Lokman Soyoral

Effects of lidocaine infiltration on cost of rhinoplasty made under general anesthesia.

AbstractThis study aimed to compare the effects of combined and noncombined lidocaine with adrenaline infiltration in general anesthesia (GA) procedures, in which the standard anesthesia depth is monitored by Bispectral Index monitoring, on minimum alveolar concentration (MAC) levels and the costs. Following approval by the local ethics committee, an American Society of Anesthesiologists physical status I–II group of 40 adult patients for whom elective rhinoplasties under GA were planned was divided into 2 double-blind randomized groups. In group 1, GA and lidocaine + adrenaline were administered, whereas in group 2, only GA and adrenaline were administered. All the patients who had been taken to the operation room underwent electrocardiography and measurements of the peripheral oxygen saturation, end-tidal carbon dioxide, heart rate, mean blood pressure, and Bispectral Index monitoring. Using the operation time and the MAC% values, the total consumed inhalation agent amounts were calculated, and the cost difference was determined. The mean blood pressure values were lower in group 1 (P < 0.05). In group 1, the MAC% was 20.83% lower than that of group 2; the consumed desflurane amount was 20.29%, and the cost was 20.29% lower than that of group 2 (P < 0.05). In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability. In addition, surgical satisfaction increased in the lidocaine + adrenaline group because of small number of agitated patients during the recovery period.

Effectivity of one session charcoal hemoperfusion treatment in severe carbamazepine poisoning.

A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 µg mL−1 to 21 µg mL−1 within 2 h, with subsequent clinical improvement.

Successful use of sugammadex for caesarean section in a patient with myasthenia gravis

Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems.

Could soluble urokinase plasminogen receptor (suPAR) be used as a diagnostic biomarker for ventilator-associated pneumonia?

Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that is increasingly used for evaluation of systemic inflammation. This study was performed to investigate whether suPAR may possess a diagnostic value in patients with ventilator‐associated pneumonia (VAP).

Femoral-Sciatic Nerve Block in a Patient with Von Willebrand's Disease: A Case Report

Von Willebrand hastalığı, vWf eksikliği veya fonksiyon bozukluklarına bağlı görülen otozomal geçişli bir kalıtsal kanama diyatezidir (1). vWh en sık görülen kalıtsal kanama diyatezlerinden biridir. Toplum taraması ile elde edilen insidans rakamları %1 dolayındadır (2). vWh, tipik olarak hafif veya orta şiddette deri mukoza kanamalarıyla karakterizedir. Sık görülen semptomlar, deride kolay ekimoz oluşması, burun kanaması, diş eti kanaması, menoraji, postpartum kanamalar, yüzeyel kesilerden sonra uzun süren kanamalar ve GIS kanamalarıdır. Kanamanın şiddeti vWf’nin düzeyine ve fonksiyon bozukluğu olup olmadığına göre farklılık gösterir (3). Bu sunuda koagulopatili bir olguda peroperatif koagulasyon faktörleri verilerek, USG eşliğinde başarılı bir periferik blok uygulaması sunulmuştur. Olgu Sunumu

The Management of Spinal Anesthesia in a Patient with Advanced Kyphoscoliosis and Cardiac Arrhythmia

Kifoskolyoz yaşla birlikte artan progresif bir hastalıktır. Gelişimsel vertebra bozukluklarının neden olduğu spinal bir segmentin arkaya ve yanlara anormal açılandığı sık görülmeyen bir deformitesidir (1). Bu hastalarda kardiyopulmoner fonksiyonlarda, nörolojik defisit ve yürüme güçlüğü gibi deformiteye bağlı etkilerle önemli bozulmalar görülebilmektedir. Kifozskolyoz, anestezi uygulamaları sırasında entübasyon güçlüğüne ve rejyonel girişim tekniklerinin zorlaşmasına neden olmaktadır (2,3). Bu yazıda, ileri derecede kifoskolyozlu, sol femur başında kırık nedeniyle opere edilen kadın olguda uyguladığımız spinal anestezi deneyimimizi sunmayı amaçladık.

The efficiency of hemodialysis in transfusion-related acute lung injury (TRALI): A case report

Transfusion-Related Acute Lung Injury (TRALI) is an important life-threatening complication that is related with blood transfusion. The frequency is reported as 1/5.000. Nearly 70% of the cases need mechanical ventilation, and the mortality of TRALI is around 8-9% (1). It is generally characterized with hypoxia that appears at the 26th hours after the blood transfusion, bilateral infiltration in the chest radiography, and noncardiogenic pulmonary edema (2). Acute respiratory distress, hypotension, tachycardia and fever accompany the clinical picture (3). Past surgery, blood transfusion, and sepsis are among the factors that trigger the disease (4). TRALI is defined as the endothelial damage of the lungs and its pathogenesis has not been explained fully yet. However, it is considered that the granulocyte antibodies in the donor plasma, active neutrophil human leukocytes antigen-1 (HLA)-1, HLA-2 antibodies are intermediaries in the pathogenesis (5,6). It has also been reported that biologically active lipids like lisophosphateidilcholine have also roles in the development of TRALI (7). In this study, the efficiency of the hemodialysis applied in the right time in the treatment of a heavy TRALI case developed after a blood transfusion has been presented. Case report