Can ultrasonographic measurement of carotid intima-media thickness predict hypotension after induction of general anesthesia?

Hypotension in patients under general anesthesia is prevalent and causes unfavorable outcomes. Carotid intima-media thickness (CIMT) is a surrogate marker for atherosclerosis and useful for evaluating the risk of cardiovascular diseases. We investigated the usefulness of preoperative CIMT measurement as a predictor of post-induction hypotension (PIH). The ultrasonographic measurement of CIMT was performed preoperatively on 82 patients scheduled for elective surgery under general anesthesia in a prospective, observational study. Mean blood pressure (MBP) was recorded before induction. Hypotension was defined as a 20% decrease in MBP from baseline. The ultrasonographic measurement of CIMT was unsuccessful in 2 (2.43%) patients, leaving 80 patients for analyses. Hypotension developed in 41 patients. CIMT was higher in the patient group with PIH than in the group without PIH (p < 0.001). There was statistically significant correlation between MBP decrease after induction and CIMT (r = 0.529, p < 0.0001). CIMT correlated positively with age (r = 0.739, p < 0.0001). The area under curve for CIMT was 0.753 [95% confidence interval (CI) 0.642-0.863]. The optimal cutoff value of CIMT was 0.65 mm with a sensitivity of 75.6% and a specificity of 74.4%. CIMT was an independent predictor of PIH after adjusting other factors with an odds ratio of 1.833 (95% CI 1.23-2.72; p = 0.003). The ultrasonographic imaging and measurement of CIMT can reliably predict hypotension with a 0.65-mm threshold level. We believe that the ultrasonographic measurements of CIMT may be included in point-of-care application in anesthesiology.

Frequency of anxiety and depression in patients of urtolithiasis undergoing Extracorporeal Shock Wave Lithotripsy in Diyarbakir, Turkey.

Extracorporeal shock wave lithotripsy (ESWL) can cause depression and anxiety for patients with urolithiasis. We evaluated the frequency of anxiety and depression in patients of urolithiasis undergoing ESWL. Thirty patients scheduled for ESWL were enrolled in Diyarbakir State Hospital, Turkey. VAS-A, APAIS, BDS and BAS scores were recorded. The patients comprised 23 males and 7 females (M/F: 3.3/1 with a mean age of 31.03 } 10.84 years. The mean VAS-A were 5.46 } 1.71. The pre-procedural anxiety were 100% (VAS-A>0) and depression of 56.6% of patients. The statistically significant difference was observed in total APAIS scores betweeen male and females. (p=0.41) There was no significant difference between the groups in terms of gender and marital status (p< 0.05), Positive and statistically significant correlation was found between anxiety level (APAISa) and requirement of knowledge (APAISk) (p< 0.05). We found that depression and anxiety rates were high in patients with ESWL procedure.

Preoperative Assessment of Ultrasonographic Measurement of Antral Area for Gastric Content.

BACKGROUND Pulmonary aspiration of the gastric contents is a serious perioperative complication. The aim of this study was to evaluate the efficacy of portable ultrasonography in the preoperative evaluation of the gastric contents of patients. The secondary aim was to examine the relationship between gastric antrum cross-sectional area and age and body mass index (BMI). MATERIAL AND METHODS This single-center, prospective, cross-sectional study included 120 patients who underwent surgery. Measurements the gastric antral cross-sectional areas and quantitative and qualitative measurements of the stomach were taken by ultrasonography guidance in all patients. RESULTS With the patient in a supine position, the mean gastric antrum cross-sectional area was found to be 3.4±2.43 cm² (range, 0.79-17.3 cm²). As the number of hours of fasting increased, the gastric antral cross-sectional area statistically significantly decreased (P<0.05). Increased age and BMI values were determined to increase the gastric antrum cross-sectional area in a linear correlation; r=0.209, P<0.05 and r=0.252, P=0.05, respectively. It was determined that 20.8% of the patients exceeded the high-risk stomach antral cutoff cross-sectional area that was defined as 340 mm2 in patients fasting for at least 8 hours. CONCLUSIONS It was determined that bedside ultrasonography is a useful, non-invasive tool in the determination of gastric content and volume. A significant proportion of surgical patients may not present with an empty stomach despite the recommended fasting protocols.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial.

OBJECTIVE: We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. METHODS: In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. RESULTS: There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). CONCLUSION: Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. LEVEL OF EVIDENCE: 2, degree of recommendation B.

The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure.

BACKGROUND: Chronic anal fissure is called the reaching the muscle layer under the skin by deepening of the fissure in the breech skin. Our purpose is to enable the tissue to heal by relaxing the anal sphincter with caudal epidural injection. METHODS: One hundred twenty cases were included in this randomized, controlled study. The cases were categorized into 2 groups; Under ultrasound guidance, the first group, caudal epidural injection group (Group CE, n = 60) was treated with 5 cc bupivakain + 5 cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; the second group, control group (Group C, n = 60) were provided medical treatment (cream, pill etc.) every day for 2 weeks. Wexner's constipation score was used to assess constipation severity and visual analog scale was used to assess pain severity. Short Form-36 was used to determine the patient's quality of life. RESULTS: This study was conducted with 2 groups of 60 people and a total of 120 patients. There was no statistically significant difference between the groups in terms of demographic characteristics (age, body mass index, gender, American Society of Anesthesiologist, mean blood pressure, heart rate) (P > .05). Out of the detected fissures, 32 (26.7%) were located anteriorly and 88 (73.3%) were located posteriorly. The groups were statistically same in terms of fissure location (P = .423). When groups were compared with pain, Wexner constipation and visual analog scale scores decreased significantly in Group CE compared to Group C after 2.and 3.sessions (P = .001 and P = .002, respectively). In Group CE, the Short Form-36 subscales increased significantly (P = .003). CONCLUSION: Caudal epidural injection has a potential to be an alternative treatment option for chronic anal fissure.

[Anatomical differences in sacral hiatus during caudal epidural injection with ultrasonography guidance and its effects on success rate]. / Ultrasonografi rehberliginde uygulanan kaudal epidural enjeksiyon sirasinda sakral hiatusdaki anatomik farkliliklar ve basari oranina etkisi.

OBJECTIVES: To investigate the anatomical differences of sacral hiatus, pain levels and success rates during caudal epidural steroid injection (CESE) using ultrasonography. METHODS: In the study, 255 patients (148 male and 107 female) with lower lumbar back pain and sciatica were included. These patients were applied caudal epidural steroid injection by ultrasonography. Sonograms were obtained by ultrasonography (USG) guideline. Patients' pain levels were assessed by the Visual Analogue Scale (VAS) during the CESE procedure performed on USG guided, and success rates were saved. The intercornual distance, sacral distance and sacrococcygeal ligament thickness were measured. RESULTS: There was no statistically significant difference between the demographic data of the patients (p>0.05). There was a significant difference between male and female patients concerning intercornual distance (15.8 versus 16.6 mm; p=0.004) and sacrococcygeal ligament thickness (4.1 mm vs. 3.7 mm; p=0.018). There was no significant difference between patients about KESE success rate, VAS values and sacral distance (p>0.05). CONCLUSION: We found that sacral hiatus has anatomical differences between male and female patients. According to current evidence, the success rate of caudal epidural steroid injection increased when the anatomical structures of sacral hiatus are shown correctly in USG guided.

The effects of music therapy in patients undergoing septorhinoplasty surgery under general anesthesia.

INTRODUCTION: Music has been used for several years as a relaxation method to reduce stress and anxiety. It is a painless, safe, inexpensive and practical nonpharmacologic therapeutic modality, widely used all over the world. OBJECTIVES: We aimed to evaluate the effect of music therapy on intraoperative awareness, patient satisfaction, awakening pain and waking quality in patients undergoing elective septorhinoplasty under general anesthesia. METHODS: This randomized, controlled, prospective study was conducted with 120 patients undergoing septorhinoplasty within a 2 months period. The patients were randomly selected and divided into two groups: group music (music during surgery) and control group (without music during surgery). All patients underwent standard general anesthesia. Patients aged 18-70 years who would undergo a planned surgery under general anesthesia were included. Patients who had emergency surgery, hearing or cognitive impairment, were excluded from the study. RESULTS: A total of 120 patients were enrolled, and separated into two groups. There were no statistically significant differences between the groups in terms of demographic characteristics, anesthesia and surgery durations (p>0.05). In the music group, sedation agitation scores were lower than those in the control group at the postoperative period (3.76±1.64 vs. 5.11±2.13; p<0.001). In addition; in patients of the music group, the pain level (2.73±1.28 vs. 3.61±1.40) was lower (p<0.001), requiring less analgesic drugs intake. CONCLUSION: Music therapy, which is a nonpharmacologic intervention, is an effective method, without side effects, leading to positive effects in the awakening, hemodynamic parameters and analgesic requirements in the postoperative period. It is also effective in reducing the anxiety and intraoperative awareness episodes of surgical patients.

Inferior vena cava diameter measurements and BUN/creatinine values to determine dehydration in patients with hip fractures preoperatively: A prospective observational study.

Dehydration is a common problem in patients undergoing hip fracture surgery. Sonographic inferior vena cava (IVC) diameter measurement evaluates to estimate volume status. The aim of the study to evaluate the relationship between IVC measurements (expiratory diameter of IVC, collabsibility index [CI], inspiratory diameter of IVC) and blood urea nitrogen (BUN)/creatinine ratio in patients undergoing hip fracture surgery. Ultrasonography of IVC was performed on 35 patients underwent hip fracture surgery. The end-expiratory diameter of IVC, end-inspiratory diameter of IVC, and CI were assessed preoperatively. The patients were classified as group 1 for BUN/Cr ratio <20, group 2 for BUN/Cr ratio of >20. Sonographic IVC measurement was not successful in 14.2% of patients and 30 patients remained. The mean age was 80.43 ±â€Š11.10 (58-95) years. The IVC diameter values had no discriminatory value for the prediction of dehydration according to BUN/creatinine ratio (P > .05). Receiver operating characteristic curve indicated that area under the curve (AUC) for CI: 49.5%, (95% CI 26.5-72.5) P > .05; for IVC inspiratory diameter: AUC: 43.3%, (95% CI, 19.9-66.6) P > .05; for IVC expiratory diameter: AUC: 45.5%, (95% CI, 26.6-65.4) P > .05. No correlations of BUN/creatinine ratio with CI and IVC expiratory diameter were found (as r = -0.262 [P = .163]; [r = 0.206, P = .274]; respectively). There were not any correlation in linear regression analysis model between BUN/Cr ratio according to independent variables (Age, CI, IVCmax, IVCmin) (P = .108, P = .419, P = .282, P = .257; respectively). No discriminatory relationship was found between the bedside ultrasonographic measurement of IVC parameters and BUN/creatinine ratio in patients underwent hip fracture surgery to predict the preoperative dehydration.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

Abstract Objective We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p> 0.05) All VAS values were statistically lower in Group S than in Group C (p< 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p< 0.05). Conclusion Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.

An Analysis of Patients Followed Up in the Intensive Care Unit with the Diagnosis of Acute Respiratory Distress Syndrome.

OBJECTIVE: To examine the factors thought to have an effect on the mortality of patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU). METHODS: A retrospective evaluation of 100 patients diagnosed with ARDS in the ICU between January 2009 and January 2013 was made. Surviving and deceased patients were compared with respect to the effect of the general characteristics, aetiological and prognostic factors, mechanical ventilation (MV) applications (especially permissive hypercapnia resulting from the restriction of the tidal volume predicted to avoid excessive distention of the alveoli), laboratory test values, multiorgan dysfunction rates, Acute Physiologic Assessment and Chronic Health Evaluation II score, Lung Injury Score, Glasgow Coma Score, Sequential Organ Failure Assessment scores, arterial blood gas parameters and partial pressure of arterial oxygen/fraction of inspired oxygen ratio values on mortality. RESULTS: There were 100 patients with ARDS comprising 61 males and 39 females with a mean age of 57.0±13.0 (range: 20-82) years and length of stay in the ICU of 38.7±13 days. The aetiological causes of ARDS were determined as pneumonia in 37 patients, trauma (traffic accidents inside or outside the vehicle and other accidents) in 14, sepsis in 19, pulmonary contusion in 9, non-pulmonary infection in 6, intoxication in 5, multiple blood transfusions in 4, firearms injury in 4 and acute pancreatitis in 2. Forty-four patients died. CONCLUSION: Survival rates were increased in patients with ARDS with early diagnosis and ICU support, lung protective MV strategy and permissive hypercapnia.

Medical Folk Remedy: Two Cases of Garlic Burns.

Over the years, many cultures have used herbs for serious health problems. Garlic (Allium sativum) pose hypocholesterolemic, fibrinolytic, antidiabetic, and antibiotic actions. However, it has unusual adverse effects such as chemical burns and contact dermatitis when used topically. In this case report, the authors present two cases of topical garlic burn caused after the use of crushed garlic with a bandage for pain relief due to arthritis.

Assessment of Relationship between Vitamin D Deficiency and Pain Severity in Patients with Low Back Pain: A Retrospective, Observational Study.

BACKGROUND: Vitamin D is associated with musculoskeletal function in our body, and its deficiency is a common health problem all over the world. Low back pain (LBP) is an important health problem in terms of low quality of life, loss of work power, and cost of diagnosis and treatment approaches. AIMS: The purpose of this study is to investigate the relationship between pain severity and Vitamin D deficiency in patients who applied to pain polyclinic with LBP. SETTINGS AND DESIGN: This was a retrospective, observational study. SUBJECTS AND METHODS: The files of patients aged between 18 and 70 years who applied to our hospital between January and February 2018 were examined retrospectively by a specialist. Serum 25-hydroxyvitamin D (25(OH)D) level, Visual Analogue Scale (VAS), age, education level, marital status, working status, and body mass index (BMI) values recorded in patient files were included in the study. The limit value of Vitamin D was accepted as 20 ng/mL. Patients were divided into two groups according to their levels of Vitamin D. Patients with serum 25(OH)D levels below 20 ng/mL were considered as the deficiency of Vitamin D (Group 1) and patients with 20 ng/mL and over 20 ng/mL values were considered as normal in terms of Vitamin D (Group 2). STATISTICAL ANALYSIS USED: Descriptive statistical data were presented as mean, standard deviation, numbers, and percentage. There was no difference between the normally distributed group and the non-normally distributed group in terms of vitamin D levels. To compare the frequencies, the Chi-square test was used. To define the linear association between independent variables and Vitamin D level, Spearman's rho correlation coefficients were calculated. RESULTS: The level of Vitamin D was measured in 98 patients aged 18-70 years who applied to our hospital's polyclinic due to LBP during the study period. The deficiency of vitamin was detected in 84 (85.7%) of the patients, while Vitamin D was found in 14 (14.3%) as normal. Groups were similar in terms of age, gender, BMI, educational level, marital status and working status (p> 0.05); however, there was a statistically significant difference between the two groups in terms of VAS score and levels of Vitamin D (P < 0.001 and P < 0.001, respectively). While there was a negative correlation between D vitamin level and VAS score (r = -0.594, P < 0.001), there was no correlation between age, gender, BMI, education level, marital status, and working status (P > 0.05). CONCLUSIONS: The deficiency of Vitamin D is often asymptomatic, and also, it can cause bone and muscle pain. In our study, we determined that the severity of pain increased in patients with LBP as the deficiency of Vitamin D increased. For this reason, we recommend to be evaluated the level of Vitamin D in patients with LBP.

Preoperative and Postoperative Assessment of Ultrasonographic Measurement of Inferior Vena Cava: A Prospective, Observational Study.

BACKGROUND: Ultrasound measurement of dynamic changes in inferior vena cava (IVC) diameter and collapsibility index (CI) are used to estimate the fluid responsiveness and intravascular volume status. We conducted an analysis to quantify the sonographic measurement of IVC diameter changes in adult patients at the preoperative and postoperative periods. METHODS: Ultrasonography was performed on 72 patients scheduled for surgery with American Society of Anesthesiologists physical status I to III. Quantitative assessments of the end-expiration (Dmin), end-inspiration (Dmax), and CI at preoperative and postoperative period were compared in a prospective, observational study. The patients received intravenous fluid according to standard protocol regimes peroperatively. RESULTS: Ultrasonography of IVC measurement was unsuccessful in 12.5% of patients and 63 patients remained for analyses. The mean age was 43.29 ± 17.22 (range 18⁻86) years. The average diameter of the Dmin, Dmax, and dIVC preoperative and postoperative were 1.99 ± 0.31 vs. 2.05 ± 0.29 cm, 1.72 ± 0.33 vs. 1.74 ± 0.32 cm, 14.0 ± 9.60% vs. 15.14 ± 11.18%, respectively (p > 0.05). CI was positively associated preoperatively and postoperatively (regression coefficient = 0.438, p < 0.01). CONCLUSION: The diameter of the IVC did not change preoperatively and postoperatively in adult patients with standard fluid regimens. The parameters of the IVC diameter increased postoperatively according to the preoperative period.

Investigation of Mean Platelet Volume and Platelet Count in the Blood of Patients with Lumbago and Sciatica.

BACKGROUND: Mean platelet volume (MPV) is a measurement defining the mean size of platelets in the blood. There has been no previous study of MPV and the level of platelets in lumbago/sciatica patients. AIM: The aim of this study was to investigate whether or not an increase is seen in platelet count and MPV which are indicators of platelet activation in lumbago/sciatica patients compared to a healthy control group. PATIENTS AND METHODS: The study included 151 patients (79 females, 72 males, mean age 43.1 ± 12.9 years) who presented at the Pain Clinic of our hospital and were diagnosed with lumbago/sciatica between July 2017 and September 2017. A control group was formed of 80 healthy individuals (40 females, 40 males, mean age 42.4 ± 12.5 years). RESULTS: No statistically significant difference was determined in the MPV of the lumbago/sciatica patients (9.76 ± 1.09 fL) compared with the control group (9.56 ± 0.92 fL) (P = 0.34). The platelet level of lumbago/sciatica patients (263.3 ± 68.7 103/mL) was determined to be statistically significantly lower than that of the control group (277.27 ± 70.7 103/mL) (P = 0.02). CONCLUSION: The results revealed that the platelet count of the lumbago/sciatica patients was lower than that of the control group while no statistically significant increase was determined in MPV. These findings may show platelet activation that is not statistically significant in lumbago/sciatica patients.

The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud's disease.

Stellate ganglion blockage (SGB) is a method used for treating Raynaud's phenomenon (RP). This study primarily aimed to determine whether the perfusion index (PI) can be used an alternative to Horner's signs in evaluating the efficacy of SGB in patients diagnosed with RP. In a total of 40 patients, aged 18-65 years and diagnosed with primary RP, SGB was applied for 5 days on the same side with the 2-finger method, using 6 mL of 5% levobupivacaine at the 7th cervical vertebra level. The PI values were recorded from the distal end of the 2nd finger of the upper extremity on the side applied with the block at baseline and at 5, 15, 30, 60 and 120 min. The onset time of Horner findings was recorded. The PI values and visual analogue scale (VAS) pain scores were recorded pre-treatment and after 2 weeks.When the PI values of the 40 patients were examined, a 62.7% increase was observed from baseline to the first session at 5 min (p < 0.05). When all sessions were evaluated, a statistically significant increase was determined in the PI values measured at 5, 15, 30, 60 and 120 min compared with the baseline PI values. There was a statistically significant decrease in the post-treatment VAS pain scores and a statistically significant increase in the post-treatment PI values (p < 0.05). By eliminating peripheral vasospasm with the application of SGB in patients with RP, the distal artery blood flow and PI are increased. PI measurement is a more objective method and therefore could be used as an alternative to Horner findings in evaluating the success of SGB. PI is a non-invasive and simple measurement and also an earlier indicator in evaluating the success of SGB than Horner's signs.

Anosmia after Caudal Epidural Steroid Injection.

There are no reports for anosmia after caudal epidural steroid injections (CESIs). General anesthesia is among the reasons, but the reports up to date are extremely limited. There are no identifiable factors contributing to anosmia after epidural injection, so it is worth discussing. We present the case of a 50-year-old woman with no previous history of any sensory deficits. She experienced anosmia after CESI that had been performed due to her chronic low back pain and lasted for 4 months. Clinical and imaging studies did not reveal any pathology. After 4 months, the olfactory dysfunction demonstrated a significant improvement. Disorders of the olfactory system are unknown after regional anesthesia. The onset of the dysfunction in correlation with the imaging findings may indicate that anesthetics can affect the olfactory dysfunction. Further studies are needed.

Unexpected Complication after Caudal Epidural Steroid Injection: Hiccup.

Persistent hiccup is uncommon, and the mechanism is poorly understood. We present the case of a 43-year-old male patient referred to the Algology department due to chronic back pain who developed what we believe a rare case of persistent hiccup secondary to caudal epidural steroid injection (CESI). The causes of hiccup are many and include electrolyte derangement, nutritional deficiencies, gastrointestinal disorders and instrumentation, cardiovascular disorders, renal impairment, central nervous system disorders, and drugs; however, the cause may be unknown. CESI is one of the treatments of back pain, in addition to various other modalities including surgical interventions. CESI has gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, side effects should be considered. We aimed to present a persistent hiccup after CESI for chronic low back pain.

A Safe Regional Technique in a High-risk Patient: Cervical Plexus Blockage.

Regional anesthesia in the form of combined cervical plexus block is gaining popularity as a technique of choice for cervical spine surgeries, especially for urgent ones. An important advantage is that it allows continuous monitoring of patient's neurological status. The success of the block often depends on accurate placement of the local anesthetic. Landmarks for the block are therefore of great importance. In this case, we aimed to present a 74-year-old man with C4-5 odontoid fracture. We planned to perform a unilateral combined cervical plexus block for anterior cervical instrumentation and fusion (ACIF) operation because of his associated high-risk comorbid disorders.

The Postdural Puncture Headache and Back Pain: The Comparison of 26-gauge Atraucan and 26-gauge Quincke Spinal Needles in Obstetric Patients.

BACKGROUND: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. AIMS: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. MATERIALS AND METHODS: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I-II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P < 0.05 was considered statistically significant for all analyses. RESULTS: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). CONCLUSIONS: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane.

PURPOSE:: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS:: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t- and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS:: The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; p<0.001), hand-squeezing (12.1±2.9 vs. 8.2±2.3 min.; p<0.001), extubation (10.1±2.87 vs. 7.1±1.6 min.; p<0.001), orientation (15.3±3.2 vs. 10.3±2.7 min.; p<0.001) and Aldrete score of 9-10 (23.3±6.1 vs. 15.8±3.8 min.; p<0.001) were significantly lower with desflurane-based anaesthesia vs. sevoflurane-based anaesthesia. CONCLUSION:: Desflurane yields early recovery functions and facilitates early postoperative neurologic examinations of intracranial surgery patients.