Effects of sevoflurane or ketamine on the QTc interval during electroconvulsive therapy.

PURPOSE: To evaluate the effect of sevoflurane or ketamine on the corrected QT (QTc) interval and the interval from the peak to the end of the T wave (Tp-e) during electroconvulsive therapy (ECT) in patients with major depression. METHODS: This prospective, randomized, double-blinded study included 24 patients that were randomly allocated to receive sevoflurane (group S) or ketamine (group K) for ECT session. Group S patients received 8 % sevoflurane for anesthesia induction, which was maintained at 2-4 % until delivery of the electrical stimulus. Group K patients received a bolus of ketamine (1 mg/kg). The mean arterial pressure (MAP) and heart rate (HR) and the electrocardiogram (ECG) were recorded before (T1) and after induction of anesthesia (T2) and 0, 1, 3, and 10 min after the electrical stimuli ended (T3, T4, T5, and T6, respectively). RESULTS: In both groups, the QTc interval was significantly longer at T2, T4, T5, and T6 than at baseline. The QTc interval was longer at T4, T5, and T6 in group S compared to that in group K, the Tp-e interval was significantly longer at T4 in group K both baseline and group S. The HR in group S was increased at T4 compared with group K. MAP was significantly higher after induction of anesthesia in group K compared to those in group S at all time points. CONCLUSIONS: Although group S showed a prolonged QTc interval after ECT compared to group K, the Tp-e interval in both groups was not significantly affected clinically. Sevoflurane blunted MAP and peak HR.

The effects of dexmedetomidine on liver ischemia-reperfusion injury in rats.

BACKGROUND: Ischemia-reperfusion (IR) injury of the liver may cause various types of damage to hepatic tissues. It can affect the prognosis of patients and the success of an operation. Dexmedetomidine is a selective α2 receptor agonist. We investigated whether dexmedetomidine provides protection against IR-induced liver injury in rats. METHODS: Forty rats were divided equally into four groups. In group 1, the liver was manipulated after the laparotomy, and no occlusion of the vessels of the liver was performed. In group 2, once the abdomen was opened, 60 min of ischemia and 60 min of reperfusion were applied according to the segmental hepatic ischemia model. In group 3, 10 µg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. In group 4, 100 µg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. Further procedures in groups 3 and 4 were the same as those of group 2. After the experiment was completed, the rats were killed. Liver tissues were removed and stored until biochemical and histologic assessments were performed. RESULTS: The malondialdehyde level in group 2 was higher than that of groups 1, 3, and 4 (P = 0.001, P = 0.000, and P = 0.000, respectively). Superoxide dismutase, catalase, and glutathione levels in group 2 were lower than those in group 1 (P = 0.001, P = 0.027, and P = 0.014, respectively). Superoxide dismutase and catalase levels in group 4 were higher than those in group 2 (P = 0.002 and P = 0.000, respectively). GSH levels in groups 3 and 4 were higher than those in group 2 (P = 0.049 and P = 0.006, respectively). A lower glutathione peroxidase level was detected in groups 2 and 3 than that in group 1 (P = 000). Group 4 demonstrated an increase in glutathione peroxidase levels compared with group 3 (P = 0.014). The histologic injury scores in groups 2-4 were higher than those in group 1 (P = 0.003, P = 0.002, and P = 0.001, respectively). However, the histologic injury scores were lower in groups 3 and 4 than those in group 2 (P = 0.003 and P = 0.002, respectively). CONCLUSIONS: This study showed that dexmedetomidine may protect the liver against IR injury in rats.

Dexmedetomidine ameliorates TNBS-induced colitis by inducing immunomodulator effect.

BACKGROUND: Since sedatives are often administered to immune-compromised and critically ill patients, our understanding of immunomodulation by sedation will be critical. Dexmedetomidine, a selective α2-adrenergic receptor agonist, is often used for sedation and analgesia especially in intensive care units. There are conflicting and little data concerning both the effect and the mechanism of dexmedetomidine on immune response. In our study, we aimed to investigate the effect of dexmedetomidine on immune system at two different doses (5 µg.kg(-1) and 30 µg.kg(-1)) during inflammatory bowel disease by using an experimental model, which resembles both systemic and local inflammation. METHODS: The effect of dexmedetomidine on the course of inflammatory bowel disease was investigated by measuring macroscopic and microscopic parameters. We investigated pro-inflammatory Th1, Th2, and Th17 cytokine levels in serum samples to analyze systemic immune response. Following this, local immune response was investigated by measuring cytokine levels in the presence of dexmedetomidine in spleen cell culture. RESULTS: Dexmedetomidine administration led to amelioration of all disease associated pathological manifestations. According to our in vitro and in vivo results, dexmedetomidine shows anti-inflammatory effect by increasing IL-4 and IL-10 levels responsible from anti-inflammatory response via Th2 pathway. Moreover, we showed for the first time in the study that dexmedetomidine administration reduces IL-23, which is responsible from initiation of inflammatory response via Th17 pathway. CONCLUSIONS: Dexmedetomidine can have beneficial effect on preoperative or postoperative inflammatory bowel disease patients in intensive care units by down-regulating inflammatory immune response not only in systemic circulation but also in tissue-specific manner.

The effects of secondhand smoke on postoperative pain and fentanyl consumption.

BACKGROUND: Although the need for increased postoperative analgesia in smokers has been described, the effect of secondhand smoke on postoperative analgesia requirements has not been studied. We examined the effects of secondhand smoke on fentanyl consumption and postoperative pain. METHODS: In this study, 101 patients (American Society of Anesthesiology physical status I and II) who underwent abdominal hysterectomy were divided into 3 groups according to history of exposure to cigarette smoke as per medical records which was retrospectively confirmed by measurement of serum cotinine: smokers (n = 28), nonsmokers (n = 31), and secondhand smokers (n = 32). All patients received propofol-remifentanil total intravenous anesthesia and used fentanyl patient controlled analgesia for postoperative pain. The fentanyl consumption visual analogue scale-pain intensity (VAS-PI) score and side effects were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 h after surgery. RESULTS: Fentanyl consumption at all the evaluation time points was significantly higher in secondhand smokers than in nonsmokers (P < 0.05). However, fentanyl consumption in secondhand smokers was lower than that in smokers in the PACU and at 24 h (P < 0.05). VAS-PI scores during movement and at rest in the PACU and at 4, 6, and 24 h after surgery were higher in secondhand smokers than in nonsmokers (P < 0.05). There were no statistically significant differences between the groups with regard to side effects such as nausea, vomiting, and dizziness (P > 0.05). CONCLUSION: Secondhand smoking was associated with increased postoperative fentanyl consumption, and increased VAS-PI scores. These findings may be beneficial for managing postoperative pain in secondhand smokers.

Effects of perineural administration of dexmedetomidine in combination with levobupivacaine in a rat sciatic nerve block.

OBJECTIVE: The aim of this study was to assess if perineural administration of dexmedetomidine combined with levobupivacaine increases the duration of the sensory and motor blockade of a sciatic peripheral nerve block in rats. METHODS: Forty male Sprague-Dawley rats were randomly divided into 5 experimental groups: Group 1, sham; Group 2, perineural levobupivacaine (0.2 mL of a 0.5% solution) and subcutaneous saline; Group 3, perineural levobupivacaine (0.2 mL of a 0.5% solution) plus dexmedetomidine (20 µg/kg dexmedetomidine) and subcutaneous saline; Group 4, perineural saline and subcutaneous dexmedetomidine; and Group 5, perineural saline and subcutaneous saline. Pain reflexes in response to a thermal stimulus were measured at 0 and 240 minutes after drug administration by using a hot-plate and tail-flick tests. Neurobehavioral status, including sensory and motor functions, was assessed by an investigator who was blinded to the experimental groups every 30 minutes until normal functioning resumed. RESULTS: The sensory and motor blockades of the rats did not increase in the treatment with dexmedetomidine plus levobupivacaine when compared with the treatment with levobupivacaine alone at all the time points (P > 0.05). Compared with rats in Group 2, those in Group 3 showed significantly higher latency times at 30 and 60 minutes in the hot plate test (P < 0.01). At 30 and 60 minutes, the latency times of the rats in Group 3 were longer than those in Group 2 in the tail-flick test (P < 0.01). Furthermore, the durations of the complete sensory and motor blockade were similar when treatment with levobupivacaine plus dexmedetomidine was compared with treatment with levobupivacaine alone. CONCLUSIONS: A 20µg/kg dose of dexmedetomidine added to levobupivacaine did not increase the duration of the sensory and motor blockades in rats. However, treatment with dexmedetomidine plus levobupivacaine increased the quality of analgesia in rats.

The effects of cognitive impairment on anaesthetic requirement in the elderly.

CONTEXT: Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls. OBJECTIVES: The primary aim was to compare the BIS and the dose of propofol required for induction in patients suffering from cognitive impairment with that in those who had normal cognitive function. This study also evaluated the effects of cognitive impairment in the elderly on anaesthetic agent consumption during surgery and on emergence from anaesthesia. DESIGN AND SETTING: This randomised controlled study was carried out in a university hospital. Patients over 65 years of age, ASA I-II and scheduled for elective orthopaedic procedures were allocated to one of two groups. INTERVENTIONS: Patients (n = 92) were allocated according to their Mini Mental State Examination score: 25 or higher (group 1) or 21 or less (group 2). All patients received propofol 0.5 mg kg(-1) following the commencement of a remifentanil infusion at 0.5 µg kg(-1) min(-1). After incremental doses of propofol up to loss of consciousness, a propofol infusion was started at 75 µg kg(-1) min(-1). Propofol and remifentanil infusion doses were adjusted to keep the BIS value between 45 and 60 during surgery. MAIN OUTCOME MEASURE: MMSE score was evaluated 24 h before and after surgery. The anaesthetic consumption, mean arterial pressure, HR and BIS values of the patients were recorded. RESULTS: Before surgery, mean Mini Mental State Examination scores were 26.8 ± 1.6 and 16.6 ± 4.2 in group 1 and 2, respectively. These returned to baseline value 24 h after surgery in group 1 (26.6 ± 1.5) and group 2 (15.6 ± 4.3). Before induction, four of 45 patients (8.9%) in group 1 had a BIS value less than 93 compared with 13 of 47 (27.7%) in group 2 (P = 0.02). The mean BIS value was significantly lower in group 2 than in group 1 before induction, during loss of consciousness, 3 and 5 min after discontinuation of the anaesthetic agents and before extubation (P < 0.05). The induction dose of propofol was lower in group 2 than in group 1 (P = 0.02). The eye opening time was significantly longer in group 2 than in group 1 (P = 0.03). CONCLUSION: The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment.

Effects of propofol or etomidate on QT interval during electroconvulsive therapy.

BACKGROUND: Because patients with major depression have an altered autonomic nervous system activity, the risk of arrhythmias and sudden cardiac death may be increased. In addition, electroconvulsive therapy (ECT) may cause an acute rise in QT dispersion, which may predispose to arrhythmias. In this study, we investigated the effects of propofol or etomidate on the corrected QT (QTc) interval during ECT in patients with major depression. MATERIALS AND METHODS: Fourteen unpremedicated American Society of Anesthesiologists I patients, each scheduled for 6 ECT sessions for major depression, were included in a prospective, randomized crossover study. The patients randomly received either 1-mg/kg propofol (propofol group) or 0.2-mg/kg etomidate (etomidate group). The mean arterial pressure (MAP), heart rate (HR), and electrocardiogram were recorded before anesthetic induction, 0 and 1 minute after the seizure ended, and 3 and 10 minutes after the seizure ended (T3 and T4, respectively). RESULTS: In the propofol group, the QTc interval was shorter than the baseline at 0 minute after the seizure ended. The QTc interval increased from the baseline at T3 and T4 in the etomidate group. In the etomidate group, the QTc interval was longer at T3 and T4 than that in the propofol group (P < 0.05). In the etomidate group, the HR increased at T3 and T4, but the MAP increased at all measurement times from the baseline value. The HR and the MAP were lower at T3 and T4 in the propofol group than in the etomidate group (P < 0.05). CONCLUSIONS: Propofol did not induce prolongation of the QT interval and controlled the hemodynamic response better than etomidate during ECT. Therefore, propofol may be more suitable than etomidate for ECT treatments.

Gender-Role Attitudes Mediate the Effects of Adult ADHD on Marriage and Relationships.

OBJECTIVE: Adult ADHD has dramatic impacts on various aspects of life and relationships. This study investigates how "gender roles" mediate the effects of ADHD on marriage. METHOD: Sixty-two heterosexual couples were included in the study. The Marital Impact Checklist is used to assess the effects of ADHD on marriage. The Gender Roles Attitude Scale is used to measure gender roles in both the patient and the spouse. RESULTS: The Turkish version of the Marital Impact Checklist is found to have good internal consistency and utility in research and clinical work with ADHD couples. The female non-ADHD partners reported feeling of "Unloved" and "Negative Impact" more than their male counterparts. Some subdomains of the gender roles of both the patient and their non-ADHD spouse seem to mediate the effect of adult ADHD's impact on marriage. CONCLUSION: Sex and gender roles diversify how ADHD affects marriage.

Propofol and erythropoietin antioxidant properties in rat brain injured tissue.

So far, several treatment modalities have been attempted to brain protection in cases such as brain trauma, stroke or brain hemorrhage. However, a treatment method that the effect begins immediately and definitely helpful has not been discovered yet. In this study, we aimed to compare the effects of propofol and erythropoietin (Epo) on brain injury caused by oxidative stress and antioxidant properties of these agents after closed head injury (CHI) in rats. For this study, female Wistar Albino rats were divided into five groups: non-traumatic control group, trauma performed group CHI, trauma with propofol (100 mg/kg) intraperitoneally (i.p.), trauma with Epo (5000 U/kg) i.p. and trauma with propofol and Epo performed study groups. Twenty-four hours after CHI, rats were sacrificed and the brains were removed. Superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) levels were measured in brain tissue. MDA and NO levels were decreased significantly in Groups Epo, Propofol and Epo+Propofol than Group CHI (p<0.01). XO activity was significantly lower in Group Epo than Group CHI (p<0.05). Epo and propofol decreased oxidative stress by decreasing MDA and NO level in brain tissue after CHI. However, combination of Epo and propofol has no significant beneficial advantage than Epo or propofol alone.

Role of oxidative and antioxidative parameters in etiopathogenesis and prognosis of panic disorder.

Free radicals have been implicated in some psychiatric disorders. This study aimed to investigate the role of oxidative and antioxidative parameters in etiopathogenesis and prognosis of panic disorder (PD), using novel methods for measurement of total oxidant and antioxidant statuses. Nineteen PD patients and 40 healthy subjects were recruited. Both total antioxidant status and oxidative stress index, and ceruloplasmin levels of PD patients were significantly higher in PD patients. Total oxidant status and oxidative stress index decreased after treatment. This study suggests an oxidative imbalance in PD and treatment can reverse overall oxidative imbalance.

An open-label long-term naturalistic study of mirtazapine treatment for depression in cancer patients.

BACKGROUND: Depression is quite common among cancer patients. It has yet to be determined which antidepressant is the most effective in cancer patients with depression. METHODS: The present study included 21 consecutive depressed oncology patients of whom 19 were followed up for 6 months. All patients initially received mirtazapine 15 mg/day and the dose was increased in the absence of significant treatment response and adverse effects. RESULTS: Depressive symptoms diminished at the end of month 1 and this improvement was maintained for the remaining 23 weeks of the study. Mean 17-item Hamilton Rating Scale for Depression (HAM-D-17) scores fell significantly from 21.4 +/- 4.9 at baseline to 6.5 +/- 3.2 at the end of the first month of treatment (p < 0.001). Among the 19 patients who were followed up, five reported at least one adverse effect during treatment; however, the vast majority of these adverse effects were described as mild to moderate. CONCLUSION: This prospective, open-label study provides preliminary evidence regarding the efficacy, safety and tolerability of mirtazapine treatment in cancer patients with depression. Relatively low doses of mirtazapine appeared to be safe and effective for treating cancer patients undergoing radiotherapy and/or chemotherapy, and the reduction in the severity of depressive symptoms was maintained until the end of the 24-week treatment period.

[Reliability and validity of the Turkish version of the internalized stigma of mental illness scale]. / Ruhsal Hastaliklarda Içsellestirilmis Damgalanma Olçegi Türkçe Formu'nun Güvenilirlik ve Geçerlik Calismasi.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Internalized Stigma of Mental Illness Scale (ISMI) in patients with psychiatric disorders. METHOD: The study included 203 patients diagnosed with various psychiatric disorders in a psychiatry outpatient clinic of a university hospital. The reliability of the scale was assessed by investigation of its internal consistency and split-half reliability. The convergent validity of the scale was demonstrated by the relationship between the Turkish form of the ISMI and various criteria scales. RESULTS: Cronbach's alpha value was 0.93 for the entire scale and ranged between 0.63 and 0.87 for the 5 subscales of the ISMI. In terms of convergent validity, the total score of the Turkish ISMI significantly correlated with the Beck Depression Inventory, Rosenberg Self-Esteem Scale, Sociotropy-Autonomy Scale, Brief Symptom Inventory, Multidimensional Scale of Perceived Social Support, Clinical Global Impression Scale, and Global Assessment of Functioning Scale scores. All values were in the expected direction. CONCLUSION: In the light of the findings, it was concluded that the Turkish version of ISMI could be used as a reliable and valid tool in assessing internalized stigma of the Turkish psychiatric patients.

Blood glucose regulation during living-donor liver transplant surgery.

OBJECTIVES: The goal of this study was to compare the effects of 2 different regimens on blood glucose levels of living-donor liver transplant. MATERIALS AND METHODS: The study participants were randomly allocated to the dextrose in water plus insulin infusion group (group 1, n = 60) or the dextrose in water infusion group (group 2, n = 60) using a sealed envelope technique. Blood glucose levels were measured 3 times during each phase. When the blood glucose level of a patient exceeded the target level, extra insulin was administered via a different intravenous route. The following patient and procedural characteristics were recorded: age, sex, height, weight, body mass index, end-stage liver disease, Model for End-Stage Liver Disease score, total anesthesia time, total surgical time, and number of patients who received an extra bolus of insulin. The following laboratory data were measured pre- and postoperatively: hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ratio, potassium, creatinine, total bilirubin, and albumin. RESULTS: No hypoglycemia was noted. The recipients exhibited statistically significant differences in blood glucose levels during the dissection and neohepatic phases. Blood glucose levels at every time point were significantly different compared with the first dissection time point in group 1. Excluding the first and second anhepatic time points, blood glucose levels were significantly different as compared with the first dissection time point in group 2 (P < .05). CONCLUSIONS: We concluded that dextrose with water infusion alone may be more effective and result in safer blood glucose levels as compared with dextrose with water plus insulin infusion for living-donor liver transplant recipients. Exogenous continuous insulin administration may induce hyperglycemic attacks, especially during the neohepatic phase of living-donor liver transplant surgery. Further prospective studies that include homogeneous patient subgroups and diabetic recipients are needed to support the use of dextrose plus water infusion without insulin.

Effects of polyenylphosphatidylcholine on cytokines, nitrite/nitrate levels, antioxidant activity and lipid peroxidation in rats with sepsis.

OBJECTIVES: To determine the effect of pretreatment with polyenylphosphatidylcholine (lecithin, PPC) on plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, total nitrite/nitrate (NOx), and tissue levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in septic rats. DESIGN: Prospective, randomized, controlled animal study. SETTING: University laboratory. SUBJECTS: Forty-five Spraque-Dawley rats were divided into three groups: group C, sham-operated; group S, sepsis; and group P, sepsis pretreated with PPC. INTERVENTIONS: Rats were made septic by cecal ligation and puncture (CLP). Group P rats were treated with PPC (100 mg/day orally) for 10 days before sepsis. Twenty-four hours later CLP, plasma concentrations of TNF-alpha, IL-6 and IL-10 and plasma levels of NOx were measured. SOD and MDA were determined in liver, lung and heart homogenates. MEASUREMENTS AND MAIN RESULTS: All rats in group P survived during the 24-h observation time after CLP, whereas survival rate in group S was 66.7% (10/15; P<0.05). PPC significantly reduced plasma levels of TNF-alpha (P=0.006), IL-6 (P=0.007), IL-10 (P=0.016), NOx (P<0.001), and tissue levels of MDA (P<0.001) in group P with respect to in group S. Tissue levels of SOD significantly increased in group P when compared with group S (P<0.001). CONCLUSIONS: These results show that PPC pretreatment exerts cumulative effects in decreasing the levels of cytokines, NOx, and tissue MDA concentrations, with a concomitant increase in survival in septic rats. Lecithin therapy may be a useful adjuvant therapy in controlling of the excessive production of the inflammatory cytokines in patients with severe sepsis. DESCRIPTOR: SIRS/sepsis, experimental studies.

Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse.

AIM: To investigate the anatomical relationships of the structures and the topographic anatomy of the sacrospinous ligament and validate current anatomic knowledge of this area. MATERIALS: Nine embalmed half female cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament. RESULTS: The average length of the sacrospinous ligament was measured to be 43.04 +/- 6.58 mm. The inferior gluteal complex emerges from the infrapiriform foramen at a distance of 17.02 +/- 3.08 mm from the ischial spine and courses to inferior-laterally with a slight curve. During this course, it passes close to the upper-lateral half of the sacrospinous ligament. The pudendal complex passes above the spine in six of the nine cases (66.6%) and lies maximum of 5.5 mm medial to the spine. On average the sciatic nerve is measured to be 25.14 +/- 3.94 mm lateral to the ischial spine. CONCLUSION: Placing the suture inferomedially and close to sacrum, the risk of complication will be minimal.

Important anatomical structures used in paravaginal defect repair: cadaveric study.

OBJECTIVE: To examine the variations and the anatomical characteristics of the tendinous arch of pelvic fascia (TAPF), the tendinous arch of levator ani (TALA) and the obturator fascia (Ofa) that are important structures in paravaginal defect repair and their relations with important neurovascular structures. STUDY DESIGN: We carried our study on 10 pelvic halves of five female cadavers fixed in 10% formaldehyde. RESULTS: TALA could show a very high location or a low location near to inferior edge of obturator internus. TAPF was not observed in four of the cases. It was examined as a quite weak structure in two of the cases. The location of obturator vessel-nerve bundle could show difference. Obturator artery (OA) and vein sometimes do not course parallel to obturator vein (OV) and make an inclination and extend to the obturator foramen (OF). The distance between TAPF and the pectineal ligament (PL) (Cooper ligament) was measured as 5 cm on average. The distance between TAPF and the entrance of obturator canal was measured as 3.2 cm on average. While the distance of pudendal vessel-nerve bundle from levator ani (LA) at the anterior border of the spine was 0 mm, 2 cm anteriorly it was measured as 4.4 mm on average. CONCLUSION: Since TAPF does not develop in every case, it is not a safe structure to be used in surgery. If TALA develop downward as a variation, it could be difficult to distinguish from TAPF. Since the obturator fascia is a thin membrane, it is not a strong structure for suture placement. The region that is 2 cm in front of the ischial spine (IS) is a dangerous zone for pudendal vessel-nerve bundle.

Microscopic anatomy of the infraorbital canal, nerve, and foramen.

OBJECTIVE: We performed this study to investigate the morphologic and topographic anatomy, and variations of the infraorbital canal (IOC), infraorbital nerve (ION), and infraorbital foramen (IOF). STUDY DESIGN AND SETTING: This study was performed at the Anatomy Department of Ankara University School of Medicine between 1999 and 2000. The morphometry of these anatomic areas on cadaver heads were studied microscopically. The morphologic and topograpic anatomies of IOC, ION, and IOF were carried out microscopically with x 25 to x 40 magnification on 10 cadaver heads (20 sides). RESULTS: We found the shape of the IOF as oval in 30% (6 sides), round in 40% (8 sides), and semilunar in 30% (6 sides) of the cadaver heads. We detected the IOF as single in 90% (18 sides), double in 5% (1 side), and triple in 5% (1 side) of the cases. We determined a complete roof (we called it as "canal") in 50% of cases and groove plus canal in 50% of the heads. The mediolateral relationship of the vessels to the nerve while emerging from the IOF was investigated, and the artery was always found in a mediosuperior position and the vein was inferior to it. In all specimens, the ION was found to be consisting of 3 to 8 fascicles interwoven with the artery and the vein in the loose connective tissue sheath. CONCLUSION: A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon while performing maxillofacial surgery and regional block anesthesia. Anatomic variations on this area may take place and a surgeon must take this into consideration so as to increase the surgical success.

Postoperative cognitive dysfunction in living liver transplant donors.

OBJECTIVES: Postoperative cognitive dysfunction is a serious complication that may be associated with increased mortality. Living-donor liver transplant includes major surgery for the donor. The purpose of this study was to evaluate preoperative and postoperative cognitive function of liver donors in living-donor liver transplant. MATERIALS AND METHODS: In 102 patients who had hepatectomy for liver transplant donation, preoperative and postoperative (1 week) neuropsychologic tests were performed including the Trail Making Test, the Stroop effect, score on the Beck Depression Inventory, and the mini-mental state examination. RESULTS: Liver transplant donors had significantly lower mean Trail Making A Test duration and greater mean Trail Making B Test error number after than before surgery. The mean Stroop effect reading durations (black and white reading; reading colored words) were significantly greater after than before surgery; the mean time difference between naming the colors of colored words minus reading colored words, and the error number, were smaller after than before surgery. The mean score on the Beck Depression Inventory and mini-mental state examination score were similar before and after surgery. CONCLUSIONS: Mild frontal lobe dysfunction may be present in liver donors at 1 week after surgery, and postoperative attention problems may be experienced by these patients.

Anesthesia management in a child with osteogenesis imperfecta and epidural hemorrhage.

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems.

Anesthesia management in a child with osteogenesis imperfecta and epidural hemorrhage.

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems.