Onur Selvi

Ultrasound guided distal adductor canal block provides effective postoperative analgesia in lower leg surgery

In order to provide adequate postoperative analgesia in patients undergoing lower extremity surgeries, blockage of both lumbar and sacral plexus originating nerves are required as part of multimodal analgesia regimens. Block of the sciatic nerve from the popliteal region is a frequently used regional anesthesia/analgesia technique in lower leg surgery. Additionally, saphenous nerve block at the adductor canal level or femoral nerve block may also be included. Runge et al. reported that local anesthetic injected at the distal of the adductor canal around the femoral artery spread both proximally to the saphenous nerve and distally to the popliteal area, around the sciatic nerve in a cadaver model [1].Morozumi et al. [2] recently described theuse of distal adductor canal block (DACB) in arthroscopic joint synovectomy, reporting their results of its use for postoperative analgesia of lower limb surgery. Sciatic nerve block at thepopliteal region and saphenousnerve block at the adductor canal region leads to effective analgesia and improved satisfaction in patients with tibia or ankle fractures [3]. This combination requires two puncture sites, positioning of the knee, removal of the patients cast and discomfort for the patient. We performed DACB as described byMorozumi et al. [2], in a patient with right trimalleolar ankle fracture. Open reduction and internal fixationwas planned in a 32 year old female patient. We described the procedure to the patient clearly and written informed consent from the patient for procedure obtained. And also; we obtained written consent from the patient to publish this case report. Under sterile conditions following premedication, slight adduction and internal rotation of the leg was performed and linear transducer was placed about 10 cm superior to themedial femoral condyle. The adductor hiatus where the femoral artery forms the popliteal artery, was located and 35 ml of local anesthetic (prepared as 40 ml–20 ml bupivacaine 0.5%, 10 ml lidocaine 2% and 10 ml serum physiologic) was administered, surrounding the femoral artery. General anesthesia was performed. Anesthesia was maintained with 0.6 MAC sevoflurane, 0.025 mcg/kg/min remifentanil infusion. Hemodynamic stability was maintained throughout surgery with no requirement for increase in remifentanil dosage. Surgery lasted 150 min. The patient received routine intravenous perioperative

Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

STUDY OBJECTIVE In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation. DESIGN Prospective, blinded study. SETTING Maltepe University. PATIENTS Four hundred fifty-one patients selected randomly who underwent general anesthesia. INTERVENTIONS In this study we compared predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy. Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation. MEASUREMENTS Patients American Society of Anesthesiology score, age and weight were recorded. TMH, TMD, MMT, ULBT, IDS and C-L scores were measured and determined. MAIN RESULTS The optimal cut-off point for TMH for predicting difficult laryngoscopy was 43.5 mm and for TMD was 82.06 mm. Use of TMH <43.5 with MMT has the highest sensitivity for predicting difficult intubation (78.38) with 75.36% specificity and 97.50% negative predictive value. TMH showed sensitivity of 91.89% and specificity 52.17% at 50 mm cut-off value. In the comparison of the area under the receiver operating characteristic curve values, none of the tests came forth individually or in combination with MMT test. CONCLUSIONS The present study demonstrates the practicality of TMH as a digitalized test however the clinical benefits of TMH in daily medical practice are drawn into question. The additional variable of race may have had some bearing on this and further studies, larger in patient sample size, may need to use different methodology concerning age-, sex-, and race-dependent variables in evaluating these tests.

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

STUDY OBJECTIVE Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DESIGN Single-blinded, prospective, randomized, efficiency study. SETTING Tertiary university hospital, postoperative recovery room & ward. PATIENTS 36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. INTERVENTIONS Standard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). MEASUREMENTS Pain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. MAIN RESULTS NRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. CONCLUSION Bilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.

Hypoxia during general anesthesia? Unknown foreign body aspiration

An 18-month-old male patient, classified as American Society of Anesthesiologists I, with bilateral inguinal hernia was scheduled for operation. Preanesthetic evaluation revealed history of completed medical treatment of acute bronchitis 10 days ago, and his respiratory examination was recorded as normal. He was successfully operated under general anesthesia with a laryngeal mask. After removal of the laryngeal mask, he displayed signs of hypoxia. Respiratory sounds were undetectable in the left thorax. He was intubated due to failure of adequate ventilation. Positive pressure ventilation and bronchodilators were administered to provide sufficient ventilation. In his chest X-ray, total atelectasis was determined in the left lung. Pleural effusion was ruled out with thoracic ultrasonography. Diagnostic rigid bronchoscopy was performed, and in left bronchial tree, hazelnut fragments were removed. The patients hemodynamic and respiratory parameters recovered quickly after foreign body removal, and the patient was transferred to intensive care unit. His parents were questioned for persistent respiratory symptoms and they gave information about repeating respiratory tract infections in the last 3 months. We predict that displaced foreign body in lobar bronchus due to mechanical ventilation can cause this condition.

A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro

INTRODUCTION Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. MATERIAL AND METHOD The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. RESULTS Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512mcg.mL-1 concentration and significantly decreased bacterial growth rate. CONCLUSION Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.

Use of Femoral and Sciatic Nerve Block Combination in Severe Emphysematous Lung Disease for Femoral Popliteal Arterial Bypass Surgery

Regional anesthesia is a widely used anesthesia technique for high-risk patients with severe vascular or pulmonary diseases in which general anesthesia is considered harmful and should be avoided. In this case, we present the use of femoral-sciatic nerve block combination for a 65-year-old, ASA IV, male patient who had severe emphysematous lung disease and was planned for a right femoral-popliteal arterial bypass surgery. He had severe pulmonary disease, hypertension, peripheral vascular disease, and was on clopidogrel treatment. Due to his existing comorbidities, regional anesthesia was considered the right method. The combination of femoral and sciatic nerve block was successfully used for the operation, which lasted for one hour and fifty minutes under sedation, and was continuously supplied with a propofol infusion. The patient was safely discharged to the surgical ward with no pain. The femoral block and sciatic block combination is described as one of the most useful, and at the same time, the most ignored anesthetic method. This technique is considered a standard technique and is often taught early in training; however, its use seems to be underestimated as there are only a few cases documented in Turkey. The aim of this case is to serve as a reminder of its significant value in patients who are not appropriate for general anesthesia and neuraxial blocks.

Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries: Case Series

The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation.

Scientific ArticleYouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesiaYouTube como fonte de informação de raquianestesia, anestesia peridural e anestesia combinada raquiperidural

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.

YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.

YouTube as a source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information.