachycardia (120–130 bÆmin), minimal mitral regurgitation and minimal tricuspid insufficiency was determined. Because the patient could not cooperate, respiratory function tests, indirect and fiberoptic laryngoscopic examination could not be performed and Mallampati scoring could not be determined. The neck was short and thick. Sternomental distance could not be measured because of the thyroid gland. Thyromental distance was measured as 4.0 cm, and the trachea could not be palpated. Under these conditions, it was decided that the case carried a high risk of difficult airway. Anesthesia induction was provided with 1 mg midazolam, 1 lgÆkg fentanyl, 1.5 mgÆkg lidocaine and incremental doses of 10 mg propofol (total 70 mg) until eyelash reflex was lost. During induction of anesthesia manually assisted spontaneous mask ventilation was maintained for 3 min with 100% oxygen. Direct laryngoscopy was performed. Direct view of the glottic area and vocal cords was obtained and a size 5.5 cuffed tracheal tube was inserted orally. After the endotracheal intubation 0.1 mgÆkg vecuronium was given for muscle relaxation. After the successful operation, the patient was transferred to our intensive care unit for mechanical ventilation and further monitoring. She was extubated and observed closely especially for the complications of tracheamalacia and bleeding for 24 h. The postoperative course was uneventful then she was discharged to the ward without any complications. When the masses that were dissected during the operation were weighed and measured right thyroid and left thyroid lobe was found 460 g in weight and 16 · 15 · 8 cm wide, 775 g in weight and 20 · 15 · 8 cm wide respectively weighing 1235 g in total. In the literature, one study claimed that the rate of difficult airway is 11.1% (2). However, another study found no association between goiter and difficult intubation in patients undergoing thyroidectomy, and the rate of difficult airway was 5.3% (3). Agarwal et al. (4) suggest that patients with longstanding goiter, even when benign, are more prone to develop tracheomalacia. On the basis of their experience they (a)