The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction.

PURPOSE: The aim of this prospective randomised double-blind study is to investigate the effect of magnesium added to local anaesthetics on postoperative VAS scores, total opioid consumption, time to first mobilisation, patient satisfaction and rescue analgesic requirements in arthroscopic ACL reconstruction surgery. METHODS: A total of 107 American Society of Anaesthesiologists physical status grade I and II patients between 18 and 65 years of age who were scheduled to undergo elective anterior crucial ligament (ACL) reconstruction with hamstring autografts were enrolled in the study. The patients were randomly allocated to Groups L (n = 51) and LM (n = 56) using the closed-envelope method. Group LM was administered 19 ml of 0.25% levobupivacaine and 1 ml of 15% magnesium sulphate, while Group L was administered 20 ml of 0.25% levobupivacaine for femoral blockade. General anaesthesia was administered using laryngeal airway masks following neural blockade in both groups. The patients were evaluated for heart rate and mean arterial pressure, oxygen saturation, visual analogue score (VAS), verbal rating scale (VRS), rescue analgesic requirements, total opioid consumption, side effects and time to first mobilisation at the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. RESULTS: There was no statistically significant difference in terms of demographic data, mean arterial pressure, heart rate or oxygen saturation between groups. The area under the curve VAS and VRS scores were lower at 4, 6, 12 and 24 h in Group LM (p = 0.001, p = 0.016, respectively). The rescue analgesic requirement and the total opioid consumption were significantly lower in Group LM (p = 0.015, p = 0.019, respectively). The time to first mobilisation and the Likert score (completely comfortable; quite comfortable; slight discomfort; painful; very painful) were higher, and the block onset time was lower in Group LM (p = 0.014 and p = 0.012, respectively). There was no difference in terms of side effects. CONCLUSIONS: The addition of magnesium to levobupivacaine prolongs the sensory and motor block duration without increasing side effects, enhances the quality of postoperative analgesia and increases patient satisfaction; however, the addition of magnesium delays the time to first mobilisation and decreases rescue analgesic requirements.

Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial.

PURPOSE: To compare hemodynamic effects of two different modes of ventilation (volume-controlled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic gynecology surgeries with exaggerated Trendelenburg position. METHODS: Thirty patients undergoing laparoscopic gynecology operations were ventilated using either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording Analytical Method by radial artery cannulation in addition to peak and mean airway pressures and expired tidal volume. RESULTS: The only remarkable finding was a more stable cardiac index in Group PCVG, where other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while peak airway pressure was lower in Group PCVG. CONCLUSION: PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated Trendelenburg position in laparoscopic surgery.

An Eye-Popping Experience Immediately After Intubation: A Case Report.

This case presents and discusses a case of unilateral proptosis immediately following intubation in a patient who underwent laparoscopic ventral hernia repair under general anesthesia. The patient developed a right-sided proptosis following intubation when noninvasive blood pressure was measured as 167/111 mm Hg. The operation was postponed, and anesthesia was terminated. Proptosis resolved spontaneously following extubation. To the best of our knowledge, there is no case report of proptosis secondary to intubation. The aim of this report is to increase the awareness of rare complications caused by intubation, especially ocular complications, and to underline the importance of preoperative evaluation.

Severe hypertension and tachycardia during transforaminal endoscopic discectomy - Is indigocarmine to blame?

Endoscopic transforaminal discectomy is a minimally invasive technique used for the surgical treatment of herniated discs. Indigocarmine is a dye which is widely used to identify the ureteral orifice in urologic procedures. Hemodynamic effects such as hypotension and anaphylaxis in addition to hypertension, bradycardia and atrioventricular block have been reported in intravenous application of indigocarmine. The aim of this case report is to prepare anesthesiologists for such cases and make them consider invasive blood pressure monitorization. Both patients had radicular pain radiating to the leg and scheduled to undergo transforaminal endoscopic discectomy. Intraoperative vital signs were within normal limits, however severe hypertension and tachyarrhythmia developed following the injection. Hemodynamics in both patients returned to normal following lidocaine and nitroglycerine injection.

Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial.

BACKGROUND/AIMS: To assess the effect of propofol supplemented with alfentanil or fentanyl on cognitive functions for sedation during elective colonoscopy. MATERIALS AND METHODS: Patients (n=150, 18-65 years old, American Society of Anesthesiologists risk group I-III) scheduled undergo elective colonoscopy were included. They were randomized into three groups using the closed envelope methodpropofol-alfentanil (Group A), propofol-fentanyl (Group F), and propofol only (Group P).Group A patients were given an alfentanil (10 mcg/kg)-supplemented propofol bolus infusion and 5 mcg/kg alfentanil when necessary. Group F patients were given fentanyl (1 mcg/kg)-supplemented propofol and 0.5 mcg/kg fentanyl when necessary. Group P patients were given 1 mg/kg propofol and 0.5 mg/kg propofol when necessary. Vital signs, depth of sedation, recovery parameters, and patient and endoscopist satisfaction were recorded. Trieger dot test (TDT) and Digit Symbol Substitution Test (DSST) were performed post procedure. RESULTS: Demographic data were similar among all patients in the groups. Bispectral index values were lower in Group P (p<0.001). DSST scores were higher in Group A (p=0.004). TDT scores and Facial Pain Scale scores were higher in Group P (p<0.005). Apnea incidence (p=0.009) and Observer's Assessment of Alertness/Sedation Scale scores (p=0.002) were also higher in Group P. Patient satisfaction and endoscopist satisfaction were similar among all patients. CONCLUSIONS: Compared with propofol-alfentanil and propofol-fentanyl, propofol alone is associated with an increased incidence of apnea, drug consumption, and reported pain. Propofol-alfentanil has a less negative effect on cognitive functions than propofol alone or propofol-fentanyl.

Use of previously divided latissimus dorsi muscle for bronchopleural fistula.

Management of postpneumonectomy bronchopleural fistula remains a major challenge for thoracic surgeons. Successful closure of a postpneumonectomy bronchopleural fistula was performed in a 60-year-old man, using a flap made by a combination of serratus anterior and latissimus dorsi muscle which had been divided during the pneumonectomy operation. The flap was prepared on the presence of a dependable collateral serratus anterior branch to the lateral thoracic artery, which provides retrograde flow to the latissimus dorsi muscle.

Endobronchial intubation in thoracic surgery: Which side should be preferred?

AIM: This study was undertaken to compare the clinical performance of right versus left double-lumen endotracheal tubes placed without using fiberoptic bronchoscopy in thoracic surgery operations. METHODS: This was a retrospective review of patients who were operated on in our institution between January 2013 and February 2014. We analyzed clinical performance in terms of hypoxia, hypercapnia, and adequate deflation of the lungs with both left- and right-sided double-lumen endotracheal tubes. RESULTS: There were 80 patients with a mean age of 53.74 ± 15.59 years. Right-sided double-lumen tubes were used in 33 patients, and left-sided double-lumen tubes were used in 47. Perioperative hypoxi (p < 0.05), hypercapnia (p < 0.01), and inadequate deflation of the lung (p < 0.001) were found more frequently with the use of right-sided double-lumen endotracheal tubes. Arterial blood gas analyses in the post-anesthesia care unit showed that high pCO2 (>45 mm Hg), low pH (<7.36), and high lactate levels (>4 mmol L(-1)) were more frequent with right-sided double-lumen endotracheal tubes (p < 0.001). The incidence of atelectasis was greater (p < 0.001) and the duration of hospital stay was longer (p = 0.02) with the use of right-sided double-lumen endotracheal tubes. CONCLUSION: Right-sided double-lumen endotracheal tubes resulted in poorer clinical performance. Therefore, a left-sided double-lumen endotracheal tube should be preferred in thoracic surgery operations when an appropriate size of fiberoptic bronchoscope is not available.

The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations.

Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups. The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively.

Ultrasound guided TAP block for the treatment of postoperative prolonged pain - an alternative approach.

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery.

The efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia technique in post-laparoscopic cholecystectomy pain treatment.

OBJECTIVES: Pain treatment in laparoscopic cholecystectomy, which is performed in increasing numbers as an ambulatory procedure, is an important issue.Although laparoscopic cholecystectomy is regarded as an ambulatory procedure, patients are often hospitalized due to pain and this increases opioid consumption and side effects caused by opioids. This study aims at evaluating the efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia (PCA) in postlaparoscopic cholecystectomy pain treatment. METHODS: 40 patients in ASA I-II risk groups aged between 18-65 years were enrolled in the study and were randomized using closed envelope method. In Group TD 600 mg tramadol and 100 mg dexketoprofen trometamol, in Group T 600 mg tramadol was added to 100 ml 0.9% normal saline for PCA. 8 mg lornoxicam iv was given if VAS >40 in the postoperative period. RESULTS: There was no statistically significant difference in terms of adverse effects (hypotension, bradycardia, sedation) but in Group T 4 patients complained of nausea and 3 complained of vomiting. Opioid consumption was lower and patient satisfaction was higher in group TD. CONCLUSION: This study has shown that adding dexketoprofen trometamol to tramadol in patient controlled analgesia following laparoscopic cholecystectomy lowers VAS scores, increases patient satisfaction and decreases opioid consumption.

Oropharyngeal angioneurotic edema due to recombinant tissue plasminogen activator following massive pulmonary thromboembolism.

Although hypersensitivity reactions secondary to recombinant tissue plasminogen activator (rtPA) are rarely encountered, they may have important consequences. In this case presentation, oropharyngeal angioneurotic edema due to rtPA following pulmonary thromboembolism is presented. On the 4th hour of initiation of treatment, throat pain, laryngeal stridor and expansive edema in the neck ensued, upon which the patient was intubated and mechanically ventilated. The patient was extubated after her findings showed a remission on the 48th hour of his inotropic, antihistaminic and intravenous corticosteroid therapy.

Severe hypertension and tachycardia during transforaminal endoscopic discectomy - Is indigocarmine to blame? / Hipertensión severa y taquicardia durante la discectomía endoscópica transforaminal: ¿se puede culpar a la indigocarmina?

Endoscopic transforaminal discectomy is a minimally invasive technique used for the surgical treatment of herniated discs. Indigocarmine is a dye which is widely used to identify the ureteral orifice in urologic procedures. Hemodynamic effects such as hypotension and anaphylaxis in addition to hypertension, bradycardia and atrioventricular block have been reported in intravenous application of indigocarmine. The aim of this case report is to prepare anesthesiologists for such cases and make them consider invasive blood pressure monitorization. Both patients had radicular pain radiating to the leg and scheduled to undergo transforaminal endoscopic discectomy. Intraoperative vital signs were within normal limits, however severe hypertension and tachyarrhythmia developed following the injection. Hemodynamics in both patients returned to normal following lidocaine and nitroglycerine injection

La discectomía endoscópica transforaminal es una técnica mínimamente invasiva utilizada para el tratamiento quirúrgico de discos herniados. Indigocarmine es un tinte que se usa ampliamente para identificar el orificio ureteral en procedimientos urológicos. Se han informado efectos hemodinámicos como hipotensión y anafilaxia además de hipertensión, bradicardia y bloqueo auriculoventricular en la aplicación intravenosa de indigocarmina. El objetivo de este informe de caso es preparar a los anestesiólogos para tales casos y hacer que consideren la monitorización invasiva de la presión sanguínea. Ambos pacientes tenían dolor radicular que irradiaba a la pierna y se programaron para recibir una discectomía endoscópica transforaminal. Los signos vitales intraoperatorios se encontraron dentro de los límites normales, sin embargo, la hipertensión severa y la taquiarritmia se desarrollaron después de la inyección. La hemodinámica en ambos pacientes volvió a la normalidad después de la inyección de lidocaína y nitroglicerina