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GirişP eribulber blok, oftalmik cerrahide anestezi ve akinezi sağlamak için kullanılan rejyonal anestezi tekniklerinden biridir. Kas konusu dışına (ekstrakonal) verilen lokal anestezik ile optik sinir hasarından kaçınılmaktadır. Bundan dolayı daha fazla anestezik ajan gerektirir. Peribulber blok, birden fazla enjeksiyona gereksinim duyulması ve fazla miktarda lokal anestezik ajan verilmesi gibi dezavantajları olmasına rağmen oftalmik cerrahi öncesinde komplikasyonların azlığı nedeniyle sıklıkla tercih edilir (1). Oftalmik cerrahi geçirecek hastalarda peribulber anestezi altında major komplikasyonların oranı %0,006 olarak bildirilmiştir (2). Teorik olarak peribulber bloğun daha güvenli ve kolay olduğu düşünülmesine rağmen literatürde peribulber blok sonrası beyinsapı anestezisi gelişen vakalar bildirilmiştir (3, 4). Olgumuzda katarakt ameliyatı öncesi yapılan peribulber bloğa bağlı muhtemel beyin sapı anestezisi nedeniyle gelişen solunum depresyonu sunulmaktadır. Olgu SunumuSağ göz için elektif katarakt cerrahisi planlanan 68 yaşındaki bayan hastanın bu raporun yayınlanması için bilgilendirilmiş yazılı onamı alındı. Yaklaşık onbeş yıldır esansiyel hipertansiyonu mevcuttu ve tedavide indapamid ve triamteren kullanmaktaydı. Hipertansiyon dışında herhangi bir sistemik hastalığı olmayan hastanın laboratuar değerlerinde özellik yoktu. Preoperatif risk skoru Amerikan Anesteziyologlar Derneği (ASA: American Society of Anesthesiologists) ASA II'idi. Bir yıl önce diğer gözden peribulber blok ile katarakt cerrahisi geçiren hasta sorunsuz taburcu edilmişti. Hasta monitorize edildi (kalp hızı, elektrokardiyografi, noninvaziv kan basıncı ve oksijen satürasyonu) ve damar yolu açıldı. Katarakt cerrahisi öncesi anestezi sağlamak amacıyla 6 mL %2 lidokain hidroklorid (Jetokain ampul; Adeka İlaç San., Samsun, Türkiye) kullanılarak alt kapakta inferotemporal alt orbital kenardan lateral kantus ve lateral limbusun ortasından 25 gauge ve 25 mm uzunluğun-da iğne ile Göz Hastalıkları uzmanı tarafından peribulber blok yapıldı.Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment. Keywords: Peribulbar anaesthesia, brainstem anaesthesia, respiratory arrest, patient monitarisation Peribulber blok ile kas konusu dışına lokal anestezik madde verilerek gözde anestezi ve akinezi sağlanmaktadır. Katarakt cerrahisi planlanan bir hastada peribulber alana 6 mL %2 lidokai...

Study DesignRetrospective.PurposeThis study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia.Overview of LiteratureMany women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia.MethodsWe examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS).ResultsFifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months.ConclusionsAge, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

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The mortality rate in ruptured abdominal aortic aneurysms can today be reduced through cardiovascular surgery. However, ischemia and reperfusion‐induced tissue damage develop due to aortic cross‐clamping applied during surgery. The present study aimed to reduce oxidative stress‐induced hepatic damage resulting from ischemia and reperfusion due to aortic cross‐clamping during surgery by means of resveratrol administration. Forty male Sprague–Dawley rats were randomly assigned into four groups: control (healthy), glycerol+ischemia/reperfusion (I/R) (sham), I/R, and I/R + Resveratrol. In all groups scheduled for I/R, 60 min of shock was followed by 60 min of ischemia. In the I/R + Resveratrol group, 10 mg/kg of resveratrol was administered 15 min before ischemia and immediately before reperfusion via the intraperitoneal route. In addition, 120 min of reperfusion was applied under anesthesia after ischemia in all groups. Intralobar and interlobar necrosis, vascular congestion, and edematous fields resulting from aortic occlusion were present. Liver tissue malondialdehyde (MDA) levels and cleaved caspase‐3 positivity increased, while glutathione (GSH) levels decreased. However, resveratrol administration reduced intralobular and interlobar necrosis, vascular congestion and edematous fields, cleaved caspase‐3 positivity, and MDA levels, and increased GSH levels. Our findings suggest that resveratrol is effective against aortic occlusion‐induced liver injury by reducing oxidative stress and apoptosis.

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Cranial nerve palsies after gunshot injury are not uncommon. However, in the literature, only 1 patient with isolated hypoglossal nerve paralysis caused by gunshot has been published. The authors describe a 34-year-old man suffering from unilateral isolated hypoglossal nerve palsy caused by gunshot injury as a second reported patient. The bullet entered maxillary sinus, and caused condylar fracture, then ended up C1-2 interspace. The bullet was surgically removed by a posterior approach. It is important to pay attention to hypoglossal nerve injury when confronted with a gunshot wound. The authors recommend early and sufficient surgical decompression.