The most practical diagnostic imaging for detecting body packers during the drug trafficking: Ultrasonography.

INTRODUCTION: Body packing is one of the most common methods used in the transboundary trafficking of illicit drugs. These drugs are packaged in capsules and taken orally or inserted into the rectum or vagina. Its diagnosis is, therefore, difficult. Methods like x-ray, ultrasonography, and computed tomography (CT) are usually used to diagnose body packers. This study aimed to evaluate the diagnostic power and feasibility of ultrasonography as a diagnostic tool in patients who have a suspicion of being body packers. METHODS: This study is designed as a prospective and single-centered case-control study in the emergency department of a training and research hospital. Cases admitted to the emergency department with suspicion of being a body packer were included in the study. The data obtained was recorded on the study form. p < 0.05 was accepted as statistically significant. RESULTS: One hundred and one patients were included in the study; 76.2% (n = 77) were male. Packages were detected in 56.5% (n = 57) of the cases. Ultrasonography was found to be significantly useful in evaluating the presence of intra-abdominal packages. Ultrasonography had 92.4% sensitivity and 97.8% specificity in evaluating the presence of packs. CONCLUSION: CT is frequently used to diagnose patients admitted to the emergency departments with suspected body packing. In our study, ultrasonography is an advantageous imaging method, given its success rate, radiation-free nature, and low cost. We have found ultrasonography to be a successful imaging modality in examining patients suspected of being body packers for the presence of packs, and it can replace CT in clinics.

Two Cases of Severe Amanita Muscaria Poisoning Including a Fatality.

Ingestion of Amanita muscaria mushrooms results in transient central nervous system excitation and depression mediated by its components, ibotenic acid and muscimol. The mushroom is distributed worldwide and ingestions occur with some frequency. Although these ingestions have traditionally been considered benign, serious complications can occur. We present 2 cases of serious toxicity, including a fatality. The first case was a 44-y-old man who presented to the emergency department (ED) after cardiopulmonary arrest approximately 10 h after ingesting 4 to 5 dried A muscaria mushroom caps, which he used for their mind-altering effects. Despite successful resuscitation, he remained unresponsive and hypotensive and died 9 days later. The second case was a 75-y-old man who presented to the ED after accidentally consuming one large A muscaria mushroom cap he foraged in Eastern Turkey. The patient initially presented to the ED with hallucinations followed by lethargy, and he was intubated for airway protection. The patient's condition gradually improved, and he made a full recovery. A muscaria ingestion should not be considered benign as serious outcomes do occur. An understanding of how the main neuroactive chemicals, ibotenic acid and muscimol, affect the brain can help anticipate outcomes. Several high-risk features that portend a more serious course are identified.

How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons.

BACKGROUND: There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. METHODS: A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants "patient age" and "endocarditis prophylaxis" and vignette 2 with determinants "anxiety" and "bisphosphonate therapy". Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. RESULTS: A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. "Patient age" and "patient anxiety" were not significantly associated with any therapy decision. However, required "endocarditis prophylaxis" led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. "Bisphosphonate therapy" was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. CONCLUSION: "Patient age" as well as "patient anxiety" appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

Human Zinc Phosphide Exposure in Lebanon: A Case Report and Review of the Literature.

INTRODUCTION: Toxicity from rodenticides such as metal phosphides is common worldwide, particularly in developing countries where consumers have access to unlabeled and uncontrolled insecticides and pesticides. CASE REPORT: We present the first documentation of a metal phosphide exposure in Lebanon. A middle-aged woman presented to the emergency department following the ingestion of an unknown rodenticide. Spectroscopy analysis of the sample brought by the patient was used and helped identify zinc phosphide. The patient developed mild gastrointestinal symptoms and was admitted to the intensive care unit for observation without further complications. REVIEW: We subsequently conducted a literature review to understand the diagnosis, pathophysiology, clinical presentation, and management of metal phosphide toxicity. Multiple searches were conducted on MEDLINE and PubMed, and articles related to the topics under discussion were included in the review. Metal phosphide is associated with significant morbidity and mortality involving all body systems. Patients presenting with metal phosphide intoxication need extensive workup including blood testing, electrocardiogram, and chest radiography. To date there is no antidote for metal phosphide toxicity, and management is mostly supportive. Many treatment modalities have been investigated to improve outcomes in patients presenting with metal phosphide toxicities. CONCLUSION: Emergency physicians and toxicologists in developing countries need to consider zinc and aluminum phosphides on their differential when dealing with unlabeled rodenticide ingestion. Treatment is mostly supportive with close monitoring for sick patients. Further research is needed to better understand metal phosphide toxicity and to develop better treatment options.

Decision-Making in Implantology-A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible.

This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants.

Potential therapeutic effects of ethyl pyruvate and N-acetyl cysteine in an experimental rat model of corrosive esophageal.

BACKGROUND AND STUDY AIMS: Esophageal burns due to ingestion of corrosive substances are frequently seen in both children and adults. However, there is no standard method of treatment to prevent associated mortality and morbidity. Therefore, this study aimed to evaluate the effects of known antioxidants, namely N-acetyl cysteine and ethyl pyruvate, on esophageal damage due to sodium hydroxide-induced corrosive burns. MATERIALS AND METHODS: Thirty-five female rats were randomly assigned to five equal groups. Group 1 was the sham group, while Group 2 was the control group. Group 3 received N-acetyl cysteine, Group 4 received ethyl pyruvate, and Group 5 received both N-acetyl cysteine and ethyl pyruvate. Rats in the "burn" groups were gavage-fed with 0.2mL of 25% NaOH. All esophagi were extracted on day 4 for histopathological evaluation. RESULTS: Total histopathological damage scores were evaluated at the end of the study. Groups 3 and 5 were significantly different from the control group in terms of total histopathological scores (p = 0.001), while no significant difference was seen with Group 4. Stenosis index results in groups 3 and 5 were similar to those seen with total histopathological scores (p = 0.004). CONCLUSION: N-acetyl cysteine, alone or in combination with ethyl pyruvate, may be useful in the treatment of esophageal damage associated with corrosive substances and in achieving histopathological improvement in an experimental setting.

Pre-implantological treatment routines for alveolar ridge atrophy - an investigation among maxillofacial and oral surgeons in southern Germany.

BACKGROUND: It is not well-known which pre-implantological procedures are preferred by maxillofacial (MFS) and oral surgeons (OS) for the narrow atrophic alveolar ridge under practice based conditions and, if different training paths in surgery lead to other pre-implantological techniques being preferred. This study aims to identify which procedures are preferred by the respective specialists in which indication. METHODS: A questionnaire was sent to a total of 300 MFS and OS in southern Germany. The questionnaire examined pre-implantological procedures (bone block, bone grafting material and/or particulate autogenous bone, titanium mesh, bone split, resection) in the edentulous severely atrophic mandible and in the severely atrophic single-tooth gap. Kendall's Tau-b test was used for statistical analyses. RESULTS: One hundred seventeen participants returned the questionnaire. 68 (58%) were OS and 49 (42%) were MFS. In the edentulous mandible, bone substitute material and resection were most preferred by both specialists. Bone blocks were statistically significantly more frequently associated with MFS and bone substitute materials with OS. Bone split was more frequently used in the atrophic single tooth gap than in the edentulous mandible. OS preferred bone blocks in the single tooth gap more often than in the edentulous mandible. MFS and OS preferred resection in the edentulous mandible significantly more frequently than in the single tooth gap. CONCLUSIONS: MFS in general prefer more invasive pre-implantological therapies with the same initial diagnosis than OS, which seems to be attributed to different training paths.

Ischemia-modified albumin and the IMA/albumin ratio in the diagnosis and staging of hemorrhagic shock: A randomized controlled experimental study.

BACKGROUND: To determine the value of ischemia-modified albumin (IMA) and IMA/albumin ratio (IMAR) in the diagnosis and staging of hemorrhagic shock (HS). METHODS: A pressure-targeted HS model was established in this study. The control and shock groups were monitored for 30 min and 60 min to simulate varying durations of exposure to HS. All subjects underwent invasive arterial monitoring during the experiment and were further divided into mild and severe shock groups based on decreases in mean arterial pressure (MAP). Biochemical and histologic comparisons were performed between the groups. RESULTS: Our results revealed higher IMA, IMAR, lactate, total oxidant status (TOS) and oxidative stress index (OSI) levels in both the 30- and 60-min shock groups compared to the control group. Concerning MAP-based shock staging, IMA, IMAR, lactate, TOS and OSI levels in the 30-min and 60-min mild and severe shock groups were higher than those of the controls. However, there was no significant difference between the mild and severe shock groups. A significant correlation was determined between all the biomarkers evaluated and HS-induced damage in various organs. This correlation was highest in lactate and IMAR levels. CONCLUSION: IMA and IMAR levels may be used in the early diagnosis of HS and also have the potential for use in determining the severity of HS. IMA and IMAR measurement may also be considered as an alternative or in addition to lactate measurement in the diagnosis of HS.

[Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial]. / Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado.

INTRODUCTION: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. MATERIALS AND METHODS: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 and 30 minutes and 1, 2, 6, 12, 24 and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. RESULTS: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p = 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p < 0.01) and 30 (p < 0.01) minutes and 1 (p < 0.01), 2 (p < 0.01), 6 (p < 0.01), 12 (p < 0.01) and 24 (p = 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p = 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p = 0.004). CONCLUSION: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Perioperative analgesic efficacy of bilateral superficial cervical plexus block in patients undergoing thyroidectomy: a randomized controlled trial / Eficácia analgésica perioperatória do bloqueio bilateral do plexo cervical superficial em pacientes submetidos à tireoidectomia: estudo clínico randomizado

Abstract Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p= 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p< 0.01), 30 (p< 0.01) minutes, and 1 (p< 0.01), 2 (p< 0.01), 6 (p< 0.01), 12 (p< 0.01) and 24 (p= 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p= 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p= 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

Resumo Introdução: O bloqueio bilateral do plexo cervical superficial (BPCS) é um método comumente usado para analgesia em tireoidectomia. Avaliamos a eficácia analgésica do bloqueio bilateral do BPCS nos períodos intraoperatório e pós-operatório. Materiais e métodos: Os pacientes (n = 46) submetidos à tireoidectomia foram randomicamente separados em dois grupos para receber anestesia geral (Grupo GA; n = 23) e anestesia geral mais bloqueio bilateral do BPCS (Grupo GS; n = 23). Avaliamos a necessidade de analgésico no intraoperatório (remifentanil) e os escores VAS (Visual Analog Scale) em vários momentos no pós-operatório (após a extubação, aos 15 e 30 minutos e em 1, 2, 6, 12, 24 e 48 horas de pós-operatório). O consumo total de tramadol e paracetamol e a quantidade usada de ondansetrona foram registrados. Resultados: A necessidade de remifentanil no intraoperatório foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,009). Os escores de dor pós-operatória foram significativamente menores no Grupo GS do que no grupo GA aos 15 (p < 0,01) e 30 (p < 0,01) minutos e em 1 (p < 0,01), 2 (p < 0,01), 6 (p < 0,01), 12 (p < 0,01) e 24 (p = 0,03) horas de pós-operatório. A necessidade de tramadol no pós-operatório foi significativamente menor no Grupo GS do que no grupo GA (p = 0,01). O número de pacientes que recebeu ondansetrona foi significativamente menor no Grupo GS do que no Grupo GA (p = 0,004). Conclusão: O bloqueio bilateral do BPCS com bupivacaína a 0,25% reduz a intensidade da dor pós-operatória e a dependência de opioides em pacientes submetidos à tireoidectomia.

Comparison of the diagnostic values of vascular adhesion protein-1 and intestinal fatty acid-binding protein in the diagnosis of acute mesenteric ischemia.

OBJECTIVES: The aim of this study is to compare the diagnostic values of plasma levels of vascular adhesion protein-1 (VAP-1) and intestinal fatty acid-binding protein (I-FABP) for diagnosing acute mesenteric ischemia (AMI). METHODS: The study used a randomized, controlled experimental design. Forty-two female Sprague-Dawley rats were divided into three control groups and three ischemia groups. Plasma VAP-1 and I-FABP levels were measured, and the extent of ischemic damage was determined using a histopathological damage score in terminal ileum tissue samples. RESULTS: In the early phase of AMI (i.e. at the 30-min time point), VAP-1 levels did not differ between the control and ischemia groups (p > 0.05), but I-FABP levels were significantly higher in the ischaemia groups (p = 0.017). Although both VAP-1 and I-FABP levels increased in the ischaemia groups, only VAP-1 levels showed a significant increase compared to the control group at the 2-h time point (p = 0.011). Ischemic damages associated with AMI became the most prominent at the 6-h time point. During this phase, both VAP-1 and I-FABP levels were significantly higher in the ischemia groups than in the control groups (p = 0.007 and p = 0.002, respectively). Both VAP-1 and I-FABP levels showed a significant correlation with ischemic changes, but a higher correlation was observed for VAP-1 levels (r = 0.771). CONCLUSIONS: Both I-FABP and VAP-1 levels were useful for diagnosing AMI, but VAP-1 levels correlated better with the extent of ischaemic damage.

Comparison of Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery.

BACKGROUND: The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)-guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. METHODS: A total of 62 adult patients scheduled for arthroscopic shoulder surgery under general anesthesia were randomized into 2 groups to receive either ISBB (IB group, n = 31) or SCBB (SB group, n = 29) with 20 mL of 0.25% bupivacaine under US guidance. Assessments included postoperative pain scores, additional analgesic requirement, timing of the first analgesic requirement, Quality of Recovery-40 (QoR-40) scores, block characteristics, and side effects. RESULTS: No significant differences were found between the 2 groups for pain scores (P = 0.34), timing of first analgesic requirement (P = 0.30), additional analgesic requirement (P = 0.34), or QoR-40 scores (P = 0.13). The block characteristics regarding procedure time (P = 0.95), block failure, and onset time of sensory blockade (P = 0.33) were similar. Horner's syndrome occurred in 8 patients in the IB group and 1 patient in the SB group (P = 0.015). CONCLUSIONS: This study showed that US-guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.

Successful resuscitation of prolonged cardiac arrest occurring in association with 'skunk' and toluene toxicity.

We report a case of prolonged and successful resuscitation following cardiotoxicity-related arrest occurring after inhaling toluene and Skunk, which is an increasingly popular synthetic cannabinoid (SC). Following presentation to the emergency department because of lethargy, nausea and chest pain, a 28-year-old male user of Skunk and toluene suffered from cardiac arrest due to ventricular fibrillation (VF). Cardiogenic shock, severe metabolic acidosis and regular wide QRS tachycardia were observed in the patient, and he developed VF every 5-10 minutes over the course of 10 hours. The patient responded to prolonged resuscitation and was discharged on 8th day of his admission in a healthy condition. This case report is the first report that cardiac arrest occurring as a result of Skunk and toluene inhalation, which was resolved without sequelae after prolonged resuscitation.

Evaluation of the perfusion index according to the visual analog scale in postoperative patients.

OBJECTIVES: To evaluate the possible value of the perfusion index (PI) as a tool for pain assessment. Methods: This prospective, observational study was performed with 89 patients underwent surgery with general anesthesia. The patients with visual analog scale (VAS) greater than 3 were grouped as M1, and patients with VAS≤3 and performed morphine were grouped as M2. After surgery patients with VAS greater than 3 were given 2mg morphine. Patients with VAS greater than 3 were given increments of intravenous morphine (2 mg) at 20 minute intervals until VAS less than 3. The correlation and difference between PI and VAS score values were evaluated before and after analgesic administration. Results: Significant changes were found in both PI values and VAS scores between M1 and M2 groups (2.80±0.77, 3.97±0.94, p less than 0.001; 6.60±1.20, 2.74±0.46, p less than 0.001) Despite no correlation was found between PI values and VAS scores of M1 and M2 groups, weak negative correlation was detected between differences in PI values and VAS scores among groups (r=-0.255, p=0.016). Conclusion: Perfusion index is a parameter that can be used in the assessment of postoperative pain and responses to analgesics.

The effect of patient positions on perfusion index.

BACKGROUND: The optimal position for surgery is one in which the patient is provided the best possible surgical intervention and put at minimum risk. Different surgical positions may cause changes in tissue perfusion. This study investigates the relationship between surgical patient positions and perfusion index. METHODS: A sample of 61 healthy individuals with no peripheral circulatory disorders, chronic diseases, or anemia was included in this study. Participants held six different positions: supine, prone, 45-degree sitting-supine, 45-degree supine with legs lifted, Trendelenburg (45-degrees head down), and reverse Trendelenburg (45-degrees head up). Perfusion index values were then measured and recorded after individuals held their positions for five minutes. RESULTS: Participants' perfusion index values were affected by different body positions (p < 0.05). Perfusion index was lowest in the sitting position (4.5 ± 2.5) and highest in individuals with Trendelenburg position (7.8 ± 3.8). CONCLUSION: Different body positions can cause changes in tissue perfusion. This should be considered in patient follow-up along with the perfusion index.

Antivenom use in bite and sting cases presenting to a public hospital.

BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases. METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis. RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital's emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite the absence of systemic or local indications (p<0.0001, χ2=80.595). CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was not indicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be made aware of the updated guidelines and references to raise their knowledge levels.

Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication.

OBJECTIVES: The purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. The pilot data acquired from this study was analysed in National Forensic Service, Daejeon Institute, South Korea and first results were published as a preliminary study. PATIENTS AND METHODS: This descriptive study was conducted at a university hospital emergency department in Turkey. 25 cases diagnosed with mad honey intoxication were obtained the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. GTX 1 and GTX 3 levels from patients' blood, urine and honey consumed were investigated simultaneously using the LC-MS/MS system. RESULTS: Mean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 µg/mL and mean GTX 3 level 0.391 µg/mL. Mean GTX I concentration in honeys consumed was 8.73 µg/gr and mean GTX 3 level 27.60 µg/gr. CONCLUSION: This descriptive study is show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.

The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy: a randomized controlled study / Efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total: um estudo randômico e controlado

Abstract Background and objectives: A transversus abdominis plane block is a peripheral block method that has been used successfully for pain relief after total abdominal hysterectomy. However, the effects of the combination of the transversus abdominis plane block and general anesthesia on analgesic and anesthetic requirements remain unclear. This randomized placebo-controlled study is aimed to evaluate the effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy under general anesthesia. Methods: Sixty-six women undergoing total abdominal hysterectomy were randomized into two groups to receive general anesthesia alone (control group) or with transversus abdominis plane block using 20 mL of 0.25% bupivacaine (transversus abdominis plane group). Intraoperative remifentanil and sevoflurane consumption were recorded. We also evaluated the postoperative pain, nausea, quality of recovery scores and rescue analgesic requirement during postoperative 24 hours. Results: The total remifentanil and sevoflurane consumption is significantly lower in transversus abdominis plane group; respectively mean (SD) 0.130 (0.25) vs. 0.094 (0.02) mcg.kg-1.min-1; p < 0.01 and 0.295 (0.05) vs. 0.243 (0.06) mL.min-1; p < 0.01. In the postoperative period, pain scores were significantly reduced in transversus abdominis plane group soon after surgery; median (range) 6 (2-10) vs. 3 (0-5); p < 0.001, at 2 h (5 [3-9] vs. 2.5 [0-6]; p < 0.001), at 6 h (4 [2-7] vs. 3[0-6], p < 0.001), at 12 h (3.5 [1-6] vs. 2 [1-5]; p = 0.003). The patients in the transversus abdominis plane group had significantly higher QoR-40 scores 190.5 (175-197) vs. 176.5 (141-187); p < 0.001). Conclusion: Combining transversus abdominis plane block with general anesthesia can provide reduced opioid and anesthetic consumption and can improve postoperative pain and quality of recovery scores in patients undergoing total abdominal hysterectomy.

Resumo Justificativa e objetivos: O bloqueio do plano transverso abdominal é um método de bloqueio periférico que tem sido usado com sucesso para alívio da dor após histerectomia abdominal total. No entanto, os efeitos da combinação do bloqueio do plano transverso abdominal e da anestesia geral sobre a necessidade de analgésico e anestésico ainda não estão claros. Este estudo randômico e controlado com placebo tem como objetivo avaliar os efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total sob anestesia geral. Métodos: Foram randomizadas em dois grupos 66 mulheres submetidas à histerectomia abdominal total para receber apenas anestesia geral (grupo controle) ou associada a bloqueio do plano transverso abdominal com 20 mL de bupivacaína a 0,25% (grupo plano transverso abdominal). O consumo de remifentanil e sevoflurano no período intraoperatório foi registrado. Também avaliamos a dor pós-cirurgia, náusea, qualidade dos escores de recuperação e necessidade de analgésico de resgate durante as 24 horas de pós-operatório. Resultados: O consumo total de remifentanil e sevoflurano foi significativamente menor no grupo plano transverso abdominal, respectivamente, média (DP): 0,130 (0,25) vs. 0,094 (0,02) mcg.kg-1.min-1; p < 0,01 e 0,295 (0,05) vs. 0,243 (0,06) mL.min-1; p < 0,01. No pós-operatório, os escores de dor foram significativamente reduzidos no grupo plano transverso abdominal logo após a cirurgia; mediana (intervalo): 6 (2-10) vs. 3 (0-5); p < 0,001, em 2 h (5 [3-9] vs. 2,5 [0-6]; p < 0,001), em 6 h (4 [2-7] vs. 3 [0-6], p < 0,001), em 12 h (3,5 [1-6] vs. 2 [1-5]; p = 0,003). As pacientes do grupo plano transverso abdominal apresentaram escores QoR-40 significativamente maiores: 190,5 (175-197) vs. 176,5 (141-187); p < 0,001). Conclusão: A combinação de bloqueio do plano transverso abdominal e anestesia geral pode proporcionar um consumo reduzido de opioides e anestésicos e melhorar a dor pós-cirúrgica e a qualidade dos escores de recuperação em pacientes submetidas à histerectomia abdominal total.

[The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy: a randomized controlled study]. / Efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total: um estudo randômico e controlado.

BACKGROUND AND OBJECTIVES: A transversus abdominis plane block is a peripheral block method that has been used successfully for pain relief after total abdominal hysterectomy. However, the effects of the combination of the transversus abdominis plane block and general anesthesia on analgesic and anesthetic requirements remain unclear. This randomized placebo-controlled study is aimed to evaluate the effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy under general anesthesia. METHODS: Sixty-six women undergoing total abdominal hysterectomy were randomized into two groups to receive general anesthesia alone (control group) or with transversus abdominis plane block using 20mL of 0.25% bupivacaine (transversus abdominis plane group). Intraoperative remifentanil and sevoflurane consumption were recorded. We also evaluated the postoperative pain, nausea, quality of recovery scores and rescue analgesic requirement during postoperative 24hours. RESULTS: The total remifentanil and sevoflurane consumption is significantly lower in transversus abdominis plane group; respectively mean (SD) 0.130 (0.25) vs. 0.094 (0.02) mcg.kg-1.min-1; p<0.01 and 0.295 (0.05) vs. 0.243 (0.06) mL.min-1; p<0.01. In the postoperative period, pain scores were significantly reduced in transversus abdominis plane group soon after surgery; median (range) 6 (2-10) vs. 3 (0-5); p<0.001, at 2h (5 [3-9] vs. 2.5 [0-6]; p<0.001), at 6h (4 [2-7] vs. 3[0-6], p<0.001), at 12h (3.5 [1-6] vs. 2 [1-5]; p=0.003). The patients in the transversus abdominis plane group had significantly higher QoR-40 scores 190.5 (175-197) vs. 176.5 (141-187); p<0.001). CONCLUSION: Combining transversus abdominis plane block with general anesthesia can provide reduced opioid and anesthetic consumption and can improve postoperative pain and quality of recovery scores in patients undergoing total abdominal hysterectomy.