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    Sedation for Colonoscopy: Comparison of Remifentanil and Alfentanil Combined with Propofol/Midazolam
    (Istanbul Training & Research Hospital, 2019) Ancan, Sule; Cicekci, Faruk; Hacibeyoglu, Gulcin; Sizer, Cigdem; Uzun, Sema Tuncer; Dertli, Ramazan; Keskin, Muharrem
    Introduction: Different drug combinations are used in patients who underwent colonoscopy for safe sedation and early discharge. Remifentanil and alfentanil are short-acting narcotic analgesic agents. A short-acting anxiolytic agent, midazolam has a potent sedative efficiency when combined with narcotic analgesics. In this study, we aimed to compare the effectiveness of the two opioids that have not been previously compared in the literature, combined with propofol/midazolam in patients who underwent colonoscopy. Methods: One hundred eighty-nine patients aged over 18 years who underwent diagnostic and/or therapeutic colonoscopy were included in the study. 1 mg midazolam + 5 mu g kg-1 alfentanil + 1 mg kg-1 propofol were administered in the alfentanil group (group A), while 1 mg midazolam + 0.1 mu g kg-1 min-1 remifentanil + 1 mg kg-1 propofol were administered in the remifentanil group (group R). Hemodynamic data, Modified Steward scale (MSS), Visual Analog scale (VAS), additional propofol doses, total procedure time, awake time, recovery time, and side effects were recorded during the procedure. After the procedure, all patients were transferred to the recovery room, and the Modified Aldrete scale (MAS) values were recorded. Results: There was a statistically significant difference between the groups in terms of total propofol and additional propofol doses (p<0.05), with additional propofol dose being higher in group A compared to group R (p<0.05). Awake time was similar between the groups. Recovery time was longer in group A compared to group R (p<0.05). No significant difference was observed in the side effects between both groups. Conclusion: Although the low dose of midazolam combined with propofol/remifentanil and propofol/alfentanil provided adequate sedation and analgesia, we believe that remifentanil is an ideal choice for daily procedures like colonoscopy because of its advantages resulting from its pharmacological properties.
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    SPINAL ANESTHESIA AND INTERSCALENE/SUPERFICIAL CERVICAL BLOCK IN MULTIPLE MYELOMA PATHOLOGICAL FRACTURE
    (Emergency Medicine Physicians Assoc Turkey, 2019) Bilge, Ayegul; Ancan, Sule
    Objective: The use of novel chemotherapeutic agents in the treatment of multiple myeloma (MM) has improved life expectancy and quality of life in these patients in the last decade. Therefore, more MM patients are treated for repeating pathological fractures. Case Report In our case spinal, interscalene and superficial cervical blocks were performed in a 61-year-old MM patient who will be operated due to tibial and humoral pathologic fractures and was at risk for general anesthesia due to cardiac and pulmonary problems. Conclusion: In this report, we demonstrated that the use of regional anesthesia is a good option in order to minimize anesthesia related risk level in the presence of MM.