Turkish journal of anaesthesiology and reanimation最新文献

Base excess (BE), a marker used to detect metabolic acid-base disturbances, is also known to predict mortality in critically ill patients; the traditional concept, originally based on the Henderson-Hasselbalch model, has been further refined through integration with the Stewart approach, enabling a more comprehensive and mechanistic evaluation of acid-base disturbances. However, the increasingly complex mathematical formulations required for this integration demand extensive calculations, which can hinder bedside assessment. To address this, the BE formula has been simplified and integrated into the Stewart concept, resulting in a more reliable, detailed, and rapid bedside evaluation. Additionally, the term "alactic BE" was introduced to distinguish metabolic acidosis caused by retention of fixed acids from that caused by lactic acid accumulation, particularly in patients with renal failure. This review discusses the concept of BE and its evolution over the years.

Objective: Regional anaesthesia for hip surgery aims to cover both articular and cutaneous nerves. Current techniques often miss components or require multiple injections. We hypothesized that the deep iliacus plane block (DIPB)-which involves injection deep to the iliacus muscle at the anterior inferior iliac spine-could simultaneously target both lumbar plexus branches and articular nerves.

Methods: We conducted a cadaveric investigation and a retrospective clinical pilot. Bilateral DIPB was performed on a fresh cadaver (50 mL dye) using 50 mL of dye to assess dye spread. Clinically, 20 hip fracture patients received a single-injection DIPB (30-40 mL of 0.25% bupivacaine). Blocks were performed postoperatively (n = 13) or preoperatively for positioning (n = 7). Primary outcomes included dye spread and opioid consumption. Pain scores were evaluated before and after the block in the positioning subset.

Results: Cadaveric dye stained the lateral femoral cutaneous nerve (LFCN), the femoral nerve (FN), and the pericapsular branches. In the clinical cohort (n = 20), the median postoperative numeric rating scale (NRS) score was 1; only one patient required rescue analgesia within 24 hours. In the positioning subset (n = 7), median NRS dropped from 9.0 (7-10) to 1.0 (0-2) 30 minutes post-block (P < 0.001).

Conclusion: Preliminary findings suggest that DIPB may provide simultaneous coverage of the LFCN, FN, and pericapsular branches with a single injection. Further prospective studies are required to confirm the safety and efficacy.

Liver transplantation is the gold standard treatment for end-stage liver failure, and early extubation in the postoperative period is recommended to improve graft function. Coronary artery bypass grafting (CABG) is a surgical procedure to restore normal blood flow to an obstructed coronary artery. Patients undergoing cardiac surgery are often heparinized, which increases the risk of hematoma associated with regional anaesthesia, particularly central neuraxial techniques. Effective analgesic management plays a crucial role in achieving early extubation in both surgical procedures. Opioid agents are often preferred for analgesia management. However, the use of opioids in these patients increases the risk of complications; therefore, regional anaesthesia techniques are preferred. In the intensive care unit, we performed a combination of modified thoracoabdominal nerve block and pecto-intercostal fascial plane block as rescue analgesia in a patient who had undergone simultaneous liver transplantation and CABG.

Objective: This study compared automatic gas control (AGC) mode with manual minimal-flow and manual medium-flow techniques in elective breast surgery, evaluating sevoflurane consumption, cost, hemodynamics, and recovery.

Methods: Following ethics approval, 90 American Society of Anaesthesiologists I-II patients (age 18-65 years) undergoing elective breast surgery were randomized to AGC mode (Group AGC, n = 30), manual minimal-flow control (Group ManCo, n = 30), or manual medium-flow control (Group ModFA, n = 30). All received standard induction after preoxygenation, with maintenance via sevoflurane and remifentanil infusion in a mixture of oxygen and medical air. After reaching a minimum alveolar concentration of 1.0, sevoflurane was adjusted to maintain a bispectral index of 40-60. Mean arterial pressure (MAP), heart rate, peripheral capillary oxygen saturation, bispectral index, inspired sevoflurane fractions and expired sevoflurane fraction, end-tidal carbon dioxide, temperature, and instantaneous sevoflurane consumption were recorded pre-induction and every 15 minutes. Extubation time, recovery time, surgery duration, and total anaesthesia time were documented. Total sevoflurane consumption and cost were calculated postoperatively.

Results: Sevoflurane consumption and related costs were significantly lower in Group AGC versus Groups ManCo and ModFA (both P <0.001) and lower in Group ManCo than in Group ModFA (P <0.001). MAP and recovery times did not differ significantly among groups (P >0.05). Pre-extubation temperature was higher in Group AGC compared to Group ManCo (P=0.014) and Group ModFA (P=0.002). Extubation time was longer in Group ManCo versus Groups AGC and ModFA (P <0.001).

Conclusion: AGC mode significantly reduces sevoflurane consumption and cost compared to both manual minimal-flow and manual medium-flow techniques, without adversely affecting hemodynamics or recovery.

Objective: We compared magnesium sulphate pre-treatment with rocuronium at a dose of 0.9 mg kg^-1 to the standard succinylcholine (1 mg kg^-1) in rapid sequence induction to see if this combination had an onset of paralysis comparable to succinylcholine.

Methods: This was a prospective, single-centre, double-blinded, parallel-arm, randomized controlled trial on patients aged 18-60 years, either sex, the American Society of Anesthesiologists I and II. Patients received a 100 mL normal saline infusion followed by either succinylcholine at 1 mg kg^-1 (Group S), or rocuronium 0.9 mg kg^-1 (Group R), or a 100 mL normal saline infusion containing magnesium sulphate 60 mg kg^-1, followed by rocuronium 0.9 mg kg^-1 (Group MgR). The primary outcome was the time of onset of paralysis evidenced by fading of train-of-four (TOF). Secondary outcomes were the intubation conditions, and the laryngoscopy response.

Results: Data from 135 patients showed TOF fading times differed significantly across the groups, with Group S showing a median (interquartile range-IQR) of 65 (61-70) seconds, Group R 102 (98-108) seconds, and Group MgR 82 (79-85) seconds (P < 0.001). The ease of laryngoscopy and response to cuff inflation showed no significant difference (P=1.000). Analysis of the position of the vocal cords suggested a significant difference (P < 0.001). Finally, the total intubating conditions indicated a significant difference among the groups (P < 0.001), favouring Group MgR for excellent intubating conditions.

Conclusion: The onset of action was significantly faster with succinylcholine than with magnesium sulphate-rocuronium. Nevertheless, it was significantly faster with magnesium sulphate-rocuronium than with rocuronium alone. However, the intubation conditions were better when magnesium was added to rocuronium.

Objective: Robot-assisted laparoscopic radical prostatectomy (RALP) is increasingly used in the treatment of prostate cancer due to its minimally invasive nature, reduced perioperative bleeding, and shorter hospital stays. However, the steep Trendelenburg position and CO₂ pneumoperitoneum required for the procedure present unique anaesthetic challenges, particularly in elderly patients with comorbidities. This study aimed to determine the incidence of anaesthetic complications during RALP and identify independent risk factors associated with these events.

Methods: A retrospective observational study was conducted at Ankara Bilkent City Hospital between 2019 and 2024. A total of 1,020 patients who underwent RALP were evaluated. Collected data included demographic characteristics, the American Society of Anesthesiologists (ASA) physical status classification, comorbidities, and intra- and postoperative outcomes. Anaesthetic complications were analyzed, and multivariate logistic regression was performed to identify independent predictors.

Results: The mean patient age was 65.0±6.3 years, with 65.3% classified as ASA II and 61.6% having at least one comorbidity. Anaesthetic complications occurred in 4.4% of patients. Those with complications were significantly older (67.9±6.2 vs. 64.9±6.3 years, P=0.004), had longer hospital stays (8.98±4.45 vs. 6.83±3.18 days, P < 0.001), and were more frequently admitted to the post-anaesthesia care unit (PACU) (73.3% vs. 46.8%, P < 0.001). Multivariate analysis identified age, hospital stay duration, and PACU admission as independent risk factors.

Conclusion: RALP can be safely performed in experienced centers with individualized anaesthetic management. However, older age, longer hospitalization, and PACU admission significantly increase the risk of anaesthetic complications. These findings emphasize the need for preoperative risk stratification and tailored perioperative care to improve safety outcomes. Prospective, multicenter studies are needed to confirm these results and guide future anaesthetic strategies in robotic urologic surgery.

We report the unanticipated intraoperative complication of a guidewire knot during central venous line insertion in the left internal jugular vein (IJV), in a child scheduled for a left pneumonectomy for leiomyosarcoma of the left lung under general anaesthesia. After an uneventful guidewire placement in the left IJV under ultrasound guidance, difficulty was encountered in advancing the central venous catheter over the guidewire. Resistance was felt when initiating the removal of the guidewire. The guidewire knot was identified with intraoperative fluoroscopic imaging. After consultation with the surgical team, the knot in the guidewire was removed by immediate venotomy. Intraoperative lung isolation and tracheal extubation after the surgery were uneventful. This report emphasises the importance of vigilance during central venous catheterisation in paediatric patients whose anatomical variations and smaller vessels exacerbate the risk of such complications. Ultrasound-based preprocedural Rapid Central Venous Assessment, and intra-procedural guidewire-tip navigation may help prevent coiling/knotting. Furthermore, it highlights the need for rapid recognition and surgical readiness to resolve unexpected issues during routine procedures.

Kinsbourne syndrome, also known asor opsoclonus-myoclonus-ataxia syndrome, is a rare paediatric neurological disorder characterised by abnormal eye movements, myoclonus, and ataxia. Its anaesthetic management presents significant challenges, especially when one-lung ventilation (OLV) is required in the prone position. This case report describes the anaesthetic management of a two year-old child with Kinsbourne syndrome undergoing T9-T11 paravertebral neuroblastoma excision. Because of the patient's size and the need for lung isolation, a Fogarty embolectomy catheter was used for OLV. Anaesthesia was induced with intravenous fentanyl, propofol, and atracurium, followed by the insertion of a 4.0 mm cuffed endotracheal tube to facilitate Fogarty catheter insertion. The catheter was positioned in the right bronchus under fibre-optic guidance; after which, a 4.5 mm cuffed tube was inserted, and the patient was placed in the prone position. Continuous fibre-optic monitoring ensured proper catheter placement. Anaesthesia was maintained with oxygen, air, and isoflurane. The patient remained haemodynamically stable, was extubated postoperatively, was observed in the paediatric intensive care unit for 24 hours, and was subsequently transferred to the ward. This case highlights the challenges of OLV in paediatric patients and demonstrates the effectiveness of a Fogarty catheter for lung isolation when traditional devices are unsuitable, emphasising the importance of multidisciplinary collaboration and continuous monitoring.

Objective: This study aims to compare the performance of artificial intelligence (AI) chatbot ChatGPT with anaesthesiology and reanimation residents at a major hospital in an exam modelled after the European Diploma in Anaesthesiology and Intensive Care Part I.

Methods: The annual training exam for residents was administered electronically. One day prior to this, the same questions were posed to an AI language model. During the analysis, the residents were divided into two groups based on their training duration (less than 24 months: Group J; 24 months or more: Group S). Two books and four guides were used as references in the preparation of a 100-question multiple-choice exam, with each correct answer awarded one point.

Results: The median exam score among all participants was 70 [interquartile range (IQR) 67-73] out of 100. ChatGPT correctly answered 71 questions. Group J had a median exam score of 67 (IQR 65.25-69), while Group S scored 73 (IQR 70-75) (P < 0.001). Residents with less than 24 months of training performed significantly worse across all subtopics compared to those with more extensive training (P < 0.05). When ranked within the groups, ChatGPT placed eighth in Group J and 47^th in Group S.

Conclusion: ChatGPT exhibited a performance comparable to that of a resident in an exam centred on anaesthesiology and critical care. We suggest that by tailoring an AI model like ChatGPT in anaesthesiology and resuscitation, exam performance could be enhanced, paving the way for its development as a valuable tool in medical education.