The result of the study show that the extra-slow injection of hyperbaric bupivacaine provided strictly unilateral sensorial and sympathetic block in 93.9 and 87.9% of the patients, respectively, and that a slow injection of low doses of hyperbaric 0.5% bupivacaine 1 ml was sufficient to provide unilateral spinal anesthesia.

Background:The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/ kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T 2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505) Keywords: Elderly, postoperative residual curarization, reintubation, sugammadex Young elderly people, middle-aged elderly people, and old elderly people have been classified, respectively, between 65-74 years of age, between 75-84 years of age, and over age 84 by gerontologists (1). A number of studies have indicated that the prevalance of postoperative residual curarization (PORC) increases with age (2,3).The principle of train of four (TOF) Watch was to indicate a pattern of stimulation that did not require the comparison of evoked responses to a control response obtained before administration of a neuromuscular blocking agent (NMBA). As well as enabling the observer to compare T 1 (first twitch of the TOF) to T 0 (control), it also enables comparison of T 4 (fourth

Büyük çocukta yabancı cisim aspirasyonu: Plastik kalem ucu Yabancı cisim aspirasyonu çocuk hekimliğinde özellikle süt çocuğu döneminde sık görülen teşhisi zor bir hastalıktır. 12 yaşında kız hasta 15 gündür devam eden öksürük, ateş şikayeti ile başvurdu. Hasta akut solunum yolu enfeksiyonu tanısı ile iki ayrı sağlık kuruluşunda parenteral ve oral antibiyotik tedavisi görmesine rağmen ateşi kontrol altına alınamadığından kliniğimize sevk edildi. Fizik muayenesinde; dinlemekle sağ akciğer orta ve bazalde solunum sesleri belirgin şekilde azalan ve PA akciğer grafisinde sağ alt zonda belirgin pnömonik infiltrasyonu olan hastaya pnömoni tedavisi verildi. Tedaviye rağmen röntgen ve dinleme bulguları düzelmeyen hastaya bronkoskopi planlandı. Bronkoskopi hazırlığı yapılırken tedavinin 12. Gününde hastaya refakatçisi tarafından uygulanan fizyoterapi esnasında yaklaşık 2x1 cm boyutlarında plastik kalem ucu spontan olarak öksürük esnasında hastanın ağzında çıktı. Öyküsünde sorgulanmasına rağmen yabancı cisim ile ilgili bir anamnez yoktu. Hastanın tedavisi 15 güne tamamlandı. Hastanın fizik muayene bulguları ve radyolojik bulguları geriledi ve taburcu edildi. Sonuç olarak; bu olgumuzda tanı konamayan kronik öksürük ve tedaviye dirençli lober pnömonilerin etyolojisinde hasta yaşı ne olursa olsun yabancı cisim aspirasyonunu da düşünmemiz gerektiğini ve tanıya gidişte en önemli basamağın anamnez olduğunu ancak nadir de olsa gerçeğe uygun olmayan anamnezin hekimi yanıltabileceğini vurgulamaya çalıştık.

ÖZETMultinodüler guatr nedeniyle opere olacak üst dudaktan sert ve yumuşak damağa uzanan hemanjiyomu ve sol mandibular kitlesi olan bir hastada, zor entübasyonda alternatif bir yaklaşım olarak gum elastik buji (GEB) kullanımı sunuldu. Hasta, dikkatli bir preoperatif değerlendirme sonucu zor entübasyon olarak değerlendirildi. Başarısız bir entübasyon denemesinden sonra trakea halkaları hissedilerek gum elastik buji itildi. Sonrasında da entübasyon tüpü trakeaya kolaylıkla yerleştirildi. Orofasiyal hemanjiyom gibi konjenital anomaliye bağlı zor entübasyon durumlarında gum elastik buji başarılı bir şekilde kullanılabilir.Anahtar kelimeler: Orofasiyal, hemanjiyom, guatr, entübasyon, zor hava yolu SUMMARY Anaesthetic Management in a Patient with Hemangioma of Upper Lip Lying to Oral Cavity (Case Report)We report an alternative approach to intubation which a gum elastic bougie (GEB) is used to facilitate an anticipated difficult endotracheal intubation in a patient undergoing thyroidectomy due to nodular goitre in a patient with hemangioma of upper lip lying to hard and soft palate and left mandibular mass. It was considered as difficult intubation after a careful preoperative evaluation. GEB was inserted through to the trachea with palpations tracheal cartilages after an unsuccessful try of intubation. Hereby intubation tube was easily placed to trachea. GEB can be used effectively in difficult intubation due to congenital anomalies like orofacial hemangioma.