In this review, one of the most compelling subjects to manage in thoracic anesthesia is explicated.Primarily, clinical experience and approach were tried to given in an algorithmic flow.All of the necessary approaches, starting from the preanesthetic phase to the end of the postoperative early period, were featured in a patient with massive hemoptysis.Fluid resuscitation; choice of anesthetics; and establishing the hemodynamic, inspiratory, and metabolic balance were given a place in extensive detail in an algorithm, which included all of the peroperative process.

Introduction: It has been previously reported that a spinal block at L1 level is adequate for transurethral resection of prostate (TURP) if low bladder pressure is provided. This study aims to compare adequacy and the characteristics of spinal anesthesia with low dose bupivacaine and bupivacaine + fentanyl combinations for TURP conducted with continuous irrigation resectoscope.Materials and Method: After Ethical Committee approval and informed consent, 50 patients were included with randomization. Spinal anesthesia was conducted in the sitting position with 5 mg of hyperbaric bupivacaine + 0.4 ml 0.9% NaCl in group B (n=25) and 5 mg of hyperbaric bupivacaine + 0.4 ml (20 mu g) fentanyl in group BF (n=25). Sensory block levels, motor block properties, quality of intraoperative anesthesia, surgical convenience and side effects were recorded.Results: The groups were similar regarding maximum block levels (L2), motor block and hemodynamic, properties. Sufficient analgesia was provided without additional analgesics in 46 of 50 patients with a sensory block higher than S1. Two groups were similar in terms of the quality of anesthesia, convenience for the surgeon and side effects.Conclusion: Bupivacaine (5mg) with or without fentanyl provides safe and adequate anesthesia, with a sensory block higher than S1, when continuous irrigation resectoscope is used for TURP.

Pediatric AnesthesiaVolume 19, Issue 2 p. 170-171 The effect of 45-degree head up tilt on bloody tap during lumbar puncture in children Ates Duman, Ates Duman Department of Anaesthesia and Intensive Care, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this authorSeza Apiliogullari, Seza Apiliogullari Department of Anaesthesia and Intensive Care, Dr Faruk Sukan Obstetrics and Children’s Hospital, Konya, Turkey (email: dumanates@yahoo.com)Search for more papers by this authorCemile Oztin Ogun, Cemile Oztin Ogun Department of Anaesthesia and Intensive Care, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this author Ates Duman, Ates Duman Department of Anaesthesia and Intensive Care, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this authorSeza Apiliogullari, Seza Apiliogullari Department of Anaesthesia and Intensive Care, Dr Faruk Sukan Obstetrics and Children’s Hospital, Konya, Turkey (email: dumanates@yahoo.com)Search for more papers by this authorCemile Oztin Ogun, Cemile Oztin Ogun Department of Anaesthesia and Intensive Care, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this author First published: 27 January 2009 https://doi.org/10.1111/j.1460-9592.2008.02910.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume19, Issue2February 2009Pages 170-171 RelatedInformation

Background: There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia.Methods: Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26-gauge, atraumatic needle either in the standard lateral decubitus, knee-chest position (group I, n = 90) or lateral decubitus, knee-chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP.Results: The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged < 12 months of age but not significant in children older than 12 months of age.Conclusions: Because of higher success rate, lateral decubitus, knee-chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.

Methods: After ethical approval, spinal block was performed in ASAI-II 60 parturients undergoing elective caesarean section following 1000ml colloid preloading. Group RF received 15mg ropivacaine 25 g fentanyl and group RFM received 15mg ropivacaine 25 g fentanyl and 100 gr morphine (M). Sensory and motor block properties, hemodynamics, postoperative analgesia, foetal outcomes and side effects were evaluated. Intraoperative pain and muscle relaxation were assesed by using visuel analog scale by the surgeon. One-way analysis of variance, Tukey-HSD, and chi-square, T tests and Kruskall-Wallis tests were used for statistical analysis (p 0.05).

This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon's canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half of the forearm, then diverged medially and extended into the Guyon's canal and was innervated by the ulnar nerve. The patient had no symptoms related to overcrowding of the Guyon's canal before the injury. A hand surgeon should be well informed about the anatomic variations of the hand to be comfortable during surgical practice.

Background: The literature is scarce on wrist tourniquets. In this study, three well-established locations of tourniquet setting including upper arm, proximal forearm, and wrist were compared on the same limb using both clinical as well as biochemical variables in paramedical volunteers.Methods. Twenty unmedicated, healthy, paramedical, right-hand dominant volunteers participated in the study. The left upper arms were used for monitoring. Blood pressures and heart rates were monitored and recorded before (baseline) and immediately after the application of the tourniquet, every 5 minutes, and at the time the patient requested deflation. An intravenous cannula (22 G) was placed on the right hand to obtain samples, which were taken at baseline and immediately after deflation of the tourniquet to evaluate the levels of pO(2), pCO(2) O-2 saturation, pH, bicarbonate, blood sugar, lactate, hematocrit, and electrolytes. The tourniquets were applied to the right upper arm, forearm, and wrist of each subject with 5-day intervals between each trial. Subjective discomfort and tourniquet pain levels were recorded. For each trial, tourniquet tolerance and details of discomfort were recorded. Statistical analysis was performed as appropriate.Results: Twenty volunteers aged 20 to 44 years were included. For each trial, in the first 10 minutes after inflation of the tourniquet, the heart rate and systolic blood pressure were increased compared with baseline values. Diastolic blood pressure was elevated immediately after inflation and remained so until deflation in each trial. Diastolic blood pressure values were higher in the upper-arm tourniquet group compared with wrist. Then pH, pO(2), and O-2. saturation values were de-creased and pCO(2) and lactate levels were increased compared with baseline values in each trial. Blood sugar was decreased significantly in the arm group. The decrease in pH, pO(2), O-2 saturation, and blood sugar in the upper arm group was significantly higher compared with wrist and forearm groups. The lactate value was higher in the upper arm group compared with wrist. Visual analog scale and numerical rating scores were lower in the wrist group compared with others at all times. The longest tourniquet tolerance was in the wrist group. In the wrist group, curling was observed in all subjects but the fingers could easily be extended.Conclusion: The wrist tourniquet is the most comfortable technique of bloodless surgery for procedures limited to the hand region.

Aim: We investigated the effects of intrathecal isobaric 0.5% ropivacaine and isobaric 0.5% ropivacaine-clonidine combination in women undergoing caesarean deliveries. Methods: Twenty-five parturients received 17.5 mg ropivacaine (group R) and twenty five parturients received 15 mg ropivacaine and 30 μg clonidine (group RC) for spinal anaesthesia. Sensory and motor block properties; haemodynamics, postoperative analgesia, foetal outcomes and side effects were evaluated. Unpaired and paired-t-tests and chi-square and Mann-Whitney-U tests were used where appropriate (p<0.05). Results: Intrathecal ropivacaine and ropivacaine-clonidine provided effective sensory anaesthesia and motor block. S2 dermatome regression time was longer in ropivacaine-clonidine combination. First minute APGAR was lower in group RC (mean 8.8±0.7) than group R (mean 9.3±1.0). Umbilical venous pH and fifth minute APGAR scores were similar between the groups. Postoperative analgesia was prolonged by clonidine. Although intraoperative ephedrine requirements (mg) were higher in ropivacaine-clonidine group, the number of patients requiring ephedrine and the number of hypotension episodes were similar. Dry mouth was observed more with clonidine. Conclusion: We concluded that, intrathecal 17.5 mg 0.5% isobaric ropivacaine provides efficient and safe anaesthesia for caesarean section delivery. The addition of 30 g clonidine to 15 mg 0.5% isobaric ropivacaine results in longer complete and effective analgesia with similar block properties. In both groups, hypotension was easily treated with ephedrine and did not affect maternal and neonatal outcome.

Methods: After ethical approval, spinal block was performed in ASAI-II 60 parturients undergoing elective caesarean section following 1000ml colloid preloading. Group RF received 15mg ropivacaine 25 g fentanyl and group RFM received 15mg ropivacaine 25 g fentanyl and 100 gr morphine (M). Sensory and motor block properties, hemodynamics, postoperative analgesia, foetal outcomes and side effects were evaluated. Intraoperative pain and muscle relaxation were assesed by using visuel analog scale by the surgeon. One-way analysis of variance, Tukey-HSD, and chi-square, T tests and Kruskall-Wallis tests were used for statistical analysis (p 0.05).

Arterial blood gas (ABG) analysis has an important role in the clinical assessment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, arterial puncture or insertion of an arterial catheter has many drawbacks. The aim of this study was to evaluate whether venous blood gas (VBG) values of pH, partial pressure of carbon dioxide (PCO(2)) and oxygen (PO(2)), bicarbonate (HCO(3)), and oxygen saturation (SO(2)) can reliably predict ABG levels in patients with AECOPD. One hundred and thirty-two patients with a prior diagnosis of COPD presenting with acute exacerbation according to AECOPD criteria were included in this prospective study. AECOPD is defined as a recent increase in cough, wheezing, the volume and purulence of sputum or shortness of breath necessitating a change in regular medication, including corticosteroids or antibiotics. ABG samples were taken immediately after venous sampling, and both were analyzed. Linear regression analysis was performed and equations were established for the estimation of arterial values. The Pearson correlation coefficients for pH, PCO(2), HCO(3), PO(2), and SO(2) were 0.934, 0.908, 0.927, 0.252, and 0.296, respectively. There was a significant correlation between ABG and VBG values of pH, PCO(2), and HCO(3) (p < 0.001). Linear regression equations for the estimation of pH, PCO(2), and HCO(3) were as follows: arterial pH = 1.004 x venous pH; arterial PCO(2) = 0.873 x venous PCO(2); and arterial HCO(3) = 0.951 x venous HCO(3). VBG analysis can reliably predict the ABG values of pH, PCO(2) and HCO(3) in patients with AECOPD.

Objective: The purpose of this study was to determine the mechanism of the direct effects of fentanyl on human veins in vitro.Design: In vitro, prospective with repeated measures.Setting: University research laboratory.Interventions: Dose-response curves were obtained for cumulative doses of fentanyl (10(-9)-10(-5) mol/L) on saphenous vein strips precontracted with (10(-6) mol/L) 5-hydroxytryptamine incubated with either naloxone (10(-4) mol/L), N omega-nitroL-arginine-methyl ester (L-NAME) (10(-4) mol/L), indomethacin (10(-5) mol/L), glibenclamide (10-4 mol/L), tetraethylammonium (10(-4) mol/L), or ouabain (10(-5) mol/L). Vein strips were also exposed to a Ca++-free solution and 0.1 mmol/L of ethylene glycol-bis-(b-aminoethylether) N,N '-tetraacetic acid; 5-hydroxytryptamine (10(-6) mol/L) was added to the bath before cumulative Ca++ (10(-4)-10(-2) mol/L). The same procedure was repeated in the presence of fentanyl (10-6, 3 x 10-6, or 10-5 mol/L) (p < 0.05 = significant).Measurements and Main Results: Preincubation of vein strips with naloxone, L-NAME, or indomethacin did not influence the relaxant responses to fentanyl (p > 0.05). Tetraethylammonium, glibenclamide, and ouabain reduced the relaxation response to fentanyl (p < 0.05). A stepwise increase in tension was recorded with cumulative doses of Ca++ (p < 0.05).Conclusions: The present results show that fentanyl causes vasodilatation via both endothelium- and opioid receptor-independent mechanisms in the human saphenous vein. The relaxant effects of fentanyl are probably via activation of K+ channel and Na+K+-adenosine trisphosphatase and inhibition of Ca++ channel. (c) 2005 Elsevier Inc. All rights reserved.

Study Design. Prospective, randomized, double blind, placebo-controlled, crossover clinical trial.Objectives. To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury.Summary of Background Data. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses.Methods. A total of 18-week study period included a 4-week medication/ placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/ placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study.Results. All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life ( P < 0.05).Conclusions. Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

Acta Anaesthesiologica ScandinavicaVolume 48, Issue 3 p. 390-390 Remifentanil has different effects on thoracic aorta strips in different species, in vitro A. Duman, Corresponding Author A. Duman * Ates Duman, MD Selcuk University Faculty of Medicine Department of Anaesthesiology and Intensive Care 42080 Konya Turkey e-mail: aduman@selcuk.edu.trSearch for more papers by this authorC. O. Ogün, C. O. OgünSearch for more papers by this authorA. S. Sahin, A. S. SahinSearch for more papers by this authorK. E. Atalik, K. E. AtalikSearch for more papers by this authorA. Erol, A. ErolSearch for more papers by this authorS. Okesli, S. OkesliSearch for more papers by this author A. Duman, Corresponding Author A. Duman * Ates Duman, MD Selcuk University Faculty of Medicine Department of Anaesthesiology and Intensive Care 42080 Konya Turkey e-mail: aduman@selcuk.edu.trSearch for more papers by this authorC. O. Ogün, C. O. OgünSearch for more papers by this authorA. S. Sahin, A. S. SahinSearch for more papers by this authorK. E. Atalik, K. E. AtalikSearch for more papers by this authorA. Erol, A. ErolSearch for more papers by this authorS. Okesli, S. OkesliSearch for more papers by this author First published: 09 October 2008 https://doi.org/10.1111/j.0001-5172.2004.0320g.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume48, Issue3March 2004Pages 390-390 RelatedInformation

Purpose: The aim of this study was to determine whether omental transposition at the time of focal cerebral ischemia can decrease ischemic brain damage produced in dogs, in a new ischemia model, which had been described by us. Methods: In group 1 (n = 5), the left internal carotid artery and arterial circle of the brain (posterior communicating artery in humans) were occluded permanently. In group 2 (n = 5), additionally to this ischemia model, omental transposition was performed simultaneously. In the postoperative early period (first 24 h), single photon emission computed tomography (SPECT) and in the late period (72–96 h) SPECT and magnetic resonance imaging (MRI) of the brain were performed. Mann-Whitney U, paired t and Wilcoxon signed rank tests were used for statistical analyses, and p < 0.05 was considered significant. Results: The dogs had a neurological score (NS) of 3.6 ± 0.5 and 3.4 ±0.5 in groups 1 and 2, respectively, in the early period (p > 0.05). In the late period, the dogs had an NS of 4.4 ± 0.5 and 5.6 ± 0.5 in groups 1 and 2, respectively (p < 0.05). The NS of each group differed significantly between the early and late period (p < 0.05). Early SPECT imaging showed 50 ± 7.0% and 52 ± 8.4% hypoperfusion corresponding to the left middle cerebral artery territory in groups 1 and 2, respectively (p > 0.05). In the late period, the degree of hypoperfusion decreased to 34 ± 5.5% and 12 ± 4.8% in groups 1 and 2, respectively (p < 0.05). The degree of hypoperfusion in both groups changed significantly between the early and late period (p < 0.05). In T1- and T2-weighted MRI images, the volume of the lesion in group 1 was significantly greater than in group 2 (p < 0.001). Conclusion: In our new ischemia model, simultaneous omental transposition is helpful in reversing the neurologic deficit and cerebral ischemic damage.

This study was designed to evaluate the effects of intrathecal isobaric bupivacaine 0.5% plus morphine and isobaric ropivacaine 0.5% plus morphine combinations in women undergoing Caesarean deliveries.Twenty-five parturients received ropivacaine 15 mg and morphine 150 micro g (RM group) and twenty-five parturients received bupivacaine 15 mg and morphine 150 micro g (BM group) for spinal anaesthesia. Sensory and motor block, haemodynamics, postoperative analgesia, fetal outcomes, and side-effects were evaluated.Intrathecal bupivacaine-morphine and ropivacaine-morphine provided effective sensory anaesthesia and motor block. Time to reach complete motor block was shorter and time to complete recovery from motor block was longer in the BM group than the RM group (P<0.05). The time to regression of two dermatomes and time for the block to recede to the S2 dermatome were similar in both groups (P>0.05). Time to first complaint of pain and the mean total consumption of tenoxicam were similar in both groups (P>0.05). APGAR scores at 1 and 5 min were similar in the two groups, as were mean umbilical blood pH values (P>0.05). Hypotension and pruritus were the most common side-effects in both groups during the operation.Intrathecal isobaric ropivacaine 0.5% 15 mg plus morphine 150 micro g provides sufficient anaesthesia for Caesarean delivery. The ropivacaine-morphine combination resulted in shorter motor block, similar sensory and postoperative analgesia.

BACKGROUND This study was designed to evaluate the effects of intrathecal isobaric bupivacaine 0.5% plus morphine and isobaric ropivacaine 0.5% plus morphine combinations in women undergoing Caesarean deliveries. METHOD Twenty-five parturients received ropivacaine 15 mg and morphine 150 micro g (RM group) and twenty-five parturients received bupivacaine 15 mg and morphine 150 micro g (BM group) for spinal anaesthesia. Sensory and motor block, haemodynamics, postoperative analgesia, fetal outcomes, and side-effects were evaluated. RESULTS Intrathecal bupivacaine-morphine and ropivacaine-morphine provided effective sensory anaesthesia and motor block. Time to reach complete motor block was shorter and time to complete recovery from motor block was longer in the BM group than the RM group (P<0.05). The time to regression of two dermatomes and time for the block to recede to the S2 dermatome were similar in both groups (P>0.05). Time to first complaint of pain and the mean total consumption of tenoxicam were similar in both groups (P>0.05). APGAR scores at 1 and 5 min were similar in the two groups, as were mean umbilical blood pH values (P>0.05). Hypotension and pruritus were the most common side-effects in both groups during the operation. CONCLUSION Intrathecal isobaric ropivacaine 0.5% 15 mg plus morphine 150 micro g provides sufficient anaesthesia for Caesarean delivery. The ropivacaine-morphine combination resulted in shorter motor block, similar sensory and postoperative analgesia.

STUDY DESIGN:Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation.OBJECTIVES:To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain.SUMMARY OF THE BACKGROUND DATA:Vertebral artery loop formation is reported to be a rare cause of cervicobrachial neuralgia, discovered incidentally during the search for its cause. It can be congenital or acquired, occurring equally in both sexes. Surgical decompression has been the preferred method in the majority of reported cases, with favorable results.METHODS:One hundred seventy-three patients with cervicobrachial pain were examined in a period of 7 months using physical examination, radiography, and magnetic resonance imaging with or without angiography.RESULTS:Thirteen patients with a mean age of 43.9 +/- 13.5 years were diagnosed with vertebral artery loop formation. The most common level was C6-C7. Four patients presented with loop formation at two levels. None of the patients had symptoms attributable to intervertebral disc pathology. The complaints were in accordance with the level of the vascular pathology. Complete relief or decrease in pain was observed in all patients with the conservative approach.CONCLUSIONS:In patients with cervicobrachialgic symptoms and without established discopathy, during the examination of sagittal magnetic resonance images, vertebral artery loop formation should be kept in mind, and in suspected cases, the vertebral artery should be visualized using three-dimensional time of flight magnetic resonance angiography. Vertebral artery-nerve root relation should also be demonstrated using the multiplanar reformatting method from time of flight images. A conservative course of treatment has a favorable outcome.