Turkish journal of anaesthesiology and reanimation最新文献

Objective: Paediatric airway management poses unique challenges due to anatomical and physiological differences compared to adults. Videolaryngoscopy (VL) has been proposed as a potential improvement over direct laryngoscopy (DL) for tracheal intubation. This study aimed to compare VL and DL in paediatric patients undergoing elective surgery.

Methods: A prospective, randomized study was conducted with 100 paediatric patients aged under 18 years, weighing 10-40 kg, and classified as American Society of Anesthesiologists physical status I-III. Patients were randomized into Group 1 (n = 50) that included patients who underwent laryngoscopic examination using Macintosh laryngoscope or Endolarenx videolaryngoscope (Group 2: n = 50). Data on intubation time, glottic view (Cormack-Lehane grades), first-attempt success rate, need for anterior laryngeal pressure, and complications were collected.

Results: VL was associated with longer intubation time than DL (29.1±5.7 s vs. 20.7±5.1 s, P=0.001). Glottic visualization was better in the VL group (Cormack-Lehane Grade 1: 78% vs. 66%), but first-attempt success rate was lower (74% vs. 98%, P < 0.001). The need for anterior laryngeal pressure was significantly reduced in VL (32% vs. 78%, P=0.01). No complications, such as trauma or hypoxaemia, were observed in either group.

Conclusion: VL improves glottic visualization and reduces the need for airway maneuvers but is associated with longer intubation times and lower first-attempt success. While DL may be more efficient for routine intubation, VL remains valuable in anticipated or emergent difficult airway situations.

Objective: This descriptive survey study aims to evaluate the knowledge, attitudes, and practices of anaesthesiology specialists and residents in Türkiye regarding advanced hemodynamic monitoring in high-risk surgical patients.

Methods: The survey, comprising 25 questions, was distributed to 960 anaesthesia professionals, with 713 completing the questionnaire.

Results: The study reveals that while invasive blood pressure monitoring is widely used (96.3%), the adoption of advanced hemodynamic monitoring techniques, such as cardiac output monitoring, remains limited (12.6%). For awake high-risk surgical patients under regional anaesthesia, a significant proportion of respondents (15.1% and 37.1%) considered non-invasive blood pressure monitoring to be insufficient. Additionally, 41.1% of participants believed that stroke volume variation, pulse pressure variation, and systolic pressure variation parameters could be used to assess fluid deficits in awake patients.

Conclusion: High costs, technical complexity, and lack of training are identified as major barriers. The findings highlight the need for enhanced educational programs and practical training to improve the utilization of advanced hemodynamic monitoring, ultimately aiming to reduce perioperative morbidity and mortality. The study underscores the importance of integrating advanced hemodynamic monitoring into routine clinical practice and suggests the development of nationwide algorithms to standardize practices.

Brain surgery presents unique challenges to the anaesthesiology team in terms of complexity of patients and procedures. Managing fluid-therapy in this setting requires profound knowledge of different types of fluids and administration regimens. This review focuses on updated information about fluid therapy in elective and emergency brain surgery with specific insight on the clinical outcomes of patients.

Objective: Procedural sedation management in geriatric patients undergoing cystoscopy requires careful monitoring due to age-related physiological changes and increased sensitivity to anaesthetic agents. Although both target-controlled infusion (TCI) and conventional total intravenous anaesthesia (TIVA) techniques with propofol are commonly used methods for sedation, their comparative effectiveness and safety in this population remain subjects of ongoing investigation. This study aims to compare the effectiveness of the two techniques in terms of time to induction, recovery time, hemodynamic stability, airway intervention requirements, and propofol consumption.

Methods: This prospective, randomized study enrolled 60 male patients aged 65 years and older who were scheduled to undergo elective cystoscopy. Participants were randomly assigned to either the TCI group (n = 30) or the TIVA group (n = 30). The two groups were compared in terms of induction time, recovery time, hemodynamic parameters, airway interventions, and total propofol consumption.

Results: Compared with the TCI group, the TIVA group presented significantly shorter induction-to-surgery initiation and recovery times (P=0.009 and P=0.016, respectively). However, systolic blood pressure was more stable in the TCI group compared to the TIVA group (P=0.014). Propofol consumption per unit time was greater in the TIVA group (P=0.048), although total propofol usage did not differ significantly. Airway intervention was more common in the TIVA group, particularly in the early phase; however, this difference was not significant.

Conclusion: Both TCI and TIVA are effective sedation techniques for geriatric cystoscopy. While TIVA provides faster induction and recovery, TCI offers better hemodynamic stability and may reduce propofol requirements. Further studies are recommended to confirm these findings in broader patient populations.

Perioperative pulmonary embolism (PE) is rare but potentially fatal and often difficult to diagnose under general anaesthesia. A fifty-one-year-old woman with hypertension and type II diabetes underwent laparoscopic hysterectomy. After pneumoperitoneum and Trendelenburg positioning, she developed hypoxemia, decreased EtCO₂, and hypotension. Hemodynamics improved after de-sufflation, but hypoxemia persisted post-extubation. Echocardiogram showed right heart strain, and computed tomography pulmonary angiography confirmed acute PE from lower extremity deep vein thrombosis. She was treated with anticoagulation therapy, vasopressor support, and inferior vena cava filter placement and discharged from intensive care unit on postoperative day 5. This case highlights the importance of early suspicion and prompt diagnostic evaluation of intraoperative PE. A multidisciplinary approach and timely anticoagulation with or without interventional therapy are critical to improve outcomes.

Objective: This study aims to evaluate the use of anaesthesia depth, nociception, and neuromuscular blockade monitoring among Turkish anaesthesiologists, exploring the frequency of their use, the devices employed, and the barriers to their routine adoption in clinical practice.

Methods: A cross-sectional survey was conducted among 62 anaesthesiologists attending a symposium in İstanbul, Türkiye. Participants were asked about their monitoring practices, devices used, and reasons for not consistently using these technologies. Data were analysed using descriptive statistics and subgroup comparisons based on professional title and hospital type.

Results: Anaesthesia depth monitoring was frequently used by only 37.1% of participants, with cost and availability as major barriers. Nociception monitoring was more commonly used (72.1% frequently) but still faced challenges such as cost and device unavailability. Neuromuscular blockade monitoring was the least used; with 24.2% of respondents never using it. There were no significant differences in responses based on professional title or hospital type.

Conclusion: The study highlights significant variability in the use of advanced monitoring technologies. Barriers such as cost, device unavailability, and reliance on alternative methods hinder their widespread adoption. Addressing these barriers could enhance patient safety and improve perioperative outcomes through more consistent use of monitoring tools.

Iatrogenic thoracic aortic injury caused by misplaced spinal instrumentation is a rare but potentially fatal complication of posterior spinal fusion and fixation procedures. The close anatomical relationship between the vertebral column and descending thoracic aorta puts the aortic wall at risk, especially when pedicle screws are malpositioned. While such injuries may remain asymptomatic initially, progressive erosion of the aortic wall can lead to catastrophic rupture. This case report highlights a 72-year-old woman with a history of diabetes, hypertension, and Takotsubo cardiomyopathy who developed a thoracic aortic injury following thoracolumbar instrumentation. Imaging revealed a pedicle screw at the T5 level, directly impinging on the aortic wall. A multidisciplinary approach involving cardiovascular, neurosurgery, and anaesthesiology teams was utilized, and thoracic endovascular aortic repair (TEVAR) was performed to stabilize the aorta before hardware removal. Despite successful surgical intervention, the patient later developed a right-sided middle cerebral artery infarction, possibly due to thromboembolism from the TEVAR site. This case underscores the importance of a staged surgical approach with TEVAR in managing aortic injury during spinal instrumentation, especially in high-risk patients with comorbidities such as Takotsubo cardiomyopathy. Careful anaesthesia management and multidisciplinary collaboration are essential to optimize outcomes in such complex cases.

Objective: We aimed to determine patient outcomes after craniotomies performed in semi-sitting position in our institution from 2019-2023. Primarily, we examined surgical and anaesthetic (clinical) outcomes. Secondarily, we evaluated any major complications that may have occurred.

Methods: Hospital records from 2019-2023 were retrospectively reviewed for adult patients who underwent craniotomy in the sitting position. Individual charts were examined for intra- and postoperative events. The demographic and clinically important findings were tabulated using Excel spreadsheet. The dataset was descriptively analyzed, with quantitative data represented as mean ± standard deviation, and qualitative data as valid percentages from the total cohort. Parametric comparisons of sex vs. (length of intensive care unit and hospital stay) and anaesthesia duration (in minutes) were performed using Student's t-test. A 95% confidence level was used to determine statistical significance. Analyses were performed using IBM SPSS^® Edition 22.

Results: From 2019-2023, 10 patients underwent craniotomy in a sitting position. General anaesthesia was induced and maintained using an intravenous target-controlled infusion of remifentanil and propofol. Nine patients developed pneumocephalus, with one developing increased intracranial pressure. One patient had a significant venous air embolism with severe manifestations, including massive pleural effusion. All patients except one were extubated at the end of the surgery.

Conclusion: Of the 10 craniotomies performed in the sitting position from 2019-2023, 90% were managed without major long-term sequelae. Although the sitting position for craniotomies is not without challenges, a dedicated and experienced team can manage complications and improve patient outcomes.