Sudden developing convulsion during interscalene block: Does propofol anesthesia diminish plasma bupivacaine level?

We aim to review local anesthetic systemic toxicity (LAST) due to suddenly developing convulsion during interscalene block in a 67-year-old patient undergoing shoulder surgery.

Comparison of high-resolution melting analysis to denaturing high performance liquid chromatography in the detection of point mutations in MEFV, F5, and F2 genes.

BACKGROUND/AIM: Sensitive and cost-effective detection of point mutations is important in genetics research. Denaturing high-performance liquid chromatography (DHPLC) is known to be one of the most sensitive techniques for point mutation detection. A more recent technique, high-resolution melting (HRM), is based on the melting behavior of PCR products. In this study, the efficiency and sensitivity of HRM and DHPLC for the detection of MEFV, F5, and F2 gene point mutations were evaluated. MATERIALS AND METHODS: We studied 15 patients with MEFV mutations (E148Q, M680I, M694V, or V726A), 7 patients with the F51691G>A mutation, and 12 patients with the F220210G>A mutation. All mutations were screened by HRM and DHPLC. RESULTS: All mutations were successfully detected by HRM. However, only 4 (MEFVE148Q and M680I, F51691G>A, and F220210G>A) of 6 mutations were successfully detected with DHPLC. CONCLUSION: Our study showed that HRM is more sensitive than DHPLC for detection of the studied point mutations.

Acute Phase Reaction after Femur Fracture in a Child with Griscelli Syndrome.

Griscelli syndrome (GS) is an autosomal recessive disorder that is characterized by partial albinism of the skin and hair shaft. Prompt and early diagnosis is a crucial step for the follow up and management of GS, which would otherwise dramatically decrease the life expectancy of the patients. This case report presents the clinical course of a femoral fracture treated with closed reduction and pelvic-pedal cast, and progression of acute phase reaction during the follow up period.

Comparison of Parasacral and Posterior Sciatic Nerve Blocks Combined with Lumbar Plexus Block.

OBJECTIVE: The aim of this study is to compare the effects of parasacral and posterior Winnie approaches when combined with the inguinal paravascular approach for lumbar plexus block. METHODS: After the approval of the Ethics Committee, 40 patients scheduled to undergo arthroscopic knee surgery were enrolled. The patients were randomly assigned into two groups in a double-blind manner to perform sciatic nerve block either by the parasacral technique (Group I) or by the posterior approach (Group II). RESULTS: The obturator nerve motor block success rate was found to be 80% (16/20) in Group I, whereas it was 10% (2/20) in Group II (p<0.05). CONCLUSION: Inguinal paravascular block with parasacral sciatic nerve block led to a much higher incidence of obturator nerve motor block when compared to the inguinal paravascular block with posterior sciatic nerve block during knee arthroscopies.

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.