No abstract

In the elderly population, the prevalence of symptomatic cardiac disease, including aortic stenosis, is increased. Despite impressive advances in anesthesiological and surgical techniques, morbidity and mortality in patients with severe aortic stenosis remains high [1]. Patients undergoing hip arthroplasty usually are elderly and present with different associated comorbidities [2]. We report successful management of a patient with aortic stenosis, hypertension, cerebrovascular disease, and a temporary pacemaker who underwent hip fracture surgery.A 75-year-old woman (60 kg, 155 cm) had fallen, resulting in a closed fracture of the right trochanter. She had cerebrovascular disease, aortic stenosis, and hypertension. Preoperative physical examination revealed findings consistent with her valvular heart disease and cardiac pulse of 35/min; the electrocardiogram showed complete atrioventricular (AV) block and left ventricular hypertrophy. A temporary pacemaker had been placed. The echocardiogram revealed an aortic valve area of 1 cm 2 and concentric left ventricular hypertrophy. Aortic valve pressure gradient was 40 mmHg. We decided that one of the best anesthetic procedures for her was combined lumbar plexus and sciatic nerve blockade, which would provide stable hemodynamic parameters. Combined paravertebral lumbar plexus and sciatic nerve block produces adequate anesthesia of the ipsilateral lower limb for surgical repair of hip fracture in the elderly [3].In the operating room, lumbar plexus block was performed using the Chayen's approach [4]. In brief, the patient was turned to the left lateral position with right hip and knee flexed to approximately 45°. A puncture point was identified 4 cm lateral from midline of the L5 spinous process along the intercristal line. A 110-mm, 22-G stimulating needle (Contiplex D; B. Braun, Melsungen, Germany) connected to a nerve stimulator (Stimuplex HNS 11, B. Braun) was advanced perpendicular to all planes, and a motor stimulus was seen in the quadriceps distribution. Sciatic nerve blockade was performed using the classic Labat's approach [5]. Briefly, the needle was inserted 5 cm below the midpoint of a line connecting the posterior superior iliac spine and the greater trochanter. After an appropriate stimulus was localized in the sciatic distribution, 10 ml levobupivacaine 0.25% was injected and the patient was returned to the supine position. Combined block developed in approximately 30 min for qualitative anesthesia. Her blood pressure was between 160/100 and 110/70 mmHg throughout the 60 min of surgery. Estimated blood loss and intraoperative urine output were 250 and 200 ml, respectively, and 1,000 ml of lactated Ringer's solution was administered. Following surgery she was taken to the postanesthesia care unit. The effective time of the nerve blocks was 20 h. She was discharged from hospital 6 days after her operation.General anesthesia could have been an option in our patient. However, general anesthetic agents can depress the myocardium, produce vasodilatation, and can...

Background. Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims. We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods. Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients’ demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results. There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups p ≤ 0.01 , while no significant difference was identified between unilateral and bilateral TAP block groups p = 0.303 . Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups p < 0.01 , p < 0.01 than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups p = 0.793 . Conclusions. Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

Objective:To investigate the effects of normal saline (0.9% NaCl) and 6% Hydroxyethyl Starch 130/0.4(HES) solution on Ischemia/Reperfusion (I/R) injury in patients undergoing knee arthroscopy operations with spinal anesthesia using a tourniquet.Methods:The study comprised 48 ASA I-II patients undergoing knee arthroscopy with spinal anesthesia using a tourniquet. The patients were randomised into two groups and after standard monitoring two venous lines were introduced to obtain blood samples and to give intravenous therapy. In the control group (Group A) (n=21) 0.9% NaCl, 10 ml/kg/hours and in the study group (Group B) (n=19) 6% Hydroxyethyl Starch 130/0.4, 10 ml/kg/hours infusion were administered. Spinal anesthesia was applied with 12.5 mg hyperbaric bupivacaine to all patients. The tourniquet was applied and the operation was started when the sensorial block level reached T10 dermatome. Blood xanthine oxidase (XO) and malondialdehyde (MDA) levels as an indicator of ischemia and reperfusion injury were measured in samples before fluid infusion (t1), before tourniquet application (t2), 1 minute before tourniquet release (t3), and at 5 (t4) and 15 (t5) minutes after tourniquet release.Results:No difference was observed between the two groups in respect of demographic parameters, the highest block level, duration before tourniquet application and tourniquet duration (p>0.05). The MDA level after tourniquet application and 15 minutes after tourniquet release was lower in Group B (p<0.05). XO levels were not different (p>0.05).Conclusion:In this study 6% Hydroxyethyl Starch 130/0.4 solution reduced MDA level which is an indicator of lipid peroxidation. 6% Hydroxyethyl Starch 130/0.4 solution may be beneficial for Ischemia/reperfusion injuries.

ALS is a rare motor neuron disease. Since surgical procedures exacerbate ALS, surgical procedures are not usually applied except in the necessary cases. Pulmonary complications are the main cause of mortality in ALS patients, because respiratory and swallowing muscles may be affected. Although opioids provide effective analgesia, they are not the best choice in ALS patients because they can cause nausea-vomiting and have negative effects on respiratory functions. Oblique Subcostal Transversus Abdominis Plane Block provides highly effective analgesia in laparoscopic cholecystectomy operations. In this case report, we evaluated the effectiveness of the OSTAP block in ALS patients, which is one of the rare diseases and rarely underwent Laparoscopic Cholecystectomy. As far as we know, this case report is the first and only in literature. Laparoscopic Cholecystectomy was performed under general anesthesia on a 56-year-old male patient. Unilateral OSTAP block (30 ml 0.25%) was applied. The patient's postoperative 10 th -hour pain score was 4, and 75 mg diclofenac sodium i.m. administered. The patient did not need any other analgesics. In this case; we detected that the OSTAP block provides effective analgesia.