Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management.

Sağ internal jugüler ven aracılığıyla santral venöz kanü-lasyon yaygın olarak kullanılan bir teknik olup, kateterin yerleştirilme aşaması, ilerletme aşaması ve çıkarılma aşa-ması gibi farklı aşamalarda komplikasyonlara yol açabilir. Santral venöz kateterin malpozisyonu, tehlikeli sonuçlara da yol açabilmektedir. Bu yazıda, kateterin çıkarılma aşa-masında fark edilen, santral venöz kateterin yedinci vertebral foramen içerisindeki sağ vertebral vene yanlışlıkla yerleştirildiği 74 yaşında erkek bir olgu sunuldu. Central venous cannulation through the right internal jugular vein, which is a widely used technique, may lead to complications at different stages, including catheter placement stage, indwelling stage and the removal stage. Malposition of the central venous catheter may also result in catastrophic consequences. In this article, we report 74-year-old male case with misplaced central venous catheter into the right vertebral vein in seventh vertebral foramen, which was detected at the catheter removal stage.

Background. Our study aimed to compare HTEA and intravenous patient-controlled analgesia (PCA) in patients undergoing coronary bypass graft surgery (CABG), based on haemodynamic parameters and myocardial functions. Materials and Methods. The study included 34 patients that were scheduled for elective CABG, who were randomly divided into 2 groups. Anesthesia was induced and maintained with total intravenous anesthesia in both groups while intravenous PCA with morphine was administered in Group 1 and infusion of levobupivacaine was administered from the beginning of the anesthesia in Group 2 by thoracic epidural catheter. Blood samples were obtained presurgically, at 6 and 24 hours after surgery for troponin I, creatinine kinase-MB (CK-MB), total antioxidant capacity, and malondialdehyde. Postoperative pain was evaluated every 4 hours until 24 hours via VAS. Results. There were significant differences in troponin I or CK-MB values between the groups at postsurgery 6 h and 24 h. Heart rate and mean arterial pressure in Group 1 were significantly higher than in Group 2 at all measurements. Cardiac index in Group 2 was significantly higher than in Group 1 at all measurements. Conclusion. Patients that underwent CABG and received HTEA had better myocardial function and perioperative haemodynamic parameters than those who did not receive HTEA.

Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.

ÖZETPropofol günümüzde yaygın olarak kullanılan sedatif bir ilaçtır. Antikonvülzan olarak tanınmakla birlikte, propofol kullanımına bağlı birçok nörolojik olay bildirilmiştir. Yirmi üç yaşında erkek hastada üretra darlığı nedeniyle internal üretrotomi girişimi planlanmıştı. Öyküsünde 1 yıl önce geçirdiği araç dışı trafik kazasına bağlı subdural hematom ve 50 günlük yoğun bakım ünitesi tedavisi yer almaktaydı. Propofol 50 mg i.v. verildikten hemen sonra miyoklonik kasılmalar gözlendi ve tablo tiyopental uygulanarak kontrol altına alındı.Anahtar kelimeler: Propofol, nöbet, sedasyon SUMMARY Propofol Induced Seizure Like PhenomenaPropofol is a widely used intravenous sedative agent. Although it has been known that propofol is an anticonvulsant agent, there have been several reported neurologic events following propofol administration. A 23-year-old male was scheduled for internal uretrotomy under sedation. He had a history of subdural hematoma and 50 day-ICU stay in coma due to traffic accident. Immediately after giving 50 mg bolus of propofol, he developed myoclonic convulsions and this phenomena subsided with administration of thiopenthal.