The Effect of Sugammadex on Time of Sciatic Block by Perineural Bupivacaine in Rats.

OBJECTIVES: We aimed to investigate the effect of sugammadex on the motor, sensory and deep sensory block in the sciatic nerve created by bupivacaine in rats. MATERIALS AND METHODS: 18 Sprague-Dawley adult male rats treated with unilateral sciatic nerve block by bupivacaine (0.2 ml) were randomly divided into three groups. Control group (Group C, n = 6, 1.5 mL saline) perineural sugammadex group (Group PNS, n = 6, 16 mg/kg) and intraperitoneal sugammadex group (Group IPS, n = 6, 16 mg/kg) Motor, sensory, and deep sensory functions were evaluated every 10 minutes by a blind researcher. 6 tissue samples each belonging to the sciatic nerve, 1.5 cm in length and 0.2 cm in diameter, were taken from paraffin blocks. Sections of 3-4 micrometers were stained with Hematoxylin + Eosin, Masson Trichrome dyes and examined under a light microscope. RESULTS: There was no statistically significant difference between 3 groups in terms of the time to return to normal motor, sensory and deep sensory function. There was also no significant difference in edema, extracellular matrix, and myelin. Inflammatory cells were seen in all groups, mainly epineurium, epineurium, and perineurium. CONCLUSION: There are findings of no histological effects or effects on local block of sugammadex in rats undergoing sciatic nerve block.

Stress response in vertebra surgery by total intravenous and inhalation anaesthesia.

OBJECTIVE: We compared inhalational and total intravenous anaesthesia about haemodynamic stability and oxidative stress response in vertebral surgery. BACKGROUNDS AND METHODS: Fifty-nine elective vertebral surgery patients were randomly divided into propofol (Group P) and desflurane (Group D) groups. Intraoperative haemodynamic parameters, preoperative and post-operative native thiol, total thiol, disulfide, C-reactive protein (CRP), albumin, cortisol and catalase levels were studied. RESULTS: Post-operative native thiol and total thiol values in Group P were higher (P = .044 and P = .031). Post-operative albumin value in Group P was lower than the preoperative value (P < .001). The post-operative CRP and albumin values in Group D were lower than the preoperative value. The cortisol value was high (P = .03, P < .001 and P < .001). The post-operative albumin value in Group P was higher (P = .03). There is a positive correlation between CRP and disulfide values (P = .017), between albumin and native thiol values (P < .001), between total thiol value (P < .001), between the cortisol value and the disulfide/native thiol value (P = .002) and between native/total thiol value (P = .003) and a negative correlation between disulfide/native thiol value (P = .005), between disulfide/total thiol value (P = .003) and between the native/total thiol value (P = .001). CONCLUSION: Dynamic thiol/disulfide haemostasis reflects oxidative stress. Propofol positively contributes to oxidative stress in elective vertebral surgery.

Transforaminal Epidural Steroid Injection in the Treatment of Pain in Foraminal and Paramedian Lumbar Disc Herniations.

AIM: To compare the effect of fluoroscopically guided transforaminal epidural steroid injections on radicular pain in foraminal and paramedian lumbar disc herniations. MATERIAL AND METHODS: This study included patients who did not benefit from previous medical treatments or are not suitable for surgery. Transforaminal epidural steroid injections for the treatment of foraminal and paramedian lumbar disc herniation were performed in 370 and 1262 patients, respectively. Every group’s preprocedural visual analogue scale (VAS) and 12-week postprocedural VAS scores were recorded, and statistical analysis was performed. The complications noted were also recorded. RESULTS: The preprocedural and postprocedural mean VAS scores for radicular pain in foraminal disc herniation were 67.11 ± 4.28 and 34.78 ± 3.64, respectively. However, the preprocedural and postprocedural mean VAS scores in paramedian disc herniation were 62.16 ± 6.65 and 19.07 ± 4.50, respectively. Statistical analysis of the varying preprocedural and postprocedural VAS scores showed that transforaminal epidural steroid injections were more effective for paramedian disc herniation than for foraminal disc herniation (p < 0.05). CONCLUSION: Transforaminal epidural steroid injections were more effective for paramedian lumbar disc herniation than for foraminal disc herniation, 12 weeks after the procedure.

The combined administration of systemic and topical tranexamic acid for total hip arthroplasty: Is it better than systemic?

OBECTIVE: The aim of this study was to evaluate the effect of combined intravenous and topical use of tranexamic acid (TXA) on total blood loss and transfusion rate in total hip arthroplasty. METHODS: This prospective randomized study included 57 patients who had undergone total hip arthroplasty between September 2016 and September 2017. The IV administration group (Group 1) consisted of 26 patients (mean age: 63.73 ± 10.29 years), while the IV and topical administiration group (Group 2) consisted of 22 patients (62.82 ± 8.31 years). Demographic data and outcomes were obtained through a review of individual medical records. Medical comorbidities, body mass index (BMI), ASA and CCI, preoperative and postoperative hemoglobin levels, postoperative transfusion records and 90-day joint-related (implant subsidence, dislocation, postoperative anemia, deep infection, hematoma and/or wound problem, postoperative periprosthetic fracture) readmission rate and complication rate were compared between the groups. RESULTS: No significant differences were observed between the 2 groups in terms of age, gender, height, weight, body mass index (BMI), the level of preoperative Hb values, and the American Society of Anesthesiologists (ASA) and Charleson Comorbidty Index (CCI) rating (p > 0.05). The mean postoperative Hgb in the group 2 was higher by a small amount compared to the group 1. No statistically significant difference was determined between the groups in respect of the Hgb values (p = 0.562). Hgb Delta in the group 2 was lower than that of the group 1. The difference between the groups in the Hgb Delta values was not statistically significant (p = 0.268). The mean total blood loss was lower in the group 2 than in the group 1 but the difference was not statistically significant (p = 0.788). There was no significant difference observed in terms of any adverse complications among the 2 groups (p > 0.05). CONCLUSION: The combined administration of IV and topical TXA compared with IV alone can decrease total blood loss and the number of blood transfusions required without increasing the risk of DVT or/and PE in total hip arthroplasty. But the statistical analysis and clinical relevance is not significant. LEVEL OF EVIDENCE: Level I Therapeutic Study.

Can we make an early 'do not resuscitate' decision in severe burn patients?

BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). RESULTS: It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort, early do-not-resuscitate or do-not-intubate protocol for these patients is suggested. Resources could then be directed to other patients with high expectancy of life and patients with burns that are beyond treatment can experience more comfortable end of life. CONCLUSION: At present in Turkey, it is not possible to give DNR order for patient with severe burns that are incompatible with survival due to legal interdiction. This subject should be discussed at high-level meetings with participation of doctors, legal experts, economists, and theologians.

The effect of surgical technique on hemodynamics, arterial oxygenation and pulmonary mechanics in radical prostatectomy operations.

OBJECTIVE: The effects of surgical technique on respiratory mechanics, arterial oxygenation and hemodynamics in radical prostatectomy operation were investigated. METHODS: The study was planned on ASA II-III, 40-65 years old, fourty patients scheduled for radical prostatectomy under general anesthesia. They were divided into two groups: perineal and suprapubic (Group P, n = 20; Group S, n = 20). Heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PIP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2) values were evaluated at 10 minutes after induction. After the position applied for surgery in the 30.60 and 90th minutes, the Alveolar-arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), arterial to end tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed. RESULTS: In the assessment of groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p > 0.05). Peak inspiratory pressure was higher in Group P. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in Group P. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0. There was no difference in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P. CONCLUSIONS: Suprapubic surgery was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in radical prostatectomy operation.

Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war.

OBJECTIVES: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kirdar Kartal Educating and Training Hospital Burn Centre of Istanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns greater than 15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.

Asymptomatic vallecular cyst: case report.

A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 µg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.

Cisto assintomático em região da valécula: relato de caso / Asymptomatic vallecular cyst: case report / Quiste valecular asintomático: relato de caso

Paciente do sexo masculino, 56 anos, apresentou-se para excisão de glioblastoma intracraniano multiforme. Após ser rotineiramente monitorado, o paciente foi pré-oxigenado. Anestesia e paralisia foram induzidas com propofol (200 mg), fentanil (50 µg) e vecurônio (9 mg). Laringoscopia direta com lâmina Macintosh número 3 revelou um cisto pedunculado de 2x2 cm, que surgia do lado direito da valécula e impedia a intubação endotraqueal. Enquanto o paciente permanecia anestesiado, consultamos rapidamente um otorrinolaringologista e o cisto foi aspirado por uma seringa com agulha de calibre 22G sob laringoscopia direta. Aspiramos 10 cc de líquido. Intubação traqueal foi feita em seguida sem intercorrências com sonda de 9,0 aramada e com balão. Uma opção para a intubação com fibra óptica pode ser a aspiração cuidadosa do cisto para facilitar a intubação.

A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 µg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.

Un paciente del sexo masculino, de 56 años, llegó para una resección de glioblastoma intracraneal multiforme. Posteriormente a la rutina de monitorización, el paciente fue pre-oxigenado. La anestesia y la parálisis se indujeron con propofol (200 mg), fentanilo (50 µg) y vecuronio (9 mg). La laringoscopia directa con lámina 3 Macintosh arrojó un quiste pedunculado de 2x2 cm que surgía al lado derecho de la valécula e impedía la intubación endotraqueal. Mientras el paciente permanecía anestesiado, consultamos rápidamente un otorrinolaringólogo y el quiste fue aspirado por una jeringa con una aguja calibre 22G bajo laringoscopia directa. Aspiramos 10 cc de líquido. La intubación traqueal se hizo enseguida sin intercurrencias con una sonda de 9,0 y un alambre en espiral y con balón. Una opción para la intubación con fibra óptica puede ser la aspiración cuidadosa del quiste para facilitar la intubación.