AIM:Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. MATERIAL AND METHODS:Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1st and 6th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1st and 6th hours were administered erythrocyte transfusion. RESULTS:Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONCLUSION:For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very important and these have to be replaced immediately.

Tracheal stenosis may occur after congenital problems and long-term endotracheal tube compression. Spinal stenosis is one of the 3 most common reasons in patients undergoing surgery due to low back and leg pain. Both general and regional anesthesia are used for lumbar surgery. A 56-year-old woman was admitted to our hospital with low back pain and leg paresthesia. A per- manent tracheal stent was placed 11 years ago due to tracheal stenosis developed after tracheostomy performed for anaphylaxis and respiratory depression. Herein, a case of regional anesthesia technique applied during spinal stenosis surgery is presented.

BACKGROUND:Acetaminophen is an analgesic drug that is used safely in therapeutic doses. At high doses, it causes hepatotoxicity, resulting in hepatic necrosis. Some medications and methods are available for treatment of acetaminophen overdose. However, results are inconsistent, and sufficient outcomes cannot always be obtained.OBJECTIVE:The mechanism of action of acetaminophen has not been fully understood. It has been suggested that it exerts its effects on GABA receptors. Flumazenil has been experimentally proven to produce an antagonism on acetaminophen's analgesic effect.The purpose of this study was to determine whether flumazenil antagonized the toxic effects of acetaminophen overdose in rats.METHODS:A total of 49 Wistar albino rats weighing between 250 - 350 g were used in the study. Nine rats were examined for a preliminary study, and the other rats were randomly divided into five groups with eight subjects in each.CONTROL GROUP:Saline; Acetaminophen group: 3 g/kg acetaminophen; Experimental Group F1: 3 g/kg acetaminophen + 0.1 mg/kg flumazenil; Experimental group F2: 3 g/kg acetaminophen + 1 mg/kg flumazenil; Experimental group F3: 3 g/kg acetaminophen + 10 mg/kg flumazenil. Acetaminophen was administered in a 3 ml saline solution by way of gastric catheter. Flumazenil was administered by way of intraperitoneal injections. Serum levels of acetaminophen, AST, ALT, LDH, ALP and bilirubin were recorded over a 24-hour period.RESULTS:Serum acetaminophen levels were similar between the groups. The AST, ALT, ALP, LDH, total bilirubin and direct bilirubin levels of Group A were significantly higher compared with the Group C, Group F1, Group F2 and Group F3. There was not a statistically significant difference in the AST, ALT, ALP, LDH, total bilirubin or direct bilirubin levels of the flumazenil-administered groups.CONCLUSION:Flumazenil's prevention of the acetaminophen-induced increase in liver enzymes is promising. There is some indication that flumazenil could be used in treatment of acetaminophen intoxication (Tab. 2, Ref. 25).

Aim: Postoperative nausea and vomiting (PONV) is a condition that adversely affects postoperative patient comfort. Supratentorial craniotomy patients were therefore monitored to establish the therapeutic efficiency of 2 different doses of palonosetron.Materials and methods: Patients scheduled for elective supratentorial craniotomy were randomly assigned to 3 groups: a control group (n = 30), a 0.05 mg palonosetron group (n = 30), and a 0.075 mg palonosetron group (n = 30). The drugs were given intravenously at the commencement of dura mater closure. Anesthesia maintenance was provided with 1 MAC sevoflurane in a 50% air and O-2 mixture. After the extubation, the patients were monitored for 72 h with respect to postoperative nausea and vomiting.Results: In the first 6 h, nausea was significantly lower in the 0.075 mg palonosetron group compared to the control group (P = 0.019). The incidences of nausea, retching, and vomiting at 0-72 h postoperatively were significantly lower in the 0.075 mg palonosetron group than in the 0.05 mg palonosetron or saline groups (P <0.001).Conclusion: In supratentorial craniotomy cases, PONV was reduced more effectively in the 0.075 mg palonosetron group than in the 0.05 mg palonosetron and control groups.

The Beckwith-Wiedemann syndrome is characterized by macroglossia; pre- or postnatal gigantism; abdominal wall defects; hypoglycaemia; umbilical hernia or diastasis recti; ear creases or posterior helical ear pits; facial nevus flammeus; renal anomalies; neoplasms; hemihypertrophy; congenital cardiac malformations; intestinal malrotation; mental retardation; polydactyly; and cleft palate. Anesthetic considerations of 7 months old girl with BeckwithWiedemann syndrome during reduction of macroglossia are presented and discussed.

Objective: The aim of this study was to evaluate the efficacy of different doses of palonosetron for the prevention of PONV in children undergoing strabismus surgery. Patients and Method: A total of 150 children who were classified with an American Society of Anesthesiologists physical status of I, were aged between 2 and 12 years, and were undergoing strabismus surgery under general anesthesia were enrolled in the study. A random numbers table was used to assign each child to receive palonosetron 0.5, 1.0, or 1.5 μg/kg (n = 50 in each group).All episodes of PONVat the intervals of 0–2, 2–6, 6–24, and 24–48 hours were evaluated using a numeric scoring system for PONV. A p-value of <0.05 was considered statistically significant. Results: The percentage of children with PONV during 0–48 hours after anesthesia was 24% with palonosetron 0.5 or 1.0 μg/kg, and 20% with palonosetron 1.5 μg/kg. There was no statistically significant difference between the study groups with respect to the number of children with PONV scores of 1, 2, or 3 during 0–48 hours after anesthesia. There was no statistically significant difference between the study groups with respect to the number of children with postoperative vomiting during all time periods after anesthesia. The percentage of children aged >6 years with postoperative nausea during 0–48 hours after anesthesia was 8.6%, 18.2%, and 15.4% with palonosetron 0.5, 1.0, or 1.5 μg/kg, respectively, but there was no statistically significant difference between the study groups. Conclusion: Palonosetron doses of 0.5, 1.0, and 1.5 μg/kg are recommended for further evaluation, as they appear to be the effective doses for the prevention of PONV following strabismus surgery in children.

Purpose: The aim of this study was to search the effects of flumazenil and naloxane, which are frequently used in intensive care units for benzodiazepine and opioid antagonism, on dexmedetomidine's antinociceptive effect. Material and Methods: 50 Bulb-C albino mice, weight between 25-35 grams, were used in the study. Mice were randomized in to 5 groups (n=10). Serum physiologic, 200 mu g/kg of dexmedetomidine, 1 mg/kg of yohimbine + 200 mu g/kg of dexmedetomidine, 1 mg/kg of flumazenil + 200 mu g/kg of dexmedetomidine or 2 mg/kg of naloxone + 200 mu g/kg of dexmedetomidine were applied to each mouse in every group. Although no significant analgesic effect was observed in 20., 40., 60., and 80. minutes in control group and yohimbine + dexmedetomidine group, the analgesic effects of drugs; applied to other groups were observed. The accompanying application of dexmedetomidine and yohimbine abolished its analgesic effect of dexmedetomidine, however, there were no statistical difference when compared to groups which dexmedetomidine is applied with flumazenil and naloxone. Conclusion: We could not find any effect of flumazenil and naloxane on antinociceptive effect of dexmedetomidine.

BACKGROUND: A critical point in craniotomy is during opening of the dura and the subsequent potential for cerebral edema. Use of desflurane in neurosurgery may be beneficial because it facilitates early postoperative neurologic evaluation; however, data on the effect of desflurane on intracranial pressure in humans are limited. Isoflurane has been used extensively in neurosurgical patients.OBJECTIVE: This study compared 1 minimum alveolar concentration (MAC) desflurane with 1 MAC isoflurane in facilitating hemodynamic stability, brain relaxation, and postoperative recovery characteristics in patients who underwent craniotomy for supratentorial lesions.METHODS: A total of 70 patients (aged 18-65 years), with American Society of Anesthesiologists (ASA) 1 or 2 physical status, who underwent craniotomy for supratentorial lesions, were enrolled in the study. For induction of anesthesia, fentanyl (2 mu g/kg IV) and propofol (2 mg/kg IV) were administered. Endotracheal intubation was performed after administration of vecuronium (0.1 mg/kg IV) for total muscle relaxation. Before insertion of the skull pins, additional fentanyl (2 mu g/kg IV) was administered. Patients were randomly allocated to 1 of 2 anesthetic regimens. For maintenance of anesthesia, 35 patients received 1 MAC of desflurane (group 1) and 35 patients received 1 MAC of isoflurane (group 2) within 50% oxygen in nitrous oxide. Intraoperatively, heart rate (HR) and mean arterial pressure (MAP) were measured and recorded before induction and 1 minute after induction, after endotracheal intubation, before skull pin insertion and 1 minute after skull pin insertion, before incision and 1 minute after incision, and before extubation and 1 minute after extubation. Also, HR and MAP were recorded at 30-minute intervals. Postoperatively, extubation time, eye opening time to verbal stimuli, orientation time, and time to reach an Aldrete postanesthetic recovery score of >= 8 were recorded. In addition, opioid consumption was calculated and recorded. Brain relaxation was evaluated according to a 4-step brain relaxation scoring scale. All outcomes of the study were assessed and recorded by an anesthesiologist blinded to the volatile anesthetic gases studied.RESULTS: No significant difference in HR was observed between the 2 groups. Intraoperative MAP values in group 1 were higher than in group 2 (P < 0.05). No significant difference was found between these groups in brain relaxation and opioid consumption. Extubation time, eye opening time to verbal stimuli, and time to reach an Aldrete score of >= 8 were found to be significantly shorter in patients in group 1 compared with patients in group 2 (P < 0.05).CONCLUSIONS: In patients who underwent craniotomy for supratentorial lesions, patients who received 1 MAC desflurane-based anesthesia had earlier postoperative cognitive recovery and postoperative neurologic examination compared with patients who received 1 MAC isoflurane-based anesthesia. The observed benefits of early recovery from anesthesia, however, should be considered with risks such as higher MAP in patients administered 1 MAC desflurane. (Curr Ther Res Clin Exp. 2011;72:49-59) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.

BACKGROUND: To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo nasal surgery. Levobupivacaine and ropivacaine are relatively new long-acting local anesthetics.OBJECTIVE: The aim of this study was to compare the analgesic effect and blood loss of preincisional levobupivacaine HCl 0.25% and ropivacaine HCl 0.375% in patients undergoing septorhinoplasty.METHODS: Sixty American Society of Anesthesiologists (ASA) I and II patients (18-55 years old) who were scheduled for elective open technique septorhinoplasty under general anesthesia were recruited for this study. The anesthetic technique was standardized for both groups. Preoperative and postoperative hemoglobin levels were recorded for all patients. Patients were assigned randomly to 1 of 2 study groups, and preincisional surgical field infiltration with 5 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline (group L; n = 30) or 5 mL of 0.75% ropivacaine plus 5 mL of 0.9% saline (group R; n = 30) was performed by the same surgeon. The degree of pain was measured by visual analogue scale (VAS) for pain and recorded at multiple time points in all patients after surgery.RESULTS: The analgesic effect at 2 hours in the postanesthesia care unit (PACU) and at 24 hours postoperatively did not differ significantly between the 2 local anesthetics (P > 0.05). Pain scores of patients decreased after the 24 hours in levobupivacaine group and ropivacaine group when compared with 0-minute VAS values, and this was statistically significant (P < 0.05). No significant difference was observed between groups with respect to the preoperative and postoperative hemoglobin (P = 0.767 and 0.824, respectively) values.CONCLUSIONS: Local tissue infiltration with 0.25% levobupivacaine or 0.375% ropivacaine is similarly effective in reducing the postoperative pain associated with septorhinoplasty. (Curr Ther Res Clin Exp. 2011;72:13-22) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.

Objective: The aim of the study is to compare the efficacy of local anesthetics, levobupivacaine and bupivacaine, for achievement of retrobulbar anesthesia and to determine patient and surgeon satisfaction in cataract surgery. Material and Methods: One hundred and twenty patients scheduled for cataract surgery were randomised, in a double-blind fashion to receive 5 ml of 0.5% levobupivacaine or 5 ml of 0.5% bupivacaine via inferotemporal injection for achievement of retrobulbar anaesthesia. Motor block durations and pain onset times were recorded. Severity of intra and postoperative pain was assessed by using visual analogue pain scale. The efficiency of anesthesia, patient and surgeon satisfaction, and akinesia durations were assessed by using point scoring scales. Hemodynamic data and adverse events were recorded. Results: Pain on injection (levobupivacaine 18%, bupivacaine 36.7%) was found to be more frequent in group B. The akinesia score after 10 minutes (median; 0, 1 respectively) and sensorial block onset time (2, 3 min) in levobupivacaine group was lower than bupivacaine group but, akinesia scores in both groups were under 4 and adequate for surgery. Surgeon and patient satisfaction regarding anesthesia were also higher in levobupivacaine group (median 10 and 10) compared to bupivacaine group (median 9 and 9) although the medians of two groups were close. Conclusions: Levobupivacaine provides better surgeon and patient satisfaction compared to bupivacaine for retrobulbar anesthesia in cataract surgery, and this finding should be supported by new and comprehensive clinical studies.

BACKGROUND:Injury of a peripheral nerve may lead to neuropathic pain, a form of chronic pain that does not respond to traditional pain therapies. The aim of this study was to investigate the effect of pulsed radiofrequency (PRF) applied to the L5 and L6 dorsal roots on the neuropathic pain that develops after sciatic nerve injury in rabbits. METHODS:In this study, 18 New Zealand rabbits were used. These were divided into 3 groups. In groups 1 and 2, the left sciatic nerve was tightly ligated as a partial ligation model with 4-0 silk sutures. Group 3 was a sham group. Pulsed radiofrequency was applied to group 1 rabbits on both dorsal roots at 42 degrees C for 8 mins. The responses of all the groups to thermal and mechanical stimuli were measured for a period of 4 weeks after this process. RESULTS:Ten days after ligation of the left sciatic nerve and before PRF application, neuropathic pain occurred; the responses of groups 1 and 2 to the hot plate test and to the mechanical stimulus were lower (P < 0.005) when compared with the baseline values. There were no statistically significant differences between baseline values and group 1 rabbits' responses to the hot plate test 2 weeks after the application of PRF or to the mechanical stimulus 3 weeks after RF application. The decrease seen in group 2 persisted after 4 weeks (P < 0.001). CONCLUSIONS:The hyperalgesia that develops as a result of neuropathic pain in rabbits was observed to be reduced by PRF application.

Awake craniotomy is a common procedure in resection of lesions near critical functional regions, particularly the speech and motor areas. During awake craniotomy, patients need to be fully alert and cooperative during testing. On the other hand, it is desirable to keep them sedated, avoiding discomfort, anxiety and pain over the rest of the surgery. In this case report, we report our successful use of dexmedetomidine-fentanyl combination for sedation in intracranial tumor resection with awake craniotomy. Dexmedetomidine-fentanyl combination was well tolerated in this adolescent patient and provided good surgical conditions and patient comfort during tumor resection and testing.