Hande Güngör, Tümay Uludağ Yanaral, Emine Uzunoğlu, Pelin Karaaslan
A 73-year-old, 104 kg female patient was hospitalised for debulking and low anterior colon resection operations. Anaphylactoid symptoms developed when administering erythrocyte suspension and fresh frozen plasma. Through the immediate haematology department consultation, it was found that the patient might possibly have immunoglobulin A deficiency. Immunoglobulin A level was found to be very low in the patient's blood sample, which was sent intraoperatively to verify the diagnosis. This case report discusses a sudden anaphylactic reaction that occurred as a result of a blood transfusion in a previously undiagnosed immunoglobulin A deficiency.
{"title":"Anaphylactoid Reactions Following Red Blood Cell Transfusion in a Patient with Previously Undiagnosed Immunoglobulin A Deficiency: Case Report.","authors":"Hande Güngör, Tümay Uludağ Yanaral, Emine Uzunoğlu, Pelin Karaaslan","doi":"10.5152/TJAR.2023.22133","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22133","url":null,"abstract":"<p><p>A 73-year-old, 104 kg female patient was hospitalised for debulking and low anterior colon resection operations. Anaphylactoid symptoms developed when administering erythrocyte suspension and fresh frozen plasma. Through the immediate haematology department consultation, it was found that the patient might possibly have immunoglobulin A deficiency. Immunoglobulin A level was found to be very low in the patient's blood sample, which was sent intraoperatively to verify the diagnosis. This case report discusses a sudden anaphylactic reaction that occurred as a result of a blood transfusion in a previously undiagnosed immunoglobulin A deficiency.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaicheng Song, Sheng Wang, Jiange Han, Luyang Jiang, Junmei Xu, Ozan Akca, Kandis Adkins, Heidi M Koenig, Mark S Slaughter, Sean P Clifford, Yuguang Huang, Jiapeng Huang
Objective: Postoperative pulmonary complications are a series of disorders that can contribute to respiratory distress and prolonged mechanical ventilation postoperatively. We hypothesise that a liberal oxygenation strategy during cardiac surgery leads to a higher incidence of postoperative pulmonary complications than a restrictive oxygenation strategy.
Methods: This study is a prospective, observer-blinded, centrally randomised and controlled, international multicentre clinical trial.
Results: After obtaining a written informed consent, 200 adult patients undergoing coronary artery bypass grafting will be enrolled and randomised to receive either restrictive or liberal oxygenation perioperatively. The liberal oxygenation group will receive 1.0 fraction of inspired oxygen throughout the intraoperative period, including during cardiopulmonary bypass. The restrictive oxygenation group will receive the lowest fraction of inspired oxygen required to maintain arterial partial pressure of oxygen between 100 and 150 mmHg during cardiopulmonary bypass and a pulse oximetry reading of 95% or greater intraoperatively, but no less than 0.3 and not higher than 0.80 (other than induction and when the oxygenation goals cannot be reached). When patients are transferred to the intensive care unit, all patients will receive an initial fraction of inspired oxygen of 0.5, and then fraction of inspired oxygen will be titrated to maintain a pulse oximetry reading of 95% or greater until extubation. The lowest postoperative arterial partial pressure of oxygen/fraction of inspired oxygen within 48 hours of intensive care unit admission will be the primary outcome. Postoperative pulmonary complications, length of mechanical ventilation, intensive care unit stay, hospital stay, and 7-day mortality after cardiac surgery will be analysed as secondary outcomes.
Conclusion: This is one of the first randomised controlled observer-blinded trials that prospectively evaluates the influence of higher inspired oxygen fractions on early postoperative respiratory and oxygenation outcomes in cardiac surgery patients using cardiopulmonary bypass.
{"title":"Intraoperative Fraction of Inspired Oxygen and Lung Injury in Coronary Artery Bypass Grafting: Study Protocol for a Randomised Controlled Trial.","authors":"Kaicheng Song, Sheng Wang, Jiange Han, Luyang Jiang, Junmei Xu, Ozan Akca, Kandis Adkins, Heidi M Koenig, Mark S Slaughter, Sean P Clifford, Yuguang Huang, Jiapeng Huang","doi":"10.5152/TJAR.2023.22974","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22974","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative pulmonary complications are a series of disorders that can contribute to respiratory distress and prolonged mechanical ventilation postoperatively. We hypothesise that a liberal oxygenation strategy during cardiac surgery leads to a higher incidence of postoperative pulmonary complications than a restrictive oxygenation strategy.</p><p><strong>Methods: </strong>This study is a prospective, observer-blinded, centrally randomised and controlled, international multicentre clinical trial.</p><p><strong>Results: </strong>After obtaining a written informed consent, 200 adult patients undergoing coronary artery bypass grafting will be enrolled and randomised to receive either restrictive or liberal oxygenation perioperatively. The liberal oxygenation group will receive 1.0 fraction of inspired oxygen throughout the intraoperative period, including during cardiopulmonary bypass. The restrictive oxygenation group will receive the lowest fraction of inspired oxygen required to maintain arterial partial pressure of oxygen between 100 and 150 mmHg during cardiopulmonary bypass and a pulse oximetry reading of 95% or greater intraoperatively, but no less than 0.3 and not higher than 0.80 (other than induction and when the oxygenation goals cannot be reached). When patients are transferred to the intensive care unit, all patients will receive an initial fraction of inspired oxygen of 0.5, and then fraction of inspired oxygen will be titrated to maintain a pulse oximetry reading of 95% or greater until extubation. The lowest postoperative arterial partial pressure of oxygen/fraction of inspired oxygen within 48 hours of intensive care unit admission will be the primary outcome. Postoperative pulmonary complications, length of mechanical ventilation, intensive care unit stay, hospital stay, and 7-day mortality after cardiac surgery will be analysed as secondary outcomes.</p><p><strong>Conclusion: </strong>This is one of the first randomised controlled observer-blinded trials that prospectively evaluates the influence of higher inspired oxygen fractions on early postoperative respiratory and oxygenation outcomes in cardiac surgery patients using cardiopulmonary bypass.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Propofol is required in higher doses for smooth insertion of the ProSeal laryngeal mask airway. The ideal adjuvant drug so as to minimise induction doses of propofol is still not known. Dexmedetomidine and midazolam are equally effective for premedication in children. We have designed this study to compare dexmedetomidine and midazolam as adjuvants with propofol for insertion characteristics of ProSeal laryngeal mask airway.
Methods: A total of 130 paediatric patients undergoing elective surgery were randomly allocated into 2 groups of 65 each. One group was induced using propofol, fentanyl and midazolam, whereas the other group received propofol, fentanyl and dexmedetomidine. Subsequently, insertion characteristics of ProSeal laryngeal mask airway were documented in terms of number of attempts and by using modified Muzi score. Post-operative sedation was recorded by Ramsay Sedation Scale and pain was assessed by using Wong-Baker Faces pain scale.
Results: Out of 130 patients, ProSeal laryngeal mask airway was inserted in a second attempt in only 5 patients of midazolam group. Time taken for insertion was significantly higher among the midazolam group (21 seconds) than the dexmedetomidine group (19 seconds). A total of 93.8% of patients administered dexmedetomidine had excellent Muzi scores in comparison to midazolam group where only 13.8% patients had excellent Muzi scores (P < .001).
Conclusion: Dexmedetomidine in a dose of 1 μg kg-1 as compared to midazolam (20 μg kg-1) produces better insertion characteristics for ProSeal laryngeal mask airway when used as adjuvant with propofol in terms of jaw opening, ease of insertion, coughing, gagging, patient movement, and laryngospasm.
{"title":"Comparison of Dexmedetomidine with Midazolam as an adjuvant with Propofol for insertion of ProSeal laryngeal mask airway in Children.","authors":"Pooja Gunwal, Sapna Bathla, Anju Kumari, Jeetendra Kumar Bajaj","doi":"10.5152/TJAR.2023.21428","DOIUrl":"https://doi.org/10.5152/TJAR.2023.21428","url":null,"abstract":"<p><strong>Objective: </strong>Propofol is required in higher doses for smooth insertion of the ProSeal laryngeal mask airway. The ideal adjuvant drug so as to minimise induction doses of propofol is still not known. Dexmedetomidine and midazolam are equally effective for premedication in children. We have designed this study to compare dexmedetomidine and midazolam as adjuvants with propofol for insertion characteristics of ProSeal laryngeal mask airway.</p><p><strong>Methods: </strong>A total of 130 paediatric patients undergoing elective surgery were randomly allocated into 2 groups of 65 each. One group was induced using propofol, fentanyl and midazolam, whereas the other group received propofol, fentanyl and dexmedetomidine. Subsequently, insertion characteristics of ProSeal laryngeal mask airway were documented in terms of number of attempts and by using modified Muzi score. Post-operative sedation was recorded by Ramsay Sedation Scale and pain was assessed by using Wong-Baker Faces pain scale.</p><p><strong>Results: </strong>Out of 130 patients, ProSeal laryngeal mask airway was inserted in a second attempt in only 5 patients of midazolam group. Time taken for insertion was significantly higher among the midazolam group (21 seconds) than the dexmedetomidine group (19 seconds). A total of 93.8% of patients administered dexmedetomidine had excellent Muzi scores in comparison to midazolam group where only 13.8% patients had excellent Muzi scores (P < .001).</p><p><strong>Conclusion: </strong>Dexmedetomidine in a dose of 1 μg kg-1 as compared to midazolam (20 μg kg-1) produces better insertion characteristics for ProSeal laryngeal mask airway when used as adjuvant with propofol in terms of jaw opening, ease of insertion, coughing, gagging, patient movement, and laryngospasm.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regional anaesthesia practice has changed dramatically, especially in the last 2-3 decades. Anaesthesiologists are far beyond doing only extremity and/or central neuraxial blocks. Unquestionably, the introduction of ultrasound into regional anaesthesia practice has a pivotal role in the so-called “renaissance” of regional anaesthesia today. Ultrasound allowed us to see not only the nerves themselves but also the fascial planes where nerves are located. In our own clinical practices, the diversity of the blocks is nothing comparable to what we used to do 15-20 years ago. Besides doing randomised controlled studies to test the newly introduced blocks
{"title":"Future of Regional Anaesthesia: \"A Block for Everyone\".","authors":"Yavuz Gürkan, Kamen Vlassakov","doi":"10.5152/TJAR.2023.22101","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22101","url":null,"abstract":"Regional anaesthesia practice has changed dramatically, especially in the last 2-3 decades. Anaesthesiologists are far beyond doing only extremity and/or central neuraxial blocks. Unquestionably, the introduction of ultrasound into regional anaesthesia practice has a pivotal role in the so-called “renaissance” of regional anaesthesia today. Ultrasound allowed us to see not only the nerves themselves but also the fascial planes where nerves are located. In our own clinical practices, the diversity of the blocks is nothing comparable to what we used to do 15-20 years ago. Besides doing randomised controlled studies to test the newly introduced blocks","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An increasing body of evidence suggests that a postoperative rise in cardiac troponin, even in the absence of other diagnostic criteria for myocardial infarction, is still associated with a range of postoperative complications including myocardial death and all-cause mortality. Myocardial injury after non-cardiac surgery is the term used to describe these cases. The true incidence of myocardial injury after non-cardiac surgery is unknown and likely underestimated. The strength of correlation with postoperative complications is also uncertain as are likely risk factors - though these are likely similar to those for infarction given the similar pathological mechanism. This review article seeks to summarise the literature which has been published over the preceding decades addressing these questions.
{"title":"Perioperative Myocardial Injury.","authors":"Jack Brooker, Alparslan Turan","doi":"10.5152/TJAR.2023.22839","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22839","url":null,"abstract":"<p><p>An increasing body of evidence suggests that a postoperative rise in cardiac troponin, even in the absence of other diagnostic criteria for myocardial infarction, is still associated with a range of postoperative complications including myocardial death and all-cause mortality. Myocardial injury after non-cardiac surgery is the term used to describe these cases. The true incidence of myocardial injury after non-cardiac surgery is unknown and likely underestimated. The strength of correlation with postoperative complications is also uncertain as are likely risk factors - though these are likely similar to those for infarction given the similar pathological mechanism. This review article seeks to summarise the literature which has been published over the preceding decades addressing these questions.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9649573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dilek Güven Taymez, Özge Telci Çaklılı, Hande Gürbüz
Maneb is a widely used agricultural fungicide, which can lead to parkinsonism due to its neurotoxic effects on the dopaminergic system after chronic low-dose exposure. Previous acute human maneb poisoning cases occurred with low-dose maneb exposure through the dermal route causing renal failure. This report presents a case of acute renal failure and delayed paralysis due to ingestion of a large dose of maneb for a suicide attempt. A 16-year-old female patient was admitted to the emergency room because of drinking almost a whole bottle of maneb (400 mL [2 g L-1]) about 2 hours before. The patient was transferred to the intensive care unit with severe metabolic acidosis and renal failure. On the 4th day in intensive care unit, although the severe acidosis was resolved with haemodialysis, the patient was intubated because of ascending muscle weakness and dyspnoea. After staying in the intensive care unit for 9 days and in the nephrology ward for 2 weeks, the patient was discharged well from the hospital with no further need for haemodialysis but a persistent bilateral drop foot. One year after the event, renal functions were normal, and motor function in the lower extremities improved entirely.
{"title":"Severe Metabolic Acidosis, Acute Renal Failure, and Delayed Paralysis Leading to Respiratory Depression due to Manganese ethylene-bis-dithiocarbamate.","authors":"Dilek Güven Taymez, Özge Telci Çaklılı, Hande Gürbüz","doi":"10.5152/TJAR.2023.21596","DOIUrl":"https://doi.org/10.5152/TJAR.2023.21596","url":null,"abstract":"<p><p>Maneb is a widely used agricultural fungicide, which can lead to parkinsonism due to its neurotoxic effects on the dopaminergic system after chronic low-dose exposure. Previous acute human maneb poisoning cases occurred with low-dose maneb exposure through the dermal route causing renal failure. This report presents a case of acute renal failure and delayed paralysis due to ingestion of a large dose of maneb for a suicide attempt. A 16-year-old female patient was admitted to the emergency room because of drinking almost a whole bottle of maneb (400 mL [2 g L-1]) about 2 hours before. The patient was transferred to the intensive care unit with severe metabolic acidosis and renal failure. On the 4th day in intensive care unit, although the severe acidosis was resolved with haemodialysis, the patient was intubated because of ascending muscle weakness and dyspnoea. After staying in the intensive care unit for 9 days and in the nephrology ward for 2 weeks, the patient was discharged well from the hospital with no further need for haemodialysis but a persistent bilateral drop foot. One year after the event, renal functions were normal, and motor function in the lower extremities improved entirely.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9634817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sukanya Mitra, Jasveer Singh, Kompal Jain, Uma Rathi
Stellate ganglion block has been described in the management of postmastectomy neuropathic pain. However, its role in the treatment of posttraumatic neuropathic breast pain has not been reported in the literature. We present a case of a 40-year-old female with a chief complaint of severe debilitating pain in her right breast following trauma, refractory to oral medications including conventional analgesics, amitriptyline, pregabalin, and duloxetine. She was successfully managed after administration of ultrasound-guided stellate ganglion block and pulsed radiofrequency ablation of the stellate ganglion. It resulted in significant and prolonged pain relief leading to improved quality of life.
{"title":"Successful Management of Unilateral Post-traumatic Neuropathic Mastalgia: A Case Report.","authors":"Sukanya Mitra, Jasveer Singh, Kompal Jain, Uma Rathi","doi":"10.5152/TJAR.2023.21216","DOIUrl":"https://doi.org/10.5152/TJAR.2023.21216","url":null,"abstract":"<p><p>Stellate ganglion block has been described in the management of postmastectomy neuropathic pain. However, its role in the treatment of posttraumatic neuropathic breast pain has not been reported in the literature. We present a case of a 40-year-old female with a chief complaint of severe debilitating pain in her right breast following trauma, refractory to oral medications including conventional analgesics, amitriptyline, pregabalin, and duloxetine. She was successfully managed after administration of ultrasound-guided stellate ganglion block and pulsed radiofrequency ablation of the stellate ganglion. It resulted in significant and prolonged pain relief leading to improved quality of life.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9634821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The dorsalis pedis artery and posterior tibial artery are recognised sites for arterial cannulation. This study aimed to compare the first-attempt success rates of cannulation along with other cannulation characteristics of these 2 arteries in adult patients undergoing surgery under general anaesthesia using the conventional palpatory method. Methods: Two hundred twenty adults were allocated randomly into 2 groups. The dorsalis pedis artery and posterior tibial artery were attempted for cannulation in the dorsalis pedis artery and posterior tibial artery group, respectively. First-attempt success rates, cannulation times, number of attempts, ease of cannulation, and complications were recorded. Results: Demographic characteristics, pulse characteristics, single-attempt success rates, ease of cannulation, reasons for failure, and complications were similar. Single-attempt success rates were similar (64.5% and 61.8%, P = .675) with equal median attempt. Easy cannulation (Visual Analogue Scale score ≤4) was the same in both groups, whereas percentages of difficult cannulation (Visual Analogue Scale scores ≥4) were 16.4% and 19.1% in the dorsalis pedis artery and posterior tibial artery groups, respectively. Cannulation time was lower in the dorsalis pedis artery group [median time in seconds: 37 (28, 63) seconds vs. 44 (29, 75) seconds, P = .027]. Single-attempt success rates were lower in the feeble pulse group as compared to the strong pulse group (48.61% vs. 70.27%, P = .002). Likewise, a higher Visual Analogue Scale of ease of cannulation (>4 score) was seen in the feeble pulse group compared to the strong pulse group (26.39% vs. 13.51%, P = .019). Conclusions: The single-attempt success rate was similar for both dorsalis pedis artery and posterior tibial artery. However, the time taken for cannulating the posterior tibial artery is significantly higher than that for dorsalis pedis artery.
目的:足背动脉和胫后动脉是动脉插管的识别部位。本研究旨在比较在全身麻醉下采用常规触诊方法进行手术的成人患者第一次插管成功率以及这两条动脉的其他插管特点。方法:将220名成人随机分为2组。在足背动脉组和胫后动脉组分别尝试足背动脉和胫后动脉插管。记录首次尝试成功率、插管次数、插管次数、插管难易程度及并发症。结果:人口学特征、脉搏特征、单次插管成功率、插管难易程度、失败原因及并发症相似。单次尝试成功率相似(64.5%和61.8%,P = 0.675)。两组容易插管(视觉模拟评分≤4分)的比例相同,而足背动脉组和胫后动脉组插管困难(视觉模拟评分≥4分)的比例分别为16.4%和19.1%。足背动脉组插管时间较短[中位时间秒:37(28,63)秒比44(29,75)秒,P = 0.027]。脉搏微弱组的单次尝试成功率低于脉搏强烈组(48.61%比70.27%,P = 0.002)。同样,弱脉组插管易度视觉模拟量表(>4分)高于强脉组(26.39% vs. 13.51%, P = 0.019)。结论:足背动脉和胫后动脉单次手术成功率相近。胫后动脉插管时间明显高于足背动脉插管时间。
{"title":"Evaluation of Success of Arterial Cannulation Employing the Dorsalis Pedis Artery Versus Posterior Tibial Artery: A Clinical Comparative Study.","authors":"Rudrashish Haldar, Tapas Kumar Singh, Priyam Saikia, Ashish Kumar Kannaujia, Prabhaker Mishra, Anil Agarwal","doi":"10.5152/TJAR.2023.22826","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22826","url":null,"abstract":"Objective: The dorsalis pedis artery and posterior tibial artery are recognised sites for arterial cannulation. This study aimed to compare the first-attempt success rates of cannulation along with other cannulation characteristics of these 2 arteries in adult patients undergoing surgery under general anaesthesia using the conventional palpatory method. Methods: Two hundred twenty adults were allocated randomly into 2 groups. The dorsalis pedis artery and posterior tibial artery were attempted for cannulation in the dorsalis pedis artery and posterior tibial artery group, respectively. First-attempt success rates, cannulation times, number of attempts, ease of cannulation, and complications were recorded. Results: Demographic characteristics, pulse characteristics, single-attempt success rates, ease of cannulation, reasons for failure, and complications were similar. Single-attempt success rates were similar (64.5% and 61.8%, P = .675) with equal median attempt. Easy cannulation (Visual Analogue Scale score ≤4) was the same in both groups, whereas percentages of difficult cannulation (Visual Analogue Scale scores ≥4) were 16.4% and 19.1% in the dorsalis pedis artery and posterior tibial artery groups, respectively. Cannulation time was lower in the dorsalis pedis artery group [median time in seconds: 37 (28, 63) seconds vs. 44 (29, 75) seconds, P = .027]. Single-attempt success rates were lower in the feeble pulse group as compared to the strong pulse group (48.61% vs. 70.27%, P = .002). Likewise, a higher Visual Analogue Scale of ease of cannulation (>4 score) was seen in the feeble pulse group compared to the strong pulse group (26.39% vs. 13.51%, P = .019). Conclusions: The single-attempt success rate was similar for both dorsalis pedis artery and posterior tibial artery. However, the time taken for cannulating the posterior tibial artery is significantly higher than that for dorsalis pedis artery.","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Postoperative analgesia in caesarean deliveries is becoming increasingly important, since early bonding between mother and infant can be established with effective postoperative analgesia while preventing the unpleasant effects of pain. Additionally, inadequate postoperative analgesia is associated with chronic pain and postpartum depression. The primary objective of this study was to compare the analgesic effects of transversus abdominis plane block and rectus sheath block in patients undergoing elective caesarean delivery.
Methods: A total of 90 parturients with American Society of Anesthesia status I-II, aged 18-45 years, at >37 gestational weeks, and scheduled for elective caesarean delivery were included in the study. All patients received spinal anaesthesia. Parturients were randomised into 3 groups. Bilateral ultrasound-guided transversus abdominis plane block was performed on the transversus abdominis plane group, bilateral ultrasoundguided rectus sheath block on the rectus sheath group, and no block on the control group. All patients were given intravenous morphine through a patient-controlled analgesia device. A pain nurse, blinded to the study, recorded the cumulative morphine consumption and pain scores during resting and coughing using a numerical rating scale at postoperative hours 1, 6, 12, and 24.
Results: Numerical rating scale values recorded during rest and coughing were lower in the transversus abdominis plane group at postoperative hours 2, 3, 6, 12, and 24 (P < .05). Morphine consumption was lower in the transversus abdominis plane group at postoperative hours 1, 2, 3, 6, 12, and 24 (P < .05).
Conclusion: Transversus abdominis plane block provides effective postoperative analgesia in parturients. However, rectus sheath block provides inadequate postoperative analgesia in parturients who undergo caesarean delivery.
{"title":"Transversus Abdominis Plane Block Versus Rectus Sheath Block for Postoperative Pain After Caesarean Delivery: A Randomised Controlled Trial.","authors":"Hadi Ufuk Yörükoğlu, Tülay Şahin, Ayşe Öge Kula","doi":"10.5152/TJAR.2023.22724","DOIUrl":"https://doi.org/10.5152/TJAR.2023.22724","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative analgesia in caesarean deliveries is becoming increasingly important, since early bonding between mother and infant can be established with effective postoperative analgesia while preventing the unpleasant effects of pain. Additionally, inadequate postoperative analgesia is associated with chronic pain and postpartum depression. The primary objective of this study was to compare the analgesic effects of transversus abdominis plane block and rectus sheath block in patients undergoing elective caesarean delivery.</p><p><strong>Methods: </strong>A total of 90 parturients with American Society of Anesthesia status I-II, aged 18-45 years, at >37 gestational weeks, and scheduled for elective caesarean delivery were included in the study. All patients received spinal anaesthesia. Parturients were randomised into 3 groups. Bilateral ultrasound-guided transversus abdominis plane block was performed on the transversus abdominis plane group, bilateral ultrasoundguided rectus sheath block on the rectus sheath group, and no block on the control group. All patients were given intravenous morphine through a patient-controlled analgesia device. A pain nurse, blinded to the study, recorded the cumulative morphine consumption and pain scores during resting and coughing using a numerical rating scale at postoperative hours 1, 6, 12, and 24.</p><p><strong>Results: </strong>Numerical rating scale values recorded during rest and coughing were lower in the transversus abdominis plane group at postoperative hours 2, 3, 6, 12, and 24 (P < .05). Morphine consumption was lower in the transversus abdominis plane group at postoperative hours 1, 2, 3, 6, 12, and 24 (P < .05).</p><p><strong>Conclusion: </strong>Transversus abdominis plane block provides effective postoperative analgesia in parturients. However, rectus sheath block provides inadequate postoperative analgesia in parturients who undergo caesarean delivery.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9634818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vishal Saxena, Harick Shah, Swarup Ray, Amrit Kaur, Raylene Dias
Decortication and stripping of infected pleura by video-assisted thoracoscopic surgery or thoracotomy is the treatment of choice in cases of empyema. The stripping is associated with intense post-operative pain. Erector spinae block is an excellent and safe alternative to thoracic epidural block. The experience in paediatric erector spinae plane block is very limited. We present our experience of continuous erector spinae block and one single-shot erector spinae plane block in paediatric video-assisted thoracoscopic surgeries. We had 5 patients aged 2-8 years with right-sided empyema, who were taken up for video-assisted thoracoscopic surgery decortication, and 2 patients aged 1-4 years with congenital diaphragmatic hernia (CDH) for video-assisted thoracoscopic surgery CDH repair. After induction and intubation, using high-frequency straight ultrasound probe, an erector spinae plane catheter was inserted and the local anaesthetic agent was administered. The patients were monitored for signs of effective analgesia. Post-extubation continuous erector spinae plane block was continued for 48 hours using bupivacaine and fentanyl. All patients had excellent postoperative analgesia for more than 48 hours. There were no side effects like motor block, nausea, vomiting, or respiratory depression. Continuous erector spinae plane block provides excellent analgesia in paediatric patients undergoing video-assisted thoracoscopic surgery, causing minimal side effects. Further, a prospective randomized control trial is suggested to establish the efficacy of this block in paediatric video-assisted thoracoscopic surgeries.
{"title":"Continuous Erector Spinae Plane Block in Paediatric VATS: A Case Series.","authors":"Vishal Saxena, Harick Shah, Swarup Ray, Amrit Kaur, Raylene Dias","doi":"10.5152/TJAR.2023.21591","DOIUrl":"https://doi.org/10.5152/TJAR.2023.21591","url":null,"abstract":"<p><p>Decortication and stripping of infected pleura by video-assisted thoracoscopic surgery or thoracotomy is the treatment of choice in cases of empyema. The stripping is associated with intense post-operative pain. Erector spinae block is an excellent and safe alternative to thoracic epidural block. The experience in paediatric erector spinae plane block is very limited. We present our experience of continuous erector spinae block and one single-shot erector spinae plane block in paediatric video-assisted thoracoscopic surgeries. We had 5 patients aged 2-8 years with right-sided empyema, who were taken up for video-assisted thoracoscopic surgery decortication, and 2 patients aged 1-4 years with congenital diaphragmatic hernia (CDH) for video-assisted thoracoscopic surgery CDH repair. After induction and intubation, using high-frequency straight ultrasound probe, an erector spinae plane catheter was inserted and the local anaesthetic agent was administered. The patients were monitored for signs of effective analgesia. Post-extubation continuous erector spinae plane block was continued for 48 hours using bupivacaine and fentanyl. All patients had excellent postoperative analgesia for more than 48 hours. There were no side effects like motor block, nausea, vomiting, or respiratory depression. Continuous erector spinae plane block provides excellent analgesia in paediatric patients undergoing video-assisted thoracoscopic surgery, causing minimal side effects. Further, a prospective randomized control trial is suggested to establish the efficacy of this block in paediatric video-assisted thoracoscopic surgeries.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9634820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}