[Pulmonary edema following cesarean section under spinal anesthesia: a case report]

This is a report of pulmonary edema following cesarean section under spinal anesthesia in a patient with valvular heart disease. The patient was a 38-yr old multigravida woman without history of cardiac disease. She was operated under spinal anesthesia and remained haemodynamically stable throughout the procedure. But she developed respiratory distress at the end of operation in the recovery room. The only finding in ECG of the patients was sinus tachycardia and chest X-ray revealed bilateral pulmonary edema. The result of echocardiography was suggestive of moderate to severe mitral stenosis. Diagnosis of pulmonary emboli was excluded by perfusion scan. The patient was treated with diagnosis of pulmonary edema and after two hours the patient showed some improvement. Result of the echocardiography on the next day, confirmed the diagnosis. Physical examination should be performed carefully in order to determine the proper method of anesthesia. Spinal anesthesia in patients with mitral stenosis, in particular in pregnancy may not be well tolerated and should be performed cautiously

[Necessary blood volume requirement during debridement and skin graft in burn patients]

Many of burn patients need to receive blood transfusion during debridement and skin grafting. Although it is vital, blood transfusion adverse effects and risks are not unlikely. Therefore, it is better to minimize blood transfusion. In this study, we have tired to estimate necessary blood volume requirement in proportion to preoperative patient hematocrite level and burn percentage that would eventually lower inappropriate blood use. This prospective study was done on all patients undergoing debridement and grafting skin surgery through 6 months. Demographic data, burn percentage, reserved and transfused blood, preoperative and postoperative Hct level were recorded. Qualified data were analyzed with Chi - square and regression analysis [p-value<0.05]. Mean age of all patients was 23 with burns affecting 33 +/- 21% of total body surface area. For all patients 181 blood units were reserved and 85 were transfused. But if indication for transfusion was determined to be Hct _ 28%, blood requirement would be just 54 units for 33 patients. "Requirement of blood transfusion" had negative correlation with "preoperative Hct" [p = 0.001], and positive correlation with "burn percentage" [p = 0.009]. The blood volume requirement for debridement and skin graft surgery in burn patients can be estimated by "preoperative Hct level" and "burn percentage"; this process can minimize unneccessary reserved and transfused blood units significantly

Evaluation of psoas compartment block in knee arthroscopy

Introduction: Psoas Compartment block [Perivascular approach] is a type of the lower limp blocks, which can block the nerves of knee area. The advantage of peripheral nerve blocking to general anesthesia is early patient's discharge from hospital, lower cost and lower complications

Material and Method: In this study, 50 patients who underwent knee arthroscopy received Psoas compartment block. The Success rate of this kind of anesthesia was evaluated in these patients

Results: 76% of patients showed a good or moderated degree of painless but most of patients experienced some degree of anxiety and nervousness and only 20% of patients were satisfied completely from this kind of anesthesia. From the surgeon's point of view 80% of patients had a good cooperation during surgery. In addition, the majority of patients had increased HR and BP during surgery

Conclusion: As a result, Just Psoas compartment block couldn't provide an adequate anesthesia for knee arthroscopy. If the block proceeded by adequate sedation or a light anesthesia, may result in a good anesthesia