[Comparison of intraoperative and postoperative analgesic properties of ilioinguinal/iliohypogastric and sacral epidural block in pediatric unilateral inguinal hernia operations]. / Çocuklarda unilateral inguinal herni operasyonlarinda ilioinguinal/iliohipogastrik ve sakral epidural blogun intraoperatif ve postoperatif analjezik özelliklerinin karsilastirilmasi.

OBJECTIVES: Central blocks such as caudal, spinal, and sacral epidural are frequently used in pediatric inguinal surgeries. Furthermore, peripheral blocks have been used and successful results have been obtained in pediatric inguinal surgeries. In this study, we aimed to compare the intraoperative and postoperative analgesic efficacy of the ilioinguinal/iliohypogastric (IL/IH) block under general anesthesia with the sacral epidural block. METHODS: This study was carried out in Gazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, after obtaining permission from the Ethics Committee of Gazi University Faculty of Medicine and the Central Ethics Committee of the General Directorate of Pharmaceuticals and Pharmacy of the Turkish Ministry of Health, numbered B.10.0.IEG.011.00.01. Sixty patients in the American Society of Anesthesiologists I-II group between the ages of 1 and 8 years who will undergo elective unilateral inguinal hernia operation under general anesthesia were randomly divided into two groups. Group S (n=30) sacral epidural block and group I (n=30) IL/IH nerve block were planned. RESULTS: Hemodynamic values were found to be statistically significantly lower than control values in both groups. The minimum alveolar concentration values for sevoflurane were statistically significantly lower values in both groups at all surgery periods. In terms of additional analgesic requirement, the group I was found to be statistically significantly lower than the group s at the 8th-12th h. When the first analgesic intake hours were examined, no significant difference was found between the two groups. CONCLUSION: In our study, group I and group S analgesic efficacy was found to be similar.

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.

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.

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.

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.

Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report.

INTRODUCTION: Pulmonary hypertension is a rare condition and in combination with pregnancy, it can result in high maternal mortality. Mitral stenosis is one of the complicated cardiac diseases that may occur during pregnancy. In this report, we describe our management of such a case, which was even more difficult in combination with pulmonary hypertension, mitral stenosis, and aortic and tricuspid valve insufficiency requiring emergency caesarean section under general anaesthesia. CASE PRESENTATION: A 29-year-old primiparae was presented to the anaesthetic department for an urgent caesarean section with a diagnosis of severe pulmonary hypertension in combination with mitral stenosis. The patient was hospitalized prepartum and received oxygen therapy and anticoagulation with heparin. The patient was monitored during labour and delivery with oximetry and arterial and central venous pressure line. Pulmonary arterial lines were not used due to an increased risk and questionable usefulness. Echocardiography revealed a systolic pulmonary arterial pressure of 75 mmHg, and mitral stenosis, aortic and tricuspid valve insufficiency. We decided to proceed under general anaesthesia. Anaesthesia was induced with etomidate, and succinylcholine. Dopamine and nitroglycerin infusion was preoperatively started and infusion was also preoperatively continued. Hemodynamic parameters were stable during delivery. Neonatal weight and apgar score were satisfactory. After the delivery of a healthy baby, oxytocin was administered. Surgery was completed uneventfully. During the postoperative period, the patient received furosemide and morphine. As the arterial blood gas analyses were stable and the chest-ray was normal, the patient was extubated postoperatively in the second hour in ICU. CONCLUSION: Patients with significant multivalvular heart disease require careful preoperative, multidisciplinary assessment and anesthetic planning before delivery in order to optimize cardiac function during the peripartum period and make informed decisions regarding the mode of delivery and anaesthetic technique.

Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report.

INTRODUCTION: The choice of anesthetic technique for Caesarean section of a pregnant woman with cerebral arteriovenous malformation (AVM) is made to maintain a stable cardiovascular system, but due to the rarity of this condition, no definitive guidelines exist. CASE PRESENTATION: We report the case of anesthetic management of Caesarean section of a pregnant woman with cerebral AVM (grade V). After the diagnosis, the radiologists decided to perform angiography and endovascular operation for treatment after the termination of pregnancy. The patient refused to undergo this procedure and with the beginning of the contractions of uterus, she was admitted to hospital urgently at the 40th week of gestational age and Caesarean section under general anesthesia was performed successfully. CONCLUSION: We concluded that in case of emergency, general anesthesia can be used satisfactorily for Caesarean section of a pregnant woman with cerebral AVM. Ensuring optimal maternal and fetal well-being, we are of the opinion that it is also possible to control the arterial blood pressure of patients with general anesthesia.

Alcohol neurolysis for persistent pain caused by superior cluneal nerves injury after iliac crest bone graft harvesting in orthopedic surgery: report of four cases and review of the literature.

STUDY DESIGN: Harvesting of autologous bone graft from the posterior iliac crest for lumbar spinal fusions is a frequently performed procedure in orthopedic surgery. The most common complication associated with this procedure is an alteration in sensation over the donor site manifested as chronic pain, hyperesthesia, dysesthesia, or diminished sensitivity resulting from superior cluneal nerve (SCN) injury. OBJECTIVE: To predict the effectiveness of alcohol neurolysis in the treatment of persistent pain caused by the entrapment of superior cluneal nerves. SUMMARY AND BACKGROUND DATA: The subjects of this study were patients with intractable pain in donor area after conventional treatments using a transverse incision, which is parallel to posterior iliac crest. The study group was composed of four patients who underwent surgery in a 1-year period and experienced chronic pain resulting from superior cluneal nerve injury. METHODS: No reports describing alcohol neurolysis of the superior cluneal nerve exist in the relevant literature. All four patients in this study were treated with alcohol neurolysis of the superior cluneal nerves. RESULTS: The study patients were observed up to 4 years, and none of them reported any problems. CONCLUSIONS: The authors suggest that conventional treatments be limited to a 2-month period, and that alcohol neurolysis be applied as soon as possible to prevent lengthy pain experiences.

Clinical approach to graft hepatic artery thrombosis following living related liver transplantation.

Hepatic artery thrombosis (HAT) has an occurrence rate of 1.7-26% following living donor liver transplantation (LDLT) and is one of the most common reasons for graft loss and mortality in this population. There is a higher incidence of HAT in pediatric recipients. The aim of this case report is to discuss clinical approaches for the treatment of HAT occurring in the early post-operative period after LDLT. An 11-month-old, 7.8-kg female with cirrhosis secondary to biliary atresia underwent LDLT at Gazi University Hospital in Ankara. The graft was a left lateral segment from her father with a left hepatic artery (HA) of 2 mm diameter and a graft weight/recipient body weight ratio of 2.0%. After an uneventful early post-operative period, HAT was diagnosed by Doppler ultrasonography (USG) on the fifth post-operative day. Following angiographic evaluation, immediate exploration and reanastomosis was performed using an operation microscope. Post-operatively, the HA was patented by Doppler USG and graft function returned to normal. Now, 42 months later, the patient continues to do well with normal graft function, using a regimen of tacrolimus monotherapy for immunosuppression. In countries which have very limited resources for urgent re-transplantation, given their serious donor shortage, graft salvage may be the only option for patient survival when HAT occurs. In these circumstances, early diagnosis and immediate revascularization may be the only method for graft salvage. A daily routine of Doppler USG examination in the early post-operative period may provide a method for the early diagnosis of HAT, before liver enzymes are elevated and hepatic necrosis has begun.