Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA) I-II patients (n = 60) who underwent hand surgery were included. For this purpose, only lidocaine (LDC), lidocaine+adjunct tramadol (LDC+TRA group), or lidocaine+systemic tramadol (LDC+SysTRA group) was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority.
Bu çalışmada, ağır-kritik COVID-19 hasta grubunda yoğun bakım başvurusu sırasında interlökin (İL)-6 ve diğer enflamatuvar belirteçler ile akciğer bilgisayarlı tomografi (BT) bulgularının ağırlığının korelasyonunu değerlendirdik. Gereç ve Yöntem: Şüpheli COVID-19 tanısı ile yoğun bakıma yatırılan 90 hasta değerlendirildi ve tanı konulan [polimeraz zincir reaksiyonu (PCR), spesifik BT bulgusu veya öykü-klinik bulgu-laboratuvar] ve yatış BT'leri ile İL-6, enflamatuvar parametre düzey ölçümleri eksiksiz elde edilen 30 hasta son analize alındı. Başvuru sırasında çekilen BT bulguları 40 puanlı bir sistem ile değerlendirildi ve yine yoğun bakım yatışı sırasında alınan İL-6, C-reaktif protein, prokalsitonin, lenfosit sayısı ve nötrofil/ lenfosit oranları ile karşılaştırıldı. Bulgular: Aynı dönemde alınmış olan BT bulguları ile İL-6 seviyeleri arasında bir korelasyon bulunamadı. İL-6 düzeyleri, bakteriyel bir süper enfeksiyonu akla getirir şekilde prokalsitonin ve mortalite oranları ile paralellik gösterdi. Sonuç: Çalışmamızda BT bulgularının ağırlığı ile İL-6 düzeylerinin yüksekliği paralellik göstermemiştir. Hücre ölümü, trombotik komplikasyonlar ve alveoler ödem oluşumu ile seyreden COVID-19 pnömonisinde, sitokin fırtınasının rolü ilerleyen çalışmalarla açıklanacaktır.
Background: With its important properties, Vitamin C has been used in several diseases and sepsis. COVID-19 may cause sepsis, and therefore high dose Vitamin C has been integrated to the treatment protocols.Concerning the potential risk of oxalate nephropaty related with the use of long term or high dose Vitamin C, we retrospectively evaluated the COVID-19 patients treated with the high dose intravenous Vitamin C, in terms of kidney dysfunction. Material and Method: Critically ill COVID-19 patients who were given Vitamin C 45-50 gr/day/5 days (Group C, n=21), and the ones who did not (Group NC, n=22) along with the hydroxychloroquine- favipiravir treatment were compared in terms of developing renal dysfunction within the 15 days of ICU stay. Results: There were no difference in the development of renal dysfunction between the groups with and without Vitamin C treatment (p>0.05). But when the patients who had KDIGO stage 1 kidney damage on admission, and had worsening renal dysfunction during ICU stay were excluded, patients groups were more similar and the development of the renal failure was significantly more in Vitamin C group(p<0.05). Conclusion: We conclude that when administering high dose parenteral Vitamin C, kidney functions should be carefully assessed.
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