Ağrı - The Journal of The Turkish Society of Algology, 2018
Surgical interventions of multiple extremities can be encountered in the practice of anesthesia. ... more Surgical interventions of multiple extremities can be encountered in the practice of anesthesia. In these patients, general anesthesia is preferred rather than regional anesthesia in order to prevent overdose of local anesthetics. One of the major benefits of using ultrasonography in the practice of regional anesthesia is that it facilitates lowering the required local anesthetic drug dose to obtain a successful block. Especially in high-risk patients, applying ultrasound-guided multiple extremity blocks may be a reasonable approach instead of general anesthesia administration. In a patient with malignant malignoma at left lateral forearm, surgical resection of the lesion, dissection of axillary sentinel lymph node and grafting from lateral left thigh were planned. As surgical procedure involves different extremities, combined blocks were performed. İn this case, we aim to present our application of ultrasound guided supraclavicular, intercostobrachial and lateral femoral cutaneous blocks in the context of literature.
The potential advantages of 0.25% concentration of levobupivacaine in performing lumbar plexus wi... more The potential advantages of 0.25% concentration of levobupivacaine in performing lumbar plexus with sciatic and iliohypogastric nerve block in patients with aortic stenosis is emphasized in this case report. A 48-yr old male patient who was scheduled for hip fracture surgery had severe aortic stenosis with aortic valve gradient of 85 mmHg. Anesthesia plan was combined lumbar plexus, sciatic and iliohypogastric nerve block with a total of 60 mL, 0.25% levobupivacaine. After performing the blocks, the patient underwent successful and uneventful hip reduction surgery except requiring only sedation medications. The patient had sufficient anesthesia and remained hemodynamically stable without the use of vasoconstrictive medication during the operation. We thought that combined lumbar plexus, sciatic and iliohypogastric nerve block with 0.25% levobupivacaine provides stable hemodynamic parameters with adequate anesthesia for hip fracture surgery in patient with severe aortic stenosis.
Objective: Despite the advance of anesthesia and surgery, postoperative neurological dysfunction ... more Objective: Despite the advance of anesthesia and surgery, postoperative neurological dysfunction has remained a challenging problem after descending and thoracoabdominal aortic surgery. The pathophysiology of early and especially late paraplegia is not clearly understood. The effect of pentoxifylline (PTX), an agent known to inhibit invitro neutrophil activation and improve recovery after cerebral ischemia in animals, was investigated on spinal cord protection. Methods: Twenty four New Zealand white rabbits were used for spinal cord ischemia models. Infrarenal aortic occlusion devices were placed. After 48 h, the rabbits were randomly taken for study. The PTX groups (n =12) was given PTX 40 mg/kg IV bolus followed by 0.2 mg/kg/min infusion. The control (CT) group (n=12) received normal saline. Two groups underwent temporary (20 -24 min) spinal cord ischemia in a conscious state. After the operation, the spinal cord function was assessed at 6, 12, 24, 48 and 72 h by the scale (score of 5= normal hop, score of 0 =no movement). Histological analysis of the spinal cords was carried out immediately after acute paraplegia or within 24 h after development of delayed paraplegia. Results: During the aortic occlusion, the distal aortic pressures were the same in both groups (PTX group: 14.92 93.78 mmHg; CT group: 17.42 9 3.2 mmHg). At the 72nd h, the scores were not different in the PTX group (1.58 92.11) and in the CT group (0.83 9 1.95) (P = 0.817). Acute paraplegia developed in 3 rabbits (25%) of each group. Delayed paraplegia was observed in 6 rabbits (50%) in the PTX group and 7 rabbits (58%) in the CT group. On morphological examination on the spinal cords, ischemic changes were observed in both groups. Although neutrophil leukocytes were noted in the control group with acute paraplegia and macrophage infiltration was noted in the control group with delayed paraplegia, there was not any leukocyte or macrophage sequestration in the PTX group. Conclusions: Neurological deficits after spinal cord ischemic/reperfusion injury were not directly responsible for blood-originated phagocytic cells and the inhibition of this type of cell function did not change the outcome.
Journal of Cardiothoracic and Vascular Anesthesia, 2001
Objective: To compare the efficacy of aprotinin and methylprednisolone in reducing cardiopulmonar... more Objective: To compare the efficacy of aprotinin and methylprednisolone in reducing cardiopulmonary bypass (CPB)–induced cytokine release, to evaluate the effect of myocardial cytokine release on systemic cytokine levels, and to determine the influence of cytokine release on perioperative and postoperative hemodynamics. Design: Prospective, randomized clinical trial. Setting: University teaching hospital and clinics. Participants: Thirty patients undergoing elective coronary artery bypass
Aims and Objectives: We used near-infrared spectroscopy to document changes in cerebral tissue ox... more Aims and Objectives: We used near-infrared spectroscopy to document changes in cerebral tissue oxygen saturation (SctO 2) in response to ventilation mode alterations after bidirectional Glenn (BDG; superior cavopulmonary connection) procedure. We also determined whether spontaneous ventilation have a beneficial effect on hemodynamic status, lactate and SctO 2 when compared with other ventilation modes. Materials and Methods: 20 consecutive patients undergoing BDG were included. We measured SctO 2 during three ventilator modes (intermittent positive-pressure ventilation [IPPV]; synchronized intermittent mandatory ventilation [SIMV]; and continuous positive airway pressure + pressure support ventilation [CPAP + PSV]). We, also, measured mean airway pressure (AWP), arterial blood gases, lactate and systolic arterial pressures (SAP). Results: There was no change in SctO 2 in IPPV and SIMV modes; the SctO 2 measured during CPAP + PSV and after extubation increased significantly (60.5 ± 11, 61 ± 10, 65 ± 10, 66 ± 11 respectively) (P < 0.05). The differences in the SAP measured during IPPV and SIMV modes was insignificant; the SAP increased significantly during CPAP + PSV mode and after extubation compared with IPPV and SIMV (109 ± 11, 110 ± 12, 95 ± 17, 99 ± 13 mmHg, respectively) (P < 0.05). Mean AWP did not change during IPPV and SIMV modes, mean AWP decreased significantly during CPAP + PSV mode (14 ± 4, 14 ± 3, 10 ± 1 mmHg, respectively) (P < 0.01). Conclusions: The SctO 2 was higher during CPAP + PSV ventilation and after extubation compared to IPPV and SIMV modes of ventilation. The mean AWP was lower during CPAP + PSV ventilation compared to IPPV and SIMV modes of ventilation.
Ağrı - The Journal of The Turkish Society of Algology, 2018
Surgical interventions of multiple extremities can be encountered in the practice of anesthesia. ... more Surgical interventions of multiple extremities can be encountered in the practice of anesthesia. In these patients, general anesthesia is preferred rather than regional anesthesia in order to prevent overdose of local anesthetics. One of the major benefits of using ultrasonography in the practice of regional anesthesia is that it facilitates lowering the required local anesthetic drug dose to obtain a successful block. Especially in high-risk patients, applying ultrasound-guided multiple extremity blocks may be a reasonable approach instead of general anesthesia administration. In a patient with malignant malignoma at left lateral forearm, surgical resection of the lesion, dissection of axillary sentinel lymph node and grafting from lateral left thigh were planned. As surgical procedure involves different extremities, combined blocks were performed. İn this case, we aim to present our application of ultrasound guided supraclavicular, intercostobrachial and lateral femoral cutaneous blocks in the context of literature.
The potential advantages of 0.25% concentration of levobupivacaine in performing lumbar plexus wi... more The potential advantages of 0.25% concentration of levobupivacaine in performing lumbar plexus with sciatic and iliohypogastric nerve block in patients with aortic stenosis is emphasized in this case report. A 48-yr old male patient who was scheduled for hip fracture surgery had severe aortic stenosis with aortic valve gradient of 85 mmHg. Anesthesia plan was combined lumbar plexus, sciatic and iliohypogastric nerve block with a total of 60 mL, 0.25% levobupivacaine. After performing the blocks, the patient underwent successful and uneventful hip reduction surgery except requiring only sedation medications. The patient had sufficient anesthesia and remained hemodynamically stable without the use of vasoconstrictive medication during the operation. We thought that combined lumbar plexus, sciatic and iliohypogastric nerve block with 0.25% levobupivacaine provides stable hemodynamic parameters with adequate anesthesia for hip fracture surgery in patient with severe aortic stenosis.
Objective: Despite the advance of anesthesia and surgery, postoperative neurological dysfunction ... more Objective: Despite the advance of anesthesia and surgery, postoperative neurological dysfunction has remained a challenging problem after descending and thoracoabdominal aortic surgery. The pathophysiology of early and especially late paraplegia is not clearly understood. The effect of pentoxifylline (PTX), an agent known to inhibit invitro neutrophil activation and improve recovery after cerebral ischemia in animals, was investigated on spinal cord protection. Methods: Twenty four New Zealand white rabbits were used for spinal cord ischemia models. Infrarenal aortic occlusion devices were placed. After 48 h, the rabbits were randomly taken for study. The PTX groups (n =12) was given PTX 40 mg/kg IV bolus followed by 0.2 mg/kg/min infusion. The control (CT) group (n=12) received normal saline. Two groups underwent temporary (20 -24 min) spinal cord ischemia in a conscious state. After the operation, the spinal cord function was assessed at 6, 12, 24, 48 and 72 h by the scale (score of 5= normal hop, score of 0 =no movement). Histological analysis of the spinal cords was carried out immediately after acute paraplegia or within 24 h after development of delayed paraplegia. Results: During the aortic occlusion, the distal aortic pressures were the same in both groups (PTX group: 14.92 93.78 mmHg; CT group: 17.42 9 3.2 mmHg). At the 72nd h, the scores were not different in the PTX group (1.58 92.11) and in the CT group (0.83 9 1.95) (P = 0.817). Acute paraplegia developed in 3 rabbits (25%) of each group. Delayed paraplegia was observed in 6 rabbits (50%) in the PTX group and 7 rabbits (58%) in the CT group. On morphological examination on the spinal cords, ischemic changes were observed in both groups. Although neutrophil leukocytes were noted in the control group with acute paraplegia and macrophage infiltration was noted in the control group with delayed paraplegia, there was not any leukocyte or macrophage sequestration in the PTX group. Conclusions: Neurological deficits after spinal cord ischemic/reperfusion injury were not directly responsible for blood-originated phagocytic cells and the inhibition of this type of cell function did not change the outcome.
Journal of Cardiothoracic and Vascular Anesthesia, 2001
Objective: To compare the efficacy of aprotinin and methylprednisolone in reducing cardiopulmonar... more Objective: To compare the efficacy of aprotinin and methylprednisolone in reducing cardiopulmonary bypass (CPB)–induced cytokine release, to evaluate the effect of myocardial cytokine release on systemic cytokine levels, and to determine the influence of cytokine release on perioperative and postoperative hemodynamics. Design: Prospective, randomized clinical trial. Setting: University teaching hospital and clinics. Participants: Thirty patients undergoing elective coronary artery bypass
Aims and Objectives: We used near-infrared spectroscopy to document changes in cerebral tissue ox... more Aims and Objectives: We used near-infrared spectroscopy to document changes in cerebral tissue oxygen saturation (SctO 2) in response to ventilation mode alterations after bidirectional Glenn (BDG; superior cavopulmonary connection) procedure. We also determined whether spontaneous ventilation have a beneficial effect on hemodynamic status, lactate and SctO 2 when compared with other ventilation modes. Materials and Methods: 20 consecutive patients undergoing BDG were included. We measured SctO 2 during three ventilator modes (intermittent positive-pressure ventilation [IPPV]; synchronized intermittent mandatory ventilation [SIMV]; and continuous positive airway pressure + pressure support ventilation [CPAP + PSV]). We, also, measured mean airway pressure (AWP), arterial blood gases, lactate and systolic arterial pressures (SAP). Results: There was no change in SctO 2 in IPPV and SIMV modes; the SctO 2 measured during CPAP + PSV and after extubation increased significantly (60.5 ± 11, 61 ± 10, 65 ± 10, 66 ± 11 respectively) (P < 0.05). The differences in the SAP measured during IPPV and SIMV modes was insignificant; the SAP increased significantly during CPAP + PSV mode and after extubation compared with IPPV and SIMV (109 ± 11, 110 ± 12, 95 ± 17, 99 ± 13 mmHg, respectively) (P < 0.05). Mean AWP did not change during IPPV and SIMV modes, mean AWP decreased significantly during CPAP + PSV mode (14 ± 4, 14 ± 3, 10 ± 1 mmHg, respectively) (P < 0.01). Conclusions: The SctO 2 was higher during CPAP + PSV ventilation and after extubation compared to IPPV and SIMV modes of ventilation. The mean AWP was lower during CPAP + PSV ventilation compared to IPPV and SIMV modes of ventilation.
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