Postoperative macroglossia is a very rare complication associated with neurosurgical procedures. There have only been 16 cases reported in the literature. With regard to spine surgery, however, only two cases have been reported. The first report was a case where the complication of postoperative macroglossia occurred during occipitocervical spine surgery in a sitting position. In this second documented incident, we report a case of massive macroglossia, in a 44-year-old man, following posterior craniocervical fixation and fusion surgery performed in a sitting position. The patient had Klippel-Feil syndrome with basilar invagination preoperatively. Postoperative macroglossia was treated by partial glossectomy, because medical management (anti-edema therapy) failed. This complication is a life-threatening complication and must be treated promptly. Diverse etiologic mechanisms are discussed along with preventive and therapeutic measures.
ÖzetGenel anestezi ile birlikte torakal epidural anestezi uygulanarak başarılı batın operasyonları gerçekleştirildiği bilinmektedir. Sunumuzda, situs inversus totalisi olan ve laparoskopik kolesistektomi operasyonu geçirecek akut kolesistitli hastada uyguladığımız segmental torakal epidural anestezi vesilesiyle bu teknik literatür eşliğinde tartışılmıştır. (Ha se ki T›p Bül te ni 2014; 52: 53-5) Anahtar Kelimeler: Torakal epidural anestezi, laparoskopik kolesistektomi, cerrahi stress cevabı Abs tract Segmental epidural anesthesia induced by administering low doses of local anesthetics into mid-thoracic segments is successfully implemented in upper abdominal operations, such as cholecystectomy. In this paper, we present a patient with situs inversus who underwent laparoscopic cholecystecto my for acute cholecystitis under thoracic segmental epidural anesthesia and, we discuss this anesthetic technique in the light of the literature. (The Me di cal Bul le tin of Ha se ki 2014; 52: 53-5)
ÖzetAmaç: Çalışmamızda, spinal anestezi uygulanan hastalara sedasyon oluşturmak amacıyla verilen midazolam ve propofolün sedasyon kalitesi, kardiyovasküler sistem ve respiratuvar sistem üzerine etkilerini karşılaştırmayı amaçladık.Yöntemler: Yirmi-70 yaş arası, ASA I-III 40 hasta çalışmaya alındı. Hastalara spinal anestezi işleminden sonra grup M'de 0,05 mg/kg bolus midazolam dozunu takiben 0,05 mg/kg/sa midazolam infüzyonu; grup P'de 1 mg/kg bolus propofol dozunu takiben 2,5 mg/kg/sa propofol infüzyonu başlanarak, istenilen sedasyon düzeyine ulaşıncaya kadar dozlar gerektiğinde titre edildi. Hastaların kan basınçları, kalp hızları, SpO 2 , solunum sayısı değerleri, sedasyon skorları ve oluşan yan etkiler kaydedildi. Bulgular: Kan basınçları, kalp hızları ve SpO 2 değerleri bakımından her iki grup arasında istatistiksel olarak anlamlı fark bulunmadı. Grup M'de solunum sayısı ortalamasının grup P'ye göre istatistiksel olarak anlamlı düzeyde düşük olduğu görüldü. Sedasyon skorları değerlendirmesinde gruplar arasında anlamlı bir farklılık yoktu. Yan etki karşılaştırmasında sadece solunum yüzeyelleşmesi grup P'de (n=6) istatistiksel olarak anlamlı düzeyde yüksek bulundu. Abs tractAim: In this study, we compared the sedation quality and cardiovascular and respiratory system effects of midazolam versus propofol in patients undergoing spinal anesthesia.Methods: 40 ASA I-III patients aged 20-70 years were enrolled. After spinal anesthesia, in group M (n=20), 0.05 mg/kg/hr midazolam infusion following 0.05 mg/kg bolus of midazolam and, in group P (n=20), 2.5 mg/kg/s propofol infusion following 1 mg/kg bolus dose of propofol following were started and titrated until the intended level of sedation was achieved. Blood pressure, heart rate, SpO 2 , respiratory rate, sedation scores and side effects were recorded.Results: There was no statistically significant difference in blood pressure, heart rate and SpO 2 values between the groups. In group M, the mean respiratory rate was significantly lower than in group P. There was no significant difference in sedation scores between the groups. In comparison of side effects, only superficial breathing was observed to be significantly higher in group P than in group M. Conclusion:Propofol and midazolam used for sedation have minimum effects on hemodinamic and respiratory parameters. We assume that there is no significant difference between these two drugs in terms of patient comfort. (The Me di cal Bul le tin of Ha se ki 2015; 53:20-3)
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