Perioperative anesthetic and surgical complications of the Nuss procedure.

OBJECTIVE: The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN: A retrospective analysis. SETTING: An academic hospital. PARTICIPANTS: Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS: Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS: No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION: Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.

Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.

BACKGROUND & AIM: The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats. METHODS: Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination. RESULTS: Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05). CONCLUSION: Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

Does bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery?

In this randomized, double-blind and controlled study we evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery. Forty-five patients were assigned to 3 groups. After general anesthesia induction, bilateral superficial cervical plexus block with 0.25% bupivacaine 15 mL in each side was performed in Group I, and local anesthetic wound infiltration with 0.25% bupivacaine 20 mL was performed in Group II. In Group III (control) no regional block was administered. Intravenous patient-controlled analgesia was used to evaluate postoperative analgesic requirement. Neither visual analog scale scores nor total patient-controlled analgesia doses were different among groups. We concluded that bilateral superficial cervical plexus block or local anesthetic wound infiltration with 0.25% bupivacaine did not decrease analgesic requirement after thyroid surgery.

The analgesic and anti-inflammatory effects of subcutaneous bupivacaine, morphine and tramadol in rats.

The analgesic and anti-inflammatory effects of subcutaneously administered bupivacaine, morphine and tramadol on formalin-induced inflammation were compared. 0.25 % bupivacaine in Group B, 20 mg/kg tramadol in Group T, 1 mg/kg morphine in Group M and 0.9 % NaCl in Group S in a volume of 200 micro l were injected into the right hind paw of the rats (n: 40) 15 minutes before injection of 50 micro l 5 % formalin. Sedation and pain behaviour scores, number of flinches and licking-time were recorded. The degree of dermal edema, intraneural edema, vasodilation, erythrodiapedesis, infiltration of polymorphonuclear leukocyte/lymphocyte and mast cell counts were analyzed histopathologically. In Group T and B, circumferential changes were lower than in Group M and S. The pain behaviour scores were significantly lower in Group T and B. The number of flinches in Group T was lower than Group B and S. The vasodilation was significant only in Group M. The dermal edema was limited to deep dermis only in Group T. Preinflammational subcutaneous tramadol infiltration can provide effective analgesia and may have anti-inflammatory effects.

The art of alleviating pain in greek mythology.

We reviewed many of the essential Greek myths to identify the methods used at that time to relieve the pain of both illness and surgery, and we discovered many pioneering methods. Both gods and demigods implemented these methods to ease pain, to conduct surgery, and, on occasion, to kill mythological beings. The myths describe the three most common components of anesthesia: hypnosis, amnesia, and (an)algesia. Drugs and music-aided hypnosis were two of the most common methods use to treat emotional and surgical pain. This article identifies highlights in the development of concepts to treat pain in Greek mythology. The examples found in the Greek myths remind us of the historical significance of pain treatment.