Objective: Multimodal pain management combined with epidural analgesia and transversus abdominal plane (TAP) block after obesity surgery, reduces side effects of opioids by
decreasing its usage and ...ensuring effective postoperative pain control in obese patients with expanded fat mass. But performing both epidural and TAP block in obese patients is
technically difficult, and sometimes it is impossible. Performing the TAP block laparoscopically may be a solution to this technical difficulty. In this study, technical success and efficacy
of laparoscopic transversus abdominis plane block in the laparoscopic sleeve gastrectomy was assessed.
Methods: This study was designed as prospectively randomized, double-blinded and placebo-controlled. Laporoscopic sleeve gastrectomy (LSG) patients underwent TAP infiltration
of 30 cc bupivacaine (Group T) or saline (Group S) was administered to bilateral petit and subcostal area in patients underwent laparoscopic sleeve gastrectomy. One hundred sixty five
patients were included in the study. All patients were administered with postoperative patient-controled analgesia device and dosed with tenoxicam 20 mg IV at postoperative 1st and
8th hours. The analgesic requirement, mean pain score, vital parameters of all patients and if any of the patients presented with nausea and vomiting were assessed by an objective
observer at postoperative 1st, 6th and 24th hours.
Results: There was no statistically significant difference between age, body maas index, mean duration of operation and gender, laparoscopic TAP block groups (p>0.05). When the
visual analogue scale score was evaluated, the mean scores of the 1st, 6th, and 24th hours in the control group (Group S) were found as statistically significantly higher than Group T
(p=0.009, p=0.002).
Conclusion: It is noteworthy that reduction of opioid-related side effects by the usage of multimodal analgesic technique, particularly in morbidly obese patients undergoing surgery.
In this study, it was projected that laparoscopic TAP block can be applied with high rate of success and reduces postoperative opioid consumption in LSG operations.
Aim: Posthypoxic myoclonus (PHM) is a rare myoclonus syndrome observed after cardiac arrest, is difficult to control and has no definitive diagnostic method. The pathophysiological mechanism of PHM, ...also known as Lance Adams Syndrome (LAS), is unknown and definitive treatment options are limited. The aim of this study was to present cases of LAS and the follow-up results of treatment following cardiopulmonary resuscitation (CPR) in our hospital. Methodology: This study included patients followed up in the intensive care clinic of our hospital between May 2012 and January 2017 after CPR in the intensive care unit (ICU). A retrospective review was made of the record files of patients who were evaluated by the Neurology Department because of epileptic seizures. Results: Evaluation was made of 19 patients with no history of epilepsy/antiepileptic drug use and treatment initiated by the Neurology Clinic for LAS. The patients comprised of 11 males (58%) and 8 females (42%) with a mean age of 55.89 + or - 19.65 y for survivors and 61.50 + or - 16.12 years for non-survivors. The mean length of hospital stay was 35 days for survivors and 17.5 days for nonsurvivors. Outcomes were determined as, mortality in 10 cases, long-term care in 7, and discharge with recovery in 2. Sodium valproate was used in 4 patients and levetiracetam in 15. The 7 patients on long-term care were found to have been lost in the 3-month period after discharge. Conclusions: In Lance Adams Syndrome the EEG may not provide any pathological clue or show epileptic changes. An early start to treatment can lead to better prognosis. It can be concluded that after CPR, myoclonic contractions can be reduced, and morbidity and mortality can improve with early diagnosis and early treatment. Key words: Post-hypoxic myoclonus; Post resuscitation; Cardiopulmonary resuscitation; Lance Adams syndrome
Objective: Klebsiella pneumoniae infections have been a problem in intensive care units (ICU) in recent years due to multi-drug resistance. In this study, it was aimed to analyze K. pneumoniae ...infections in ICU, determine distribution of carbapenem resistance rates and risk factors. Methods: Nosocomial infections (NI) with K. pneumoniae between January 2017-January 2020 were evaluated retrospectively. In cases with recurrent K. pneumoniae infection, only the first episode was included. Results: K. pneumoniae infections were developed in a total of 78 patients. Bloodstream infections (BSI) were the most common (51.3%), followed by pneumonia (41%) and urinary tract infections (7.7%). Among BSI cases, 52.5% were associated with central venous catheter (CVC) and 81.2% of pneumonia cases were ventilator-associated pneumonia (VIP). It was observed that while the proportion of BSI was gradually decreasing in years, pneumonia rates have increased. Among BSI, it was observed that the rate of CVC-related BSI was increased from 33.3% in 2017 to 62.5% in 2019. Carbapenem resistance was 52.6% and colistin resistance was 17.9% in K. pneumoniae isolates and both increased over 3 years. When carbapenem-resistant K. pneumoniae infections were compared with carbapenem-sensitive K. pneumoniae infections, the independent risk factors associated with carbapenem resistance were found to be carbapenem use (p=0.008, OR: 8.45, 95% CI: 1.76-40.64), prior NI developing with different microorganism (p=0.005, OR: 8.70, 95% CI: 1.91-39.65) and total parenteral nutrition (TPN) use (p=0.04, OR: 4.2, 95% CI: 1.06-16.67). Conclusions: Carbapenem-resistant K. pneumoniae infections are gradually increasing in ICUs, and colistin resistance has started to be observed recently. Our study showed that carbapenems are independent risk factors in carbapenem resistance and suggested that carbapenem use should be restricted in our unit. It is important for each center to reveal its own data of frequency and resistance, in order to decrease infection rates with the infection control measures and determine the antibiotic using policies.
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