Hand ischaemia after radial artery cannulation.

Arterial cannulation for haemodynamic monitoring has become a routine procedure in the clinical management of critically ill adults. Thrombosis is the most common complication of this procedure. We report the case of a patient with multiple traumatic injuries in which radial artery cannulation was associated with compartment syndrome of the forearm and hand.

Rectal eversion and double-stapled ileal pouch anal anastomosis in familial adenomatous polyposis syndrome.

INTRODUCTION: Surgery is the only treatment option for familial adenomatous polyposis (FAP). Aim of surgery in FAP is to minimize colorectal cancer risk without need for permanent stoma. There are especially two operation options; Total colectomy with ileorectal anastomosis (IRA) and total proctocolectomy with ileo-pouch anal anastomosis (IPAA). We report here a patient with FAP who had resection via rectal eversion just over the dentate line under direct visualization and ileoanal-J pouch anastomosis by double-stapler technique. PRESENTATION OF CASE: A 40 yr. old female patient with FAP underwent surgery. Firstly, colon and the rectum mobilized completely, and then from the 10 cm. proximal to the ileo-caecal valve to the recto-sigmoid junction total colectomy was performed. Rectum was everted by a grasping forceps which was introduced through the anus and then resection was performed by a linear stapler just over the dentate line. A stapled J-shaped ileal reservoir construction followed by intraluminal stapler-facilitated ileoanal anastomosis. Follow up at six months anal sphincter function was found normal. DISCUSSION: There is only surgical management option for FAP patients up to now. Total colectomy with IRA and restorative proctocolectomy with IPAA is surgical options for FAP patients that avoid the need for a permanent stoma. Anorectal eversion may be used in the surgical treatment of FAP, chronic ulcerative colitis and early stage distal rectal cancer patients. CONCLUSION: J-pouch ileoanal anastomosis can safely be performed by rectal eversion and double stapler technique in FAP patients.

Effect of pheniramine maleate on reperfusion injury in brain tissue.

BACKGROUND: The aim of this study was to investigate the protective effects of methylprednisolone (Pn), which is a potent anti-inflammatory agent, and pheniramine maleate (Ph), which is an antihistaminic with some anti-inflammatory effects, on reperfusion injury in brain developing after ischemia of the left lower extremity of rats. MATERIAL AND METHODS: Twenty-eight randomly selected male Sprague-Dawley rats were divided into 4 groups: Group 1 was the control group, Group 2 was the sham group (I/R), Rats in Group 3 were subjected to I/R and given Ph, and rats in Group 4 were subjected to I/R and given Pn. A tourniquet was applied at the level of left groin region of subjects in the I/R group after induction of anesthesia. One h of ischemia was performed with no drug administration. In the Ph group, half of a total dose of 10 mg/kg Ph was administered intraperitoneally before ischemia and the remaining half before reperfusion. In the Pn group, subjects received a single dose of 50 mg/kg Pn intraperitoneally at the 30th min of ischemia. Brains of all subjects were removed after 24 h for examination. RESULTS: Malondialdehyde (MDA) levels of the prefrontal cortex were significantly lower in the Ph group than in the I/R group (p<0.05). Superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzyme activities were found to be significantly higher in the Ph group than in the I/R group (p<0.05). Histological examination demonstrated that Ph had protective effects against I/R injury developing in the brain tissue. CONCLUSIONS: Ph has a protective effect against ischemia/reperfusion injury created experimentally in rat brains.

Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain.

OBJECTIVES: Propofol causes considerable pain upon injection, although different methods and propofol formulations have been used to decrease this pain. We aimed to investigate the effect of i.v. esmolol pretreatment on propofol injection pain. METHODS: Ninety ASA I-II patients undergoing elective surgery under general anesthesia were randomly assigned into three groups of thirty each. A 20 G cannula was inserted into the dorsum of the nondependent hand. After venous occlusion for one minute, groups E, L and S were pretreated with 5 mg/ml (total 2 ml) esmolol, 40 mg lidocaine and 2 ml saline i.v. respectively. After release of venous occlusion, one fourth of the total propofol dose was administered at a rate of 0.5 ml/sec. During the injection of both pretreatment solution and propofol, patient pain was assessed by using 4 point scale. Heart rate and noninvasive arterial blood pressure values were recorded before induction, just after entubation and five minutes after entubation. RESULTS: Demographic values were similar among groups. Incidence of pain on injection of propofol in the control, esmolol and lidocaine groups was 90%, 33.3%, 50% respectively (p<0.05). Heart rate, systolic arterial pressure, and diastolic arterial pressure values were not different between the groups. CONCLUSION: Pretreatment with low dose esmolol i.v. Seems to be effective in attenuating pain during propofol injection.

Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Hemodynamic changes caused by carbon dioxide (CO(2)) insufflation occur frequently in patients who undergo laparoscopic surgery. One indicator of these changes is corrected QT dispersion (QTcd), an index of myocardial function. Prolongation of QTcd has been associated with cardiovascular morbidity and mortality. We compared the effects of high-pressure (15 mmHg) and low-pressure (7 mmHg) CO(2) pneumoperitoneums on the QT interval, the rate-corrected QT interval (QTc), the QT dispersion (QTd), and the corrected QT dispersion (QTcd) during laparoscopic cholecystectomy. METHODS: Twenty consecutive patients were in a low-pressure pneumoperitoneum group and 32 were in a high-pressure pneumoperitoneum group. A 12-lead electrocardiogram was used to monitor cardiac variables. In all patients, serial electrocardiograms were recorded before anesthesia induction (baseline), immediately after the pneumoperitoneum had been created, every 15 minutes during CO(2) insufflation, and 5 minutes after deflation. Two observers measured the QT intervals independently, and the QTcd was calculated using Bazett's formula. RESULTS: The QT interval and the QTc interval did not change significantly during the study in either group. The QTd and QTcd in the high-pressure pneumoperitoneum group increased significantly during CO(2) insufflation and were significantly higher in the high-pressure pneumoperitoneum group compared with the low-pressure pneumoperitoneum group. Changes caused by CO(2) insufflation were reversible. CONCLUSIONS: Statistically significant increases of QTd and QTcd, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO(2) insufflation in both high-pressure and low-pressure pneumoperitoneums. QTd and QTcd were significantly higher in the high-pressure pneumoperitoneum group than they were in the low-pressure pneumoperitoneum group. QT interval changes were not related to anesthetic agents, surgical stress, hypercapnia, or duration of CO(2) insufflation. Increased intra-abdominal pressure may have caused these changes.

Byler's disease and anesthetic consideration.

Byler's disease is an autosomal recessive condition characterized by intrahepatic cholestasis, progressive fibrotic changes and finally cirrhosis that leads to death during childhood. This is a report of a six-year-old girl with Byler's disease and retrobulbar hematoma as a result of trauma who underwent enucleation and implantation. This case report describes the anesthetic features of a patient with Byler's disease in which anesthetic agents with no or minimal hepatotoxic effect should be used to avoid deterioration of liver function.