Yunus Oktay Atalay

A complication of the laryngeal mask airway: Pharyngolaryngeal rupture and pneumomediastinum.

A 72-year-old man, weight 80 kg, height 178 cm, American Society of Anesthesiologists’ (ASA) physical status 2 (arterial hypertension) was having a cystoscopy under general anaesthesia to investigate the cause of haematuria and urinary retention. After applying standard ASA monitoring, anaesthesia was induced by the intravenous administration of 150 mg fentanyl, 150 mg propofol and 10 mg rocuronium. Facemask ventilation was performed until the conditions for insertion of a LMA were suitable. A size 4 LMA (LMA Classic; LMA North America, San Diego, CA, USA) was easily inserted by an experienced user at the first attempt, using the digital technique. Following insertion, the LMA was inflated with 30 ml of air until the airway was sealed. Controlled mechanical ventilation was initiated with a tidal volume of 8 ml kg at 10 breaths per minute (I:E ratio 1 : 2), 4 l min fresh gas flow rate and 20 cmH2O peak airway pressure. To maintain anaesthesia, the inspired agent concentrations were 50% O2 in N2O with 1 to 2% sevoflurane and this was supplemented with a remifentanil infusion (0.05 to 0.1 mg kg min). In the first hour of the operation, peak airway pressure progressively increased up to 30 cmH2O and abdominal distension and subcutaneous emphysema developed. The laryngeal mask was deflated, 30 at the end of the operation. The patient’s haemodynamic and respiratory parameters were stable, and the trachea was extubated after 2 h. A chest radiograph and computerised tomography revealed no pneumothorax, but a widespread pneumomediastinum and pneumoperitoneum were observed, with subcutaneous emphysema extending from the cervical region to the anterior abdominal wall (Fig. 1). There was no leakage of nonionic contrast medium from the oesophagus. A mucosal abrasion of the left posterolateral region of the pharynx was observed on flexible endoscopy. The patient remained stable and, with the subcutaneous emphysema resolving, he was discharged to the ward next day.

Does Bedside Sonography Effectively Identify Nasogastric Tube Placements in Pediatric Critical Care Patients

BACKGROUND A nasogastric tube (NGT) insertion is a common procedure in intensive care units, with some serious complications that result from the malposition of the NGT tip. This pilot study was designed to investigate the efficiency of ultrasound in verifying correct NGT placement and to compare these results with radiographic findings. MATERIALS AND METHODS This was a single-center, double-blind prospective study of patients who had received an NGT in the pediatric critical care unit. Twenty-one patients aged 1 month to 18 years were included in this study. All NGTs were inserted by the same critical care physician. After insertion, the physician first confirmed NGT placement by the auscultation of the epigastrium following the insufflation of air. Confirmation was supplemented with an abdominal radiograph. A radiologist who was unaware of the radiographic findings performed bedside sonography on all patients and verified the location of the NGTs. The findings from these 2 physicians were then compared. RESULTS NGTs were inserted without any complications, and none of the NGTs were positioned in the respiratory tract in any of the patients. All NGT tips were visualized by radiography and sonography with a sensitivity of 100%. CONCLUSION Bedside sonography performed by a radiologist is an effective and sensitive diagnostic procedure for confirming the correct NGT position in patients in the pediatric critical care unit.

The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease.

Objectives Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke. Methods Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio. Patients with a platelet-to-lymphocyte ratio value between 55.0 and 106.71 were assigned to Group I, patients with a platelet-to-lymphocyte ratio value between 106.79 and 160.61 were assigned to Group II and patients with a platelet-to-lymphocyte ratio value between 162.96 and 619.61 were assigned to Group III. The carotid arterial stenosis calculated was classified as per the criteria of North American Symptomatic Carotid Endarterectomy Trial. Results One hundred fifty patients were included in our trial (mean age 61.9 ± 13.1 with 104 males). The rate of carotid arterial stenosis was detected to be higher in patients with a high platelet-to-lymphocyte ratio value (p = 0.010). Additionally, the platelet-to-lymphocyte ratio was positively correlated with the carotid arterial stenosis percentage (r = 0.250, p = 0.002). In the multi-variate regression analysis, platelet-to-lymphocyte ratio was detected to be an independent variable with respect to stroke (odd’s ratio = 1.012, confidence interval = 1.001–1.024, p = 0.031). Conclusions Increased platelet-to-lymphocyte ratio could be a simple and practical marker of the clinical course in patients with carotid arterial stenosis.

Anesthesia Management in a Patient with Kabuki Syndrome

ABSTRACT Background and objectives: The aim of this case was to describe the anesthetic approach to a patient with Kabuki syndrome. Case report: A patient with Kabuki syndrome had revision surgery for scoliosis. On physical examination, shown were long palpebral fissures, large, prominent fissures with an eversion of the lateral third of the lower eyelids, large, prominent malformed ears with low implantation, a short nasal septum, micrognathia, thoracolumbar scoliosis, a depressed left shoulder, a low-set occipital hairline and a short neck. The skin was elastic, and joints were lax. The laryngoscopy showed a Grade II Cormack and Lehane view of the larynx. The trachea was intubated easily. The patient was positioned carefully. Vital signs remained stable during surgery. The patient was extubated and transported to the post-anesthetic care unit. Conclusion: Anesthesiologists should be aware of possibly difficult tracheal intubation cardiac lesions, respiratory problems, neurological and musculoskeletal disorders, and a latex allergy when managing anesthesia for a patient with Kabuki syndrome.

The anesthetic management of emergency general surgery cases: A retrospective analysis

Received: 27.07.2017 Accepted: 28.11.2017 1Ondokuz Mayıs University Medicine Faculty Anesthesiology And Reanimation Department, Samsun, Turkey 2Ondokuz Mayıs University Medicine Faculty Radiology Department,outpatient Anesthesia Service, Samsun, Turkey 3Ondokuz Mayıs University Medicine Faculty General Surgery Department, Samsun, Turkey Yazışma adresi: Ersin Köksal, Ondokuz Mayıs University Medicine Faculty Anesthesiology And Reanimation Department, Samsun, Turkey e-mail: drekoksal@yahoo.com GİRİŞ

Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis

Introduction: Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population. Methods: A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process. Results: A total of 300 (American Society of Anesthesiology I–II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process. Conclusion: IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI.

Anaesthesia and orphan disease: sedation with ketofol in two patients with Joubert syndrome.

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Airway Management in Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis is an important functional pathology that restricts mouth-opening, decreases quality of life, and is associated with facial deformities and orthognathic and orthodontic problems. Airway management in such cases poses a multitude of challenges. This case report pertains to successful airway management in the background of difficult airway.

Remifentanil protects uterus against ischemia-reperfusion injury in rats

PURPOSE To investigate the effects of remifentanil as an antioxidant and analyze the histopathologic, biochemical changes in experimental ischemia-reperfusion (I/R) exposed rat uteri. METHODS Wistar albino rats were assigned to three groups (n = 7). 2h period of ischemia was followed by 1h of reperfusion in the I/R and the I/R-remifentanil groups. After ischemia, no drug was administered in the sham and I/R groups. In the I/R-remifentanil group, remifentanil infusion (2 μg/kg/min) was started in the ischemia period, and continued until the end of reperfusion. After the ischemic and reperfusion period, the ischemic uterine horns were removed surgically for biochemical and histopathologic examination. Tissue damage scores (endometrial epithelial glandular leukocytosis, degeneration, and endometrial stromal changes) were examined. Malondialdehyde levels and catalase, superoxide dismutase enzyme activities in tissue were measured. RESULTS We found significantly lower epithelial leukocytosis and cell degeneration in the I/R-remifentanil group (p<0.05). Remifentanil administration significantly decreased concentrations of malondialdehyde, and increased catalase and superoxide dismutase enzyme activities (p<0.05). CONCLUSION Remifentanil appears to protect the uterine tissue against ischemia-reperfusion and can be used safely in uterus transplantation.