Mürsel Ekinci

The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

STUDY OBJECTIVE The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination. DESIGN Randomized controlled clinical trial. SETTING Operating rooms of university hospital of Erzurum, Turkey. PATIENTS Sixty-four 18- to 45-year-old American Society of Anesthesiologists I-II patients scheduled for cesarean delivery under spinal anesthesia having hardly palpated anatomic landmarks on vertebral column. INTERVENTIONS Palpation difficulty of vertebral column landmarks was scored as 0, 1, 2, or 3 from easy to difficult for all patients in sitting position. The patients with score 2 or 3 were randomly allocated into 2 groups as group C (conventional, n=32) and group U (ultrasound, n=32) in which ultrasound guidance was used. MEASUREMENTS The number of skin punctures, the number of needle steering, the number of puncture tried vertebral levels, and procedure time were all recorded. MAIN RESULTS The number of skin punctures was significantly lower in group U (P<.001). Successful subarachnoid puncture on first attempt was also significantly higher in group U (P<.01). The duration of procedure in the patients with score 2 was determined to be significantly longer in the ultrasound-guided group (P<.001). CONCLUSIONS Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.

Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study

STUDY OBJECTIVE The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN Randomized controlled clinical trial. SETTING Operating rooms of university hospital of Erzurum, Turkey. PATIENTS One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.

Síndrome de Horner transitória após bloqueio paravertebral em injeção única

BACKGROUND Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. CASE REPORT We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. CONCLUSIONS It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

Anaesthetic management of emergency thoracic endovascular aneurysm operation in an aorta’s involved patient with neurovascular Behçet’s disease

Behçet’s Disease is an autoimmune chronic multisystem inflamatory disorders, characterized by remissions and exacerbations. As a systemic disease, it can involve visceral organs such as gastrointestinal, pulmonary, musculoskeletal, cardiovascular and neurological systems. All anesthesia attempts from vessel canulation and intubation to anethesia medication may exacerbate the disease and precipitate organ failures in Behçet’s patients, so anaesthetic management in these patients should be carried cautiously both in elective and emergency operations. In this case report it was viewed the anaesthetic management of emergency endovascular stent grafting of thoracic aortic aneurysm, in a patient with neurovascular Behçets Disease. Pam Med J 2017;10(1):87-90

The comparison of ultrasonography guided transversus abdominis plane block and wound infiltration for pediatric inguinal hernia repair: Randomised clinical study

Objective: Postoperative analgesic effect of transversus abdominis plane (TAP) block in patients undergoing abdominal surgery has been debatable. The aim of this study was to compare the analgesic effect of ultrasound guided TAP block and wound infiltration in pediatric patients undergoing inguinal herniorrhaphy. Methods: After ethical board approval, 60 children between 3 and 8 years of age undergoing unilateral inguinal hernia repair were randomized to TAP block (Group TAP, n=30) or to wound infiltration (Group infiltration, n=30). Group TAPB received ultrasoundguided TAP block with 0.25% bupivacaine 0.5 ml/kg and Group C received wound infiltration with 0.25% bupivacaine 0.5 ml/kg before surgery. Pain scores (Wong-Baker Faces), parental satisfication, block complications and additional analgesia requirements were recorded. Results: Compared with the infiltration group, the pain scores were statistically lower in the TAPB group during the first 12 hours (p<0.05). The additional analgesia requirement was statistically lower in the TAPB group than Group infiltration group (10/30 vs 18/30 respectively, p=0.038). Parental satisfaction was statistically higher in the Group TAPB than Group infiltration (p<0.001). Conclusion: Despite the postoperative effect of TAP block is debatable; ultrasoundguided TAP block reduces postoperative pain after pediatric inguinal hernia repair compared to wound infiltration.

Is saphenous nerve radio frequency an effective treatment for advanced gonarthrosis in elders with cardiac comorbidity

BACKGROUND Pulsed radiofrequency (PRF) used for knee pain originating from osteoarthritis is one of these methods. OBJECTIVES The aim of the study was to evaluate the knee functional status and pain palliation following the application of pulse radiofrequency in patients with cardiac comorbid disease who were diagnosed with advanced stage osteoarthritis. METHODS Thirty-eight patients with high surgical risk having cardiac comorbidities with grade 3-4 gonarthrosis according to the Kellgren-Lawrence classification were retrospectively analyzed. PRF was applied to the saphenous nerve of each patient. Visual Analog Scale for knee pain evaluation both at rest and on movement and the Lysholm Knee Scoring Scale for function evaluation were used. The patient status was evaluated before the procedure and at the first and sixth months after the procedure. RESULTS The mean age was 68.8 years (range, 53-82 years). Both the rest and movement post-procedural Visual Analog Scale scores at first and sixth months were significantly lower than pre-procedural values (p< 0.001). A statistically significant improvement was also determined when pre- and one and six months post-procedural Lysholm scores were compared (p< 0.001). CONCLUSIONS PRF is a safe and function sparing minimally invasive pain palliation method for knee osteoarthritis in elders with cardiac comorbidity.

Our management of anesthesia in elective and emergency cesarean surgery: A retrospective evaluation of the last ten years

received: 27.07.2016 Accepted: 30.08.2016 1Erzincan University School of Medicine, Mengücekgazi Regional Training and Research Hospital, Department of Anaesthesiology 2Erzurum Regional Training and Research Hospital, Department of Anaesthesiology 3Kars Harakani Public Hospital, Department of Anaesthesiology 4Erzurum Nene Hatun Maternity and Children Hospital, Department of Anaesthesiology 5İstanbul Medipol University, School of Medicine, Department of Anaesthesiology Yazışma adresi: Özgür Özmen, Erzincan University School of Medicine, Mengücekgazi Regional Training and Research Hospital, Department of Anaesthesiology, Erzincan e-mail: dr.ozgurozmen@yahoo.com.tr GİRİŞ

Effects of Anthropometric Measurements on Spinal Anaesthesia Block Characteristics and Hemodynamics

We aimed to determine the effects of some anthropometric values on sensorial block characteristics of spinal anesthesia and hemodynamics in patients unergoing elective cesarean sections performed under spinal anesthesia. Weight, length, body surface area, and body mass index, abdominal, waist, and hip circumferences of 50 patients were measured. Spinal anesthesia was applied while the patient was sitting erect. The time of sensorial block to reach the T4 level and the maximum sensorial block level were recorded in each case. Cases who developed hypotension and bradycardia during the spinal anesthesia were recorded. In this study hypotension was observed in 54% of patients and it was determined that the prevalence of hypotension increased in patients with a shorter height, larger abdominal circumference, higher body mass index, lower body surface area and a higher waist/hip ratio. It was found that the prevalence of bradycardia increased in patients with a shorter height, higher body mass index, lower body surface area and a higher waist/hip ratio. This study also determined a positive correlation between the values of height, weight and body surface area and the time of sensorial block to reach the T4 dermatome; and a positive correlation between the body mass index and the dermatome area of the maximum sensorial block In line with the values provided by simple and non-time consuming anthropometric measurements the patients who are planned to receive a spinal anesthesia may be priorly prepared against advers effects of bradycardia and hypotension that may develop, and to estimate the sensorial block characteristics of the spinal anesthesia.

Clinical Outcomes and Mortality Analysis of Patients with COPD Admitted to an Intensive Care Unit: Retrospective Analyses of Five-Year Data

Received: 16.06.2016 Accepted: 26.07.2016 1Sabuncuoğlu Şerafeddin Training Hospital, Department of Anesthesia 2Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation 3Palandöken State Hospital, Department of Anesthesia 4Harakani State Hospital, Department of Anesthesia Yazışma adresi: Ali Ahıskalıoğlu, Ataturk University, School of Medicine, Department of Anesthesiology and Reanimation, Erzurum e-mail: aliahiskalioglu@hotmail.com GİRİŞ