Turkish journal of anaesthesiology and reanimation最新文献

Artificial intelligence (AI) is rapidly transforming anaesthesiology through advances in machine learning, deep learning, and large language models. AI-driven tools now contribute to nearly every phase of perioperative care, including preoperative risk stratification, intraoperative monitoring, imaging interpretation, airway assessment, regional anaesthesia, and critical care. Applications such as automated American Society of Anesthesiologists classification, prediction of postoperative complications and intensive care unit needs, electroencephalography-based depth-of-anaesthesia estimation, and proactive haemodynamic management are reshaping clinical decision-making. AI-augmented echocardiography enhances chamber recognition and functional measurements, whereas computer vision systems support airway evaluation and ultrasound-guided regional anaesthesia by providing real-time anatomical identification and facilitating training. In critical care, AI models facilitate the early detection of sepsis, organ dysfunction, and haemodynamic instability, while improving workflow efficiency and resource allocation. AI is increasingly used in academic writing, data processing, and medical education, offering opportunities for personalised learning and simulation but raising concerns about accuracy and hallucinations. In this review, we aimed to summarise the current applications of AI in anaesthesiology, highlight the methodological, ethical, and practical challenges that limit its integration, and discuss future directions for its safe and effective adoption in perioperative care.

Objective: The efficacy and safety of sedation administered by non-anaesthesia healthcare professionals should be evaluated within the framework of evidence-based protocols, and approaches should be adopted to ensure patient safety at the highest level. We aimed, with a scientific approach, to evaluate non-operating-room anaesthesia applications performed by non-anaesthesia health professionals in terms of patient safety, quality, and consistency, and to identify areas of deficiency.

Methods: After obtaining ethical approval, a questionnaire was prepared to evaluate practitioners' awareness of the anaesthesia and sedation processes administered to patients during procedures performed in their clinics. An electronic questionnaire (Google Form) was used to collect data.

Results: This study revealed that non-operating-room sedation applications are widely practiced across various specialties in our country, but levels of knowledge and skill regarding these applications are not standardized. Extending in-service training, developing practical skills in managing complications, and using objective criteria for patient follow-up after sedation are of great importance for patient safety and clinical efficacy.

Conclusion: Standardization of sedation practices can be achieved through multidisciplinary cooperation and the adoption of protocols based on current guidelines. In this context, it is recommended that structured training programs and clinical guidelines be established for non-anaesthesia healthcare professionals.

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.

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: This study was designed to determine why anaesthesiologists working in various institutions in our country prefer current regional anaesthesia methods and to evaluate the use and prevalence of ultrasonography in these methods.

Methods: A questionnaire created on SurveyMonkey.com was sent electronically or face-to-face to anaesthesiology and reanimation physicians working in different provinces of our country, and they were asked to fill it out. The survey was intended to be administered to at least 200 volunteer anaesthesiologists. The questionnaire consisted of 34 questions, including demographic characteristics, neuraxial block and peripheral nerve block (PNB) applications, drug choices, preferences in paediatric cases, training, and safety measures.

Results: A total of 215 anaesthesiologists participated in our questionnaire. 39.2% were working in a university hospital, and 38.2% were working in a training and research hospital. PNB training was received by 89.2% of the participants during specialty training. For analgesic purposes, the interscalene block was preferred for shoulder surgery (57.4%), the axillary block for elbow, forearm, and hand surgery (49.8%), the erector spinae plane block for thoracic surgery (33.8%), and the transverse abdominis and rectus block for open abdominal surgery (51.5%).

Conclusion: Regional anaesthesia is an essential part of multimodal analgesia and is used both as an anaesthetic and analgesic in routine practice. In recent years, many new techniques have been utilized as a result of advancements. However, for these to be implemented in practice, up-to-date information should be closely followed, and anaesthetists should be supported in terms of training and equipment.

Anaesthetics are commonly used agents during medical interventions and surgeries. Exposure to anaesthetic agents in late intrauterine life or early childhood may cause neurodegeneration in developing brains. Neuroapoptosis and neural inhibition provided by several mechanisms and microRNAs (miRNAs) have crucial roles in this milieu. miRNAs have critical roles in response to anaesthetic exposure. Through this review, we performed a systematic search of the PubMed database for studies on the role of anaesthetics in the brain and their relation with miRNAs. The terms "anesthetic", "miRNA", and "brain" were searched. Here we summarized the roles and interactions of miRNAs under exposure to anaesthetics in vivo and in vitro studies. Anaesthetic agents studied included sevoflurane, isoflurane, ketamine, and propofol. Many microRNAs were identified to have regulatory roles in anaesthesia-induced neurotoxicity. The literature study supports the idea that miRNAs play crucial functions in neuroprotection and neurotoxicity in anaesthesia administration. The exact role and implication of miRNA in anaesthesia neurotoxicity needs to be elucidated to gain more knowledge about the area. Several gaps in knowledge should be filled by conducting basic, clinical, and translational analyses in the future to decipher the definite role of miRNAs and their functions in the context of anaesthesia-induced neurotoxicity.

Hereditary angioedema (HAE) causes recurrent angioedema attacks in the oropharynx, larynx, face, and other regions due to bradykinin overproduction as a result of C1 esterase inhibitor deficiency. Surgical interventions requiring general anaesthesia might trigger HAE attacks. Laryngeal angioedema is the most important cause of perioperative mortality. Tracheal dilatation was performed by rigid bronchoscopy in our patient with type 1 HAE, because of tracheal stenosis due to prolonged intubation, which occurred after the attack. The patient was administered 2x500 IU C1 esterase inhibitor approximately 24 hours before rigid bronchoscopy. No complication developed after the first procedure. Two months later, tracheal dilatation was repeated and 2x500 IU C1 esterase inhibitor was administered. While the patient was followed up in the intensive care unit, significant oedema developed in the facial area, especially the tongue and lips, approximately 10 hours after the procedure. Our patient also had stridor due to airway obstruction. The patient was treated with 1000 IU C1 esterase inhibitor and 3 units of fresh frozen plasma (FFP). After FFP, edema started to regress. The patient was discharged after symptoms improved. The patient should be monitored in the intensive care unit for a minimum of 48 hours to monitor for postoperative laryngeal oedema.

Objective: Paediatric airway management is challenging due to anatomical differences, making effective endotracheal intubation crucial during surgery. While direct laryngoscopy (DL) has been the standard method, video laryngoscopy (VL) has emerged as a promising alternative. This study compared the effectiveness of King Vision aBlade non-channeled VL (KVL) with Miller/Macintosh DL for intubation in children.

Methods: In this prospective, randomized, single-blinded study, 150 children aged 2-10 years undergoing elective surgery were randomly assigned to either Group DL (n = 75) or Group KVL (n = 75). Data was collected on intubation success, time, glottic view, external maneuvers, and hemodynamic parameters [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SpO₂)] at various intervals.

Results: The mean age of patients was similar in both groups (P=0.15). The DL group had a higher success rate on the first attempt (P < 0.001) and shorter intubation times (9.97±3.12 sec vs. 14.35±2.99 sec, P < 0.001) compared to KVL. Although KVL provided a better glottic view, this difference was not statistically significant (P=0.059). Hemodynamic parameters (SBP, DBP) were significantly higher in the DL group post-intubation (P < 0.05), with no significant differences in HR or SpO₂ between groups. The DL group required more external maneuvers for intubation (P=0.022).

Conclusion: DL showed a higher success rate, faster intubation times, and greater hemodynamic stability compared to KVL. While KVL offered better glottic views, it had longer intubation times and lower success rates. Further studies with larger sample sizes are recommended to validate these findings.

Advanced hemodynamic monitoring has revolutionized perioperative medicine and critical care by providing comprehensive insights into cardiovascular physiology and facilitating precise assessment and management of complex parameters such as cardiac output, systemic vascular resistance, fluid responsiveness, and tissue perfusion. These technologies enhance the capacity of clinicians to detect subtle physiological alterations, enabling timely interventions and individualized therapeutic strategies, particularly for critically ill patients and those undergoing major surgical procedures. This two-part review offers a comprehensive analysis of hemodynamic monitoring. Part I examined the fundamental principles of macrohemodynamics and microhemodynamics. Part II focuses on advanced hemodynamic monitoring tools, tracing the evolution of cardiac output measurement techniques from Fick's oxygen consumption method in 1870 to contemporary innovations, such as pulse contour analysis, bioimpedance/bioreactance, and real-time non-invasive modalities like advanced echocardiography. By examining the underlying principles, devices, invasiveness, clinical applications, advantages, and limitations of various monitoring techniques, this review elucidates the clinical utility of advanced tools in addressing the limitations of standard monitoring and optimizing patient outcomes in modern anaesthesia and critical care practices.

Objective: This retrospective study aimed to evaluate and compare the clinical efficacy of intradiscal ozone therapy (OT) against a combination therapy of ozone and platelet-rich plasma (PRP) in patients diagnosed with intervertebral disc degeneration (IVDD).

Methods: The study included a cohort of 50 patients, divided equally into two groups of 25, who received either intradiscal OT or ozone + PRP combination therapy between February 2022 and February 2023. The sample comprised 20 females and 30 males, with ages ranging from 19 to 76 years (mean age 48.8). Pain intensity was measured using the visual analog scale (VAS), while disability levels were assessed using the oswestry disability index (ODI) prior to treatment and at 1, 3, and 6 months post-treatment. Additionally, lumbar magnetic resonance imaging was conducted at the 3-month mark post-treatment, with evaluations based on the Pfirrmann disc degeneration classification.

Results: Significant improvement in both VAS and ODI scores was observed in both treatment groups (P < 0.001). The ozone + PRP combination therapy group exhibited no statistically significant difference in VAS and ODI scores compared to the ozone-only group (P > 0.05).

Conclusion: Intradiscal OT and the ozone + PRP combination therapy represent effective minimally invasive treatment options for patients suffering from IVDD, yielding substantial clinical benefits with minimal side effects. That is why it is suggested as a potential preferred therapeutic approach prior to the consideration of surgical interventions.