Zekiye Bigat

Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91–10.08] min, LD = 13 [6.76–20.19] min, LDc = 6 [4.44–8.43] min) and sensory block (L = 7 [5.21–10.30] min, LD = 12 [6.11–19.40] min and LDc = 6 [4.2–8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.

Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia.

AbstractBackground: To evaluate the clinical efficacy and safety of unilateral spinal anaesthesia with 0.66% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine for arthroscopic knee surgery. Patients and methods: Forty patients with American Society of Anesthesiology physical status grade I–II were randomly and double blindly allocated to one of two groups. Spinal anaesthesia was performed from the L3-4 or L4-5 interspace with the patient in the lateral decubitus position and with the operative side below. Group B (n = 20) received 7.5mg of 0.5% hyperbaric bupivacaine and group R (n = 20) received 10mg of 0.66% hyperbaric ropivacaine. Patients stayed in the lateral decubitus position for 10 minutes and were then turned to the supine position. The characteristics of spinal block, intraoperative quality of spinal anaesthesia, adverse effects and recovery times were recorded. Results: The onset of sensory block and motor block were significantly earlier in group B compared with group R (p < 0.05). The duration of sensory block and motor block were significantly shorter for group R compared with group B (p < 0.05). Bilateral sensory block occurred in 85% of patients in group B and in 40% of patients in group R (p < 0.05). Bilateral motor block occurred in 70% of patients in group B and in 25% of patients in group R (p < 0.05). Conclusion: For outpatient knee arthroscopy, 10mg of 0.66% hyperbaric ropivacaine is preferred to 7.5mg of 0.5% hyperbaric bupivacaine because it provides a more selective unilateral block and a faster recovery.

Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia

BACKGROUND AND OBJECTIVES We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n=48) received single-shot spinal anesthesia (SSS), group 2 (n=45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p<0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p<0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p<0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p<0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p<0.05). The time to first analgesic was significantly longer in group 3 (p<0.05). CONCLUSIONS Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

O bloqueio combinado raqui-peridural com extensão do volume peridural causa nível mais alto de bloqueio do que a raquianestesia com dose única

JUSTIFICATIVA E OBJETIVOS: Avaliamos os efeitos da administracao peridural de levobupivacaina ou solucao salina, extensao do volume peridural (EVE), em bloqueio combinado raqui-peridural (BCRP) para cesariana. METODOS: Foram incluidas no estudo 138 pacientes com gravidez a termo de 37-42 semanas programadas para cesariana. O Grupo 1 (n = 48) recebeu raquianestesia com dose unica (RADU), o Grupo 2 (n = 45) recebeu BCRP-EVE com solucao salina e o Grupo 3 recebeu BCRP-EVE com levobupivacaina. As caracteristicas do bloqueio motor e sensorial os efeitos nas alteracoes hemodinâmicas maternas e nos recem-nascidos foram comparados. RESULTADOS: O tempo para atingir o bloqueio sensorial maximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de regressao do bloqueio sensorio em dois segmentos foi significativamente menor no Grupo 1, enquanto foi significativamente maior no Grupo 3 em relacao ao Grupo 2 (p < 0,05). O tempo de inicio do bloqueio motor foi significativamente maior no Grupo 1 do que nos grupos 2 e 3 (p < 0,05). O tempo para atingir o bloqueio motor maximo foi significativamente menor no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo de recuperacao do bloqueio motor foi significativamente maior no Grupo 3 do que nos grupos 1 e 2 (p < 0,05). O tempo para o primeiro analgesico foi significativamente maior no Grupo 3 (p < 0,05). CONCLUSAO: Bloqueio sensorio-motor rapido e adequado foi obtido em todas as pacientes do presente estudo; no entanto, o bloqueio sensorio-motor teve inicio mais rapidamente, foi mais prolongado e atingiu um novel mais alto nos grupos 2 e 3; esses efeitos foram mais acentuados no Grupo 3.

Intrathecal bupivacaine or levobupivacaine: Which should be used for elderly patients?

Objectives To compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged ≥65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M). Methods Patients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded. Results The study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine. Conclusion These current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥65 years of age undergoing elective TUR-P or TUR-M operations.

Intrathecal Ropivacaine versus Ropivacaine plus Fentanyl for Out-patient Arthroscopic Knee Surgery

We evaluated the effects of low-dose intrathecal ropivacaine with or without fentanyl for arthroscopic knee surgery. Fifty patients were randomized in equal groups to receive an intrathecal solution (3 ml) containing either 10 mg isobaric ropivacaine or 8 mg isobaric ropivacaine plus 25 μg fentanyl. Complete motor blockade occurred in 22 patients (88%) in both groups. The time taken to reach sensory blockade to T10 and total motor blockade was shorter in the ropivacainetreated group, but differences were not statistically significant. The duration of sensory and motor blockade was shorter in the ropivacaine plus fentanyl-treated group. The cephalad spread of sensory blockade was higher with ropivacaine than with ropivacaine plus fentanyl. We conclude that although 25 μg fentanyl added to 8 mg ropivacaine provided shorter motor and sensory blockade durations than 10 mg ropivacaine alone, small doses of ropivacaine plus fentanyl can be used safely for arthroscopic knee surgery.

Depth Control of Desflurane Anesthesia with an Adaptive Neuro-Fuzzy System

This paper is the first step of a multi-sensor fusion system for control of dept of desflurane anesthesia. In this study, depth of desflurane anesthesia was examined through cardiovascular-based an adaptive neuro-fuzzy system according to changing in the blood pressure and heart rate taken from the patient. The second step, in the next paper will be based on auditory evoked responses. The system designed for anesthetic agent, desflurane, because it is very popular and among the first choices of anesthesiologist for inhalation anesthesia. Intraoperative awareness resulting from inadequate anesthetic is a rare but serious complication during general anesthesia. In order to prevent possible intraoperative awareness, anesthesiologists usually apply anesthetics at level much above the minimal necessary. Anesthetic overdosing prolongs the recovery period, which may cause severe hemodynamic depression and a life-threatening scenario in critically ill patients. To increase patient safety and comfort is one of the most important potential benefits of the system. The second important aim of the study is to relase the anesthesiologist so that he or she can devote attention to other tasks that can’t yet be adequately automated. Also, to make the optimum in the area of anesthetic agent and to economize by lessening the costs of an operation are included the benefits which are coming with this system.

Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases

In this report we present two cases of gunshot injury related midfoot defects, reconstructed with a chimeric partial scapula and latissimus dorsi muscle flap and short perforator‐based skin flap. The first case, a 14 years old male, had 10 × 8 cm medial plantar and 6 × 4 cm dorsal foot defects and the second case, a 55 years old female, had only 8 × 6 cm dorsal foot defect. In both cases the defects were associated with fractures, one with lateral cuneiform and cuboid with 90% bone loss and the other with navicular bone, respectively. After 6 months, the patients could walk well without support, and radiographs confirmed bony union. A chimeric partial scapula and latissimus dorsi muscle flap and short perforator‐based skin flap may be used for the reconstruction of combined bony and soft tissue defects of the midfoot and to promote bone healing.

Effect of nerve localization using a pen device on the success of axillary brachial plexus block

Objective The effectiveness of axillary brachial plexus block (ABPB) performed using peripheral nerve stimulation (PNS) alone was compared with PNS preceded by nerve localization using a pen device, enabling nerve mapping without puncturing the skin. Methods Patients undergoing unilateral hand or forearm surgery suitable for ABPB were randomly assigned to receive either PNS alone (pen − group) or PNS preceded by nerve localization using a pen device (pen + group). Parameters related to the block procedure and patient comfort were assessed. Results Thirty patients were included in each group. The block performance time was longer in the pen + group than the pen − group despite a reduced number of needle insertions. The complete block rate was higher and intraoperative analgesic usage lower in the pen + group compared with the pen − group. Patient satisfaction and complication rates were similar in the two groups. Conclusion The pen device seems to be a helpful addition to PNS for ABPB, with improved results in terms of block success and patient comfort, but further studies are needed to confirm these findings.

Effects of use of Thiopental + Mannitol or Etomidate + Mannitol on Cerebral Ischemia During Temporary Occlusion of Middle Cerebral Artery in Intracranial Aneurysm Surgery

Temporary vessel occlusion is an effective technique used by microvascular surgeons to facilitate dissection and permanent clipping of cerebral aneurysms. Prolonged temporary occlusion carries the risk of infarction in the territory distal to the point of occlusion. The risk of infarction can be reduced by reducing the oxygen requirements of the brain and by maintaining collateral circulation by means of blood pressure control. We studied the effects in 90 patients of etomidate + mannitol or thiopental + mannitol usage during temporary clipping in aneurysm surgery on SjVO2. group 1 received thiopental + mannitol and group 2 received etomidate + mannitol for protection before temporary clipping. After normalization of blood pressure (mild hypertension, mean arterial pressure 90-110 mm Hg) a temporary clip was used. Blood samples were taken from the jugular venous bulb catheter to assess SjVO2 at intervals during the procedure. Postoperative radiologic and clinical ischemia were evaluated with a CT scan and neurologic examination. In group 1, 6 patients were given inotropic agent infusion to maintain mean arterial pressure. However, in group 2, the inotropic agent was not required. SjVO2 values increased more than 80% in 1 patient in group 1 and in 2 patients in group 2. A new radiographic stroke was observed in 2 patients in group 2. When etomidate + mannitol was used for protection before temporary clipping, cerebral infaction appeared to be permanent as a result of the prolonged occlusion time. The results of this clinical study need further investigation.