Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

Original Investigation 158 IntroductionTwenty million cesarean sections (CS) are performed worldwide each year (1, 2). The CS rates have steadily increased worldwide over the past decades (3-6) Moreover, Turkey has experienced a rapid increase in the rate of CSs. According to data from the Turkish Ministry of Health and National Institute of Statistics, the CS rate per live births increased from 21.2% in 2003 to 48% in 2011. Although the safety of CSs has improved, it is still associated with greater rates of maternal morbidity and mortality than vaginal delivery (7,8). CS delivery is associated with severe maternal morbidity, including obstetric hemorrhage, hysterectomy, anemia, blood transfusion, and infection (9-11). Among these operative morbidities associated with CS, obstetric hemorrhage is the leading cause of maternal mortality worldwide. Because of both the potential maternal risks and financial concerns, the increase in the cesarean rate is a serious public health problem (12, 13). Anesthesia in pregnant women has always been a concern in obstetric surgery. Anesthesia in CS is of particular concern because it affects millions of women worldwide. Despite substantial improvements in anesthetic and surgical techniques, operative blood loss during CS is still an important medical issue (14). Therefore, this study aims to compare the effects of general and spinal anesthesia on maternal blood loss among women scheduled for elective CS. Material and MethodsThis study is a prospective randomized study. It was performed in a tertiary referral hospital between September 2013 and February 2014. The study protocol was approved by Objective: We aimed to compare the effect of general and spinal anesthesia on maternal blood loss in elective cesarean section (CS). Material and Methods:This was a prospective randomized study and included 418 healthy pregnant women with a term uncomplicated singleton pregnancy between 37 and 41 weeks of gestation. The study participants were randomly divided into two groups: the general anesthesia group and spinal anesthesia group. CSs were all performed using the same surgical technique, and within the groups, the same anesthetic procedures were used (either general or spinal). The primary outcome for this study was operative blood loss. Hemoglobin and hematocrit concentrations were compared between the two groups. Results:The preoperative hemoglobin and hematocrit levels were similar in the both groups (p=0.08 and p=0.239, respectively). Significantly lower operative blood loss was achieved using spinal anesthesia versus general anesthesia during elective CS. The differences between preoperative and postoperative blood values for both the study groups were statistically significant (p<0.001). Conclusion:This study demonstrates that spinal anesthesia is associated with a lower risk of operative blood loss than general anesthesia in low risk patients undergoing elective CS. (J Turk Ger Gynecol Assoc 2015; 16: 158-63) Keywords: Operative blood loss, cesarean section, anesthesia Receiv...

The colonization rate of Candida spp. reaches up to 80% in patients who reside in intensive care units (ICUs) more than a week, and the mean rate of development of invasive disease is 10% in colonized patients. Since invasive candidiasis (IC) in ICU patients presents with septic shock and high mortality rate, rapid diagnosis and treatment are crucial. The aim of this study was to assess the relationship between invasive infection and the determination of Candida colonization index (CI) and Candida score (CS) in patients admitted to ICU who are at high risk for IC and likely to benefit from early antifungal therapy. A total of 80 patients (34 female, 46 male; age range: 12-92 years, mean age: 69.57 ± 16.30) who were in ICU over seven days or longer of Anesthesia Department of Kayseri Education and Research Hospital between April, 2014 and July, 2015 were included in the study. None of the patients were neutropenic. After admission, throat, nose, skin (axillary region), urine, rectal swab and blood cultures have been collected weekly beginning from day zero. Isolation and identification of Candida strains were performed by using conventional mycological methods. CI was calculated as the ratio of the number of culture-positive distinct body sites (except blood culture) to the total number of body sites cultured. CI> 0.2 was considered as fungal colonization, while CI≥ 0.5 as intensive colonization. CS value was calculated according to the components including total parenteral nutrition (TPN) (plus 0.908 points), surgery (plus 0.907 points), colonization in multiple areas (plus 1.112) and severe sepsis (plus 2.038 points), and cut-off value for CS was accepted as >2.5. In our study, overall 1009 cultures (mean: 13 cultures per patient) were taken from 80 patients, and yeast growth was detected in 365 (36.2%) of them. Accordingly, among 68 (85%) of 80 patients included, in at least one sample, yeast growth was determined. No yeast growth was observed in the blood cultures. Of 365 yeast-positive cultures, C.albicans was isolated from 184 (50.4%), C.glabrata from 66 (18%), C.parapsilosis from 42 (11.5%), C.tropicalis from 12 (3.3%), C.kefyr from three (0.8%), and C.krusei from one (0.3%) samples, whereas six (1.6%) samples yielded other yeasts (3 Saprochaete capitata, 3 Trichosporon spp.) and 51 (13.9%) samples yielded multiple yeast growth. The highest colonization rates were detected in rectal swabs (27.4%), urine (23.3%) and throat (22.5%) samples. CI value was found as >0.2 in 65% (52/80), and ≥0.5 in 25% (20/80) of the patients, whereas CS value was >2.5 in only 2.5% (2/80) of the patients. In the statistical evaluation, significant correlations were found between fungal colonization (CI> 0.2) and gender (p=0.032) and length of stay in ICU (p=0.004), and between intensive colonization (CI≥ 0.5) and gender (p=0.008) and age (p=0.012). However, the correlation between Candida colonization and the presence of underlying diseases, APACHE II score, Glasgow coma scale, invasive procedures, use of extended-spectrum antibi...

Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy.

Background: Recent reports demostrated that levosimendan improved post-resuscitation myocardial function in rat and pig models. Materials and methods: Rabbits were randomized into 4 groups as 12 rabbits in each group. Bupivacaine 10 mg/kg was injected as an intravenous bolus to all groups. Basic life support was performed by mechanical ventilation and manual external chest compressions. After 1 min, animals in the group 1 received 1.5 ml/ kg saline 0.9 % solution, and animals in the groups 2 and 4 received 5 ml/kg 20 % lipid emulsion for 1 min through the ear vein followed by continuous infusion at 0.25 ml/kg/min. Three additional boluses of 1.5 ml/ kg lipid emulsion were repeated at 5-min intervals. The group 3 received fl uid resuscitation plus levosimendan (3 μg/kg/min) 1 min after asystole and the group 4 received both levosimendan and lipid emulsion treatment. Return of spontaneous circulation and hemodynamic metrics were obtained in 20 minutes. Results: The number of rabbits that survived after cardiac resuscitation was lower in the Groups 1 (0 %) and 3 (33.3 %) than in the Group 4 (91.7 %) with a statistically signifi cant difference (p < 0.001). The number of rabbits that survived resuscitation was higher in the Group 4 than in the Group 2 (66.7 %), though not with a statistically signifi cant difference (p = 0.317). The median duration of cardiac arrest in the Group 4 was significantly shorter than that in the other three groups (p < 0.001). Conclusions: In this rabbit model of bupivacaine-induced cardiac arrest, resuscitation with combined iv lipid emulsion and levosimendan was more effi cacious than lipid alone (Tab. 3, Ref. 24). Text in PDF www.elis.sk.