BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS:A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS:Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION:In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

Propofol-ketamine combination is an advantageous choice in means of achieving sedation in a shorter period of time, a better hemodynamic stability, less nausea and vomiting and respiratory complication rates. Yet it seems that this choice might be related with longer recovery duration.

Purpose: Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. Methods: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I ---Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II ---Only propofol and remifentanil was used during maintenance, III ---Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV ---Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. Results: VAS scores were significantly lowest in group I (p = 0.001---0.028). PNV incidence was significantly lowest in group I (p = 0.026). PNV incidence was also lower in group III compared to group IV (p = 0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p = 0.001) however blood pressures were similar in all groups (p = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024---0.03). Conclusion: Using esmolol during anesthetic maintenance significantly decreases anestheticanalgesic requirements, postoperative pain and PNV.Esmolol; Dor no pós-operatório; Vômito no pós-operatório Efeito da infusão de esmolol sobre a necessidade de anestesia no intraoperatório e analgesia, náusea e vômito no pós-operatório em um grupo de pacientes submetidos à colecistectomia laparoscópica Resumo Objetivo: A dor e a incidência de náusea e vômito no período pós-operatório (NVP) são comuns em pacientes submetidos à colecistectomia laparoscópica. Os agentes simpatolíticos podem diminuir a necessidade de opiáceos ou anestésicos inalatórios ou intravenosos. Neste estudo, nosso objetivo foi analisar os efeitos de esmolol sobre a necessidade de anestésico no período intraoperatório e de analgésico no pós-operatório e a incidência de dor e NVP. Métodos: Sessenta pacientes foram incluídos. Propofol, remifentanil e vecurônio foram usados para a indução. Os grupos de estudo foram os seguintes: grupo I, a infusão de esmolol foi adicionada aos anestésicos (propofol e remifentanil) para manutenção; grupo II, apenas propofol e remifentanil foram usados durante a manutenção; grupo III, a infusão de esmolol foi adicionada aos anestésicos (desflurano e remifentanil) para manutenção; grupo IV, apenas desflurano e remifentanil foram usados durante a manutenção. O período de acompanhamento foi de 24 horas para avaliar a incidência de NVP e a necessidade ...

Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.

Local anaesthetic (LA) toxicity is the most fatal complication of peripheral nerve block techniques. Accidental intravascular application or use of doses above the safety range are the most common cause of toxicity. Bupivacaine is a long-acting LA frequently used for long procedures or those associated with significant post-procedural pain. Fatal central nervous system and cardiovascular system toxicity are described. In this paper, we reported a young patient who showed LA toxicity symptoms 7 h after an infraclavicular peripheral block. Keywords: Infraclavicular block, local anaesthesia, drug toxicityLokal anestetik (LA) toksisitesi periferik sinir bloğu tekniklerinin mortalitesi en yüksek komplikasyonudur. LA'ların yanlışlıkla intravasküler uygulanması ya da emniyet sınırının üzerindeki dozlarda kullanımı toksisitenin en sık nedenleridir. Bupivakain etki süresinin uzun olması nedeniyle uzun süreli girişimlerde tercih edilen bir lokal anestetiktir. Ölümcül seyredebilen santral sinir sistemi ve kardiyovasküler sistem toksisitesi bilinmektedir. Biz bu olgu sunumunda lateral sagittal yaklaşım ile infraklaviküler blok uygulanan genç hastada yedi saat sonra gelişen ve bulguları belirgin olmayan lokal anestezi toksisitesini sunmayı amaçladık. 199Giriş G ünübirlik cerrahi işlemlerde sıklıkla kullanılan periferik sinir blokları uygulamasında mortaliteye en çok neden olan komplikasyon lokal anestetik (LA) toksisitesidir (1). Toksisiteye genellikle LA'nın yanlışlıkla sistemik dolaşıma verilmesi veya emniyet sınırlarının üzerindeki miktarlarda LA kullanımı yol açmaktadır. Bupivakain ve etidokain gibi kardiyotoksisitesi yüksek LA'larla gerçekleşen toksisitelerin tedaviye dirençli malign aritmiler, asistoli ve mortaliteyle sonuçlandığı rapor edilmiştir (1). Bupivakainin santral sinir sistemi (SSS) ve kardiyovasküler sistem (KVS) toksisitesi uzun zamandan beri bilinmektedir (2, 3). Toksisite belirtileri genellikle, yanlışlıkla yapılan intravasküler enjeksiyonlar, hızlı sistemik emilim veya yüksek doz ilaç kullanılmasına bağlı olarak ortaya çıkmaktadır (4). Bu olgu sunumunda; sağ el palmar ve dorsal yüzde flep revizyonu yapılan hastaya infraklaviküler blok uygulamasından yedi saat sonra gelişen ve bulguları belirgin olmayan lokal anestetik toksisitesini sunmayı amaçladık. Olgu Sunumuİş kazası sonrası acil servise başvuran 23 yaşında 86 kg, ASA I risk belirlenen hastaya, genel anestezi altında acil olarak sağ elde sinir ve tendon onarımı girişimi yapıldı. Üç hafta sonra elektif olarak palmar ve dorsal yüzde flep revizyonu planlandı. Hastaya ultrasonografi (USG) eşliğinde infraklaviküler blok uygulamayı planladık. Cerrahi ve anestezi işlemleri için hastaya detaylı bilgi verilerek yazılı onam alındı. Blok uygulama öncesinde premedikasyon olarak 2 mg intravenöz (iv) midazolam yapıldı. Supin pozisyonda yatırılan hastanın elektrokardiyografi, periferik O 2 satürasyonu (SpO 2 ) ve noninvazif kan basıncı monitörizasyonunu takiben başı blok uygulanacak bölgenin karşı tarafına çevrildi. Povidon iyot ile yapılan dezenfeksiyon sonrası e...

Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

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In this study, we aimed to investigate the frequency of postoperative hypothermia in our hospital.In Keçiören Training and Research Hospital,