Müge Arıkan

High-Flux Hemodialysis and Levocarnitine in the Treatment of Severe Valproic Acid Intoxication

Valproic acid (VPA) intoxication incidence is increasing, because of the use of VPA in psychiatric disorders. The most common finding of VPA intoxication is central nervous system depression which leads to coma and respiratory depression. Pancreatitis, hyperammonemia, metabolic, and bone marrow failure (thrombocytopenia and leukopenia) have also been described. Treatment is mainly supportive. We present the case of an 18-year-old female patient, who made an attempt to autolysis with VPA. Our patients VPA plasma level was very high (924 μg/mL), confirming that it was a severe intoxication. Our treatment including levocarnitine (50 mg/kg per day for 3 days), and high-flux hemodialysis was performed for four hours. The patients hemodynamic status and mental function improved in conjunction with the acute reduction in VPA concentrations. Her subsequent hospital course was complicated by transient thrombocytopenia and levocarnitine induced hypophosphatemia. By day 6, the patients laboratory values had completely normalized, and she was transferred to an inpatient psychiatric facility for continuing therapy.

An Unusual Cause of Carbon Monoxide Poisoning: Narghile Smoking

Patient: Male, 27 Final Diagnosis: Carbon monoxide poisoning Symptoms: Dizziness • nausea • Syncope Medication: — Clinical Procedure: O2 treatment Specialty: Anesthesiology Objective: Challenging differential diagnosis Background: Carbon monoxide (CO) poisoning is commonly seen during the winter season in Turkey due to use of charcoal stoves and water heaters, but narghile smoking is a rare cause of CO poisoning. Case Report: In this paper, we report a CO poisoning case caused by narghile smoking. The patient was admitted to the ED with nausea, dizziness, vertigo, and syncope. Conclusions: The diagnosis of CO poisoning depends on suspicious anamnesis. The major treatment of CO poisoning is oxygen supply.

Intrathoracic migration of a Kirschner wire

Kirschner (K) wires can easily migrate, resulting in serious complications. We report a 49-year-old woman who had a rare and late complication related to the migration of K wire. It had been used for left hip replacement 8 years ago. The patient admitted to our hospital with breathing-dependent chest pain and increasing dyspnea for ∼2 h. Chest X-ray and chest computed tomographic scans revealed the presence of a metallic image of ∼5–6 cm in the right hemithorax. There was a large hemothorax but no pneumothorax. A right thoracotomy was performed and the wire was removed without complications. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. Patients, who are treated with K wire, should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography.

Tips in Anesthesia for Robotic Surgery

In this chapter we aim to provide an overview of the risks and possible anesthesia-related complications during robotic assisted urologic surgery, and tips and tricks to minimize these risks and to manage these complications.

Comparison of Two Different Doses of Fentanyl Combined With Levobupivacaine For Elective Cesarean Section

Objectives: In this prospective, randomized, double-blind, controlled study, we compared the effects of two different doses of fentanyl (10 μg or 25 μg) given intrathecally in addition to 0.5% levobupivacaine for cesarean section. Methods: Eight hundred, ASA I-II parturients, who were scheduled for elective cesarean section, were enrolled in the study. They were randomly allocated into three groups. Group I received 0.5% levobupivacaine; Group II received 0.5% levobupivacaine plus 15 μg fentanyl; Group III received 0.5% levobupivacaine plus 25 μg fentanyl intrathecally. Ephedrine was administered as a bolus dose (0.1 mg/kg), and then the continuous infusion was initiated. The rate of infusion was maintained with respect to baseline systolic blood pressure until umbilical cord clamping. We recorded maternal sistolic blood pressure, heart rate, total ephedrine dose, fetal Apgar scores (at 1st and 5th min), and umbilical cord blood parameters. Other side effects, such as hypotension, nausea/vomiting, bradycardia, etc. were also noted. Results: Bolus, infusion and total ephedrine doses were significantly lower in Group III when compared with the other groups (P<0.05). The incidences of hypotension in the I, II, and III groups were 17.30%, 13.38%, and 11.63%, respectively. There was no significant difference between the three groups regarding the Apgar scores at the 1st or 5th min, umbilical arterial or venous pH. There was no difference in the incidence of other side effects among the three groups. Conclusion: We conclude that the addition of 25 μg fentanyl to adjusting the dose of levobupivacaine to a patients height decreases the ephedrine requirement without additional side effects and adverse neonatal outcomes when compared with the other groups. The levobupivacaine doses as determined by the length of the patients’ and the use of the appropriate fluid resuscitation therapy with an infusion of ephedrine can be used effective methods.

BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.