Butane is a commonly misused volatile agent, and a cause of intoxication. We present a case, who had a syncope and persistent ventricular fibrillation during the course of resuscitation. We discussed the management of this case in the intensive care unit and the accompanying difficulties in the light of the current literature.

The Pringle maneuver is used in hepatic surgery to prevent blood loss but is associated with ischemia- reperfusion injury. To investigate the effect of infliximab on inflammation and apoptosis in rat intestinal mucosa during ischemia-reperfusion (IR) injury. A total of 30 male Wistar albino rats were equally divided into three groups to be subjected to (i) sham operation (sham), (ii) IR injury via Pringle maneuver (pringle) or (iii) infliximab (IFX) group (IFX was given at a dose 3 mg/kg for 3 days before IR injury). Following reperfusion period of 60 min., intestinal tissue and blood samples were taken and processed by standard histological methods. The Pringle maneuver and following reperfusion caused significant histopathological changes, increased serum transaminases’ activity and the levels of oxidative stress markers and decreased glutathione peroxidase activity. IFX pretreatment partially prevented these changes. Infliximab pretreatment may protect intestinal mucosa against ischemia-reperfusion injury. Further studies are needed to investigate mechanism and evaluate safety and optimal dosing of IFX in humans exposed to the possible tissue damage by ischemia-reperfusion. (Folia Histochemica et Cytobiologica 2014, Vol. 52, No. 1, 36–41) The Pringle maneuver is used in hepatic surgery to prevent blood loss but is associated with ischemia- reperfusion injury. To investigate the effect of infliximab on inflammation and apoptosis in rat intestinal mucosa during ischemia-reperfusion (IR) injury. A total of 30 male Wistar albino rats were equally divided into three groups to be subjected to (i) sham operation (sham), (ii) IR injury via Pringle maneuver (pringle) or (iii) infliximab (IFX) group (IFX was given at a dose 3 mg/kg for 3 days before IR injury). Following reperfusion period of 60 min., intestinal tissue and blood samples were taken and processed by standard histological methods. The Pringle maneuver and following reperfusion caused significant histopathological changes, increased serum transaminases’ activity and the levels of oxidative stress markers and decreased glutathione peroxidase activity. IFX pretreatment partially prevented these changes. Infliximab pretreatment may protect intestinal mucosa against ischemia-reperfusion injury. Further studies are needed to investigate mechanism and evaluate safety and optimal dosing of IFX in humans exposed to the possible tissue damage by ischemia-reperfusion. (Folia Histochemica et Cytobiologica 2014, Vol. 52, No. 1, 36–41)

This study investigates analgesic and nociceptive effects of adding dexmedetomidine to bupivacaine neuraxial anesthesia through Tail-flick (TF) and Hot-plate (HP) tests and the pathohistological changes on spinal nerves and nerve roots through light microscopy. Forty anesthetized, male Sprague-Dawley rats were intrathecally catheterized. Basal values of TF and HP tests were measured before and after catheterization. Thirty-six successfully catheterized rats were assigned to four groups. Group B received 10 μg bupivacaine, Group BD3 received 10 μg bupivacaine + 3 μg dexmedetomidine, Group BD10 received 10 μg bupivacaine + 10 μg dexmedetomidine and Control group received 10 μL volume of artificial cerebrospinal fluid. TF and HP tests were performed between the 5(th) and 300(th) minutes of drug administration. Twenty-four hours after administration of drugs, rats were sacrificed and spinal cord and nerve roots were removed for pathological investigation. Baseline values of the TF and HP tests were not statistically different among the groups (6.8±0.15s). TF and HP latencies in the Control group did not change significantly during the study. TF and HP test results showed that adding 3 and 10 μg dexmedetomidine caused a dose-dependent increase in duration and amplitude of analgesic and nociceptive effect of bupivacaine (TF: 37.52±1.08%, 57.86±1.16% respectively, HP: 44.24±1.15%, 68.43±1.24% respectively). There were no apparent pathohistological changes at least 24 hours after the intrathecal administration of a single dose of dexmedetomidine 3 μg and 10 μg. Dexmedetomidine added to bupivacaine for spinal block improves analgesia and prolongs block duration.

Justificativa e objetivos Comparamos a eficiência do videolaringoscópio King Vision e do laringoscópio Macintosh, quando usados por anestesiologistas experientes em pacientes adultos com diferentes condições de intubação, em um estudo clínico prospectivo randomizado e controlado. Métodos: Foram selecionados 388 pacientes com estado físico ASA I ou II (de acordo com a classificação da American Society of Anesthesiologists – ASA), programados para anestesia geral com intubação traqueal. Cada paciente foi intubado com ambos os laringoscópios sucessivamente, em uma ordem aleatória. A taxa de sucesso da intubação, o tempo até a melhor visibilização da glote, o tempo de intubação, o tempo de ventilação, a classificação de Cormack‐Lehane (graus) e as complicações relacionadas à laringoscopia e intubação foram analisados. Resultados e conclusões As taxas de sucesso na intubação na primeira tentativa foram similares para o King Vision e o Macintosh (96,6% vs. 94,3%, respectivamente, p > 0,05). As médias dos tempos até a melhor visibilização da glote (IC 95% 0,5–1,4 s, p < 0,001) e de intubação (IC 95% 3–4,6 s, p < 0,001) foram maiores no King Vision. A diferença no tempo de intubação foi semelhante quando as tentativas malsucedidas de intubação foram excluídas (IC 95% 2,8–4,4 s, p < 0,001). Com base na classificação de Mallampati modificada na consulta pré‐operatória, o King Vision melhorou significativamente a visibilização da glote em mais pacientes (220 pacientes, 56,7%) em comparação com o Macintosh (180 pacientes, 46,4%) (p < 0,001). Nenhum dos pacientes apresentou dessaturação periférica de oxigênio abaixo de 94%. Os anestesiologistas experientes podem obter taxas semelhantes de sucesso na primeira tentativa de intubação e de traumas das vias aéreas com ambos os laringoscópios. O King Vision requer tempos mais longos até a visibilização da glote e de intubação traqueal, mas não causa dessaturação adicional. Background and objectives We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. Methods: A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack–Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. Results and conclusions First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p > 0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5–1.4 s, p < 0.001), and time to intubation (95% CI 3–4.6 s, p < 0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8–4.4 s, p < 0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p < 0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively.Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]).Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.