Pulmonary embolism presenting as syncope: a case report.

INTRODUCTION: Despite the high incidence of pulmonary embolism its diagnosis continues to be difficult, primarily because of the vagaries of symptoms and signs in presentation. Conversely, syncope is a relatively easy clinical symptom to detect, but has varied etiologies that lead to a documented cause in only 58% of syncopal events. Syncope as the presenting symptom of pulmonary embolism has proven to be a difficult clinical correlation to make. CASE PRESENTATION: We present the case of a 26-year-old Caucasian man with pulmonary embolism induced-syncope and review the pathophysiology and diagnostic considerations. CONCLUSIONS: Pulmonary embolism should be considered in the differential diagnosis of every syncopal event that presents at an emergency department.

Effects of preoperative lornoxicam versus tramadol on postoperative pain and adverse effects in adult tonsillectomy patients.

OBJECTIVES: This study assessed the efficacy and adverse effects of preoperatively administered lornoxicam versus tramadol in adults, for post-tonsillectomy pain. METHODS: This prospective, double blind, randomized, clinical research was performed in the Ear, Nose and Throat Surgery Room in the Department of Anesthesia and Reanimation, Gazi University Faculty of Medicine. Forty American Society of Anesthesiologists (ASA) status I-II patients of both gender, aged 18-55 years, were included. RESULTS: Tonsillectomy patients were divided into two groups: Those in Group L received 8 mg lornoxicam and in Group T received 50 mg tramadol intravenously just before induction of general anesthesia. Induction and maintenance of anesthesia (propofol, atracurium, nitrous oxide and sevoflurane) were standardized. Heart rate and systolic and diastolic arterial pressure data were monitored during the anesthesia. Intra-operative bleeding was scored by the same operator using a 5-point scale at the end of the surgery. Postoperative pain on swallowing was scored by a blinded anesthesiologist using Verbal Rating Scale (VRS) on arrival in the Post Anesthesia Care Unit (T(0)), at 30 min (T(1)), 1h (T(2)), 2h (T(3)), 3h (T(4)), 4h (T(5)), 5h (T(6)), and 6h (T(7)) thereafter. During the first postoperative 6 hours, when VRS >/=2, 1mg.kg(-1) im meperidine was used as a rescue analgesic. Adverse effects in the postoperative 6h period were noted. T(1) and T(2) pain scores in Group T were higher than in Group L (p=0.049, p=0.007, respectively). The number of patients requiring rescue analgesics during the first 6 hours in Group L was lower than in Group T. Nausea-vomiting, bleeding and postoperative hemorrhage values were similar between Group L and Group T. CONCLUSION: Preoperative 8 mg lornoxicam was more effective than 50 mg tramadol with respect to early postoperative tonsillectomy pain in adult patients, and side effects were similar.

Comparison of the efficacy of propofol and metoclopramide in preventing postoperative nausea and vomiting after middle ear surgery.

OBJECTIVE: To compare the administration of sub hypnotic dose of propofol with metoclopramide and placebo in prevention of postoperative nausea and vomiting (PONV) after middle ear surgery. METHODS: This clinical research was performed in the Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey, between December 2004 and October 2005. Following approval by the hospital ethics committee, 60 adult patients scheduled for a middle ear operation were randomly assigned into 3 groups. The patients in group P received 0.5 mg x kg(-1) propofol; in group M, 0.2 mg x kg(-1) metoclopramide, and in group C, 0.9% saline solution. The number of patients suffering from nausea and vomiting at 0-4, 4-12, and 12-24 hours postoperatively, and additional use of antiemetics was recorded. RESULTS: Comparisons of the data showed that at 0-4th hours, the incidence of vomiting was 25% in group P, 40% in group M, and 75% in group C. The incidence rate of group P was significantly lower than that of group C (p=0.002), and the rate of antiemetics use in group C was higher than that in group P (p=0.028). The Nausea Vomiting Scale scores of group C were also significantly higher than those of group P (p=0.005). There were no significant differences between the values at 4-12 and 12-24 hours. CONCLUSION: The administration of a sub hypnotic dose of propofol at the end of surgery was found to be at least as effective as metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing middle ear surgery.

Percutaneous pulsed radiofrequency reduces mechanical allodynia in a neuropathic pain model.

BACKGROUND: Neuropathic pain is a result of a primary lesion or dysfunction of the peripheral or central nervous system, and its treatment is challenging. Animal models have been helpful in understanding mechanisms of neuropathic pain and in developing new treatment strategies. In this study, we examined the effect of percutaneous pulsed radiofrequency (PRF), which is a minimally invasive pain treatment method, on mechanical allodynia in a neuropathic pain rat model. METHODS: Neuropathic pain was achieved in a peripheral nerve pain model by performing L5-6 spinal nerve ligation. On the 14th postoperative day, percutaneous PRF was applied to the plantar side of the left rear paw. Animals were evaluated for mechanical allodynia with both dynamic plantar aesthesiometer (DPA) (weight and paw withdrawal time) and von Frey filaments (VF) on the 14th postoperative day and 1, 3, 5, 7, 10, and 14 days after PRF treatment. Experiments were conducted in six groups: Sham-operated+placebo PRF 6 min, sham-operated+PRF 6 min, neuropathic (NP)+2 min placebo PRF, NP+2 min PRF, NP+6 min placebo PRF, and NP+6 min PRF. RESULTS: Allodynia developed in all animals in the NP groups compared to sham-operated animals (P=0.0001). DPA and VF showed that PRF application for 2 min significantly improved allodynia on 1-14th post-PRF day, compared to placebo PRF (P=0.0001). Although DPA (both weight and paw withdrawal time) did not show any therapeutic effect from 6 min PRF application on 1-14th post-PRF days (P=1.00), VF demonstrated transient improvement for the first week, which disappeared on later evaluations of the 6 min PRF group. CONCLUSIONS: Percutaneous PRF is an effective treatment option in the NP pain model, and further studies are needed to clarify its underlying mechanisms of action.

The effect of nicotine on the recovery of rats receiving anesthesia.

OBJECTIVE: To determine the effect of intraperitoneal (ip) nicotine on the recovery of rats receiving general anesthesia compared with placebo. METHODS: The placebo controlled experimental study was conducted in the Faculty of Medicine, Gazi University, Turkey, between April and May 2005. Twenty-one male and 21 female rats were randomly divided into 3 groups. Group C (n=14), comprising a female group CF (n=7), and male group CM (n=7) received ip 0.9% sodium chloride (NaCl), group P (n=14), comprising a female group PF (n=7), and male group PM (n=7) received ip propofol 150 mg/kg, and group NP (n=14), comprising a female group NPF (n=7), and male group NPM (n=7) received 0.4 mg/kg ip nicotine followed by 150 mg/kg propofol after 15 minutes. For the evaluation of recovery period, tail pinch test was used, and for cognitive performance, the radial arm maze test was used. RESULTS: The number of entrances and exits decreased in group P significantly compared to group C (p<0.05), and the decrease in group PF was higher than it was in group PM. Entrance and exit in group NP increased significantly compared to group P (p<0.05). The increase in entrance and exit in group NPF was much higher compared to group NPM. The recovery period in group NP was significantly shorter than in group P (p<0.05). CONCLUSION: The ip administration of nicotine in rats shortens the recovery from propofol anesthesia and improves cognitive performance.

Comparison of the antiemetic effects of ondansetron and dexamethasone on middle ear surgery.

OBJECTIVE: To compare the antiemetic efficacy of ondansetron and dexamethasone in adults undergoing middle ear surgery. METHODS: This clinical research took place in the Faculty of Medicine, Gazi University, Turkey between January to December 2004. The study included 60 cases, classified by the American Society of Anesthesiology physical status group I-II, who underwent middle ear surgery. We carried out anesthesia induction with 5 mg x kg(-1) sodium thiopental and performed muscle relaxation with 0.5 mg x kg(-1) atracurium to be followed by orotracheal intubation. Anesthesia was maintained at 5 L x min(-1) gas flows with 2-3% sevoflurane inhalation in 70/30% O(2)/N(2)O. We randomly distributed the cases into 2 groups, and the first group (Group O) was administered with 4 mg ondansetron intravenously (IV) at the stage of surgical skin closure and the second group (Group D) with 5 mg dexamethasone IV immediately after anesthesia induction. In the first 24 hours postoperatively, nausea vomiting score (NVS) and nausea, vomiting frequency, Metamizole-Na and non-steroidal anti-inflammatory drug use, the need for additional antiemetics and cost as well as the number of cases with nausea, vomiting and the need for extra antiemetics during 0-4, 4-12 and 12-24 hours were recorded, and their distribution to groups was evaluated. RESULTS: The NVS was 0 (0-0) in group O compared with 1 (0-3) in group D (p=0.003). The use of additional antiemetics was found to be significantly lower in group O (1 +/- 0.6) compared with group D (3.70 +/- 1.02) (p=0.028). In comparing the cost, group O (9.8 dollars) was found to have a significantly higher cost compared with group D (1.1 dollars) (p<0.0001). CONCLUSION: Ondansetron had a more significant effect on nausea and vomiting in the early period, however, no difference was found after 4 hours of administration. Furthermore, dexamethasone was found to cost less compared with ondansetron.