[Rare reflex in regional anesthesia which have a high-risk in case of forgotten: Bezold-Jarisch reflex]. / Rejyonel anestezide nadir görülen unutulmasi durumunda yüksek risk tasiyan bir refleks: Bezold-Jarisch refleksi.

Bezold-Jarisch reflex is a reflex that may occur during regional anesthesia, upper-extremity blocks and sometimes in general anesthesia, resulting in hypotension, bradycardia, apnea or cardiac arrest elicited by chemical or mechanical receptor stimulations. This reflex mostly occurs in the sitting position during upper-extremity nerve blocks can be forgotten in other complications. The complications that occurred after this reflex can be overcome by taking necessary precautions and providing sufficient cardiac monitorization. In our cases to be presented, we want to remind you of Bezold-Jarisch reflex, which may cause severe complications when forgotten.

Evaluation of the Efficacy of the Erector Spinae Plane Block for Postoperative Pain in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial.

Purpose: To compare the efficacy of the erector spinae plane block (ESPB) and conventional analgesia (CA) in pain management after percutaneous nephrolithotomy (PCNL). Materials and Methods: After obtaining the approval of the institutional ethics committee and patients' written informed consent, 60 cases ages 18 to 65 years, with the status of American Society of Anesthesia I/II and body mass index of 18.5 to 30, were included in the study. The patients were randomized to receive ESPB or CA by a computer-based list. Results: The demographic parameters were similar in both groups. Regarding the visual analog scale (VAS) score assessment, the patients in the ESPB group described statistically less pain according to the total score and evaluations at hours 0, 1, 6, and 24 (p = 0.001, 0.009, <0.001, and 0.014, respectively). The time to first rescue analgesic was longer in the ESPB group compared with the CA group (172.33 ± 180.5 minutes vs 84.33 ± 71.12 minutes), which was statistically significant (p = 0.016). The use of tramadol and paracetamol was less in the ESPB group (60 ± 72.3 mg vs 120 ± 55 mg and 1.8 ± 0.76 g vs 3.2 ± 0.99 g, respectively). (p = 0.001 and <0.001, respectively). Conclusions: ESPB is a safe technique that provides effective postoperative analgesia in patients undergoing PCNL. ESPB decreases the postoperative VAS score, prolongs the salvage analgesia time, and reduces the need for paracetamol and tramadol use compared with general anesthesia with CA.

Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease.

We investigated the effect of spinal anesthesia combined with obturator nerve block (ONB) during the transurethral resection of lateral bladder wall tumors (TUR-BT) on the presence of detrusor muscle tissue in tumor specimens and on tumor recurrence. TUR-BT was performed on 96 patients with a lateral bladder wall tumor under spinal anesthesia in our clinic between January 2011 and December 2015. The patients were divided into two groups: 49 patients only received spinal anesthesia and 47 patients received spinal anesthesia combined with ONB. The groups were retrospectively compared in terms of adductor muscle contraction, bladder perforation, complete tumor resection, presence of muscle tissue in the pathology material, and recurrence rate during follow-up. The obturator reflex was significantly observed in the non-ONB group (p < 0.05). In the ONB group, the percentages of complete resection and detrusor muscle tissue were significantly higher (p = 0.003 and p = 0.001, respectively). The postoperative recurrence rate was found to be significantly higher in the non-ONB group than in the ONB group (p = 0.025). Spinal anesthesia combined with ONB during TUR-BT prevent obturator reflex and facilitate complete resection including detrusor muscle tissue, independent from the size or number of tumors, thus reducing the recurrence of the disease.

What Is the Best Pulmonary Physiotherapy Method in ICU?

Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.

At what age range should children be circumcised?

BACKGROUND: Although male circumcision is a surgical intervention that is frequently performed in children, there is no consensus about the age at which it should be performed. OBJECTIVES: The purpose of this study was to determine the best age range for routine male circumcision with respect to a child's health and the cost. PATIENTS AND METHODS: This clinical trial was conducted in the affiliated hospital of the Erzincan University of Medical Sciences, Turkey, in 2014. The circumcised children were evaluated in 3 groups: < 1 year old (Group 1), 1-7 years old (Group 2), and > 7 years old (Group 3). To obtain a satisfactory Wilton sedation score, midazolam 0.1 mg/kg IV was administered first. If adequate sedation was not achieved, ketamine 2 mg/kg IV was also administered. If adequate sedation was still not achieved, general anesthesia was administered via a laryngeal mask. At the end of the surgery, the groups were compared in terms of post-anesthesia recovery duration, complications, discharging duration, and cost. RESULTS: A total of 603 children were circumcised, 374 in Group 1, 94 in Group 2, and 135 in Group 3. Midazolam was sufficient for sedation in 364 Group 1 patients (97.3%), 6 Group 2 patients (6.3%), and 38 Group 3 patients (28.1%). The shortest post-anesthesia recovery duration after surgical intervention and time until discharge, the lowest cost, and the fewest anesthesia complications were observed in Group 1 (P < 0.05 for all). CONCLUSIONS: Although almost all of the < 1 year-old children could be sedated with midazolam alone, most of the > 1 year-old children required ketamine or general anesthesia. Performing circumcision when children are less than 1 year old decreases the risk of complications due to anesthesia and lowers the costs compared with performing the procedure on older children.

Ultrasound-guided bilateral greater occipital nerve block for the treatment of post-dural puncture headache.

BACKGROUND AND OBJECTIVE: Post-dural puncture headache (PDPH) is one of the complications frequently observed after spinal or epidural anesthesia with dural penetration. For PDPH patients who do not respond to conservative medical treatment, alternative treatments such as bilateral occipital nerve block should be considered.In this study the efficacy of bilateral occipital nerve block was retrospectively evaluated in patients with post-dural puncture headache. METHODS: Ultrasound-guided bilateral occipital nerve block was administrated in 21 patients who developed PDPH after spinal anesthesia, but did not respond to conservative medical treatment within 48 hours between January 2012 and February 2014. The study was conducted at Erzincan University Faculty of Medicine Gazi Mengucek Education and Research Hospital. RESULTS: Mean Visual Analog Scale (VAS) pain scores at 10 minutes and 6, 10, 15 and 24 hours after the block were significantly improved compared to the patients with a pre-block VAS score between 4 and 6 as well as patients with a pre-block VAS score between 7 and 9 (p<0.01). After 24 hours of the block applied, VAS pain score dropped to 1 for all 12 patients who had a pre-block VAS score between 4 and 6. Whereas, VAS score decreased to 2 at 24 hours after the block in only one of the patients with a pre-block VAS between 7 and 9. For the patients with a pre-block VAS score between 7 and 9, there was no significant improvement in the mean VAS score 24 hours after the block. CONCLUSIONS: For patients with PDPH and a pre-block VAS score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective.

Ultrasound-Guided Bilateral Greater Occipital Nerve Block for the Treatment of Postdural Puncture Headache.

Treatment of postdural puncture headaches involves oral or intravenous (IV) fluid or caffeine-containing analgesics, micro-catheterization of spinal space, epidural administration of blood obtained from the patient, or epidural blood patch and fiberoptic imaging-guided epidural interventional techniques. Epidural blood patch is, to date, the most effective treatment, but it is an invasive procedure that may result in serious complications. Spinal anaesthesia was planned for a 22 year old male patient diagnosed with inguinal hernia and for a 42 year old female patient diagnosed with venous stasis. On the first post-operative day, the patients with a postdural puncture headache received conservative medical treatment. As medical treatment was ineffective, they received ultrasound-guided greater bilateral occipital nerve block. In this case report, the effect of the ultrasound-guided bilateral greater occipital nerve block on postdural puncture headache is discussed.