RESUMEN
Aims: To present the combined spinal-epidural anesthesia and postoperative analgesia in two geriatric patients, with low Ejection Fractions (EF) that underwent hip fracture surgery. Presentation of Case: Herein, 90 and 106-years-old geriatric patients respectively, with low ejection fractions were admitted to the orthopaedic ward because of hip fracture. These patients were planned to undergo hip prosthesis surgery. Anesthesia and postoperative analgesia were achieved by Combined Spinal-Epidural (CSE) techniques in both patients. We observed that spinal anesthesia using low dose hyperbaric bupivacaine with fentanyl was an effective and safe method, and post-surgical patient controlled analgesia via an epidural catheter provided sufficient pain control for 48 h. Discussion: In older patients with hip fracture, comorbidities such as cardiac disease increase the risk of perioperative morbidity and mortality. Individuals that undergo hip prosthesis surgery are usually geriatric patients, and comorbidities can increase their risk of perioperative morbidity and mortality during surgery. Regional anaesthesia techniques are widely utilized for surgical procedures (especially obstetrics, orthopaedics, urology, general surgery) and pain management, and they are known to have favourable effects on the vital signs and endocrine and metabolic responses after the operation compared with those of general anesthesia. In addition, regional anaesthesia is preferable because of its superior results in relation to postoperative pain control. Conclusion: Combined spinal epidural anaesthesia with low-dose hyperbaric bupivacaine and fentanyl in hip fracture surgery is a safe and efficient method when used in geriatric patients with low EF. In addition, we find that patient controlled epidural analgesia is a considerably effective technique in postoperative pain management.
RESUMEN
Aims: To present the clinical findings and intensive care management of Hyoscyamus niger (HN) intoxication in a 7-year-old patient. Presentation of Case: A seven-year-old girl was admitted to the emergency department who had eaten a plant in large amounts. She had psychomotor agitation, inability to recognize her family, slurred speech, dry mouth, flushing, over-distended urinary bladder, visual and hearing hallucinations. After a nasogastric tube was inserted, gastric lavage was performed and activated charcoal was administered. Symptomatic treatment including oxygen, fluid-electrolyte balance, and gastric protective drugs was established. Physostigmine infusion (0.02 mg/kg) was given due to tachycardia at the second hour of hospitalization. The plant that was responsible for the clinical picture was confirmed as ‘deli bat bat grass’. The clinical symptoms resolved after 2-hours administration of physostigmine. She was transferred to pediatric ward after 24 hours of monitorization in intensive care unit. Discussion: HN is commonly known as black henbane or deli bat bat grass in the Eastern Anatolian Region in Turkey. Oral intake of this plant can cause central and peripheral anti-cholinergic effects. This clinical picture described as ‘central anticholinergic syndrome’ is characterized by thought impairment, hallucinations, hyperpyrexia, ataxia, excitement, drowsiness, coma, dry skin and flushing, tachycardia, mydriasis, and reduction of bowel movements. Diagnosis of HN intoxication is made by clinical symptomatology and ingestion history of the parts of HN. Therapy includes stomach lavage, supportive therapy, and physostigmine as a specific antidote in some cases. Conclusion: Physicians should always keep in mind for plant poisoning in patients with anti-cholinergic symptoms.