Tamamlayýcý ve alternatif týp yöntemleri (TAT), primer baþ aðrýsý tedavisi için pek çok ülkede kullanýlmaktadýr. Türk popülasyonunda, primer baþ aðrýlarýnda TAT yöntemlerinin bilinirliði, kullanýmý ve yararýna yönelik epidemiyolojik veri bulunmamaktadýr. Üç baþ aðrýsý merkezine baþvuran 110 primer baþ aðrýlý olguya baþ aðrýsýnda kullanýlan TAT yöntemlerinin bilinirliði, kullanýmý ve yararlanýlmasýna iliþkin sorular içeren formlar verilerek yanýtlanmasý istendi. Hastalarýn yaþ ortalamasý 34,7 ± 9,6 (32,8-36,5) idi. Hastalarýn 2/3’si yüksek okul veya üniversite mezunu, 1/3’I ise ev hanýmýydý. Olgularda en sýk aurasýz migren (%45,5), daha az sýklýkla auralý migren (%19,1) ve gerilim tipi baþ aðrýsý (%18,2) saptandý. Hastalarýn %43,6’sýnda baþ aðrýsý sýklýðý 5-10/ay bulunmuþtur. En sýk bilinen modaliteler sýrasýyla masaj (%74,5), akupunktur (%44,5), yoga (%31,8), egzersiz (%28,2), psikoterapi (%25,5) ve biberiye kullanýmý (%23,6) idi. En sýk kullanýlan TAT yöntemi masaj (%51) ve egzersiz (%11) olarak saptandý. Bununla beraber olgularýn 1/3’ü masajdan fayda gördüðünü belirtti.
Bizim verilerimiz primer baþ aðrýlý Türk hastalarýn, standart tedavilere ek olarak alternatif tedavi arayýþlarý olduðunu ve bu tedavilerden en azýndan birkaçýný kullandýklarýný göstermiþtir. Nörologlarýn bu konuda bilgilerini arttýrmalarý yanýnda, bu konuda yapýlacak büyük gruplarý içeren randomize çalýþmalara ihtiyaç duymaktadýr.

Objective: Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache.
Methods: One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches.
Results: The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not.
Conclusion: Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

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Amaç: Intravenöz tramadol infüzyonuna, transdermal fentanil ve oral morfin uygulamasýna yanýt vermeyen ayrýca bu ilaçlarýn kabul edilemeyen ve tedavi edilemeyen yan etkilerini tölere edemeyen; ileri evre jinekolojik kansere baðlý þiddetli kronik aðrýsý olan hastalarýn yönetiminde subkutanöz yerleþtirilen epidural portlarýn etkinliðini deðerlendirmektir.
Gereç ve Yöntem: Prospektif çalýþma dizaynýna göre, evre IV jinekolojik kanserli 21 hastada (over n = 6, endometrium n = 3, serviks n = 10, vajina n = 1 ve vulva n = 1) þiddetli kronik aðrýnýn giderilmesi için morfin uygulanmasýna imkan veren epidural portlar subkutanöz olarak yerleþtirildi. Epidural port uygulamasýndan önce ve 5., 15. ve 30. günlerden sonra aðrýnýn seviyesini tanýmlamak üzere görsel analog skalasý (GAS) ve hasta memnuniyeti skorlamasý (HMS) kullanýldý.
Bulgular: Epidural port uygulanan vakalarýn ortalama genel saðkalým süresi 80 gündü [daðýlým: 31-560]. Aðrý parametreleri açýsýndan, 5., 15. ve 30. günlerin sonundaki deðerler (GAS2, GAS3 ve GAS4), epidural port yoluyla morfin uygulamasýndan önceki deðerden (GAS1) anlamlý düþük idi, (p<0.01). Beþinci, 15. ve 30. günlerdeki HMS, port yerleþtirilmeden önceki HMS’dan anlamlý yüksek idi, (p<0.05). Aðrý yönetimi 2 mg morfin ile baþlatýldý ve en fazla 4 mg morfin epidural boþluða günlük uygulandý. Takip sýrasýnda, klinik olarak tespit edilen enfeksiyon durumu ve tedavi gerektirecek morfin ile iliþkili yan etki geliþmedi.
Sonuç: Subkutanöz yerleþtirilen epidural port yoluyla morfin verilmesi yan etki yaratmadan mükemmel aðrý kontrolü saðlamakta, hayat kalitesini artýrmakta ve ayrýca hayatdan zevk alma yeteneðine katký yapmaktadýr.

Objective: We aimed to evaluate the effectiveness of subcutaneously implanted epidural ports (SIEP) in the management of patients with advanced-stage gynecologic cancer-related severe chronic pain who do not respond to intravenous tramadol infusion, transdermal fentanyl, and oral morphine administration or who cannot tolerate the unacceptable and unmanageable side effects of these drugs.
Methods: In this prospectively designed study, SIEP to permit the administration of morphine were implanted for relief of severe chronic pain in 21 cases with stage IV gynecological cancer (ovarian [n=6], endometrium [n=3], cervix [n=10], vaginal [n=1], and vulvar [n=1]). In order to define the level of pain, visual analogue scale (VAS) and patient satisfaction score (PSS) were used before and on the 5th, 15th, and 30th days after epidural port application.
Results: The mean overall survival period of the cases undergoing epidural port application was 80 days (range: 31-560). In terms of pain parameters, values at the end of the 5th, 15th and 30th days (VAS2, VAS3 and VAS4) were significantly lower than the value before morphine application via SIEP (VAS1) (p<0.01). PSSs at the 5th, 15th and 30th days were significantly higher than the PSS before port implantation (p<0.05). Pain management was started with 2 mg morphine with a maximum of 4 mg morphine administered into the epidural space per day. No clinically detected infectious condition or morphine-related side effects that required treatment occurred during the follow-up.
Conclusion: Morphine administration via SIEP provided excellent pain relief without creating side effects, increased patient quality of life, and contributed to the patient’s ability to enjoy life.

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Amaç: Günübirlik operasyonlardan sonra yeterli aðrý kontrolü hastalarýn erken taburcu olmalarýnda önemlidir. Çalýþmamýzda, operatif histeroskopi geçiren hastalarýn postoperatif aðrý tedavisinde intravenöz parasetamol ile intravenöz deksketoprofen trometamol’ün analjezik etkinliklerini karþýlaþtýrmayý planladýk.
Gereç ve Yöntem: Fakülte Etik Kurul izni (KA09/258) ve hasta onayý alýndýktan sonra ayaktan, ASA I-II, genel anestezi altýnda operatif histeroskopi operasyonu geçirecek 114 hasta prospektif, randomize olarak çalýþmaya alýndý. Hastalar 3 gruba ayrýldý. Grup D’ye iv. 50mg deksketoprofen trometamol, Grup P’ye iv. 1000 mg parasetamol ve Grup C’ye intravenöz % 0.9 NaCl tek doz olarak uygulandý. Postoperatif 15 dk, 30 dk,1 s, 2 s ve 3. s’lerde Görsel Aðrý Skalasý (VAS) ile aðrý þiddeti, aðrý hafiflemesi, sedasyon, bulantý-kusma skorlarý, diðer yan etkiler ve ek analjezik ihtiyaçlarý kaydedildi. VAS ≥ 40 mm olan hastalara ek doz analjezik olarak iv. meperidin 0.25 mg/kg uygulandý.
Bulgular: VAS skorlarý Grup D’de 15 dk,30 dk 1 s ve 2. s izlemde Grup C’ye göre daha düþük; 15. dk ve 30. dk. Grup P ye göre daha düþük bulundu. Grup D’de Grup P ve Grup C’ye göre opioid ihtiyacý olan hasta oraný (sýrasýyla % 34, % 60, % 63; p<0.05) ve ihtiyaç duyulan opioid miktarý (sýrasýyla 0.10 ± 0.16 mg/kg, 027 ± 0.33 mg/kg, 0.28 ± 0.25 mg/kg; p < 0.05) anlamlý olarak daha düþük bulundu Aðrý hafiflemesi postoperatif 15. dk’da Grup D’de Grup C’ye göre anlamlý olarak daha düþük bulundu (p < 0.05).
Sonuç: Günübirlik operatif histeroskopide iv. deksketoprofenin postoperatif analjezide parasetamol ve plaseboya göre daha etkin olduðunu düþünüyoruz.

Objective: Adequate pain management following day-case surgery allows early ambulation of patients. In this study, we aimed to compare postoperative analgesic efficacy of intravenous (iv) dexketoprofen vs. iv paracetamol following day-case operative hysteroscopy.
Methods: One hundred and fourteen American Society of Anesthesiologists (ASA) I-II patients scheduled for day-case operative hysteroscopy were recruited and randomized to three groups in the study. Group D received 50 mg iv dexketoprofen trometamol, Group P 1000 mg iv paracetamol and Group C normal saline solution. Visual Analogue Scale (VAS) pain intensity, pain relief, sedation, nausea-vomiting, other side effects, and additional opioid analgesic requirement were noted at postoperative 15 minutes (min), 30 min, 1 hour (h), 2 h, and 3 h. Patients with VAS ≥40 mm received meperidine 0.25 mg/kg as rescue analgesic medication.
Results: VAS scores at 15 min, 30 min, 1 h, and 2 h were significantly lower in Group D compared to Group C. VAS scores at 15 min and 30 min were significantly lower in Group D compared to Group P. The percentages of patients who required opioid treatment were 34%, 60%, and 63% in Groups D, P and C, respectively (p<0.05). Total delivered opioid dose was 0.10±0.16 mg/kg, 027±0.33 mg/kg and 0.28±0.25 mg/kg in Groups D, P and C, respectively (p<0.05). Pain relief score was significantly better in Group D at postoperative 15 min when compared with Group C (p<0.05).
Conclusion: Our study demonstrated that iv dexketoprofen has superior efficacy for postoperative pain management following day-case operative hysteroscopy when compared with paracetamol and placebo.

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Amaç: Non-steroidal anti-inflammatuar ilaçlar (NSAÝÝ) multimodal postoperatif aðrý tedavisinde kullanýlmasý önerilen ilaçlardýr. Bu çalýþmanýn amacý major ortopedik cerrahi sonrasýnda kullanýlan deksketoprofen ve lornoksikamýn postoperatif analjezik etkinliðini ve morfin tüketiminde yaptýðý azalmayý incelemektir.
Yöntem: Etik kurul izni ve hasta onamý alýndýktan sonra genel anestezi altýnda elektif kalça veya diz total protezi uygulanacak 120 hasta iki doz 50 mg deksketoprofen (GD), iki doz 8 mg lornoksikam (GL) veya plasebo (GP) alacak þekilde randomize edildi. Postoperatif dönemde, 0.01 mg.kg-1 bolus doz ve kilitli kalma 10 dak olacak þekilde morfin içeren HKA bazal infüzyon olmadan baþlandý. Aðrý deðerlendirmesi postoperatif 1, 2, 4, 6, 8, 12 ve 24. saatlerde istirahat ve hareket halinde VAS ile yapýldý.
Bulgular: Gruplar arasýnda yaþ, cinsiyet, ASA deðeri, kalça ve diz protezi yapýlan hasta sayýsý, aðýrlýk, boy ve operasyon süresi açýsýndan fark yoktu. GD ve GL hastalarýnýn istirahat ve aktif hareket halindeki VAS deðerleri GP’deki hastalardan anlamlý olarak daha düþüktü. GD’nin istirahat ve aktif hareket halindeki VAS deðerleri GL’den daha düþük olarak bulundu. GD ve GL’deki hastalarýn postoperatif morfin tüketimi GP’dekilerden anlamlý olarak daha düþüktü. GD’deki hastalarýn toplam morfin tüketimi GL’den daha düþük bulundu.
Sonuç: 50 mg deksketoprofenin ve 8 mg lornoksikamýn intravenöz yoldan günde iki doz uygulanmasýnýn major ortopedik cerrahi sonrasý plaseboya göre daha iyi analjezi saðladýðý ve morfin tüketimini azalttýðý bulundu. Iki aktif ilaç karþýlaþtýrýldýðýnda ise analjezik etkinlik ve morfin tüketimi açýsýndan deksketoprofen lornoksikamdan daha üstün bulundu.

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for multimodal postoperative pain management. The purpose of this study was to evaluate the postoperative pain relief and opioid-sparing effects of dexketoprofen and lornoxicam after major orthopedic surgery.
Methods: After obtaining ethical committee approval and informed consent, 120 patients undergoing elective hip or knee replacement under general anesthesia were randomized to receive two intravenous injections of 50 mg dexketoprofen (GD), 8 mg lornoxicam (GL) or saline as placebo (GP) intravenously. Postoperatively, patient-controlled analgesia (PCA) morphine was started as a 0.01 mg.kg-1 bolus dose, with lockout time of 10 minutes without continuous infusion. Pain assessment was made using the Visual Analogue Scale (VAS) at rest or during movement at postoperative 1, 2, 4, 6, 8, 12, and 24 hours.
Results: The three groups were similar in terms of age, gender, American Society of Anesthesiologists (ASA) class, number of patients who underwent hip or knee surgery, weight, height, and operation duration. Patients in GD and GL demonstrated significantly reduced pain scores at rest and active motion compared to GP, with lower scores in the dexketoprofen group. Patients in GD and GL used significantly less morphine in the postoperative period compared to GP. The total morphine consumption of patients in GD was lower than in GL.
Conclusion: Intravenous application of 50 mg dexketoprofen twice a day and 8 mg lornoxicam twice a day improved analgesia and decreased morphine consumption following major orthopedic surgery. When the two active drugs were compared, it was found that dexketoprofen was superior to lornoxicam in terms of analgesic efficacy and opioid consumption.

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Giriþ: Bu çalýþmada, intravenöz (IV) deksketoprofen trometamol’ün (DT) gömük üçüncü molar diþ cerrahisindeki preemptif analjezik etkinliðinin plasebo grubuyla karþýlaþtýrýlmasý amaçlandý.
Materyal-metot: Bilateral gömük diþ çekimi yapýlacak 18 yaþ üzerinde 20 hasta prospektif, randomize, plasebo kontrollu çalýþmaya dahil edildi. Bir diþ çekiminde 50 mg DT alan hastaya diðer diþ çekiminde plasebo uygulandý.Toplam 40 gözlem yapýldý. Aðrý skorlarý cerrahi sonrasý Sözel Aðrý Skalasý (VRS) ile deðerlendirildi. Ayrýca ilk analjezik alma zamaný, ek analjezik ihtiyacý olan hastalar, hasta ve hekim memnuniyeti, yan etkiler kaydedildi.
Bulgular: Ýlk 12 saat içinde VRS skoru DT grubunda plasebo grubuna göre anlamlý olarak daha düþüktü. (p<0.05). Ýlk analjezik ihtiyacý plasebo grubunda DT grubuna oranla istatistiksel olarak anlamlý daha erken oldu (p<0.05). Plasebo grubundaki hastalarýn ek analjezik ihtiyacý DT alan hastalara oranla istatistiksel olarak anlamlý daha fazlaydý (p<0.05). DT grubunda hasta ve hekim memnuniyeti istatistiksel olarak daha fazlaydý (p<0.05).
Sonuç: Üçüncü molar diþ cerrahisinde preemptif IV DT kullanýmýnýn plaseboya oranla çok daha etkin postoperatif analjezi saðladýðýný saptadýk.

Objective: The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery.
Methods: Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined.
Results: During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05).
Conclusion: Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery.

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Psoas kompartman bloðu, lumbar pleksusun kökler hizasýnda bloke edilmesi sebebiyle periferik yaklaþýmlara göre daha tam bir bloktur. Genellikle yüzeyel anatomik iþaret noktalarý kullanýlarak blok lokalizasyonu belirlenir ve lokal anestezik enjeksiyonu periferik sinir stimülatörü ile kuadriseps kasýnýn kontraksiyonu görülerek uygulanýr. Ultrason sinir bloklarýnda tek baþýna veya sinir stimülatörü yardýmý ile rehberlik saðlayabilir. Biz, bu yazýda spinal anestezi giriþimini reddeden, genel anestezi ve ultrason rehberliðinde psoas kompartman bloðu altýnda diz artroskopi cerrahisi geçiren, 48 yaþýnda, ASA II, erkek hasta ile ilgili deneyimimizi sunduk. Hastaya standart monitorizasyon uygulandi ve lateral dekübit pozisyon verilmesi sonrasýnda vertebra, psoas, erektor spina and kuadratus lumborum kaslarý L4-5 seviyesinde konveks prob ile gözlendi. Ýðne ultrason rehberliðinde ilerletildi ve iðne ucunun lokalizasyonu kuadriseps kas kontraksiyonu ile doðrulandý. Otuz mL lokal anestezik karýþýmýnýn (10 mL % 2 lidokain and 20 mL % 5 levobupivakain) lumbar pleksus etrafýna enjekte edilmesinin ardýndan hastaya genel anestezi uygulandý. Anestezi ve cerrahi iþlem ek anestezik/analjezik ihtiyacý veya komplikasyon olmaksýzýn baþarýyla tamamlandý. Hastanýn postoperatif dönemde istirahatte ya da mobilizasyonda ilk 24 saatte aðrý þikayeti olmadý. Bu olgu sunumu, ultrason rehberliðinde psoas kompartman bloðunun diz artroskopi cerrahisinde peri- ve post-operatif analjezi için uygun ve etkin bir yöntem olduðunu göstermektedir.

Anesthetizing the lumbar plexus at its origin facilitates a more “complete” psoas compartment block compared to peripheral approaches. It is usually performed using surface anatomical landmarks, and the site for local anesthetic injection is confirmed by observing quadriceps muscle contraction to peripheral nerve stimulation. Ultrasound may provide guidance alone or together with the aid of nerve stimulation during nerve blocks. We present a 48-year-old male patient, American Society of Anesthesiologists (ASA) physical status II, who refused spinal anesthesia, and underwent knee arthroscopy with ultrasound-guided psoas compartment block and general anesthesia. Following the standard monitoring and lateral decubitus positioning, the vertebral body, psoas, erector spinae, and quadratus lumborum muscles and hyperechoic nerve roots of the patient were visualized at the level of L4-5 with curvilinear ultrasound probe. The needle was inserted with ultrasound guidance, and correct tip position was confirmed with quadriceps contraction. Then, the mixture of 30 mL local anesthetic (10 mL 2% lidocaine and 20 ml 5% levobupivacaine) was injected at the estimated position of the lumbar plexus (junction of the posterior third and anterior two-thirds of the psoas muscle). He also received general anesthesia for the surgery. Anesthesia and surgical procedures were completed successfully without any additional anesthetic/analgesic requirement or complication. The postoperative period was pain-free both at rest and during mobilization for 24 hours. This case report shows that ultrasound-guided psoas compartment block is feasible and efficient for peri- and postoperative analgesia during knee arthroscopy.

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Cerrahi ve anestezi tekniklerindeki geliþmeler, yüksek riskli hastalarýn anestezi alma ve ameliyat olabilme ihtimalini de beraberinde getirmektedir. Meme kanseri cerrahisinde genel anestezi tercih edilen baþlýca yöntem olmasýna raðmen, alternatif olarak rejyonel anestezi teknikleri de uygulanabilmektedir. Rejyonel anestezi uygulamasýnýn peroperatif stres yanýt ile postoperatif mortalite ve morbiditeyi azalttýðý, ilave olarak beslenmenin ve mobilizasyonun erken baþlamasýnda etkili olduðu bilinmektedir. Rejyonel anestezi tekniklerinden yüksek torasik epidural anestezi, servikal epidural anestezi ve paravertebral blok ile mastektomi ameliyatlarýnýn baþarý ile yapýldýðý daha önceki çalýþmalarda bildirilmiþtir. Torasik epidural anestezi ile kombine yapýlan interskalen blok tekniðide servikal epidural anestezi veya genel anesteziye iyi bir alternatif olabilir. Bizde pulmoner problemleri olan, torasik epidural anestezi ile kombine interskalen blok altýnda, mastektomi ve aksiller disseksiyon planlanan hastayý sunmayý amaçladýk.

Recent advances in surgical and anesthetic techniques have facilitated general anesthesia and surgical possibilities in the higher-risk patient group. Although general anesthesia is the only preferred approach for breast surgery, there have been many clinical trials about breast surgery that has been achieved with regional anesthesia techniques. It is known that regional anesthesia application decreases the preoperative stress, postoperative morbidity and mortality. Additionally, this application positively affects the early start of feeding and mobilization. Regional anesthesia techniques like high thoracic epidural anesthesia, cervical epidural anesthesia and paravertebral block have been applied successfully in mastectomy operations. Combined thoracic epidural anesthesia-interscalene block technique may also be a good alternative to general or cervical, high thoracic epidural anesthesia. We aimed herein to present a case who underwent successful mastectomy and axillary dissection under combined thoracic epidural anesthesia-interscalene block.

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Dört aylýk infanta lokal anestezi altýnda sünnet planlandý. lokal anestezi uygulandýktan sonra hastanýn aðlamasý durdu, jeneralize tonik klonik konvulzyonlar ve yaygýn eritematöz döküntü oluþtu. Hemen % 100 O2 ile maske ventilasyonu saðlandý, monitorize edildi ve intramüsküler olarak 1 mg midazolam uygulandý. Damar yolu açýldýktan sonra 50 mg sodyum tiyopental intravenöz yoldan uygulandý ve konvulzyonlar kontrol altýna alýndý ve endotrakeal entübasyon gerçekleþtirildi. Entübasyondan 30 dakika sonra hasta ekstübe edildi. Fakat gürültülü solunumu olmasý üzerine hasta tekrar entübe edildi ve endotrakeal entübasyon esnasýnda larenksin hafif ödematöz olduðu gözlendiðinden 10 mg prednizolon intravenöz yoldan uygulandý. Ýkinci entübasyondan yaklaþýk iki saat sonra spontan olarak soluyan ve gözlerini açan hasta ekstübe edilerek yoðun bakým ünitesine alýndý. Hasta 2 gün sonra taburcu edildi. Bu hastada lokal anestezik sistemik toksisitesi düþünüldü. Pediatrik hastada lokal anestezi uygulanýrken endikasyonunun doðru olmasý, preoperatif dönemde hastanýn monitorize edilmesi, damaryolunun açýlmasý, lokal anestezik toksisitesi geliþme ihtimaline karþý CPR uygulamasý dahil tüm önlemlerin alýnmýþ olmasý gerekir. Uygulama sýrasýnda ise lokal anesteziðin maksimum uygulama dozlarý dikkate alýnmalý ve dilüe edilerek kullanýlmalýdýr.

A circumcision was planned for a four-month-old infant under local anesthesia. After the application of lidocaine, the infant stopped crying, and then generalized tonic-clonic convulsions and a diffuse erythematous rash developed. The patient was immediately monitored, ventilation was provided, and 1 mg midazolam was given intramuscularly. After insertion of a cannula, sodium thiopental 50 mg was given intravenously, the patient’s convulsions were controlled, and endotracheal intubation was performed. The patient was extubated 30 minutes later. However, the patient was re-intubated due to his noisy breathing, and 10 mg prednisolone was given intravenously due to mild edema seen in the larynx during endotracheal intubation. Two hours after the second intubation, the patient started to breath spontaneously and opened his eyes; he was extubated and transferred to the intensive care unit. Two days later the patient was discharged. Systemic toxicity to the local anesthesia was considered in this patient. All precautions need to be considered during the application of local anesthesia in pediatric patients, including proper indication, monitoring of the patient in the preoperative period, establishment of venous access, and readiness to apply cardiopulmonary resuscitation in the event of local anesthetic toxicity. The maximum dose of local anesthesia should be considered and it should be diluted during application.

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