It was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.

PURPOSE:To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS:After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/ kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t-and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS:The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

SummaryBackgroundOver the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year.Material/MethodsPatients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index.ResultsMean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating “good” and “excellent” satisfaction was 66% (23 persons) on the last follow-up.ConclusionsWhile it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

Background. Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape. Methods. In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF <0.9) with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered. Results. Time elapsed until sugammadex administration following neostigmine 37 ± 6 min, following sugammadex it took 2.1 ± 0.9 min to reach TOF ≥0.9, and the extubation time was 3.2 ± 1.4 min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period. Conclusion. Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient.

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.

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.

Background: Organophosphates (OP) are frequently used as pesticides around the world in agriculture. Exposures to OP cause a significant number of poisonings each year and lead to deaths. Acute toxicity manifests as cholinergic crisis with glandular secretions, myasthenic-like syndrome, peripheral neuropathies, neuropsychiatric abnormalities, extrapyramidal disorders, altered mental status, and weakness. Summary: After Institutional Review Board approval, this retrospective study was performed by evaluating the hospital records of patients admitted to an intensive care unit with acute OP poisonings. Data regarding age, gender, duration of hospitalization, severity, complications, and outcome of the patients were recorded. The data were presented as mean ± standard deviation, analyzed with SPSS software. A total of 47 patients were included in the study of whom 70.2% were female and 29.8% were male. Mean age of the patients was 25.8 years. The reason for poisoning was suicide in 80.9% and accident in 19.1%. Mean intensive care unit stay was 5.9 days. The mortality rate was 12.8%. Key Messages: Our study contributes substantial information regarding the epidemiology and outcomes of acute OP poisonings in a tertiary care training hospital in a rural area; its relatively small sample size and its being a retrospective record-based study are limitations of the study. There is a need for future studies to reveal the underlying factors responsible for acute OP poisonings in Turkey and accordingly to solve these problems and thereby reduce the incidence of acute OP cases.

Background:The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles.Aims:The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes.Materials and Methods:After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P < 0.05 was considered statistically significant for all analyses.Results:There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05).Conclusions:The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.