Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet.
Background: This study aimed to compare remifentanil and ketamine-propofol in terms of hemodynamic response, duration of recovery and patient satisfaction in operative hysteroscopy cases who underwent monitored anaesthesia care in combination with paracervical block. Methods: Monitored anaesthesia care was used in 60 ASA I-II female patients. The patients were divided into two groups as remifentanil (Group R) and ketamine-propofol (Group K-P). The hemodynamic effects of remifentanil and ketamine-propofol, and duration of recovery were recorded and compared. The patient satisfaction was also recorded and the two groups were compared. Results: Age, body mass, ASA status, duration of anaesthesia and type of surgery were found to be similar between groups. The time of the Aldrete score reaching ≥ 9 was found to be shorter in Group R when compared with Group KP (Group R: 4.1 ± 1.9 min, Group K-P: 6.1 ± 2.6 min) (P < 0.05). The incidence of postoperative nausea and vomiting was found to be significantly higher in the remifentanil group (P ≤ 0.05). When the groups were compared in terms of patient satisfaction, in both groups this was found to be similar. Conclusion: Sedation with remifentanil combined with a paracervical block during monitored anaesthesia care provides early recovery with effective sedation and analgesia in hysteroscopy procedures.
Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet.
IntroductionClinicians use either direct or indirect (Seldinger) techniques for internal juguler or subclavian vein catheterization. This report aims to point out that the success rate of the direct technique where the catheter is inserted directly through the cannula may be higher particularly in catheterization of pediatric cases.Case presentationA 7.5-month-old female infant weighing 7200 gm was operated on for liver transplantation. The patient suffered jaundice at one month of age and was diagnosed with neonatal colestatic hepatitis. After routine monitoring, via indirect technique, central catheterization was attempted through internal jugular vein. However, the attempt failed. Therefore, again via indirect technique, catheterization was achieved through the right subclavian vein and fixed at 8 cm. After the operation started, fluid replacement and central venous pressure monitoring were performed with this catheter. Immediately after the operation, a control postero-anterior chest radiograph of the patient was obtained. This graph revealed that the tip of the catheter was fixed in the right internal jugular vein. Since the vital symptoms of the patient were not stable, the catheter was not removed and fluid replacement was performed via this technique. The catheter was removed on the postoperative 2nd day.ConclusionThe J wire advanced via the indirect technique advances anatomically following the upper wall of subclavian vein. Because of the smaller vessel dimensions and sharper, more angulated routes the subclavian and internal jugular veins make in infants, the rigid J wire may advance in the cephalic direction. However, in the technique where the catheter (Cavafix ® catheter) is inserted directly through the cannula, this probability is less since J wire is not used and the catheter employed is flexible. We concluded that especially in pediatric cases, employment of the technique where the catheter is inserted directly through the cannula would be more convenient in order to decrease the catheter malpositioning probability.
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