Umit Yasar Tekelioglu

Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy.

The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients.

Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty.

Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P ≤ 0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P < 0.001 and P < 0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (P = 0.002 and P < 0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients.

Woven coronary artery anomaly associated with acute coronary syndrome.

The woven coronary artery anomaly is a rare congenital anomaly in which a coronary artery is divided into thin channels that merge again into the distal lumen. Only a few cases of woven coronary artery have been reported in the literature. This anomaly is accepted as a benign condition. We describe a case of acute coronary syndrome in a patient with woven coronary artery anomaly.

Ultrasound-guided femoral and sciatic nerve blocks combined with sedoanalgesia versus spinal anesthesia in total knee arthroplasty.

Background Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. Methods We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. Results A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). Conclusions Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia

BACKGROUND The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

Forearm compartment syndrome owing to being stuck in the birth canal: a case report

Neonatal compartment syndrome is a rare condition mainly involving the upper extremity associated with necrotic lesions. It is often initially misdiagnosed because the skin lesions mimic several other conditions of the newborn. Early diagnosis and timely intervention are of paramount importance to achieve the best outcome. In the present case, we describe a newborn with forearm compartment syndrome owing to being stuck in the birth canal.

A case of anesthesia mumps after general anesthesia

To the Editor: We report a 57-year-old female patient who underwent a correction of surgical scar and sagging of the abdominal skin by plastic surgeons. She was 155 cm and 95 kg, with body mass index 37.5 kg/m. She had a history of arterial hypertension for 5 years. General anesthesia was induced by propofol 3 mg/kg and fentanyl 1 lg/kg. Endotracheal intubation was performed with muscle relaxation using rocuronium bromide 0.6 mg/kg after assisted ventilation and induction. Maintenance of anaesthesia was achieved with sevoflurane (2–3 vol%) in 50% O2 and 50% air. The patient was extubated without any problems at the end of the surgery. In the recovery room, a painless swelling on the left pre-auricular and post-auricular areas extending up to the angle of the mandible was detected (Fig. 1). In addition, there was crepitation on palpation. There was no evidence of inflammation. The left parotid gland swelling was decreased in the next 24 h and resolved completely in 2 days. Pneumoparotitis is a postoperative complication of general anesthesia characterized by acute transient swelling of the parotid gland that is defined as ‘‘anesthesia mumps.’’ Anesthesia mumps is a rare and interesting clinical entity. However, the phenomenon is a clinical condition well known to experienced anesthesiologists. This clinical entity results from air refluxing into the parotid ductal system via an incompetent Stensen duct orifice [1]. These swellings usually resolve spontaneously over a period of a few hours to a few days without any known sequelae [2]. The exact mechanism of the development of pneumoparotitis in not fully understood. Stensen’s duct leaves the lateral surface of the parotid gland, passes lateral to the masseter muscle, and enters the oral cavity through the buccal tissues adjacent to the maxillary first and second molars [3]. Possible explanations include positive pressure ventilation during general anesthesia and increased pressure in the oral cavity. Pneumoparotitis has been reported in the following situations or maneuvers in the literature: wind instrumentalists, balloon and glass blowers, bicycle tire inflation by mouth, dental procedures using air-powered equipment, cough in chronic obstructive pulmonary disease and cystic fibrosis, nose blowing, whistling, valsalva maneuver to clear ears, and spirometry [4]. We thought that the clinical picture in the present case may have resulted from intra-oral pressure increase via mask ventilation during general anesthesia. Medical history and physical examination are important in the differential diagnosis of the disease. Obstructive, inflammatory, metabolic, and neoplastic causes of parotid gland enlargement should be ruled out. Crepitation on palpation is diagnostic for pneumoparotitis, but it can be mistaken in up to 50% of the patients [4]. Gland swelling, erythema, and tenderness on palpation may be detected in pneumoparotitis as a consequence of inflammation and infection [5]. In our case; the clinical examination showed swelling of the gland and crepitation on palpation, but erythema and pain were not observed. In conclusion, parotid gland enlargement with air after general anesthesia is a rare condition. Medical history, physical examination, and radiologic studies may play an important role in the differential diagnosis and management of the condition. U. Y. Tekelioglu (&) A. Akkaya A. Demirhan H. Bayır H. Kocoglu Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey e-mail: drtekelioglu@yahoo.com

Combinations of fentanyl and levobupivacaine for post-thoracotomy pain

The aim of the present study is to evaluate the analgesic activity, patient satisfaction, and side effect profile of different concentrations of levobupivacaine plus fentanyl administered through thoracic epidural patient-controlled analgesia in patients undergoing thoracotomy. The study included 60 patients who were randomly divided into three groups. At the end of the surgery, group I (n = 20) received 0.125% levobupivacaine plus 3 mg fentanyl, group II received 0.1% levobupivacaine plus 3 mg fentanyl, and group III received 0.05% levobupivacaine plus 3 mg fentanyl via an epidural catheter placed at the level of T(10-11) or T(11-12). For all groups, the patient-controlled analgesia device was programmed to deliver a loading dose of 14 mL at an infusion rate of 4 mL/h, and a bolus dose of 2 mL/h, with a locked out interval of 15 minutes and 60 mL of a 4-hour limit. The following parameters were evaluated at 5, 10, 15, 20, 30, and 40 minutes and at 1, 2, 4, 8, 16, and 24 hours after admission to the intensive care unit, at which nausea and vomiting scales, Visual Analog Scale I-II, Ramsay sedation scale, Bromage scale, pupil diameter, arterial blood pressure, heart rate, respiratory rate, and SpO(2) were measured and recorded. Any side effect was also documented. As the result of the evaluation, visual Analog Scale I-II scores, patient satisfaction scores, mean arterial blood pressure, and heart rate significantly differed in group I as compared with groups II and III. No side effects were encountered except mild nausea, which was seen in group III and did not require treatment. Motor blockage, pupil size, respiratory rate, and SpO(2) were not monitored in any of the patients in all groups. In conclusion, our study suggested that the use of 0.125% levobupivacaine, together with 3 mg/mL fentanyl, constitutes a good combination, and can be used safely without causing hemodynamic change and motor block.

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

BACKGROUND AND OBJECTIVES Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. METHOD 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50mgkg(-1) over 10min and maintained at 15mgkg(-1)h(-1); in Group D, dexmedetomidine was given at 1mcgkg(-1) 10min before induction and maintained at 0.6mcgkg(-1)h(-1). Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. RESULTS Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. CONCLUSIONS Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

Predictive value of aortic knob width for postoperative atrial fibrillation in coronary artery bypass surgery.

OBJECTIVE The aim of our study was determine whether aortic knob width (AKW) is associated with the development of atrial fibrillation (AF) after isolated coronary artery bypass surgery (CABG). METHODS In this retrospective observational cohort study, we evaluated 135 patients without hemodynamically significant valvular problems. AKW was measured on chest X-ray by digital system. Multiple logistic regression analysis was used to find independent associates of postoperative AF (POAF). The diagnostic value of AKW was assessed using ROC analysis. RESULTS POAF occurred in 43 (31.8%) of all patients. The age, AKW, left atrial (LA) diameter and C-reactive protein (CRP) were significantly higher in patients with POAF than without POAF (67.2 ± 8.6 vs 61.3 ± 9.8 years, p=0.004; 45.6 ± 5.8 vs 36.1 ± 3.8 mm, p<0.001; 37.9 ± 3.5 vs 35.8 ± 3.1mm, p=0.002 and 10.6 ± 8.5 vs 5.6 ± 6.5 mg/L, p=0.001 respectively). Multiple logistic regression analysis demonstrated that AKW, LA diameter and CRP were independently associated with POAF (OR=4.527, 95% CI=1.315 -15.588, p=0.017; OR=2.834, 95% CI=1.091-7.360, p=0.032 and OR=1.300, 95% CI=1.038-1.628, p=0.022 respectively). ROC analysis has demonstrated that aortic knob of 36.5 mm constitutes the cut-off value for the occurrence of POAF with 84.4% sensitivity and 64.6% specificity (AUC=0.84, 95% CI=0.75-0.94, p<0.001). CONCLUSION We have demonstrated a significant association between the AKW and AF development after isolated CABG. PA chest radiography is a cheap and readily available clinical tool and it can be examined easily by every cardiovascular surgeons.