Effect of hypotensive anesthesia on cognitive functions. A comparison ofesmolol and remifentanil during tympanoplasty

To compare the effects of esmolol and remifentanil, used as adjuncts for induced hypotension on surgical conditions and short-term cognitive functions, during tympanoplasty. The study was conducted in Hacettepe University, School of Medicine, Ankara, Turkey between January 2005 and December 2006 following Institutional Ethical Committee approval, 40 ASA I-II patients, between 18 and 60 years of age were included in this study. With the induction of anesthesia, for group E, an esmolol infusion of 50-250 microg.kg[-1].min[-1] was titrated, following a bolus of 0.5 mg.kg[-1]; for group R, a remifentanil infusion of 0.2-0.5 microg.kg[-1].min[-1] was titrated; to achieve a mean blood pressure [BP] of 55-65 mm Hg. Arterial BP were recorded continuously throughout the operation. Mini Mental State Test [MMS] was performed at the preoperative 30th minute [MMS[60], postoperative 30th minute [MMS[30]], 60th minute [MMS[60]] and 24th hour [MMS[24]]. Surgical field was evaluated by the blinded surgeon, using a 6 point category scale. Patient demographics were similar in both groups. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Surgical field scores were lower in group R [P<0.05], although the scores were

Intracerebral hemorrhage following enucleation: a result of surgery or anesthesia ? A Case Report

Choroidal melanoma is the most common primary intraocular cancer in adults. A sixty-nine years old, hypertensive male with a choroidal melanoma underwent enucleation. After extubation he woke up confused and unconscious. An emergent computed tomographic [CT] scan demonstrated intracerebral hematoma. The underwent repeat surgery in the postoperative first hour, because of left parietotemporal intracerebral hematoma. His neurological state became worse and he died in the eighth postoperative day. Sympathetic stimulation due to extubation, causing increase in the intracranial pressure or uncontrolled hypertension, may be reasons precipitating intracranial hemorrhage. In patients, who undergo intracranial or intraorbital surgery, had risk factors of intracranial hemorrhage or showed labile blood pressure perioperatively and were confused or unconscious in the postoperatively or had delayed emergence, intracranial hematoma must be suspected

Spinal anesthesia in kartagener's syndrome

Kartageners syndrome, an autosomal recessive disorder is a combination of dextrocardia situs inversus, bronchiectasis and sinusitis. We report a 22-year-old woman with this syndrome scheduled for appendectomy. Spinal anesthesia was preferred for the patient with this rare disorder due to the relative advantages of the regional technique over general anesthesia