Current Anesthetic Management in a 20-Month-Old Pediatric Patient With Intestinal Transplantation Due to Microvillous Inclusion Disease

Intestinal transplantation is a complex procedure both in terms of anesthesia and surgery. In particular, pediatric anesthesia management during intestinal transplant surgery can become even more complicated. It has been stated that propofol, remifentanil, and sevoflurane reduce patient mortality by reducing the incidence of intestinal ischemiareperfusion injury. Although studies of these agents continue to be conducted in vivo or in vitro, these anesthetics are currently used for specific procedures that have a high risk of incurring ischemia-reperfusion injury. Herein, we present the case of a male child, aged 20 months, who was dependent on total parenteral nutrition and was found to have intestinal failure associated with liver disease type 1. Hematologic tests showed findings of anemia and metabolic acidosis. Propofol was administered for induction of anesthesia. Anesthesia maintenance was achieved using sevoflurane with remifentanil infusion. We ensured safe and adequate vascular access in the patient and performed hematologic and biochemical tests with detailed system controls. Before the procedure, we prepared a leukocyte-poor erythrocyte suspension, leukocyte-poor random or apheresis platelets, and ABO- and Rh-compatible fresh frozen plasma. We monitored for signs of acidosis, hypotension, coagulation disorders, and hyperkalemia during the reperfusion period.We maintained patient normothermia. In this case report on the anesthetic management of a pediatric patient aged 20 months who received a small bowel transplant due to microvillous inclusion disease, we found that the selection of anesthetic agents may affect the prognosis of future surgical procedures.

Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia

Background

Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia.

Methods

A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period.

Results

No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5 ± 10.0 in Group 1 and 39.6 ± 8.6 in Group 2 (p = 0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5 ± 0.6 in Group 1 and 3.5 ± 1.2 in Group 2 (p < 0.001).

Conclusions

Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery

BACKGROUND

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure.

METHODS

Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period.

RESULTS

A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay.

CONCLUSION

Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

[The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery]

BACKGROUND

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure.

METHODS

Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period.

RESULTS

A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay.

CONCLUSION

Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Complications and their management in endometriosis surgery

Endometriosis is a common chronic disease mostly seen in young women. Endometriosis surgery may be considered as rather challenging in gynecology. In this article, we tried to emphasize on basic concepts of endometriosis surgery, the best surgical method that should be applied and the complications and the management of the complications.

[Outcomes after operative treatment of distal radius fractures - an analysis of 721 patients]

AIM OF THE STUDY

Treatment strategies in distal radius fractures differ nationally and internationally. Conservative and operative treatment options compete as well as implants, postoperative therapy regimens and the necessity of implant removal. In our institution operative treatment is favoured. In the following the results of 721 surgically treated patients are presented.

PATIENTS

PATIENTS who underwent operative treatment of their distal radius fractures in our institution between 2008 and 2011 were retrospectively analysed. Following patient characteristics have been surveyed regarding age, sex, location of plate osteosynthesis, operation time, time of cast immobilisation and complications like infections, tendon ruptures, need of revision surgery.

RESULTS

721 patients (mean age: 59.03 years) were retrospectively analysed. 514 of them (71.29 %) were female. Time of operation was after a mean duration of 5.48 days. In 558 (77.39 %) patients we performed palmar plate osteosynthesis. 89 (12.34 %) had dorsal plate osteosynthesis and 74 (10.3 %) cases were treated with either K-wires or screws. 18 (2.5 %) patients had concomitant traumatic carpal tunnel syndrome and a concomitant SL rupture was seen in 38 (5.27 %) patients. 40 (5.55 %) patients underwent operative revision because of posttraumatic carpal tunnel syndrome (n = 15), tendon ruptures (n = 7), malposition of screws (n = 6), loss of reduction (n = 6) and infection (n = 3). Mean duration of in-hospital stay after operation was 6.6 days. Implant removal was performed in 77 (10.7) patients; 59 (8.2 %) patients had palmar plate osteosynthesis and 18 (2.5 %) patients had dorsal plating.

CONCLUSION

Because of the low complication rate after operative treatment of distal radius fractures, osteosynthesis of this fracture seems to be warranted. Regarding the patients' higher age we have seen an unexpectedly long in-hospital stay with a mean time of 6.6 days. Herein attempts should be made to reduce time of in-hospital stay. In our opinion implant removal should not be recommended routinely.

Propofol infusion syndrome or adrenoleukodystrophy?

Following a propofol anesthetic, a 5-year-old girl with lower extremity spasticity seized and developed hypertriglyceridemia, hyperkalemia, and metabolic acidosis. A presumed diagnosis of propofol infusion syndrome (PRIS) was made, but further investigation revealed neonatal adrenoleukodystrophy. PRIS should be considered with this constellation of symptoms, but other neurometabolic disorders must always be ruled out.

A patient presenting with concha bullosa in another concha bullosa: a case report

Introduction

Anatomic variations of the paranasal sinuses are very common. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery.

Case presentation

A 53-year-old Caucasian woman was admitted to our clinic with complaints of nasal breathing difficulties and headache persisting for a long time. Another concha bullosa was detected in the middle concha bullosa on preoperative paranasal computed tomography examination. It is known that the paranasal sinuses have a number of anatomical variations.

Conclusion

Herein we report a rare case, along with a review of the literature, to emphasize that a concha bullosa inside another concha bullosa should not be ignored.

Extraordinary pathologic entities within the concha bullosa

OBJECTIVE

To retrospectively analyze the extraordinary pathologic entities inside the concha bullosa (CB).

METHODS

Surgical interventions were performed on 136 patients (234 CB) at the Department of Ear, Nose, and Throat, and Head and Neck Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey between January 2002 and December 2007. Radiological and histopathological findings of these cases were reviewed retrospectively.

RESULTS

In 203 (86.8%) of the 234 cases, only a pneumatized cavity was observed. The cavity was filled with purulent secretion in 13 (5.6%) cases. A bony septum, pyocele, polyp, ossifying fibroma, fungus ball, and cholesteatoma were the other extraordinary pathologies associated with CB.

CONCLUSION

Although most of the CB cases have pneumatized cavity, it should be kept in mind that some extraordinary pathologies can be associated with CB.

A comparison of analgesic effect of intra-articular levobupivacaine with bupivacaine following knee arthroscopy

OBJECTIVE

To compare the postoperative analgesic effects of intra-articular levobupivacaine with bupivacaine following knee arthroscopy.

METHODS

Forty patients, aged between 20-60 years and undergoing elective knee arthroscopy were enrolled into the study protocol that was carried out in Tepecik Education and Research Hospital, Izmir, Turkey between January and June 2007. General anesthesia protocol was the same in all patients. At the end of surgery, the patients were randomly assigned into 2 groups (n=20 in each group). Group L received 20 ml 0.5% levobupivacaine and Group B received 20 ml 0.5% bupivacaine intra-articularly. We evaluated the level of postoperative pain (by visual analogue scale at 1, 2, 4, 6, 12, and 24 hours after surgery), first analgesic requirement time (period measured from the end of the surgery until further analgesia was demanded), and total analgesic consumption during 24 hours.

RESULTS

There were no significant difference in the postoperative pain scores of the patients between groups. The first analgesic requirement times were not statistically different. Twelve patients in Group L (60%) and 9 patients in Group B (45%) needed no additional analgesic during the 24 hours (p>0.05). No complications and side effects were found related to the intra-articular treatment.

CONCLUSION

The results of the study show that intra-articular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine.

The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery: a randomised controlled study

INTRODUCTION

The aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery.

METHODS

Sixty patients scheduled for elective major abdominal surgery were randomly assigned to three groups after ethics committee approval. Patients in Group PRE (n=20) received lornoxicam i.v. 8 mg 20 min before incision and saline i.v. after skin closure; patients in Group POST (n=20) received saline i.v. 20 mins before incision and lornoxicam i.v. 8 mg after skin closure; patients in Group C (n=20) received saline i.v. 5 min before incision and after skin closure. A standardized general anesthetic was used. All patients were started on i.v. tramadol patient-controlled analgesia during the postoperative period. Pain intensity was measured using the visual analog scale (VAS), and tramadol consumption. In addition, the incidences of side effects were recorded at the end of the study period.

RESULTS

There were no significant differences among the three groups of the demographic data. Groups PRE and POST demonstrated significantly reduced pain scores compared to Group C at various points in time. Group PRE also demonstrated a weakly significant reduction in analgesic consumption of tramadol postoperatively compared to Groups POST and C.

CONCLUSION

Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and leads to reduced consumption of tramadol postoperatively in patients undergoing major abdominal operations.

Auditory event related potentials relate with the clinical progression in idiopathic generalized epilepsy

Auditory event related potential (ERP) was studied in 60 patients with idiopathic generalized epilepsy and 33 age and sex matched healthy subjects. Thirty nine patients came to the control three months later and were reassessed. All auditory evoked potential latencies were prolonged in epileptics compared to those of healthy subjects. Multiple drug using or history of more than 100 seizures was associated with prolonged P3 latency. History of status epilepticus was observed together with prolongation of N2 and P3 latencies. Patients using their antiepileptic drugs more properly after the first control showed shortened P3 latency in the second control.

Combined (hormonal and microsurgical) therapy in infertile women with endometriosis

Fifty patients with moderate or severe endometriosis received 5 mg/day lynestrenol for 6 months prior to microsurgery. A significant regression of the ovarian and peritoneal implants was observed in 72% of the cases after progestative treatment, but the presence of residual epithelium in all cases made surgical resection necessary. After preoperative medical treatment and microsurgery, intrauterine (living births) pregnancy rates of 60 and 47% were obtained in cases of moderate and severe endometriosis, respectively. The following prognostic factors were found in this series: the degree of endometriosis, the concomitant male factors, the decrease of endometriotic lesions after treatment, and the unilaterality of ovarian endometriosis.

Effect on ovulation of surgically induced endometriosis in rabbits

To study the effect of endometriosis on follicular rupture, endometrial tissue was autografted to New Zealand White rabbits. Endometrium was surgically implanted into the peritoneal cavity or into the rectus muscle. Human chorionic gonadotropin was administered to induce ovulation. During three subsequent laparotomies, the number of corpora lutea and stigmata were counted. The viability of the implants was demonstrated histologically. Ovaries were removed during the last laparotomy and ovarian serial sections were examined. In rabbits with peritoneal induced endometriosis, the percentage of stigmata/corpora lutea was significantly decreased. Macroscopic study was confirmed by histological examination. Indeed, a high incidence of entrapped oocytes was found in rabbits with peritoneal endometriosis. Extraperitoneal endometriosis had no effect on ovulation. Our data demonstrated that endometriosis induced a failure of follicular rupture. After endometriumectomy, no failure to ovulate was observed, suggesting that the effect of endometriosis on the ovulation disappeared with excision of endometrial implants.

Surgical management of tubal obstruction at the uterotubal junction

The advantages of microsurgical anastomosis for cornual occlusion are evaluated in a series of 82 pure cases of pathologic cornual occlusion. The term pregnancy rate was 44% and the ectopic pregnancy rate was 7%. The following factors were found influencing the pregnancy rate: maximized tubal length; preserved intramural portion; absence of chronic inflammation; absence of tubal inclusions; absence of tubal endometriosis.

Morphologic study of mechanically induced hydrosalpinges in rabbits

Ligation of the proximal and distal ends of the rabbit oviduct was used to induce hydrosalpinges, which shows a remarkable resemblance, both macroscopically and microscopically, to human hydrosalpinges. Isthmic and ampullary biopsies obtained at varying intervals were examined with light microscopy. Progressive deciliation and decrease of epithelial and mucosal fold height were observed in the ampulla, but not in the isthmus. Microstereological study shows progressive reduction of both the number and the relative volume of capillaries in the ampulla. Considering the parallelism of time and localization, it is suggested that epithelial deciliation is caused by vascular disorders.