Stellate ganglion blockage (SGB) is a method used for treating Raynaud’s phenomenon (RP). This study primarily aimed to determine whether the perfusion index (PI) can be used an alternative to Horner’s signs in evaluating the efficacy of SGB in patients diagnosed with RP. In a total of 40 patients, aged 18–65 years and diagnosed with primary RP, SGB was applied for 5 days on the same side with the 2-finger method, using 6 mL of 5% levobupivacaine at the 7th cervical vertebra level. The PI values were recorded from the distal end of the 2nd finger of the upper extremity on the side applied with the block at baseline and at 5, 15, 30, 60 and 120 min. The onset time of Horner findings was recorded. The PI values and visual analogue scale (VAS) pain scores were recorded pre-treatment and after 2 weeks.When the PI values of the 40 patients were examined, a 62.7% increase was observed from baseline to the first session at 5 min (p < 0.05). When all sessions were evaluated, a statistically significant increase was determined in the PI values measured at 5, 15, 30, 60 and 120 min compared with the baseline PI values. There was a statistically significant decrease in the post-treatment VAS pain scores and a statistically significant increase in the post-treatment PI values (p < 0.05). By eliminating peripheral vasospasm with the application of SGB in patients with RP, the distal artery blood flow and PI are increased. PI measurement is a more objective method and therefore could be used as an alternative to Horner findings in evaluating the success of SGB. PI is a non-invasive and simple measurement and also an earlier indicator in evaluating the success of SGB than Horner’s signs.
S edation has become common for advanced endoscopic procedures, such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in semiprone position. EUS and ERCP, are partly invasive-procedures, causing discomfort and pain to the patients; therefore, analgesics and sedatives are notably requested for these procedures [1, 2]. However , the choice of optimal sedation regimen in overweight and obese patients undergoing these advanced procedures remains unclear [3]. Obese patients pose a high-risk group of patients, and for them, the pharmacokinetics of drugs cannot be predicted; as the volume of distribution increases, a higher dose of the lipid-soluble agents is needed to achieve the ABSTRACT OBJECTIVE: Current literature covers limited data on the safety of sedation in advanced endoscopic procedures in obese patients. The present study aims to evaluate the association between obesity and the frequency of sedation-related complications in patients who were undergoing advanced endoscopic procedures. METHODS: A retrospective chart analysis of 1172 consecutive patients, meeting the inclusion and exclusion criteria for this study and undergoing intravenous ketamine-propofol (ketofol) sedation for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) procedures were evaluated. The patients were classified into three groups according to their body mass index (BMI) (kg/m2). Group I comprised patients with a BMI between 25 and 30, group II with a BMI between 30 and 35, and group III with a BMI between 35-40. The sedation-related outcomes in the form of adverse events, and airway interventions were compared between the groups. RESULTS: For analysis, out of the 1172 available records, 289 patients had a BMI between 35-40 and were predominantly male patients. The total adverse events were more common in obese patients, with apnea (in 5.5% patients in group I, 5.7% in group II, 22.8% in group III p<0.000), oxygen desaturation (in 7.7% patients in group I, 9.4% in group II, and 27.7% in group III p<0.000), and airway obstruction (in 4.9% patients in group I, 5.4% in group II, 22.8% in group III, p<0.000). Moreover, the obese patients more frequently required airway interventions, including airway placement, suctioning and bagmask ventilation. CONCLUSION: Higher BMI was associated with an increased frequency of sedation-related complications. However, we concluded that ketofol sedation regimen could be used safely in obese patients during advanced endoscopic procedures by skilled anesthesia providers.
Background: Supraclavicular (SCL), infraclavicular (ICL), and axillary (AX) brachial plexus nerve blocks are used for the upper extremity. Regional nerve blocks should be considered for their beneficial effects and less risk of complications. Objectives: The aim of this study was to conduct a retrospective evaluation of our experiences in ultrasound (US)-guided techniques of the SCL-ICL and AX approaches for brachial plexus block (BPB) in producing high-quality surgical anesthesia for operations below the shoulder. Methods: The records of 182 American Society of Anesthesiologists (ASA) grade I–III patients undergoing upper extremity and vascular surgeries under BPB by US guidance were evaluated. SCL, AX, and ICL approaches were used. A linear US probe was used for all patients. Data pertaining to demographic characteristics, ASA physical status, underlying diseases, block type, time between the block performance and the start of the operation, duration of the operation, type of surgeries, needle length, toxicity findings, postoperative complications, and success rates were assessed. Results: Demographic data were found to be similar with no statistically significant differences between the study groups (p > 0.05). The three groups were also similar in ASA physical status, type of surgery, the experience of the anesthesiologists who performed the blocks, the time between the end of the block performance and the start of the operation, and the quality of the surgical anesthesia. Transient Horner’s syndrome was detected in 3 patients in the SCL group and in 1 patient in the ICL group. Conclusions: All three approaches can be used for US-guided BPB with adequate quality of surgical anesthesia.
Persistent hiccup is uncommon, and the mechanism is poorly understood. We present the case of a 43-year-old male patient referred to the Algology department due to chronic back pain who developed what we believe a rare case of persistent hiccup secondary to caudal epidural steroid injection (CESI). The causes of hiccup are many and include electrolyte derangement, nutritional deficiencies, gastrointestinal disorders and instrumentation, cardiovascular disorders, renal impairment, central nervous system disorders, and drugs; however, the cause may be unknown. CESI is one of the treatments of back pain, in addition to various other modalities including surgical interventions. CESI has gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, side effects should be considered. We aimed to present a persistent hiccup after CESI for chronic low back pain.
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