In patients undergoing lower limb amputation, performing epidural anesthesia or peripheral nerve block, instead of general anesthesia or spinal anesthesia, might attenuate phantom and stump pain in the first week after operation. Anesthetic technique might not have an effect on phantom limb pain, phantom sensation, or stump pain at 14 to 17 months after lower limb amputation.

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Determining the type of anesthesia is a complex medical decision that depends on many factors including co-morbidity, age, type of surgery performed, and the risk of the anesthetic techniques. This study evaluated the effects of anesthesia type on postoperative mortality and morbidity in hip fractures. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : One hundred eighty-five patients older than 60 years who were operated for hip fracture between 2005-2009 were retrospectively analyzed. Patients received general anesthesia (n=67), spinal anesthesia (n=67), or epidural anesthesia (n=51). The clinical features of the patients were obtained from the hospital records. Morbidity outcomes were assessed on postoperative day 7. Mortality rates were calculated on postoperative day 7 and postoperative day 30. R Re es su ul lt ts s: : There were no significant differences between the three groups with regard to intraoperative blood loss, intraoperative blood transfusion, smoking status, length of stay in hospital, American Society of Anesthesiology (ASA) physical status, and Charlson Comorbidity Index (CCI) (p=0.393, p=0.088, p=0.369, p=0.228, p=0.491, p=0.371 respectively). Similarly, no difference was detected between the three groups regarding patient mortality rates for day 7 and 30 (p=0.738, p=0.805 respectively). C Co on nc cl lu us si io on n: : No technique was superior to the others. Due to the similar mortality rates among the groups, we suggest that the proper anesthetic technique selected according to the clinical features of the patient combined with adequate monitorization would yield successful results with all three techniques. K Ke ey y W Wo or rd ds s: : Hip fractures; mortality; anesthesia Ö ÖZ ZE ET T A Am ma aç ç: : Anestezi tipinin belirlenmesi, yaş, uygulanacak cerrahi tipi ve anestezi tekniklerinin riski gibi birçok faktörün göz önüne alınmasını gerektiren, kompleks bir tıbbi karardır. Bu çal-ışmada, kalça kırıklarında anestezi tipinin cerrahi sonrası mortalite ve morbidite üzerindeki etkileri değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada, 2005-2009 yılları arasında kalça kırığı operasyonu geçiren 60 yaş üzeri 185 hasta retrospektif olarak analiz edilmiştir. Hastalara genel anestezi (n=67), spinal anestezi (n=67) ve epidural anestezi (n=51) yöntemlerinden biri uygulanmıştır. Hastalara ait klinik bilgiler hastane kayıtlarından elde edilmiştir. Morbidite sonuç-ları operasyon sonrası yedinci günde değerlendirilmiştir. Mortalite oranı ise operasyon sonrası 7. ve 30. günlerde hesaplanmıştır. B Bu ul lg gu ul la ar r: : Her üç grupta cerrahi sırasındaki kan kaybı ve kan transfüzyonu, sigara içme durumu, hastanede kalış süresi, American Society of Anesthesiology (ASA) skoru ve Charlson morbidite indeksi skoru açısından anlamlı bir fark bulunmamıştır (sırasıyla p=0,393, p=0,088, p=0,369, p=0,228, p=0,491, p=0,371). Hastaların 7. ve 30. günlerdeki mortalite oranları açısından gruplar arasında anlamlı bir f...

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We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.

The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n=45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n=45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P <0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.