Altered expression of Notch signaling, Tlr receptors, and surfactant protein expression after prostaglandin inhibition may be associated with the delayed labor in LPS-induced mice.

PURPOSE: This study aims to investigate whether indomethacin (IND) delays preterm birth by regulating the Notch pathway, Tlr receptors, and Sp-A in the placenta in lipopolysaccharide (LPS)-induced preterm labor (PTL) model. METHODS: CD-1 mice were distributed to the pregnant control (PC), Sham, PBS, IND (2 mg/kg; i.p.), LPS (25 µg/100 µl; intrauterine), and LPS + IND groups. The injections were performed on day 14.5 of pregnancy. Placentae were collected on day 15.5 of pregnancy, and immunohistochemical analyzes were performed. Differences in staining intensities between the Cox-1, Notch-1 (N1), Dll-1, Jagged-2 (Jag-2), Tlr-2, and Tlr-4 proteins were compared. RESULTS: Preterm labor rates were 100% and 66% (preterm delivery delayed 5 h) in the LPS and LPS + IND groups, respectively. In LPS-treated mice, a general morphological deterioration was observed in the placenta. Total placental mid-sagittal measurement was significantly reduced in the LPS-treated group, while it was similar to the PC group in the LPS + IND group. Cox-1 expression in the LZ increased, and Sp-A expression decreased after LPS injection, and IND administration diminished this increase. N1 expression increased in the labyrinth zone (LZ) and the junctional zone (JZ). Dll-1 and Jag-2 expression increased in the JZ after LPS injection (p < 0.0001). IND administration diminished Tlr-2 expression in the LZ and Tlr-4 expression in the JZ after LPS injection. CONCLUSION: In conclusion, PG (prostaglandin) inhibition may alter Notch signaling, Tlr, and Sp-A protein expression and may be associated with delayed labor in LPS-induced mice.

The effect of co-administration of berberine, resveratrol, and glibenclamide on xenobiotic metabolizing enzyme activities in diabetic rat liver.

It is possible to use plant-derived antioxidant molecules in the form of dietary supplements. However, dietary supplement-drug interaction pattern has not been well defined for most of these products. The aim of this study was to determine the effects of berberine, resveratrol, and glibenclamide on xenobiotic metabolizing enzyme activities in diabetic rats. Streptozotocin was administered to create experimental diabetes. Resveratrol (5 mg/kg) (R), glibenclamide (5 mg/kg) (G), and berberine (10 mg/kg) (B) were administered individually or in combinations in DMSO by intraperitoneal administration route to the diabetic rats. DMSO was also given to non-diabetic control (C) and diabetic control (D) groups. Livers of rats were taken under anesthesia at the end of the treatment period (12 days). Ethoxyresorufin O-deethylase (EROD), pentoxyresorufin O-depentylase (PROD), aniline 4-hydroxylase (A4H), erythromycin N-demethylase (ERND), glutathione S-transferase (GST), catalase (CAT), and glutathione reductase (GR) activities were measured in microsomes and cytosols. In addition, histomorphological studies were also performed in the liver tissues. EROD activity of D+R was significantly higher than C and D+R+B. PROD activity of D+R was significantly higher than C, D, D+R+G, D+R+B, and D+R+B+ G. PROD activity of D+B was significantly higher than C and D+R+B. ERND activity of D+R was significantly higher than D+R+G and D+R+B. GST activity of D+R was significantly higher than D+R+G. CAT activity of D+B was significantly lower than C. It is clear that co-administration of resveratrol, berberine, and glibenclamide modifies some of the important xenobiotic metabolizing enzyme activities. Resveratrol and berberine have the potential to cause dietary supplement-drug interaction.

Relationship of Notch Signal, Surfactant Protein A, and Indomethacin in Cervix During Preterm Birth: Mast Cell and Jagged-2 May Be Key in Understanding Infection-mediated Preterm Birth.

Although it is thought that there is a close relationship between Notch signal and preterm birth, the functioning of this mechanism in the cervix is unknown. The efficacy of surfactants and prostaglandin inhibitors in preterm labor is also still unclear. In this study, 48 female CD-1 mice were distributed to pregnant control (PC), Sham, PBS, indomethacin (2 mg/kg; intraperitoneally), lipopolysaccharides (LPS) (25 µg/100 µl; intrauterine), LPS + IND, and Surfactant Protein A Block (SP-A Block: SP-A B; the anti-SP-A antibody was applied 20 µg/100µl; intrauterine) groups. Tissues were examined by immunohistochemistry, immunofluorescence, and Western blot analysis. LPS administration increased the expression of N1 Dll-1 and Jagged-2 (Jag-2). Although Toll-like receptor (Tlr)-2 significantly increased in the LPS-treated and SP-A-blocked groups, Tlr-4 significantly increased only in the LPS-exposed groups. It was observed that Jag-2 is specifically expressed by mast cells. Overall, this experimental model shows that some protein responses increase throughout the uterus, starting at a specific point on the cervix epithelium. Surfactant Protein A, which we observed to be significantly reduced by LPS, may be associated with the regulation of the epithelial response, especially during preterm delivery due to infection. On the contrary, prostaglandin inhibitors can be considered an option to delay infection-related preterm labor with their dose-dependent effects. Finally, the link between mast cells and Jag-2 could potentially be a control switch for preterm birth.

Protective effects of curcumin against methotrexate-induced testicular damage in rats by suppression of the p38-MAPK and nuclear factor-kappa B pathways.

OBJECTIVE: The present study aimed to investigate the possibility that curcumin (CMN) protects against methotrexate (MTX)-induced testicular damage by affecting the phospho-p38 (p-p38) mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB) signaling pathways. METHODS: Eighteen male Wistar albino rats were randomly divided into three groups. The control group was given an intragastric administration of dimethyl sulfoxide (DMSO) daily for 14 days, the MTX group was given a single intraperitoneal dose of MTX (20 mg/kg) on the 11th day, and the MTX+CMN group was given intragastric CMN (100 mg/kg/day, dissolved in DMSO) for 14 days and a single intraperitoneal dose of MTX (20 mg/kg) on the 11th day. At the end of the experiment, all animals were sacrificed and the testicular tissues were removed for morphometry, histology, and immunohistochemistry. Body and testicular weights were measured. RESULTS: Body weights, seminiferous tubule diameter, and germinal epithelium height significantly decreased in the MTX group compared to the control group. Whereas, the number of histologically damaged seminiferous tubules and interstitial space width significantly increased in the MTX group. In addition, the number of p-p38 MAPK immunopositive cells and the immunoreactivity of NF-κB also increased in the MTX group compared to the control group. CMN improved loss of body weight, morphometric values, and histological damage due to MTX. CMN also reduced the number of p-p38 MAPK immunopositive cells and the NF-κB immunoreactivity. CONCLUSION: CMN may reduce MTX-induced testicular damage by suppressing the p38 MAPK and NF-κB signaling pathways.

Can Positive-Pressure Ventilation be Administered with Laryngeal Mask to Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Operation?

OBJECTIVES: We aimed to investigate the effects of intubation and laryngeal mask airway (LMA) use by evaluating the results of blood gas tests, end-tidal CO2 measurements, and airway changes during laparoscopic inguinal hernia repair in children. METHODS: This study was designed to be a prospective randomized study enrolling 150 ASA-I patients, aged 1-8 years; who were scheduled for laparoscopic inguinal hernia repair. Group 1 (n=75) received general anesthesia with fentanyl, propofol, and rocuronium and they were orotracheally intubated. Group 2 (n=75) received general anesthesia with fentanyl and propofol and were inserted an LMA. Demographical data were recorded. Arterial blood gas test results at baseline, in the 10th min after the insufflation, and in the 10th min after the end of the insufflation were noted. The end-tidal CO2, HR, SPO2, inspiratory pressure, plateau pressure, tidal volume (TV), and respiratory frequencies were recorded. The duration of anesthesia, operation, and insufflations was noted. Emergent complications were recorded. RESULTS: The duration of both anesthesia and recovery was longer in Group 1 compared to Group 2. Hemodynamical parameters, end-tidal CO2 values, TVs, airway pressures, and respiratory frequencies were not statistically significantly different between the groups. There were no statistically meaningful differences in the levels of pH, PCO2, and PO2 between the groups. CONCLUSION: Compared to orotracheal intubation during laparoscopic inguinal surgery; LMA did not cause any statistically significant differences in the blood gas test results or airway pressures and recovery was faster with LMA. Therefore, LMA can be used in pediatric laparoscopic surgery as a safe tool for maintaining the airway.

Effects of Pneumoperitoneum on Splanchnic Oxygenation during Abdominal Laparoscopic Surgery in Paediatric Patients: A prospective, Observational Study.

OBJECTIVE: Pneumoperitoneum can cause disruption in splanchnic perfusion. This study aims to investigate effects of pneumoperitoneum on splanchnic oxygenation during abdominal laparoscopic surgery in paediatric patients with NIRS (Near-Infrared Spectroscopy). MATERIAL AND METHODS: A total of 45 patients between 1 and 4 years of age with ASA physical status I-II and scheduled to undergo abdominal laparoscopic surgery under general anaesthesia were enrolled in this prospective, observational surgery. No premedication was used. Standard monitoring and regional splanchnic saturation (rSPcO2), regional cerebral oxygen saturation (rScO2) with NIRS were established before anaesthesia. Anaesthesia was induced with an inhalational agent and maintained with an oxygen/air mixture and sevoflurane. Peripheral oxygen saturation (SPO2), rSPcO2, rScO2, heart rate (HR), mean arterial pressure (MAP), end tidal CO2 (Et-CO2), and insufflation pressure (IP) were continuously monitored during administration of anaesthesia and recorded. After intubation (baseline T0); before CO2 insufflation induced pneumoperitoneum (PP) (T1); CO2 PP insufflation (T2); 5 minutes after PP insufflation (T3); 10 minutes after PP insufflation (T4); 15 minutes after PP insufflation (T5); 20 minutes after PP insufflation (T6); 30 minutes after PP insufflation (T7), 60 minutes after PP insufflation (T8), and after desufflation (T9). Bradycardia and hypotension were recorded. Paracetamol IV 10 mg kg-1 was applied for post-operative analgesia. p<0.05 wasconsidered significant. RESULTS: HR, rScO2, and rSPcO2 decreased at all measured time intervals when compared to T0 (p<0.01) MAP decreased at T1 compared to T0 (p<0.001). Et-CO2 increased at T3-T4-T5-T6 compared to T0 (p<0.001). CONCLUSION: We found that pneumoperitoneum reduced splanchnic oxygenation during laparoscopic abdominal surgery in paediatric patients, which was measured using NIRS.

Comparing I-Gel to Proseal Laryngeal Mask Airways in Infants: A Prospective Randomised Clinical Study.

OBJECTIVE: Laryngeal mask airways and the I-gel have become increasingly popular for children undergoing minor surgery. The goal of our study is to compare I-gel and ProSeal laryngeal mask airways (LMA) in infants by analysing different parameters, such as insertion success, ventilation, haemodynamic changes and postoperative complications. METHODS: For this prospective, randomised study, we selected 123 infants with an American Society of Anaesthesiologists (ASA) status I, who were undergoing minor elective lower abdominal surgery. After obtaining verbal and written informed consent from the parents, the infants were divided into two groups: the I-gel group (n=60) and the ProSeal LMA group (n=63). The times and ease of insertion, percentages of tidal volume leakage, and means and leakage pressures of these two supraglottic airways were noted. The complications and side-effects of each method were also recorded. RESULTS: The insertion time of the ProSeal group was statistically shorter than that of the I-gel group. The peak and mean pressures and the leakage percentage of the ProSeal group were statistically lower than those of the I-gel group. The leakage pressure of the ProSeal group was statistically higher than the I-gel group. CONCLUSION: In comparison with I-gel, the use of ProSeal LMA in infants' anaesthesia presents many advantages, such as the ease of its insertion, better oropharyngeal leakage pressure and less mucosal hyperaemia.

Peritonsillar dexamethasone-bupivacaine vs. bupivacaine infiltration for post-tonsillectomy pain relief in children: a randomized, double-blind, controlled study.

OBJECTIVE: Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for post-tonsillectomy pain control. In our study, we aimed to compare the effects of perioperative peritonsillar dexamethasone-bupivacaine and bupivacaine-alone infiltration on pain control in pediatric patients. MATERIALS AND METHODS: This prospective, randomized, double-blind, controlled clinical trial was conducted between February 2018 and May 2018 in a single-center tertiary education and research hospital, otorhinolaryngology/head and neck surgery clinic, under general anesthesia, which included 120 pediatric patients between the ages of 2-12 (mean 5.7 ± 1.8), and who were with ASA (American Society of Anesthesiologists) I-II classification. Patients were randomly divided into three groups as 40 participants in each group. Group 1 consisted of patients who were injected with dexamethasone-bupivacaine into their peritonsillar region, group 2 consisted of patients who were injected with bupivacaine only, and group 3 consisted of patients who were injected with saline only as the control group. FLACC (face, legs, activity, cry, consolability) Scale and Wong-Baker FACES® Pain Rating Scale (WBS) were used for early and late period postoperative pain scoring. Patients with pain score ≥ 4 were treated with paracetamol rescue analgesia. Side effects such as nausea, vomiting and bleeding were recorded. Data of all groups were compared statistically and p ≤ 0.05 was considered statistically significant. RESULTS: There was no significant difference between the groups in terms of demographic data, duration of operation and duration of anesthesia. The pain scores of group 1 were significantly lower than those of the control group except for postoperative 45th min, 2nd day and 3rd day. The pain scores of the group 1 were significantly lower at all times except for the postoperative 12th and 24th hour, than those of group 2. The pain scores of the group 2 were lower than the control group only at postoperative 7th day, but no significant difference was found at other times. No statistically significant difference was found between the groups in terms of requirement rates for the first 60 min recovery analgesia (p = 0.686). No statistical difference was found between the groups in terms of side effects. CONCLUSION: In our study, preoperative local dexamethasone-bupivacaine infiltration in pediatric patients was shown to be more effective than bupivacaine-only and serum-only infiltration for early and late post-tonsillectomy pain control.

Prolonged Analgesic Efficacy of Articaine with the Addition of Tramadol in Axillary Brachial Plexus Block.

OBJECTIVES: Articaine is a rapid-onset, short-duration, local anesthetic. The aim of this study was to study the effect of adding tramadol to articaine in an axillary block to prolong the analgesic effect. METHODS: This study was conducted with 60 patients of American Association of Anesthesiologists classification I or II and aged 18 to 60 years who underwent hand or forearm surgery with an axillary plexus block using a nerve stimulation technique. The patients were randomized into 2 groups: Group A (n=30) received 40 mL 1% articaine and Group AT (n=30) was administered 40 mL 1% articaine with 100 mg tramadol. The onset of sensory block, motor block, duration of sensorial block and motor block, duration of analgesia and hemodynamic parameters were recorded before the block and 5, 10, 20, 30, 60, 120, 180 minutes after the local anesthetic injection. RESULTS: The sensory block duration in Group AT (187.5±13.0 min) was significantly longer than that of group A (140.78±8.74 min) (p<0.02). The motor block duration in Group AT (137.4±3 min) was significantly longer than that seen in Group A (93.71±9.6 min) (p<0.01). The duration of analgesia was longer in Group AT (218.8±18.2 min) than in Group A (170.8±17.2 min) (p<0.05). In group AT, 2 patients experienced the side effect of nausea and 1 patient had hypotension in the postoperative period. CONCLUSION: This study demonstrated that the addition of 100 mg of tramadol to articaine used for an axillary plexus block prolonged analgesia.

Comparison of Macintosh Laryngoscope and GlideScope® for Orotracheal Intubation in Children Older Than One Year.

OBJECTIVES: We aim to investigate intubation conditions, intubation times, and hemodynamic response with the GlideScope video laryngoscope or the Macintosh direct laryngoscope for orotracheal intubation in children older than one year. METHODS: Eighty patients aged 1-12 years, scheduled to undergo elective surgery under general anesthesia with endotracheal intubation were included in a prospective, single-blinded, randomized trial. Exclusion criteria were risk of pulmonary aspiration, craniofacial malformation, difficult intubation, emergency surgery, cardiovascular disease, respiratory disease, and hemodynamic instability. After standard anesthesia induction, patients were randomized into two groups. The group G patients (n=40) were intubated with the GlideScope and the group M patients (n=40) were intubated with the Macintosh laryngoscope. Intubation time, number of attempts, Cormack-Lehane score, airway maneuvers, and visual analog score were recorded. Hemodynamic variables were recorded before and after anesthesia induction, at intubation, and 1., 3., and 5. minutes after intubation. Student's t-test, Mann-Whitney U test, and the χ2 test were used for statistical analysis, with p<0.05 considered significant. RESULTS: The demographic data, operation time and hemodynamic parameters were similar between the two groups. The intubation time was longer in Group G than Group M. The incidence of Cormack-Lehane score 1 was higher in Group G than Group M while Cormack-Lehane score 2 was higher in Group M. CONCLUSION: We concluded that the GlideScope video laryngoscope provided better glottis visualization, but prolonged intubation time. There was no superiorty on hemodynamic effect with the video laryngoscope.

Evaluation of Neurotoxicity of Multiple Anesthesia in Children Using Visual Evoked Potentials.

OBJECTIVES: Anesthetic applications may cause increased neuronal damage in infants and children. Commonly cognitive or learning disability tests were used to investigate the neurological progress in children. Visual Evoked Potential is a gross electrical signal generated by the occipital regions of the cerebral cortex in response to visual stimulation and an objective assessment of brain function. In this study, to acquire more objective results, Visual Evoked Potential responses of children who had multiple exposures to anesthesia during the treatment of corrosive esophagitis were compared to children who have never received anesthesia before. METHODS: In this prospective, single-blinded, randomized, controlled study, 25 children, who were admitted to our pediatric surgery clinic because of corrosive esophagitis and who received general anesthesia more than 15 times composed Group-P; 25 children, who admitted to our well-child-clinic and who had never received anesthesia before consisted Group-C. The flash and pattern VEP responses of both groups were measured at the electrophysiology laboratory without any anesthetic drug application. The VEP responses of children in Group-P were recorded at least three days after the last exposure to anesthesia. RESULTS: Latencies and amplitudes of the N2 and P2 components of the pattern and flash VEP responses were statistically significantly different between the two groups (p=0.000). CONCLUSION: This study shows that in children who had repeated anesthetic applications VEP parameters are significantly altered. We believe that VEP responses may be a reliable objective criterion for the evaluation of anesthesia neurotoxicity.

The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial.

BACKGROUND: Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. OBJECTIVES: We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery. MATERIALS AND METHODS: A total of 90 ASA I-II patients undergoing elective arthroscopic meniscectomy under general anesthesia were enrolled. The participants were randomly allocated to three groups to receive the following intra-articular medications after completion of the surgery and before deflation of the tourniquet: Group S, 20 mL of saline; Group T, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 100 mg of tramadol in 20 mL saline; and Group M, 35 mg of levobupivacaine, 20 mg of tenoxicam, and 4 mg of morphine in 20 mL saline. Visual analogue scale values at rest (VASr) and at active flexion of knee (VASa) at postoperation hours 1, 2, 4, 8, 12, and 24, duration of analgesia, total analgesic consumption, and number of rescue analgesia at 24 hours were evaluated. RESULTS: VASr and VASa were significantly higher in group S in comparison to other groups (P < 0.05). Duration of analgesia was significantly longer in Group T and Group M than in Group S (P < 0.05). The difference between group T and group M was also significant (P < 0.05). Number of rescue analgesia and total analgesic consumption at postoperative hour 24 was significantly fewer in group M compared with other groups (P < 0.05). CONCLUSIONS: Intra-articular levobupivacaine-tenoxicam-morphine combination provides effective pain relief, longer analgesic duration, and less analgesic requirement when compared with intra-articular levobupivacaine-tenoxicam-tramadol combination and saline after knee arthroscopic surgery.

Comparison of unilateral spinal and continous spinal anesthesia for hip surgery in elderly patients.

BACKGROUND: Continous spinal anesthesia (CSA) and frequently unilateral spinal anesthesia (USpA) are usually preferred for lower extremity surgeries. In this study, we aimed to compare the effects of these anesthetic techniques, on hemodynamic parameters, quality of anesthesia and complications in elderly patients undergoing hip surgeries. METHODS: Forty patients aged 65 years and older, assigned to receive either CSA or USpA with 7.5 mg (1.5 cc) 0.5% hyperbaric bupivacaine initially. In CSA group, additional doses of 2.5 mg bupivacaine were applied until sensory block reach to T10. Maximum sensorial block level, time to reach the level of T10 (defined as onset time) and to regress to T12, hemodynamic parameters and ephedrine requirements were recorded peroperatively and during 2 h postoperatively. RESULTS: Hemodynamic parameters, ephedrine requirements and regression of sensory block by two levels were similar in two groups. The onset time of anesthesia was significantly longer in USpA group than CSA group. Neuraxial anesthesia had to be converted to general anesthesia in 5 patients (25%) in CSA group and 1 patient (5%) in USpA group. CONCLUSIONS: We conclude that both USpA and CSA techniques have similar effects in elderly high risk patients. On the other hand, USpA is more preferable for surgeries with shorter durations due to its low cost and high success rate.

Marjolin ulcer: clinical experience with 34 patients over 15 years.

BACKGROUND: Malignancies that arise from scars are referred to as Marjolin ulcers. The association between chronic ulcers and squamous cell carcinomas is well established. There are many case reports in the literature regarding Marjolin ulcer; however, randomized controlled clinical series that describe a thorough evaluation of these patients are rarely encountered. OBJECTIVE: We present our clinic's 15 years of experience with 34 Marjolin ulcer patients and their treatment modalities. METHODS: A retrospective analysis of 302 squamous cell carcinoma patients who were treated in the plastic surgery department between 1997 and 2011 was performed. Thirty-four (10.3%) histopathologically confirmed Marjolin ulcer patients were further analyzed. RESULTS: Although burn scars represented 77% of the patients in the present study, unstable scars that formed following traffic accidents and fistula tracts are also among the commonly encountered etiologies. Based on our observations, squamous cell carcinoma, in addition to malignant melanoma and verrucous carcinoma, is frequently observed in cases of Marjolin ulcers. CONCLUSION: If the goal is to eradicate this clinical entity, all of the chronic ulcers that fail to heal require biopsies at regular intervals. Large excisional margins, lymphadenectomies in cases of palpable lymph nodes, and a well-defined oncology protocol are all essential in treating Marjolin ulcer.

The feasibility of tissue expansion in reconstruction of congenital and aquired deformities of pediatric patients.

Skin expansion is one of the major developments in reconstructive surgery. The use of tissue expansion has been popularized among plastic surgeons and has become the treatment method of choice for many congenital and acquired defects in a wide variety of diseases in adults and then later in children. The authors analyze their clinical experience in the treatment of burn scars and complex defects by tissue expansion in pediatric patients. The study included thirty five expansion procedures performed in 25 patients. Smooth surface expanders with a remote valve were used in the scalp (22), face (2), neck (3), hand (2), thorax (2), breast (1), palate (2), abdomen (1). Self-inflating osmotic tissue expanders were used in four patients, one of them had cleft palate and the other two of them had congenital hand anomalies and the last one had frontal scar and alopecia in the frontal hairline. In 19 out of 25 cases (76%) tissue expansion was achieved without complications. At the same time, in 1 cases minor complications and in 5 cases major complications occurred. The number of expanders per patient was only one in 16 cases. More than one expander was used to remove parts of the same injury in 9 cases. Our study may help to draw attention again on different aspects in tissue expansion and critically focus on each step of the tissue expansion both using self-filling tissue expanders and smooth surface tissue expanders with a remote valve.

Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients.

BACKGROUND: Alpha-2 adrenergic agonists are used to premedicate pediatric patients to reduce separation anxiety and achieve calm induction. The clinical effects of clonidine are similar whether via the oral or nasal route. However, oral dexmedetomidine is not preferred because of its poor bioavailability. The objective of this study was to evaluate the effects of nasal versus buccal dexmedetomidine used for premedication in children. METHODS: Sixty-two patients, aged 2-6 years, undergoing minor elective surgery were randomly assigned to two groups to receive dexmedetomidine, either 1 µg·kg(-1) buccally (group B) or 1 µg·kg(-1) intranasally (group N) for premedication 45 min before the induction of anesthesia. Heart rate, peripheral oxygen saturation, and respiratory rate were measured before and every 10 min after administering dexmedetomidine in all children. Level of sedation was assessed every 10 min until transport to operating room. Drug acceptance, parental separation, and face mask acceptance scores were recorded. RESULTS: There was no significant difference between the two groups in patient characteristics, nor was there any significant difference between the two groups in heart rate, respiratory rate, or SpO(2) values at all times after premedication. Levels of sedation, parental separation, and mask acceptance scores were significantly higher in group N than in group B at the various times. CONCLUSIONS: These results suggest that intranasal administration of 1 µg·kg(-1) dexmedetomidine is more effective than buccal administration of 1 µg·kg(-1) dexmedetomidine for premedication in children.

Anomalous large unique muscle belly of flexor digitorum superficialis and the absence of palmaris longus in the forearm.

Anomalies of muscles of the upper extremity are frequently encountered and anatomic variations of the flexor digitorum superficialis (FDS) muscle-tendon unit are frequently reported by anatomists and clinicians. FDS anomalies can be in forms of tendon interconnections, substitution, absence or muscle belly variations and most of the times the anomalies of FDS produce few clinical symptoms. We report a rare and unusual case of FDS anomaly with a unique and large muscle belly. The deformity is type V according to the classification of Elliot et al. in which the muscle belly extends to four digits (the index, middle, ring and little finger) in the right hand of patient and there is absence of the palmaris longus tendon. The hand surgeon should be able to realise all variations of the FDS tendon and should be prepared for unexpected findings during surgery.

The effects of Different Concentrations and Equivalent Volumes of Levobupivacaine in Epidural Anesthesia.

BACKGROUND: Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. Previous studies have examined different concentrations of levobupivacaine in similar ways. OBJECTIVES: This prospective, randomized, double-blind study was designed to determine the clinical efficacy and hemodynamic effects of different concentrations and equivalent volumes of levobupivacaine in epidural anesthesia. To our knowledge, this is the first study to evaluate the effects of concentration lower than 0.5% levobupivacaine. METHODS: Forty adult patients with an American Society of Anesthesiology (ASA) I-III physical status undergoing transurethral endoscopic surgery were randomly divided into 2 groups to receive either 10 mL of isobaric levobupivacaine (0.5% + 5 mL 0.9% saline [group 1; n = 20]) or 10 mL of isobaric levobupivacaine (0.75% + 5 mL saline 0.9% saline [group 2; n = 20]) for epidural anesthesia. An observer blinded to group division evaluated the time of onset, maximum level, and time to 2-segment regression of sensory block. RESULTS: There were no differences between the 2 groups in terms of hemodynamic parameters and time of onset of the sensory block. There were significant differences, however, between the 2 groups in the maximum level of the sensory block (group 1, T9; group 2, T8; P = 0.010) and the time to 2-segment regression of sensory block (group 1, 46.35 minutes; group 2, 62.94 minutes; P = 0.013). CONCLUSION: This study indicated that 10 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline is a suitable solution for use in epidural anesthesia because it produces a block clinically comparable to that of 10 mL of 0.75% levobupivacaine plus 5 mL of 0.9% saline for transurethral resection of prostate surgery.

[Challenges in the treatment of pain in children with cancer and tunneling of epidural catheter for long term infusion]. / Cocukta kanser agrisi tedavisinde sorunlar ve uzun süreli epidural infüzyon için tünel uygulamasi.

The main differences of cancer pain in children from adults are predominance of tumor related pain, difficulties in pain assessment and rare use of regional blocks. A 2.5 years old girl with severe pain due to pelvic/sacro-cocygeal mass will be presented here. Pain assessment depended on the observations of other patients' parents in the ward, because the child's family was uncooperative. An epidural catheter was placed at T12-L1 level when the conventional methods were unsuccessful and tunneled 5 cm away from the insertion site. Infusion of bupivacain 0.2 mg/kg/hr + fentanyl 0.4 mg/kg/hr from the catheter provided pain relief. Another epidural catheter placed when intravenous morphine infusion (0.02 mg/kg/hr) became inefficient following accidental removal of the initial one. The patient was transferred to another hospital for chemotherapy on the 2nd week. The good interactions between the anesthesiologists accomplished the continuity of pain therapy. Tunneling epidural catheter is an invaluable technique in children who are resistant to conventional pain therapies.