Targeting the epithelial-mesenchymal transition (EMT) pathway with combination of Wnt inhibitor and chalcone complexes in lung cancer cells.

Non-small cell lung cancer (NSCLC) is the most common type of the lung cancer. Despite development in treatment options in NSCLC, the overall survival ratios is still poor due to epithelial and mesenchymal transition (EMT) feature and associated metastasis event. Thereby there is a need to develop strategy to increase antitumor response against the NSCLC cells by targeting EMT pathway with combination drugs. Niclosamide and chalcone complexes are both affect cancer cell signaling pathways and therefore inhibit the EMT pathway. In this study, it was aimed to increase antitumor response and suppress EMT pathway in NSCLC cells by combining niclosamide and chalcone complexes. SRB cell viability assay was performed to investigate the anticancer activity of drugs. The drugs were tested on both NSCLC cells (A549 and H1299) and normal lung bronchial cells (BEAS-2B). Then the two drugs were combined and their effects on cancer cells were evaluated. Fluorescence imaging and enzyme-linked immunosorbent assay were performed on treated cells to observe the cell death manner. Wound healing assay, real-time quantitative polymerase chain reaction, and western blot analysis were performed to measure EMT pathway activity. Our results showed that niclosamide and chalcone complexes combination kill cancer cells more than normal lung bronchial cells. Compared to single drug administration, the combination of both drugs killed NSCLC cells more effectively by increasing apoptotic activity. In addition, the combination of niclosamide and chalcone complexes decreased multidrug resistance and EMT activity by lowering their gene expressions and protein levels. These results showed that niclosamide and chalcone complexes combination could be a new drug combination for the treatment of NSCLC.

Synthesis of the New 1-(7-Methoxy-1-benzofuran-2-yl)-3-(4-methylphenyl)prop-2-en-1-one and Controlling of Spectroscopic, Optical and Conductivity Properties by Concentration.

Chalcone derivatives have an important place in science due to their different applications ranging from their semiconductor properties to biological properties. In this work 1-(7-methoxy-1-benzofuran-2-yl)-3-(4-methylphenyl)prop-2-en-1-one (2) has been prepared by condensation of 1-(7-methoxy-1-benzofuran-2-yl)ethanone with 4-methylbenzaldehyde in basic medium. The chemical structure of 2 was confirmed by elemental analysis, FT-IR, 1H NMR and 13C NMR. UV spectroscopic characteristics, absorption band edges, optical band gaps, refractive indices, environmental behaviors and conductivity properties of 2 in solutions at different concentrations were investigated in detail. With the concentration, we examined how the spectroscopic, optical and conductivity properties of 2 have changed and can be controlled.

Immediate Sequential Bilateral Vitrectomy Surgery for Retinopathy of Prematurity: A Single Surgeon Experience

Objectives: We report the safety and efficacy of simultaneous bilateral vitrectomy for stage 4 and stage 5 retinopathy of prematurity (ROP). Materials and Methods: Babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were included in this retrospective study. Clinical history, demographic characteristics of the patients, surgical procedure details, perioperative and postoperative ophthalmic and systemic complications, and postoperative anatomical success rates were evaluated. General anesthesia features were also recorded. Results: Seventy eyes of 35 babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were reviewed. At the time of surgery, the mean age was 41.4±4.9 weeks. There was preoperative plus disease in 58.6% of the eyes. The mean surgery/eye ratio was 1.2. Mean anesthesia time was 95±64 minutes. The mean follow-up was 28.1 months (3 to 84 months). Anatomical success was 95.7% for stage 4A (44/46 eyes), 83.3% for stage 4B (15/18 eyes), and 50% for stage 5 (3/6 eyes) ROP. Patients with stage 5 ROP had significantly less anatomical success than stage 4A and 4B (p=0.004). None of the patients had endophthalmitis and anesthesia-related severe complications. Conclusion: Immediate sequential bilateral vitrectomy surgery can be considered an option for patients with active bilateral stage 4 and stage 5 ROP. The risk of endophthalmitis should be weighed against the risks of disease progression and anesthesia-related complications.

Anaesthetic Management in Successive Spinal Surgeries During Pregnancy and Postpartum.

In this case report, we present a parturient with spinal tumour who required neurosurgery before and after caesarean delivery under general anaesthesia. A 25-year-old woman at 30 weeks of gestation and suffering from bilateral lower-limb weakness and sensory deficit due to spinal tumour underwent emergent laminectomy and decompression surgery under general anaesthesia. In this case, total intravenous anaesthesia was used. Two weeks later, the patient underwent emergent caesarean delivery under general anaesthesia due to preterm labour and gave birth to a healthy new-born. Meanwhile, pathological exam revealed soft tissue sarcoma requiring re-operation for gross total excision in the postpartum Week 4, which was followed by multisession chemoradiotherapy. The patient survived for 3 years, that is, until generalised systemic and neural metastasis. General anaesthesia management in surgeries before and after caesarean delivery in patients with spinal tumours is of utmost importance in providing optimal maternal, foetal and neonatal safety using a multidisciplinary team approach.

Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy.

The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].

Evaluation of pain and patient satisfaction by music therapy in patients with endoscopy/colonoscopy.

BACKGROUND/AIMS: Endoscopy and colonoscopy are frequently performed procedures to evaluate the gastrointestinal system. These procedures are sometimes disturbing and painful for the patient. In gastrointestinal suits, endoscopy and colonoscopy may be performed on awake or sedated patients. Music therapy is a common and non-pharmacological treatment for various medical conditions, pain, and anxiety. The aim of the present study was to add music therapy to sedation administered during endoscopy and colonoscopy. The effect of music treatment on drug consumption, anxiety, and pain was investigated. MATERIALS AND METHODS: American Anesthesiologist Association I-III adult patients scheduled for endo/colonoscopy were randomized to music treatment and no music treatment groups. Patients with endoscopic ultrasound and endoscopic retrograde colangiopancreaticography were excluded from the study. Anxiety score and pain severity were evaluated before and after the procedure. Heart rate, mean arterial pressure, and oxygen saturation were recorded before, during, and after the procedure. Total drug consumption was recorded. Patient satisfaction and desire for the same protocol for recurrent procedures were investigated. RESULTS: Music therapy added to deep sedation administered by anesthesiologists provided decreased anxiety score and propofol consumption. Patient satisfaction was increased, and patients reported a desire for the same protocol for recurrent procedures. CONCLUSION: The present study may serve as the beginning of using music therapy for pain treatment in gastroenterology procedures in our hospital with/without sedation. Music and other non-pharmacological treatment methods must be remembered to increase patient comfort during enco/colonoscopies and other painful procedures.

Novel 1-(7-ethoxy-1-benzofuran-2-yl) substituted chalcone derivatives: Synthesis, characterization and anticancer activity.

Cancer treatment still requires new compounds to be discovered. Chalcone and its derivatives exhibit anticancer potential in different cancer cells. A new series of benzofuran substituted chalcone derivatives was synthesized by the base-catalyzed Claisen-Schmidt reaction of the 1-(7-ethoxy-1-benzofuran-2-yl) ethanone with different aromatic aldehydes to yield 1-(7-ethoxy-1-benzofuran-2-yl) substituted chalcone derivatives 3a-j. The derivatives were characterized by elemental analysis, FT-IR, 1H NMR and 13C NMR spectroscopy techniques. The anti-growth effect of chalcone compounds was tested in breast cancer (MCF-7), non-small cell lung cancer (A549) and prostate cancer (PC-3) cell lines by the SRB and ATP cell viability assays. Apoptosis was detected by mitochondrial membrane potential, Annexin V staining and caspase 3/7 activity. Formation of reactive oxygen species was determined by DCFDA. The results revealed that chalcone derivatives have anticancer activity with especially chalcone derivative 3a showing cytotoxic effects on cancer cells. In addition, chalcone derivative 3a induced apoptosis through caspase dependent pathways in prostate, lung and breast cancer cells.

Relationship between obesity and musculoskeletal system findings among children and adolescents.

OBJECTIVES: This study aims to demonstrate the relationship between obesity and musculoskeletal system examination findings and functionality among 5-16 years old population-based sample. PATIENTS AND METHODS: This is a cross-sectional field study. Sample of this study was selected from 4,246 participants of a study, which assessed the prevalence of obesity among school children aged between 6-15 in Pendik, Istanbul, in 2013-2014 school year. Physical examination included inspection, gait, balance, muscle strength and range of motion (ROM) assessment. Turkish version of Pediatric Outcomes Data Collection Instrument (PODCI) was used. Physical examination findings and PODCI scores of "normal weight" and "overweight/obese" groups were compared. Correlation between body mass index (BMI), ROM and PODCI subscale scores were also evaluated. RESULTS: A total of 318 children were included in the study. 39.3% (n=125) were normal weight, 61.7% (n=193) were overweight/obese. Pes planus was the most common musculoskeletal problem with a rate of 23.9%. We found that pes planus was more common (p=0.000), standing time on one leg was shorter (p=0.002), time to complete timed up and go test (TUG) was longer (p=0.004) and "happiness" subscale scores of PODCI were lower (p=0.000) in overweight/obese children compared to their normal weight peers. Range of motion values were decreased, especially on the lower limbs, in overweight/obese children (p<0.05) compared to normal weight children. Body mass index values showed a negative correlation with ROM and PODCI "happiness" subscale scores (p<0.05). CONCLUSION: Musculoskeletal problems are more common in overweight/obese children than in their normal weight peers. Increase in BMI correlates with decrease in balance, emotional functionality and ROM values. It may be possible to protect overweight/obese children from serious musculoskeletal disorders by interventions that reduce BMI.

Neurolysis for Treatment of Infraorbital Neuropathy.

Two patients, a woman aged 34 and a man aged 56, were included in the study. They reported the existence of pain in the areas of the infraorbital nerve, which, over the last four to five years, aggravated by the stimuli of eating, laughing, and being touched. 2 ml of 0.5% lidocaine was administered to these patients six times percutaneously. It was observed that the ease of pain lasted until the local anesthesia lost its effect, and the pain resumed its original intensity. Neurolysis with 0.5 ml of 50% ethanol was applied to the infraorbital nerve. This procedure was applied to the first patient twice and three times to the second. Thereafter, the patients were cured completely. For the treatment of idiopathic chronic infraorbital neuropathy, the neurolysis of the infraorbital nerve using 50% ethanol could be considered as an effective treatment alternative.

Therapeutic effects of intralipid and medialipid emulsionsin a rat model of verapamil toxicity.

BACKGROUND/AIM: Lipid emulsions are promising as a potential new therapy for severe verapamil overdose. Our purpose is to draw attention to the choice of solution by investigating the efficacy of intralipid 20% or medialipid 20% in verapamil overdose. MATERIALS AND METHODS: Eighteen adult Sprague Dawley rats were randomly divided into three groups: control (saline; Group C), intralipid 20% (Group I), and medialipid 20% (Group M). Rats were anesthetized with ketamine. Blood gas analysis, baseline heart rate (HRb), and mean arterial pressure (MAPb) were evaluated. Verapamil at 2.5 mg kg-1 min-1 was infused until the HRb and MAPb decreased by 50% and the times to HR0 and MAP0 were recorded. Treatment solutions of the groups were administered as 12.4 mL kg-1 in 5 min. RESULTS: While HR did not show a difference, MAP showed statistically significant differences among the groups. Intralipid 20% was more efficient than the other two treatments at an early stage; however, as the administration time progressed, medialipid 20% also turned out to be more efficient than the control treatment. CONCLUSION: Our findings indicate that in a toxicity model of rats produced with verapamil, intralipid 20% and medialipid 20% solutions partially eliminate cardiac-depressant effects and increase the survival rate.

Reliability of cross-cultural adapted Turkish version of the Pediatric Outcomes Data Collection Instrument (PODCI).

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) has been created to evaluate functional status, to assess therapeutic needs and changes after treatment in 2 to 18 years old children and adolescents who have orthopedic problems. The PODCI has three forms; parent form for children, parent and self report forms for adolescents. Instrument has 86 items assessing `upper extremity and physical function', `transfer and basic mobility', `sports and physical function', `pain/comfort', `happiness', `global functioning' and `expectations from treatment domains'. The PODCI has been validated in multiple languages. The aim of this study was to investigate the reliability of the cross-cultural adapted Turkish version of the PODCI parent forms for children and adolescents in a variety of chronic musculoskeletal disorders. METHOD: This was a methodological study. The instrument was translated and cross-culturally adapted into Turkish. Turkish version was called Bedensel Islevsellik Degerlendirme Araci (BIDA). It was completed by the parents/caregivers of ninety-eight children and adolescents being treated at Marmara University Medical School Department of Physical Medicine and Rehabilitation outpatient clinics at the baseline and 2-4 weeks after between April 2013-October 2013. Internal consistency and test-retest reliability (ICC) were determined. RESULTS: Internal consistency of the subscales and test/retest cronbach alpha values were 0.90-0.91 (r= 0.71, p= 0.000) for ``upper extremity and physical function''; 0.95-0.95 (r= 0.84, p= 0.000) for ``transfer and basic mobility''; 0.93-0.91 (r= 0.78, p= 0.000) for ``sports and physical functioning''; 0.77-0.82 (r= 0.45, p= 0.000) for ``happiness'' and 0.96-0.96 (r= 0.82, p= 0.000) for ``global functioning''. Pain/comfort subscale showed low internal consistency (-0.38-0.49; r= 0.34, p= 0.004). CONCLUSION: The Turkish version of the PODCI was found to be a reliable instrument to evaluate functionality of children and adolescents with chronic musculoskeletal disorders.

The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy

Background: The aim of this study was to assess the early postoperative pulmonary function and arterial blood gases in patients who have undergone open versus laparoscopic nephrectomy. Materials and Methods: Forty patients were randomly assigned to undergo laparoscopic (LN, n=20) or open nephrectomy (ON, n=20). Pulmonary function tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume at 25% (FEF25), forced expiratory volume at 50% (FEF50), forced expiratory volume at 25% to 75% (FEF25–75), forced expiratory volume in 1 second (FIV1) and peak expiratory flow (PEF) were performed one day before the operation and on the postoperative day 1. The arterial blood gas analysis (pH, pCO2, pO2, SaO2) was made at breathing room preoperatively, in the recovery phase and on postoperative day 1. Results: All spirometric variables decreased after both open and laparoscopic nephrectomy on postoperative day 1. FEV1, FVC, FEF25 and FEF25–75 values decreased on postoperative day 1 (39.7%, 37.4%, 27.7%, 51.8% respectively) in the open surgery group and they were significantly lower in laparoscopic group (29.9%, 32.5%, 23.2%, 44.5% respectively). There were no significant differences in FEF50, PEF and FIV1 between the groups. The SaO2 and pO2 values also decreased in both groups. During early recovery, pH decreased while pCO2 increased significantly but they returned to preoperative values on postoperative day 1 in both groups. Conclusion: Laparoscopic nephrectomy is better than open nephrectomy considering pulmonary functions.

The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy.

BACKGROUND: The aim of this study was to assess the early postoperative pulmonary function and arterial blood gases in patients who have undergone open versus laparoscopic nephrectomy. MATERIALS AND METHODS: Forty patients were randomly assigned to undergo laparoscopic (LN, n=20) or open nephrectomy (ON, n=20). Pulmonary function tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume at 25% (FEF25), forced expiratory volume at 50% (FEF50), forced expiratory volume at 25% to 75% (FEF25-75), forced expiratory volume in 1 second (FIV1) and peak expiratory flow (PEF) were performed one day before the operation and on the postoperative day 1. The arterial blood gas analysis (pH, pCO2, pO2, SaO2) was made at breathing room preoperatively, in the recovery phase and on postoperative day 1. RESULTS: All spirometric variables decreased after both open and laparoscopic nephrectomy on postoperative day 1. FEV1, FVC, FEF25 and FEF25-75 values decreased on postoperative day 1 (39.7%, 37.4%, 27.7%, 51.8% respectively) in the open surgery group and they were significantly lower in laparoscopic group (29.9%, 32.5%, 23.2%, 44.5% respectively). There were no significant differences in FEF50, PEF and FIV1 between the groups. The SaO2 and pO2 values also decreased in both groups. During early recovery, pH decreased while pCO2 increased significantly but they returned to preoperative values on postoperative day 1 in both groups. CONCLUSION: Laparoscopic nephrectomy is better than open nephrectomy considering pulmonary functions.

The extent of blockade following axillary and infraclavicular approaches of brachial plexus block in uremic patients.

INTRODUCTION: This study was aimed to compare the axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method in terms of the sensory and motor block onset, quality, and extent of blocks of brachial plexus in uremic patients who underwent arteriovenous fistula surgery. METHODS: Forty patients scheduled for creation of arteriovenous fistula with axillary brachial plexus block (group AX, n = 20) or infraclavicular brachial plexus block (IC group, n = 20) were examined. The median, radial, ulnar, and musculocutaneous nerves were selectively localized by nerve stimulation. The volume of the local anesthetics was calculated based on the height of each patient, and the volume determined was prepared by mixing 2% lidocaine and 0.5% bupivacaine in equal proportions. Sensory and motor block were assessed at 3, 6, 9, 12, 15, 18, and 30th min and their durations were measured. RESULTS: While the adequate sensory and motor block rate with axillary approach was 100% in musculocutaneous, median, radial, ulnar and medial antebrachial cutaneous nerves, it was 65% in axillary nerve, 80% in intercostobrachial nerve and 95% in medial brachial cutaneous nerve. This rate was found to be 100% for all the nerves with infraclavicular approach. CONCLUSION: For arteriovenous fistula surgeries in uremic patients, both axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method can be used successfully; however, for the short performance of the procedure, infraclavicular block may be preferred. KEYWORDS: Brachial plexus block; Axillary; Infraclavicular; Uremic patients.

Target-controlled infusion of remifentanil with propofol or desflurane under bispectral index guidance: quality of anesthesia and recovery profile.

BACKGROUND: Our objective was to examine the clinical properties of two anesthetic regimens, propofol target-controlled infusion (TCI), or desflurane using remifentanil TCI under bispectral index (BIS) guidance during ear, nose, and throat (ENT) procedures. METHODS: FORTY CONSENTING PATIENTS WHO SCHEDULED FOR ENT PROCEDURES WERE PROSPECTIVELY STUDIED AND WERE INCLUDED IN ONE OF THE TWO GROUPS: TCI group or desflurane (DES) group. General anesthesia was induced with 3 ng mL(-1) and 4 µg mL(-1) effect site concentrations (Ce) of remifentanil and propofol, respectively, with TCI system. After intubation, while propofol infusion was continued in the TCI group, it was ceased in the DES group and desflurane with an initial delivered fraction of 6% was administered. The Ce of propofol infusion and inspired fraction of desflurane was adjusted in order to keep BIS as 50 ± 10. RESULTS: General mean values of mean arterial pressure (MAP) and heart rate (HR) for the TCI group was significantly higher than DES group (89.3 mmHg and 72.4 bpm vs. 77.1 mmHg and 69.5 bpm). Early emergence from anesthesia did not significantly differ between the groups. The rate of patients' Aldrete score (ARS) to reach 10 was found to be 100% at the 15(th) min in both groups. CONCLUSIONS: Bispectral index guided combinations of remifentanil TCI either with propofol TCI or desflurane anesthetic regimens are both suitable for patients undergoing ENT surgery. The lower blood pressure in the remifentanil TCI with desflurane anesthetic regimens may be a significant advantage.

A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval.

OBJECTIVE: To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval. METHODS: Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effect-site concentration of 1.5 µg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded. RESULTS: Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea. CONCLUSION: Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.

A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval

OBJECTIVE: To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval. METHODS: Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effectsite concentration of 1.5 μg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded. RESULTS: Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea. CONCLUSION: Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.

Remifentanil versus fentanyl compared in a target-controlled infusion of propofol anesthesia: quality of anesthesia and recovery profile.

PURPOSE: The aim of the present study was to compare the clinical properties of fentanyl versus remifentanil in a target-controlled infusion (TCI) of propofol anesthesia regimen with bispectral index (BIS) monitoring. METHODS: Forty consenting patients scheduled for elective septorhinoplasty were prospectively studied as one of two groups: fentanyl (group F) or remifentanil (group R). After loading boluses of fentanyl 3 microg kg(-1) or remifentanil 1 microg kg(-1) were administered, the continuous infusion of fentanyl or remifentanil was started at a rate of 0.03 or 0.15 microg kg(-1) min(-1), respectively. Propofol infusion was then commenced with a 3 microg ml(-1) effect site concentration (Ce) by means of a TCI device. The Ce propofol was adjusted to keep BIS at 50 +/- 10. RESULTS: The general mean value of propofol Ce for group F and group R was 4.0 and 3.5 microg ml(-1), respectively. As to the recovery profile, the eye opening time (mean, 6.7 vs. 4.6 min), extubation time (mean, 7.3 vs. 4.7 min), and orientation time (mean, 7.6 vs. 4.9 min) were found to be significantly longer in group F than in group R. CONCLUSION: We concluded that in propofol-based TCI anesthesia under BIS supervision for septorhinoplasty operations, remifentanil was better than fentanyl, especially with respect to emergence from total intravenous anesthesia (TIVA). Furthermore, the durations of anesthesia and operation were rather short, which indicates that fentanyl can be safely used.

Malposition of subclavian vein catheter inserted through indirect technique in a pediatric liver transplantation: a case report.

INTRODUCTION: Clinicians use either direct or indirect (Seldinger) techniques for internal juguler or subclavian vein catheterization. This report aims to point out that the success rate of the direct technique where the catheter is inserted directly through the cannula may be higher particularly in catheterization of pediatric cases. CASE PRESENTATION: A 7.5-month-old female infant weighing 7200 gm was operated on for liver transplantation. The patient suffered jaundice at one month of age and was diagnosed with neonatal colestatic hepatitis. After routine monitoring, via indirect technique, central catheterization was attempted through internal jugular vein. However, the attempt failed. Therefore, again via indirect technique, catheterization was achieved through the right subclavian vein and fixed at 8 cm. After the operation started, fluid replacement and central venous pressure monitoring were performed with this catheter. Immediately after the operation, a control postero-anterior chest radiograph of the patient was obtained. This graph revealed that the tip of the catheter was fixed in the right internal jugular vein. Since the vital symptoms of the patient were not stable, the catheter was not removed and fluid replacement was performed via this technique. The catheter was removed on the postoperative 2(nd) day. CONCLUSION: The J wire advanced via the indirect technique advances anatomically following the upper wall of subclavian vein. Because of the smaller vessel dimensions and sharper, more angulated routes the subclavian and internal jugular veins make in infants, the rigid J wire may advance in the cephalic direction. However, in the technique where the catheter (Cavafix ((R)) catheter) is inserted directly through the cannula, this probability is less since J wire is not used and the catheter employed is flexible. We concluded that especially in pediatric cases, employment of the technique where the catheter is inserted directly through the cannula would be more convenient in order to decrease the catheter malpositioning probability.