Perfusion index as an objective, simple and quick parameter for determining the success of paravertebral block.

BACKGROUND: The use of paravertebral block (PVB) for postoperative analgesia in the thoracic surgery has increased in recent years. However, the traditional methods used to evaluate the success and adequacy of the block are time-consuming, subjective and depend on the patient's compliance. Therefore, the search still continues to find a method to objectively evaluate the success and adequacy of the paravertebral block. AIMS: The aim of this study was to investigate whether the Perfusion Index (PI) measured by pulse oximetry technology was an early and quantitative marker for the success of PVB. We also aimed to compare the PI and pinprick method. METHODS: The study included a total of 38 patients undergoing elective thoracotomy surgery within the age group of 18-65 years, with class I-II American Society of Anesthesiologists' (ASA) physical status classification. Thoracic PVB was performed for all patients using 20 mL of 5% bupivacaine under ultrasound guidance. After the block was performed, PI measurements were made from the finger and earlobe of the block side for 30 minutes at one-minute intervals. The spread of the block to the anterior chest wall T3-T8 dermatomes was recorded by pinprick sensory test before the block application and fifth, 10th, 15th, 20th, and 30th minutes following the block application. RESULTS: The PI value measured from the finger on the block side increased 1.5 times compared to the baseline value 12 minutes after the block application (p < 0.05). The sensitivity and specificity of PI in determining the success of PVB at 12th minute were 67% and 85%, respectively. Positive predictive value [PPV] was 93% and negative predictive value [NPV] was 75%. The accepted cut-off PI value was found to be 0.84 for a successful PVB. A weak positive correlation was observed between PI and pinprick test (rs = 0.35, P < 0.05). CONCLUSION: The present study has shown that PI is an objective, fast, practical and non-invasive method, when compare with pinprick method, that can be used to evaluate PVB success.

Using Proseal LMA and I-gel for difficult airway management in patient with diffuse tracheal stenosis and pulmonary artery sling.

Pulmonary artery sling (PAS) is a rare congenital anomaly frequently accompanied by focal or long-segment tracheal stenosis. We presented a 34-year-old female patient with severe long-segment tracheal stenosis associated with PAS which was assessed with Multi Slice Computed Tomography (MSCT) consisting of axial, three dimensional and virtual bronchoscopic images of the airway. This case report discussed the management of her difficult airway condition during surgical cholecystectomy and thyroidectomy by using proseal- LMA and I-gel, respectively (Fig. 4, Ref. 10).

Protective effects of dexmedetomidine in pneumoperitoneum-related ischaemia-reperfusion injury in rat ovarian tissue.

OBJECTIVES: To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia-reperfusion (I/R) injury in rat ovarian tissue. STUDY DESIGN: Animals were randomized into three groups: Group S (n=8), no pneumoperitoneum; Group C (n=8), pneumoperitoneum; and Group D (n=8), 100µg intraperitoneal dexmedetomidine 30min before pneumoperitoneum. Ovarian tissue was collected from all rats 30min after desufflation, and fresh frozen for histological and biochemical evaluation. RESULTS: Body weight was similar in all three groups (202.62±28.86, 211.00±14.45 and 212.87±15.71g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p<0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p<0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p<0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p>0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p<0.05). CONCLUSION: Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R.