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Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization.

This is a prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with levobupivacaine or levobupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. The objective of the study was to determine the efficacy of preemptive wound infiltration with levobupivacaine and levobupivacainemethylprednisolone at the surgical site for pain relief. Patients usually suffer significant pain after lumbar discectomy. Wound infiltration with local anesthetics with or without corticosteroids is one method to address this. A total of 100 patients were randomly allocated to five equal groups as follows: Group I had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group II had the same region infiltrated with 30 mL 0.25% levobupivacaine alone before closure; Group III had this region infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV this region was infiltrated with 30 mL 0.25% levobupivacaine alone before incision; and in Group C (controls) this region was infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores and morphine usage were recorded. All four treatment groups showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of levobupivacaine or levobupivacaine-methylprednisolone into the muscle near the operative site provides more effective analgesia after lumbar discectomy. Our data suggest that preemptive infiltration of the wound site with levobupivacaine alone or combined with methylprednisolone provides effective pain control with reduced opiate dose after unilateral lumbar discectomy.

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Amaç: Lokal anestezikler uygun yoğunlukta verildiklerinde, uygulama yerinden başlayarak sinir iletimini geçici olarak bloke ederler. Toksisitede kardiyovasküler sistem depresyonu, solunum arresti, koma, konvülsiyonlar, bilinç kaybı, kas seğirmesi, görme bozukluğu, baş dönmesi, sersemlik ve dilde uyuşma görülebilir. Toksisite tedavisinde ise hava yolu kontrolü sağlanması, konvülsiyon gibi oluşabilecek semptomların tedavisi ve %20 lipid solüsyonu kullanılmaktadır. Bu çalışmanın amacı yaygın olarak kullanılan lokal anestezikler ve toksisitesi hakkında araştırma görevlilerinin bilgilerini incelemek ve lokal anestezikler hakkında farkındalığı arttırmaktır.Yöntemler: Hastanemizde farklı branşlarda çalışmakta olan 115 araştırma görevlisine 20 sorudan oluşan anket formu verildi. Bulgular:Yüz iki (%88,6) katılımcı anketi tamamladı. Katılım-cıların yaş ortalaması 28,73 idi. En çok %15,8 oranında Acil Tıp Kliniği ankete katıldı. Katılımcıların %40,6'sı 2-5 yıldır araştırma görevlisi idi. Katılımcıların %44,4'ü lokal anestezikleri hergün kullanmakta iken %70,3'ü bu konu ile ilgili hiçbir eğitim almamıştı. Anesteziyoloji ve Reanimasyon Kliniği araştırma görevlileri diğer kliniklerden anlamlı olarak yüksek oranda (%76,9) lokal anestezikler ile ilgili eğitim almıştı. Lokal anestezik toksisitesinde erken dönem bulgular ile ilgili soruya anafilaksi (%12,7), aritmi (%12,7) ve geç klinik bulgular ile ilgili soruya hepatotoksisite (%10,8) cevabı en çok verildi. Katılımcıların %87,9'u daha önce lokal anestezik toksisitesi hiç görmemişti. Lokal anestezik toksisitesinde %20 lipid kullanımını katılımcıların %67,4'ü duymamış-tı. %20 lipid kullanımını duyan katılımcılar (%52,2) ise uzmanlarından duymuşlardı. Hastanemizde %20 lipid solüsyonu olmasına rağmen %8,4 katılımcı bunu biliyordu. Sonuç:Özellikle lokal anestezik toksisitesi hakkında ek eğitim programı ile bu eksikliklerin giderilmesi gerektiğini düşünüyoruz. Anahtar kelimeler: Lokal anestezik, toksisite, anketObjective: Cardiovascular system depression, respiratory arrest, coma, convulsions, loss of consciousness, muscle twitching, blurred vision, vertigo, dizziness and numbness of the tongue can be seen in local anaesthetic toxicity. Treatment includes 20% lipid solutions, airway control, symptomatic treatment for arrhythmia and convulsions. The aim of this study is to present the knowledge of research assistants, who used local anaesthetics in daily practice, regarding these medications and toxicity treatment and to raise awareness. Methods:The questionnaire comprising 20 questions was administered to 115 research assistants who worked at different specialities in our hospital. Results:One hundred and two (88.6%) research assistants answered the questionnaire. Participants' mean age was 28.93 years. Most of them were from the Emergency Department (15.7%). A total of 40.6% of participants worked for 2-5 years at their departments. Local anaesthetics were used in daily practice for 44.4% of them, but 70.3% of them had not been educated about local anaesthetics. Research assistants ...

OBJECTIVEThe aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.INTRODUCTIONAnesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.METHODSThirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg−1 (Group K) or propofol 0.5 mg.kg−1 (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.RESULTSThere were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).CONCLUSIONThere were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.

Our results showed that block recovery time was shorter in the levobupivacaine group, this may be a disadvantage for longer operative procedures. But with proper patient selection this can be eliminated. Recovery time was shorter in levobupivacaine group. Therefore, postoperative neurological examination can be done earlier. In addition, early mobilization can be an advantage for postoperative recovery.