Small-dose infusions of both propofol and NAC appear to provide similar protection against ischaemia-reperfusion injury in arthroscopic knee surgery.

Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia.

Remifentanil with controlled hypotension may reduce edema and ecchymosis of the upper and lower eyelids, by reducing mean arterial pressure and amount of bleeding in rhinoplasty.

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2–t 9 and t 2–t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2–t 8 and t 2–t 9. IMA levels in Group T were significantly lower than those in Group S at t 2–t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

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Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

The effects of the pre-emptive oral gabapentin on post-anesthesia recovery criteria, acute post-thoracotomy pain and development of chronicity in pain with benign thoracotomy operationsPreemptif oral gabapentinin benign torakotomi ameliyatlarında anestezi sonrası derlenme kriterleri, torakotomi sonrası akut ağrı ve ağrının kronikleşmesi üzerine etkileri So nuç: 1200 mg pre-emptif oral gabapentin derlenme kalitesini artırabilir ve torakostomi sonrasında akut ve kronik ağrıyı azaltabilir.Anah tar söz cük ler: Gabapentin; ağrı; torakotomi. Background:In this article, we evaluated the effects of preemptive oral gabapentin on post-anesthesia recovery criteria and acute and chronic post-thoracotomy pain.Methods: This prospective, randomized, clinical comparison study included 60 ASA II-III class patients undergoing thoracotomy for segmentectomy. The patients were randomly divided into two groups: Group G (n=29) received pre-emptive gabapentin 1200 mg peroral while group C (n=31) received placebo. Anesthetic procedure and post-anesthetic analgesia protocol were standardized. Spontaneous respiration, extubation, swallowing, spontaneous eye opening and verbal cooperation times, sedation, agitation and activity levels and modified Aldrete scores were evaluated. Time to first analgesic requirement, acute post-thoracotomy pain, and postoperative total morphine and additional analgesic consumption were recorded. The chronicity of post-thoracotomy pain was questioned using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) at the end of one year follow-up.Results: Shorter verbal cooperation times (p= 0.012), less agitation (at 15 min, p= 0.001, and 30 min, p= 0.001) and earlier recovery times (p<0.0005, at 15 and 30 min), despite greater sedation (at 15 min, p<0.0005, and 30 min, p= 0.016) were observed in the gabapentin group. The time to first analgesic requirement was delayed (p<0.005 for all follow-up) and, total morphine and additional analgesic consumptions (p<0.0005 for all follow-ups) were consistent with the numerical rating scale scores. Gabapentin reduced persistent post-thoracotomy pain during the first year (at two, three, six, and 12 months; p= 0.040, p=0.031, p=0.001 and p=0.001, respectively).Conclusion:Pre-emptive oral gabapentin 1200 mg may improve the quality of recovery and reduce acute and chronic postthoracotomy pain.

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