Acetaminophen reduces acute and persistent incisional pain after hysterectomy.

OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.

Acetaminophen Reduces acute and persistent incisional pain after hysterectomy.

OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.

Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects.

During surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 µg/kg) plus atropine (15 µg/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group.

Cost-Conscious of Anesthesia Physicians: An awareness survey.

OBJECTIVE: Increasing competitive pressure and health performance system in the hospitals result in pressure to reduce the resources allocated. The aim of this study was to evaluate the anesthesiology and intensive care physicians awareness of the cost of the materials used and to determine the factors that influence it. METHODS: This survey was conducted between September 2012 and September 2013 after the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units. RESULTS: One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation. CONCLUSION: Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively.

[Assessment of the perioperative period in civilians injured in the Syrian Civil War]. / Avaliação do período perioperatório em civis feridos na Guerra Civil Síria.

BACKGROUND: Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS: The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS: The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION: Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

Assessment of the perioperative period in civilians injured in the Syrian Civil War / Avaliação do período perioperatório em civis feridos na Guerra Civil Síria

BACKGROUND: wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS: the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS: the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION: among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

JUSTIFICATIVA: Historicamente, as guerras e seus desafios afligem a humanidade. Na Síria, lesões graves ocorreram devido às armas de fogo e explosivos usados na guerra entre as forças governamentais e civis durante um período de mais de dois anos. MATERIAIS E MÉTODOS: O estudo incluiu 364 pacientes, admitidos no Hospital da Universidade Mustafa Kemal da Faculdade de Medicina (Hatay, Turquia) e submetidos à cirurgia. Os sobreviventes e não sobreviventes foram comparados quanto ao local e tipo da lesão e número de transfusões administradas. A taxa de mortalidade encontrada neste estudo também foi comparada àquelas relatadas em outras guerras civis. RESULTADOS: A média de idade foi de 29 (3-68) anos. Os principais locais de lesão incluíram extremidades (56,0%), cabeça (20,1%), abdome (16,2%), estruturas vasculares (4,4%) e tórax (3,3%). Os tipos de lesões incluíram ferimento de arma de fogo (64,4%), lesão causada por explosão (34,4%) e ferimentos diversos (1,2%). A taxa de sobrevivência foi de 89,6%, enquanto a taxa de mortalidade foi de 10,4%. Observou-se uma diferença significativa entre as taxas de mortalidade neste estudo e aquelas relatadas para as guerras civis da Bósnia e Líbano; e a diferença ficou extremamente significativa quando comparada com as taxas de mortalidade relatadas para as guerras civis do Vietnã e do Afeganistão. CONCLUSÃO: Dentre as lesões relacionadas à guerra, a maior taxa de mortalidade foi observada em lesões de cabeça-pescoço, abdome e vasculares. Acreditamos que a maior taxa de mortalidade na Guerra Civil da Síria, em comparação com as guerras da Bósnia, Vietnã, Líbano Afeganistão, se deva ao fato de os civis terem sido vistos como alvo direto durante a guerra.

Assessment of the perioperative period in civilians injured in the Syrian Civil War.

BACKGROUND: wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS: the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS: the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION: among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

Effectiveness of sub-Tenon's block in pediatric strabismus surgery / Eficácia do bloqueio subtenoniano em cirurgia de estrabismo pediátrico

ABSTRACTBACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n = 20), patients did not receive sub-Tenon's anesthesia. In group 2 (n = 20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p > 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p < 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p < 0.05).CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.

RESUMOJUSTIFICATIVA E OBJETIVO: A cirurgia de estrabismo é um procedimento oftalmológico comum em pediatria. Um grande problema que ocorre com frequência em pacientes submetidos a esse tratamento envolve o reflexo oculocardíaco. Esse reflexo está associado ao aumento da incidência de náusea, vômito e dor. O objetivo deste estudo foi investigar os efeitos do bloqueio subtenoniano sobre o reflexo oculocardíaco, a dor, a náusea e o vômito no período pós-operatório.MÉTODOS: Foram incluídos no estudo 40 pacientes entre 5-16 anos, estado físico ASA I-II, submetidos à cirurgia eletiva de estrabismo. Foram randomicamente alocados em dois grupos, com o método de envelope lacrado. No Grupo 1 (n = 20),pacientes não receberam bloqueio subtenoniano. No Grupo 2 (n = 20), após a intubação, o bloqueio subtenoniano foi feito no olho submetido à cirurgia. Uso de atropina, escores de dor, reflexo oculocardíaco e incidência de náusea e vômito foram comparados.RESULTADOS: Não houve diferença significativa entre os grupos em relação ao reflexo oculocardíaco e ao uso de atropina (p > 0,05). Os escores de dor em 30 minutos de pós-operatório foram significativamente menores no Grupo 2 do que no Grupo 1 (p < 0,05). A necessidade de analgésico adicional durante o período pós-operatório foi significativamente menor no Grupo 2 do que no Grupo 1 (p < 0,05).CONCLUSÕES: O bloqueio subtenoniano, em combinação com anestesia geral, não é eficaz e confiável para diminuir o reflexo oculocardíaco, bem como náusea e vômito pós-operatórios (NVPO). Porém, esse método é seguro para diminuir a dor no período pós-operatório e reduzir a analgesia adicional necessária em cirurgia de estrabismo pediátrico.

[Effectiveness of sub-Tenon's block in pediatric strabismus surgery]. / Eficácia do bloqueio subtenoniano em cirurgia de estrabismo pediátrico.

BACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05). CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.

Effectiveness of sub-Tenon's block in pediatric strabismus surgery.

BACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. METHODS: Forty patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05). CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions.

Anaesthesia represents a specific set-up in respect to pharmacology, and during this time, early hypersensitivity reactions or anaphylaxis may occur in patients who are exposed to a great number of foreign substances. Intravenous ephedrine (5 mg) was applied to a 37-year-old patient due to the development of intraoperative hypotension in a total abdominal hysterectomy operation. After application, hyperaemia was seen in the track of the intravenous catheter of that extremity. Approximately 15 minutes later, urticarial plaques were observed extensively in the abdomen and in both extremities. Methylprednisolone (100 mg+100 mg) and pheniramine (45.5 mg) were given with an increasing infusion rate of intravenous crystalloid. The patient was extubated without any problem and removed to the recovery unit for observation. After the total disappearance of lesions at postoperative 60 minutes and because of the stability of vital signs, the patient was removed to the service. In the follow-up of surgery, no complication developed, and the patient was discharged on postoperative day 2.

Successful Management of Aluminium Phosphide Poisoning Resulting in Cardiac Arrest.

Aluminum phosphide has high toxicity when it is ingested, and in case of contact with moisture, phosphine gas is released. Aluminum phosphide poisoning causes metabolic acidosis, arrhythmia, acute respiratory distress syndrome and shock, and there is no specific antidote. A 17-year-old male patient was referred to our hospital because of aluminum phosphide poisoning with 1500 mg of aluminum phosphide tablets. The patient's consciousness was clear but he was somnolent. Vital parameters were as follows: blood pressure: 85/56 mmHg, pulse: 88 beats/min, SpO2: 94%, temperature: 36.4°C. Because of hypotension, noradrenaline and dopamine infusions were started. The patient was intubated because of respiratory distress and loss of consciousness. Severe metabolic acidosis was determined in the arterial blood gas, and metabolic acidosis was corrected by sodium bicarbonate treatment. In addition to supportive therapy of the poisoning, haemodialysis was performed. Cardiac arrest occurred during follow-ups in the intensive care unit, and sinus rhythm was achieved after 10 min of cardiopulmonary resuscitation. The patient was discharged after three sessions of haemodialysis on the ninth day. As a result, haemodialysis contributed to symptomatic treatment of aluminum phosphide poisoning in this case report.

The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report / Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso / Desarrollo de fibrilación ventricular debido al etomidato para la inducción anestésica: un efecto colateral muy raro, relato de caso

Background and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature. .

Justificativa e objetivos: A ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato. Relato de caso: Paciente do sexo feminino, 56 anos, com pré-diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3 mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188 bpm foram detectadas no monitor. O ritmo converteu-se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente. Conclusão: Além dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato. .

Justificación y objetivos: La aparición de fibrilación ventricular en un paciente puede originar complicaciones inesperadas. Nuestro objetivo es presentar un caso de fibrilación ventricular que ocurrió después de la inducción anestésica con administración de etomidato. Caso clínico: Paciente del sexo femenino, 56 años, con prediagnóstico de cálculos biliares que entró en quirófano para colecistectomía laparoscópica. La inducción de la anestesia fue realizada con administración de etomidato con una dosis en bolo de 0,3 mg/kg. La paciente presentó una grave y rápida aducción de los brazos inmediatamente después de la inducción. En el monitor se detectó taquicardia con QRS ancho y frecuencia ventricular de 188lpm. El ritmo se convirtió en fibrilación ventricular durante la preparación para la cardioversión. La pacientefue inmediatamente sometida a la desfibrilación. Se logró el ritmo sinusal. Decidimos postergar la cirugía debido a la condición de inestabilidad del paciente. Conclusión: Además de los efectos secundarios conocidos del etomidato también se pueden observar taquicardia ventricular y fibrilación (aunque sea algo muy raro). Hasta donde sabemos, este es el primer caso de fibrilación ventricular causado por etomidato en la literatura. .

[The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report]. / Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso.

BACKGROUND AND OBJECTIVES: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. CASE REPORT: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. CONCLUSION: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature.

The effects of nitrous oxide on vascular endothelial growth factor (VEGF) and its soluble receptor 1 (VEGFR1) in patient undergoing urological surgery.

OBJECTIVE: Anesthesia and surgical intervention, leads to the development of systemic inflammatory response. The severity of the inflammatory response depends on the pharmacological effects of anesthetic agents and duration of anesthesia. OBJECTIVE of the study was to investigate the effect of nitrous oxide on VEGF and VEGFR1 levels in patients undergoing surgery. METHODS: Forty-four patients undergoing elective urological surgery were included in the study. Anesthesia maintenance was provided with 1-2 MAC sevoflurane, O2 50%, N2O 50% in 4L/m transporter gase for group 1 (n=22) and 1-2 MAC sevoflurane, O2 50%, air 50% in 4L/m transporter gase for group 2 (n=22) Venous blood samples for the measurement of VEGF and VEGFR1 were taken before the induction of anaesthesia, 60 minutes of anesthesia induction, at the end of anaesthesia and 24 hours after operation. In statistical analysis Bonferroni test and analysis of variance at the repeated measures were used Results: In the postoperative period serum VEGF levels had decreased significantly in both group whereas VEGFR1 did not show a significant change. CONCLUSIONS: Nitrous oxide showed significant effect on angiogenic parameters. Further detailed studies are required to evaluate the effect of nitrous oxide.

Oral intralipid emulsion use: a novel therapeutic approach to pancreatic ß-cell injury caused by malathion toxicity in rats.

We aimed to investigate whether oral intralipid emulsion (OIE) reduces pancreatic ß-cell injury (PßCI) by chelating with malathion (M), or increases PßCI by increasing M absorption in the stomach. Fifty rats were randomly divided into six groups: control group (C); OIE administered group (L); M-treated group (M); OIE-administered group immediately after given M (M0L); OIE-administered group 6 hours after being given M (M6L) and OIE administered group 12 hours after being given M (M12L). M induced PßCI, hyperglycemia, temporary hyperinsulinemia and oxidative stress (OS). However, there was no significant difference in serum levels of glucose, insulin, total oxidants (TOS) and liver TOS between the M0L group and groups C and L. Also, insulin levels of M12L significantly increased, compared to the M6L group. Biochemical results, which were confirmed by histopathology, indicate that administering OIE after 6 hours and immediately after taking M may markedly prevent PßCI, hyperglycemia and OS. In addition, OIE's effectiveness decreased after 6 hours and was totally ineffective after 12 hours. We concluded that OIE may help to achieve a better prognosis and reduce mortality rate in cases presented to the emergency department, particularly within the first 6 hours, resulting from organophosphate pesticide poisoning by oral ingestion.

Perioperative Anaesthetic Approach in a Homozygous Sickle Cell Anaemia Patient with Frequent Pain Crises.

Sickle cell disease (HbS) is a haemolytic anaemia characterized by the formation of abnormal haemoglobin. In patients with sickle cell disease, high rates of erythrocyte generation, degradation, and hyperbilirubinemia increase the risk for cholelithiasis. Previous studies have found that the incidence of cholelithiasis is 70% in adult patients. In sickle cell disease, decreased oxygen concentration leads to the sickling of erythrocytes by causing aggregation and polymerization. Sickle erythrocytes can have devastating effects on many vital organs by causing microvascular occlusion. In patients with sickle cell anaemia, anaesthetic technique, anaesthetic agents, and surgical trauma may cause additional risk. In this case report, we present a perioperative anaesthetic approach in the laparoscopic cholecystectomy of a patient with HbS, elevated liver function tests, and frequent pain crises.

Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy.

OBJECTIVE: To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic-femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). METHODS: Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2 ml (10 mg) of 0.5% levobupivacaine and the USFB group received a 25 ml mixture consisting of 10 ml of 2.0% lidocaine, 10 ml of 0.5% levobupivacaine and 5 ml of saline (15 ml for the femoral and 10 ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. RESULTS: A total of 40 patients were enrolled in the study (n = 20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. CONCLUSIONS: USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.