Case Report 280Parkinson's is a neurodegenerative disease characterized by increased activity of GABA in basal ganglia and the loss of dopamine in nigrostriatum, associated with rigidity, resting tremor, gait with accelerating steps, and fixed inexpressive face. Being a neurological disease, spinal anaesthesia is often avoided in Parkinson's. Yet, in Parkinsons' patients, general anaesthesia may mask neurological symptoms in the intraoperative period and exacerbate them postoperatively. Moreover, the drugs administered in general anaesthesia more likely interact with anti-Parkinson drugs and may have side effects. With spinal anaesthesia, unlike general anaesthesia, because muscle relaxants and opioids are avoided, the exacerbation is not going to be masked due to muscle relaxation, and neurological symptoms may be distinguished clinically. In addition, the known effects of spinal anaesthesia, like suppression of surgical stress, postoperative pain relief, and early mobilization, may be advantageous in Parkinson's disease. Treated for Parkinson's disease for about 10 years at the age of 77 and with American Society of Anesthesiologists physical classification III (hyperlipidemia, hypertension, coronary artery disease, and chronic obstructive lung disease), a female patient was scheduled for elective surgery for fracture of the left distal tibia. In this case, we aimed to report a patient with Parkinson's disease who underwent spinal anaesthesia in order to avoid the disadvantages of general anaesthesia and reviewed the literature.
We conclude that the tenth rib line is better than Tuffier's line for accuracy with palpation. However, it must be confirmed by further studies including more than one examiner for palpation and also include different patient populations.
Independently from the chronic anxiety disorder, patients could feel nervousness and anxiety due to surgical stress during preoperative period. Preoperative anxiety could lead to various complications owing to autonomous nerve system activation. We targeted to examine the effects of preoperative anxiety on bronchospasm. In the study, 20-50 years old ASA I patient to be given elective endoscopic urologic operations were included. Totally 124 patients were evaluated during preoperative period. The patients were interviewed before the operation to determine their anxiety levels (Beck Anxiety Scale). Patients were grouped according to anxiety state. 58 anxious patients (Study Group) and 66 non-anxious (Control Group) were compared according to bronchospasm, wheezing, SpO2 paucity and ETCO2 extent. Incidence of bronchospasm and wheezing were found more in the patient group having preoperative anxiety (p<0.05). No meaningful correlation was found between the groups with regard to the changes in SpO2 and ETCO2. Various studies were conducted using emotion-induction techniques. However, they produced artificial stress and these results were not associated with any surgical procedures. Unlike all these studies, we showed natural clinical course of non-induced anxiety effects on all perioperative period. Our study demonstrated that anxiety prior to a general anesthesia and changes in the emotional state could create a risk for total respiratory resistance. These changes could arise as bronchospasm and wheezing during the perioperative period.
Ankilozan Spondilit, cerrahi hastalarda nadir görülen ve hem genel hem de rejyonal anestezi uygulamasının zor olduğu bir kronik, ilerleyici seronegatif spondiloartropatidir. Sol spermatosel nedeni ile elektif cerrahi planlanan, 38 yaşında ve 170 cm boyunda, 82 kg ağırlığında, Amerikan Anestezistler Derneği fiziksel sınıflaması (ASA) II olan erkek hastada yaklaşık 14 yıldan beri Ankilozan spondilit bulunmaktaydı. Servikal eklemlerinde ciddi düzeyde ekstansiyon kısıtlaması olduğundan spinal anestezi planlandı. Ancak lomber düzleşme ve sindezmofit oluşumu nedeni ile median yaklaşımla iğne girişi mümkün olmayan hastaya L4-5 aralığından paramedian yaklaşımla spinal anestezi uygulandı. Sonuç olarak ileri safhadaki Ankilozan Spondilitli hastalarda paramedian yaklaşımla spinal anestezi başarı oranının artabileceği kanısındayız.
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