To the Editor, The study entitled "Evaluation of the Tobacco Control Law at Cafes and Restaurants" (1), which is published in this issue of your journal, is rather important for the inspection of the implementation of the law to ban smoking in indoor areas, which was enacted in 2008 in our country. Smoking is still the most significant cause of diseases and death. It is known that smoking caused approximately 100 million deaths, particularly in developed countries in the 20 th century. It is expected that smoking-induced deaths would reach approximately 1 billion in the 21 st century, particularly in underdeveloped and developing countries.
The application of local anesthetics in areas with a high blood supply, such as scalp block, is more susceptible to systemic effects of local anesthetics such as methemoglobinemia because of the high absorption rate and the risk of intravascular injection. In this study, we aimed to evaluate the risk of methemoglobinemia by reviewing methemoglobin values after scalp block in patients with a deep brain stimulation (DBS) due to neurological diseases, especially Parkinson's.The study included 41 patients aged >18 years who were admitted between January 2017 and December 2018 for DBS and underwent regional anesthesia (n = 41). Patients were administered scalp block (n = 10) and infiltration anesthesia (n = 31). Using data from the patients' medical records, we statistically analyzed the patients' age, American Society of Anesthesiologists (ASA) status, gender, DBS indication, scalp block/infiltration anesthesia, highest methemoglobin level in arterial blood gas, pH, pO2, SpO2, and clinical symptoms.The indications for DBS were Parkinson's disease in 29 patients hyperreactivity, dystonia and tremor in the remaining patients. Furthermore, 33 patients were classified as ASA class II. The methemoglobinemia level was >2% in two patients who underwent scalp block and six patients who underwent infiltration anesthesia. However, there was no statistically significant difference in methemoglobin levels between scalp and infiltration anesthesia.In areas with high blood flow, such as the scalp, caution should be exercised in administering local anesthesia because of the patient's risk of developing methemoglobinemia, although there are no clinical findings on this topic.
Patent ductus arteriosus is among the most common congenital heart diseases. With the increasing use of transcatheter closure procedures, the incidence of complications related to the procedure has increased. Embolization of the ductus closure device to the pulmonary artery is a very rare complication. Since those procedures are often performed under non-operating room anesthesia, anesthetic management of such patients is of great importance. Herein, anesthetic management of embolization of the ductus closure device to the pulmonary artery in a little girl was presented. This is the first case regarding the anesthetic management of such complication.
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