Can Perfusion Index be used as an objective tool for pain assessment in Labor Analgesia?

Objective: To establish a relationship between the Visual Analog Scale for pain [VAS] in the recovery time of epidural analgesia and the Perfusion Index [PI] values at that time and to test the possibility of using PI as an objective tool for pain assessment

Methods: Thirty women were included in the study. After inserting epidural catheter, the initial applicationtime of epidural analgesia was taken as 0th minute. Hemodinamics, VAS, and PIvalues were recorded at 5th, 10th, 30th, 60th minutes and every two hours until the birth and the 30th minute after the birth

Results: HR, SAP, DAP, PI, VAS values before the procedure were different than all follow-ups [p<0.00]. A negative and significant correlation was found at 10th, 30th, 60th minutes and 2nd hour after drug administration from epidural catheter[rho:0.38; p:0.03, rho:0.47; p:0.009, rho:0.75; p<0.001, rho:0.46; p:0.009, respectively]. As the pain decreased, the perfusion index increased. In 17 patients requiring additional doses, PI increased after the all medications, but a decrease was observed in the VAS values[p<0.05]

Conclusions: In this study, it was determined that the pain decreased with epidural analgesia, perfusion index increased and the pain level increased significantly when the perfusion index started to decrease

Effect of preemptive intravenous ibuprofen on postoperative edema and trismus in third molar tooth extraction: A randomized controlled study

BACKGROUND: This study aimed to evaluate the anti-inflammatory efficacy of preemptive intravenous ibuprofen on inflammatory complications such as edema and trismus in patients undergoing impacted mandibular third molar surgery. METHODS: Sixty patients were included and divided into three groups (800 mg IV ibuprofen + 50 mg dexketoprofen, 800 mg IV ibuprofen, and control). In all patients, preoperative hemodynamic values were recorded before the infusions. The operation was started at 15-min post-infusion. Evaluation of edema size on the face and mouth opening (trismus) was conducted in the preoperative period, and at postoperative 48 h and 1 week. RESULTS: No difference was determined among the groups in trismus and edema size in postoperative measurements (P > 0.05). There was a difference between group 2 and group 3 only in measurement value of tragus-corner of the mouth on the postoperative day 2 (P < 0.05). A difference was found between the measurement values of trismus preoperatively and at preoperative day 2, and between postoperative day 2 and 1 week in group 3 based on time (P < 0.05). In group 3, edema on the face on postoperative day 2 increased significantly compared to that in the preoperative period (P < 0.001); in addition, edema increased significantly in groups 1 and 2 in the postoperative period but was less than that in group 3 (P < 0.001). CONCLUSIONS: In this study, intravenous ibuprofen was determined to be more effective alone or in combination in alleviating trismus and to better limit the postoperative edema.

Use of sugammadex in Rett syndrome: A case report

Rett syndrome (RS) is a neurodevelopmental disorder characterized by loss of cognitive, motor, and social skills, epilepsy, autistic behavior, abnormal airway patterns, gastroesophageal reflux, nutritional problems, and severe scoliosis. Although girls with RS show normal or near-normal growth until 6–8 months, they lose their skills after that. The anesthetic management of these patients requires care because of all these clinical features. Especially in the postoperative period, prolonged apnea is common and extubation is delayed. In this case report, the effect of using sugammadex was presented in a 16-year-old girl with RS. The patient's all bimaxillary teeth and 4 wisdom teeth were extracted under general anesthesia in one session with minimal surgical trauma and moderate bleeding. Sugammadex can be a rapid and reliable agent for the reversal of the neuromuscular block in neurodegenerative patients.

Thoracic epidural analgesia in a patient with multiple comorbidities for subxiphoid incisional hernia repair

Anesthetic preparation before non-cardiac surgery deserves particular attention in patients with cardiac disease as these are prone to develop hemodynamic instability and myocardial ischemia. Risk of complications is not only related to individual patient characteristics, but also to surgery related factors. In this report we present our experience regarding anesthetic management of a patient with multiple comorbidities including advanced chronic obstructive pulmonary disease, severely impaired left ventricular systolic function and occluded by pass grafts. We chose thoracic epidural analgesia for his subxiphoid incisional hernia repair. The operative and postoperative course was uneventful