Retrospective Evaluation of the Effects of Local Anesthesia Before Tooth Extraction Procedures under General Anesthesia on Physiologic Parameters and Postoperative Bleeding in Children.

BACKGROUND: Studies have been conducted to evaluate changes in hemodynamics, postoperative bleeding, and pain in pediatric dental patients receiving general anesthesia (GA). However, a limited number of studies have evaluated the effects of local anesthetics (LA) on tooth extraction procedures during GA. There is no consensus in the literature regarding LA application in the perioperative period for dental treatments performed within the scope of GA. AIM: This study aimed to determine the retrospective physiologic effects of fluctuations in vital signs and postoperative bleeding in children who did or did not receive LA for tooth extraction under GA. METHODS: A retrospective evaluation of 77 patients aged 5.16 ± 1.85 years who had the extraction of primary posterior teeth with or without LA under GA were reviewed in the post-anaesthesia care unit (PACU) for postoperative bleeding and the effects of intraoperative LA on fluctuations in postoperative parameters such as mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), respiratory rate (RR), and the end-tidal carbon dioxide (EtCO2). These were compiled from the patient records of the procedures. RESULTS: Significant differences between the baseline and peak MAP (P < 0.001), HR (P = 0.011), and EtCO2 (P = 0.002) were noted in children without LA compared to those who had LA. In addition, substantial variations were observed between the baseline and peak values for MAP (P < 0.001) and HR (P = 0.037) in children who had tooth extraction in the mandibular region. Statistically significant differences were noted between the baseline and peak values for patients who did not receive LA before the extraction of the first primary molar in terms of MAP (P < 0.02) and EtCO2 (P = 0.032). Similarly, significant differences in MAP (P < 0.02) and EtCO2 (P = 0.034) were noted in the extraction of the second primary molar. In addition, there was a significant difference in bleeding based on the number of tooth extractions in those who did not receive LA (P = 0.020). CONCLUSION: This study showed that in children who underwent tooth extraction under GA, additional LA application minimized changes in HR, MAP, and EtCO2, whereas a lack of LA application produced significant fluctuations from baseline to peak values of HR, MAP, and EtCO2. In addition, LA application reduced postoperative bleeding.

The comparison of the effects of T-piece and CPAP on hemodynamic parameters, arterial blood gases and success of weaning.

Weaning from mechanically ventilation is a period of transition from total ventilatory support to spontaneous breathing. The aim of this study was to compare the effects of T-Piece and continuous positive airway pressure (CPAP) on hemodynamic parameters, arterial blood gases and success of weaning. In a prospective, randomized, controlled trial, 40 consecutive patients requiring mechanically ventilation in our 8-bed adult general intensive care unit (ICU) for >48 hrs were considered eligible for this study. Patients were randomly divided into two groups (n: 20). Group T-piece received, 4 L/min, Group CPAP received, PEEP < or =5 cm H2O, FiO2 < or = 0.4. At the beginning of the weaning, duration of extubation and after 48 hours of extubation the arterial blood samples were taken for blood gases analysis, also the mean arterial pressure and heart rate were recorded. 40 patients in the ICU were included in the study. There were no significant differences within and between T-piece and CPAP groups according to hemodynamic parameters and arterial blood gases at the weaning period. The number of patients who could be unsuccessful weaned in the T-piece group was higher than the number of patients in the group CPAP (p < 0.001, p < 0.01). Whether, the technique used to wean patients, in this setting, resulted in a clinically relevant improvement in the outcomes addressed above requires further carefully designed, randomized, controlled trials (Tab. 4, Ref. 25).

A memantin HCL intoxication responsive to plasmapheresis therapy.

Memantin HCL (Ebixa) is a drug which antagonizes the effects of N-methyl-D-aspartat receptors and which is used for the treatment of acute Alzheimer patients. Plasmapheresis is a method of cleaning nonspecific extracorporeal blood and it is applied in many immunologic and toxicologic diseases. Female patient at the age of 35 was admitted to the emergency department with complaints of tendency to sleep and sensory loss. About 12 hours before her history she had taken 200 tablets of 10 mg memantin HCL (Ebixa) (2000 mg) and she was transferred to an intensive care department with the diagnosis of drug toxicity (400 mg toxic dose). Her memantin HCL (Ebixa) level in blood was 12,000 ng/mL. It was reported in her physical examination that she was unconscious, her general condition was bad, there were no cooperation and orientation, ahe hadmydriasis and reflexes of light, cornea and eyelash were bilaterally positive and she had horizontal nystagmus. Glascow Coma Scale of the patient was 6, body temperature was 37.5 degrees C and she had tachycardia (130/min) and hypertension (160/90 mmHg). Intravenous Diazepam was effective aginst recurring convulsions. Sinusoidal tachycardia was detected with electrocardiography (EKG) and respiratory alkalosis in arterial blood gases. Six cysles of plasmapheresis were aplied and in the sixth cycle the memantin HCL (Ebixa) level turned to normal. As a result of the sixth plasmapheresis the findings were normal and that is why she was discharged from the hospital. Plasmapheresis should be taken into consideration in case of drug overdose or high doses of plasmatic proteinous drug toxicities (Ref. 11).

Comparison of alfentanil and remifentanil infusions in combination with propofol for the outpatient extra-corporeal shock wave lithotripsy.

PURPOSE: The aim of this study is to compare the efficiency of propofol+remifentanil to propofol+alfentanil in reducing pain in patients with urinary system stones undergoing outpatient Extracorporeal Shock Wave Lithotripsy (ESWL). METHODS: In this prospective study, 30 patients, ASA (American Society of Anesthesiologist) I-II, who are 18-60 years old and undergoing Extracorporeal Shock Wave Lithotripsy for urinary system stones were included. Patients were randomly selected for either propofol+remifentanil (Group PR) or propofol+alfentanil treatment (Group PA). Propofol was given at a dose 1 mg/kg, and then 5mg doses were given to maintain a BIS (Bispectral Index) level 60-70. Remifentanil (0.2 microg/kg (-1) bolus dose and later 0.02 microgkg(-1) min(-1) infusions) was given to the group PR and alfentanil (bolus dose 7 microgkg(-1) and later with 0.7 microgkg(-1) min(-1) infusions) was given to the group PA. If needed, the patients might use 10 ig remifentanil and 50 ig alfentanil bolus doses in group PR and PA using patient controlled analgesia (PCA) device. ECG, SpO2, BIS levels and arterial blood pressures were monitored and recorded. Patients were evaluated with Ramsay Sedation Level Evaluation Scale and with Modified Aldrete Scoring System during and after the procedure. VAS was given to patients to mark their pain level on this scale at the end of the procedure. RESULTS: The values at pre-induction and post- induction in each group were statistically different but difference did not exist between the PR and PA groups. CONCLUSION: We concluded that both methods may be successfully used for patients undergoing ESWL (Tab. 6, Rief. 29).

Nasogastric tube aided fiberoptic intubation through laryngeal mask airway (case report).

Burn scars in early childhood often impairs normal development of the structures of the face. Multiple reconstructive interventions contribute to airway deformity with excessive scar and contracture band formation. Such patients are the most difficult group because of the risk of difficult ventilation and intubation in anesthesiology practice. Although developments in complex airway management techniques are increased, solutions may be achieved with simple approaches. For this purpose, we report about a patient with an anticipated difficult airway who has rejected awake fiberoptic intubation. The patient was managed successfully using classical laryngeal mask airway and nasogastric tube with the guidance of fiberoptic bronchoscope under deep sedation.

[Seronin syndrome and cardiac arrest caused by high-dose moclobemide (case report)].

Serotonin syndrome is the syndrome resulting from brain tissue serotonin accumulation and accompanying by central nervous system dysfunction and circulatory collapse, which leads to a serious mortal danger to life. A female patient aged 31 years, diagnosed as having chronic psychosis in the history, was admitted to an intensive care unit in a critical state for having taking an increased moclobemide dose. The patient developed cardiac arrest and cardiopulmonary resuscitation (CPR) was initiated. A 15-minute CPR recovered sinus rhythm and pulse on the peripheral arteries of the limbs. When consciousness and respiration improved, the patient was weaned from resuscitation and extubated on the second day. On day 4, the patient was transferred from the intensive care unit to the department of psychiatry. The authors consider that patients with overdosage of antipsychotic agents at a risk for such serious complications, such as cardiac arrest, should be necessarily monitored in the intensive care unit.