The present study may serve as the beginning of using music therapy for pain treatment in gastroenterology procedures in our hospital with/without sedation. Music and other non-pharmacological treatment methods must be remembered to increase patient comfort during enco/colonoscopies and other painful procedures.

Rationale:Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration.Patient concerns:A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil. At the end of the operation, sugammadex was administered and resulted in initially hypotension and bradycardia then the situation worsened by premature ventricular contraction and bigeminy with tachycardia, bronchospasm, and hypoxia.Diagnosis:The Ring and Messmer clinical severity scale grade 3 anaphylactic reaction occurred just after sugammadex injection and the patient developed prolonged hypotension with recurrent cardiac arrhythmias in postoperative 12 hours.Interventions:Treatment was initiated bolus injections of ephedrine, epinephrine, lidocaine, steroids and antihistaminic and continued with lidocaine bolus dosages and norepinephrine infusion for the postoperative period.Outcomes:The general condition of the patient improved to normal 3 hours after the sugammadex injection, and she was moved to the intensive care unit. At 2nd and 8th hours of intensive care unit follow-up, she developed premature ventricular contraction and bigeminy with the heart rate of 130 to 135 beats/min, which returned to sinus rhythm with 50 mg lidocaine. After that, no symptoms were observed and the patient was discharged to plastic surgery clinic at the following day.Lessons:Sugammadex may result in life-treating anaphylactic reaction even in a patient who did not previously expose to drug. Moreover, prolonged cardiovascular collapse and cardiac arrhythmias may occur.

We assessed in vivo the mode of delivery, short-term patency and cellular response to a prototype endovascular stent. The stent is designed for delivery through a modified microcatheter and is retrievable with detachment from a delivery wire effected by electrolysis. We successfully deployed 12 stents in a range of sizes from 3-4 mm in straight and angled arteries of pigs. At control angiography 3 and 6 weeks later, nine arteries were patent, two occluded and one narrowed; patency was not related to vessel or stent size. The device shows promise as a stent for intracranial arteries since it can be delivered through microcatheters small enough for intracranial navigation and provides the operator with greater control than currently available self- or balloon-expanded stents.

Plasenta akreta, inkreta veya perkrata gibi plasenta yapışma anomalileri ciddi postpartum kanama riski nedeniyle morbidite ve mortalite artışına neden olabilirler. Otuz altı haftalık multipar gebede plasenta previaya bağlı vajinal kanama nedeniyle acil sezaryen için uygulanan spinal anestezi yönetimi ve cerrahi yaklaşımı literatür eşliğinde tartışarak sunmayı amaçladık. Spinal anestezi için intratekal olarak 12 mg hiperbarik bupivakain+10 µg fentanil+ 150 µg morfin verildi. Göbek kordonu klemplendikten sonra oksitosin, metilergonovin ve traneksamik asit verildi. Plasentaya zarar vermekten kaçınmak için uterusa yapılan vertikal kesiyle bebek makat doğurtuldu. Plasentaya dokunmadan yerinde bıraka-rak subtotal histerektomi yapıldı.Yaklaşık 40 dk. süren girişimde 2 ünite eritrosit süspansiyonu verildi. Hasta postoperatif 4. günde sorunsuz taburcu edildi. Sonuç olarak sezaryenle doğum sırasında plasenta inkreta ile karşılaşılan olguda genel anesteziye geçilmeden tek doz spinal anestezi, histerektomi ameliyatının sonuna dek başarıyla devam ettirildi.Anahtar kelimeler: Plasenta yapışma anomalisi, plasenta previa, plasenta inkreta, sezaryen, spinal anestezi Abnormal placental attachments, such as placenta accreta, increta or percrata, can result in increased morbidity and mortality because of the risk of severe postpartum haemorrhage. We aimed to present the management of spinal anaesthesia and surgical approach for emergent caesarean section because of vaginal bleeding in a multiparous pregnant woman with placenta previa at 36 weeks' gestation. Hyperbaric bupivacaine 12 mg, fentanyl 10 µg and morphine 150 µg were intrathecally administered for spinal anaesthesia. Oxytocin, methyl ergonovin and tranexamic acid were administered after umbilical cord clamping. Breech delivery of the baby was provided by a vertical incision to the uterus for avoiding placental harm. Subtotal hysterectomy was performed leaving the placenta in situ. Two units of red blood cells were transfused during the operation, lasting approximately 40 min. The patient was uneventfully discharged on the postoperative fourth day. In conclusion, a single-shot spinal anaesthesia was successfully maintained without conversion to general anaesthesia until the end of the hysterectomy in the patient in whom placenta increta was observed during caesarean delivery.