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

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.

effects of tourniquet on intraocular pressure during knee surgery

In this prospective study we aimed at examining the effects of pneumatic tourniquet on intraocular pressure during elective knee surgery. Twenty patients undergoing elective knee surgery under general anesthesia with tracheal intubation were inluded the study. Anesthesia was induced with pentothal, rocuronium and fentanyl, then maintained with sevoflurane and nitrous oxide in oxygen. Intraocular pressure measurements were performed at 7 time points; awake [baseline], following induction, following tracheal intubation, just before tourniquet inflation, after the inflation of tourniquet, before tourniquet deflation, after the deflation of the tourniquet. Baseline IOP was 15 +/- 1 mmHg. Following the induction of anesthesia IOP was reduced significantly [12 +/- 1 mmHg] [p<0.05], then increased to 16 +/- 1 mmHg after tracheal intubation [p<0.05]. IOP was significantly higher after tourniquet inflation compared with just before [13 +/- 1 mmHg vs 16 +/- 1 mmHg recpectively] [p<0.05]. There was no significant difference between the IOP measurements after the inflation and before the deflation of the tourniquet [p>0.05]. The lowest value was 12 +/- 0 mmHg measured after the tourniquet loosened and it was significant compared with the baseline and the measurement performed before deflation of the tourniquet [16 +/- 0 mmHg] [p<0.05]. Pneumatic tourniquet may cause a significant IOP increase in patients performing knee surgery under general anesthesia

Pretreatment with stellate ganglion blockade before ischemia reduces infarct size in rat hearts

To investigate the role of stellate ganglion blockade [SGB] in cardio-protection against ischemia reperfusion injury. This prospective randomized, experimental study was carried out between August and October 2008 in the Department of Anesthesia, Abant Izzet Baysal University, Bolu, Turkey. Twenty-one rats were randomly divided into 3 groups; group 1 -SGB group [rats with percutaneous ganglion blockade], group 2 - preconditioned [P] group [rats that were subjected to ischemia and then reperfusion periods for 5 minutes], and group 3 - control group [rats that were injected with normal saline]. During the ligation period, the length of arrhythmia was significantly shorter in group 2 compared with group 3 [p<0.001]. The arrhythmia score in groups 1 and 2 was significantly lower compared with group 3 [p<0.001]. In the reperfusion period, the length of arrhythmia was not significantly different in all study groups [p>0.05]. But the arrhythmia score was significantly lower both in group 1 and group 3, compared with group 2 [p<0.02]. Both in the ischemic and reperfusion periods, the incidence of arrhythmia was lowest in group 1. The infarct size was measured significantly less in groups 1 and 2 compared with group 3 [p<0.001]. Pretreatment with the left SGB leads to lower arrhythmia scores and reduced infarct size in the Langendorff-perfused rat hearts compared with group 3, but not with group 2

Perimortem Cesarean Delivery Following Severe Maternal Penetrating Injury

The case of a severely traumatized pregnant patient, in whom a perimortem cesarean section, in the emergency department, led to the birth of a viable baby, with long-term survivor, is described. A postmortem cesarean section, resulting in fetal survival, performed after 45 minutes of maternal cardiopulmonary resuscitation is reported in a patient with multiple penetrating injuries. A 27-year-old primigravida suffered cardiopulmonary arrest at the 34th week of gestation following multiple knife injuries. Although extensive advanced cardiopulmonary resuscitation was performed for 45 minutes, her vital signs did not return to normal levels. A low segment cesarean delivery was performed, and a female baby was delivered. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation are important determinants of fetal survival. A perimortem cesarean section is advised in case of multiple penetrating injuries, even after 45 minutes of cardiopulmonary resuscitation, since it may result in fetal salvage.