Tülay Tunçer Peker

External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

Purpose To investigate the reliability of intra-atrial electrocardiogram (ECG) use for external jugular vein (EJV) catheterization. Materials and Methods Patients undergoing open heart surgery in Suleyman Demirel University Hospital between February and June 2006 were included in the study. Using a sterile Seldinger technique, a triple lumen polyurethane central venous catheter was introduced (Certofix® Trio V 720, length 20 cm, 7 French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. Results In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. Conclusion Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

Addition of N-acetyl cysteine to carvedilol decreases the incidence of acute renal injury after cardiac surgery.

Oxidative stress and inflammation during cardiac surgery may be associated with acute renal injury (ARI). N‐acetyl cysteine (NAC) and carvedilol have antioxidant and anti‐inflammatory properties.

The role of nitric oxide on the analgesic effect of tramadol

Abstract Aims: The involvement of NO modulation in tramadols mechanism of action is demonstrated indirectly by the alteration of the effect with the use of nitric oxide synthase inhibitor nitroG-L-arginine methyl ester (L-NAME). We aimed to investigate the alterations in serum and spinal cord NO levels following tramadol used alone or in combination with L-NAME or specific neuronal nitric oxide synthase (NOS) inhibitor 7-nitroindazole (7-NI), beside the changes in tail immersion reponses. Methods: Seventy-seven rats were randomly allocated into 7 groups. Group 1: sham group; Group 2: no drug; Group 3: tramadol 10 mg kg−1; Group 4: L-NAME 5 mg kg−1 + tramadol 10 mg kg−1; Group 5: L-NAME 10 mg kg−1 + tramadol 10 mg kg−1; Group 6: 7-NI 50 mg kg−1 + tramadol 10 mg kg−1; Group 7: 7-NI 100 mg kg−1 + tramadol 10 mg kg−1. Apart from Group 1, all the animals were exposed to a tail immersion test before medications (baseline) and 15 min after the tramadol injection. Following the tail-immersion test, a blood sampl...

Comparison of Intraoperative and Postoperative Effects of Lateral Epidural and Midline Epidural Anaesthesia in Patients Undergoing Unilateral Lower Extremity Operation

OBJECTIVE We aimed to compare lateral and midline epidural anaesthesia using a levobupivacaine-fentanyl combination in patients undergoing unilateral lower extremity operation for anaesthetic effects and postoperative complications. METHODS The study included 40 American Society of Anesthesiologists (ASA) I-II group patients. At the L4-5 space, an epidural catheter was placed in patients in Group 1 by directing the tip of the needle at a 45-degree angle to the operation side and in Group 2 with the needle tip in the cephalad direction. Patients in both groups were administered a combination of 10 mL 0.5% levobupivacaine and 50 μg fentanyl via the epidural catheter. Sensorial and motor block levels during the perioperative and postoperative periods and postoperative complications were recorded. RESULTS The maximum level of sensory block on the operated side was found to be at the T10 (T8-T10) level in both groups, while the level of sensory block on the non-operated side was at the L2 (L3-T10) level in Group 1, and at the T10 (T8-T10) level in Group 2 (p=0.000). The motor block was more intense on the non-operated side in Group 2 than in Group 1. The postoperative motor block ended earlier in Group 1. The incidence of complication development was similar between the groups. CONCLUSION With a shorter lasting and lower level sensorial and motor block, lateral epidural anaesthesia may be a more advantageous method than midline epidural anaesthesia.

[Carotico-jugular fistula following a ballistic injury].

Carotico-jugular fistulae are known complications of gunshot injuries and stab wounds, but they can be iatrogenic. Untreated, these lesions may lead to heart failure, endocarditis, or cerebral embolization. We present the computerized tomography (CT)-angiographic view and its value in the treatment strategy in carotico-jugular fistula. A 35-year-old male was referred in the second hour of a ballistic injury to the right side of the neck. Physical examination revealed hematoma, exit hole and thrill on the right sternocleidomastoid muscle. Diagnosis was confirmed with Doppler ultrasound and CT angiography. Surgical interposition with 6 mm polytetrafluoroethylene for the carotid artery and with 12 mm Dacron for the internal jugular vein was performed. The fistulous tract was ligated. In the postoperative sixth month, Doppler ultrasound was normal and the patient was on antiaggregant therapy and healthy.

Artroskopik girişimlerde ünilateral spinal levobupivakain, levobupivakain-fentanyl ve levobupivakain-morfin kombinasyonlarının analjezik ve hemodinamik etkilerinin karşılaştırılması

Objectives: Aim of the study was to compare the analgesic and hemodynamic effects of levobupivacaine, levobupivacaine-fentanyl, levobupivacaine-morphine for arthroscopic knee surgery under unilateral spinal anesthesia. Methods: A total of 44 ASA I/II patients scheduled for arthroscopy were included in the study. After prehydration patients kept in a lateral position on the nondependent side. Spinal puncture was performed at L3n4/L4n5 intervertebral space. Patients divided into three subgroups: Group L (n=14) received 0.5% levobupivacaine 1 ml+1 ml distilled water; Group LF (n=15), 25 mcg fentanyl (0.5 ml)+0.5 ml distilled water; and Group LM (n=15), 0.01 mg morphine (0.5 ml)+0.5 ml distilled water. Patients remained in that position for 15 minutes. Blood pressure and heart rate were recorded before and 1st, 3rd, 5th, 10th, 15th, 20th and 30th minutes after the block and every 15 minutes during the operation. Motor blockade and sensorial level, side effects, motor block regression time (MBRT), first urination time and first analgesic need (FAN) were recorded. Results: Group LM had the longest MBRT, but difference with other groups did not reach to a significant level (p>0.05). Group LM had significantly longer FAN time compare with other groups (p

Unusual obstruction of nasotracheal tube

SIR—General anesthesia is often needed to provide dental care to children and for mentally handicapped patients. Nasal intubation may be preferred to offer to the dentist a large exposure in the mouth, but sometimes it brings some unusual complications. A 13-year-old female patient with mental retardation was scheduled for dental extraction under general anesthesia. After induction with thiopental and succinylcholine, a wire reinforced flexible 6.5 mm tube was easily inserted through the nose and placed into the trachea under direct vision using Magill forceps. After inflation of the cuff, an extremly high airway pressure prevented ventilation of the patient. The cuff was deflated but inflation of the lungs remained impossible. Any visible obstruction related to the tube was not seen. Then the patient was extubated and the lungs were easily inflated using a facemask. Nasotracheal intubation was reperformed via the same nares using another tube. The examination of the first tube revealed total obstruction of the lumen (Figure 1). When the tube was cut a corn grain appeared to be responsible for the obstruction (Figure 2). Conversation with the parents revealed that they had eaten corn about 1 week previously. Children or mentally handicapped adults are prone to insert foreign bodies into the nose or the ear. Many authors reported nasal foreign bodies discovered incidentally on routine dental radiographs (1–2). The foreign body must be radiopaque by its nature or from the encasing calculus-like material in order to be visible on dental radiographs (3). In our department of dentistry, orthopantomographic and periapical imagings are routinely required for patients with dental caries, but as this patient was extremely uncooperative it was not possible to perform a radiographic examination. Our patient had inserted the corn grain in the nose about 1 week ago, insufficent time for the formation of calcified material, and it would not be visible on the radiograph. Mayumi et al. (4) reported a case in which the nasotracheal tube was obstructed completely by a dislodged bone fragment after nasotracheal intubation. As in the current case, if this foreign body had not totally obstructed the tube lumen, it could have been transported into the trachea or perhaps to the bronchial tree. The authors were reminded that when normal ventilation is impossible immediately after nasotracheal intubation, the only method to improve the situation is to remove the tube, keeping in mind that the airway obstruction may be the result of a dislodged foreign body. In conclusion, if children or mentally handicapped patients are scheduled for an oral surgical procedure under general anesthesia, the diagnosis of a nasal foreign body is important because the foreign body may be transported into the trachea during nasal intubation. Careful examination of these patients may prevent further complications. Dilek Karaaslan* Tulay Tunçer Peker* Ays e Ilknur Karaduman† Nuh Tufan Alt ıN D I Ş* Esin Oğuzhanoğlu* *Department of Anesthesiology, Suleyman Demirel University School of Medicine, Isparta, Turkey †Department of Oral and Maxillofacial Surgery, DDS, Süleyman Demirel University School of Dentistry, Isparta, Turkey (email: dilek@med.sdu.edu.tr) Figure 2 The corn grain responsible of the intubation tube obstruction.