Turkish journal of anaesthesiology and reanimation最新文献

We describe cases in which a preoperative computed tomography was used to guide the placement of an epidural catheter through the defect in the intervertebral foramina in patients with severe lumbar scoliosis. We demonstrate the adroitness with which epidural catheters were inserted through the intervertebral foramina. Computed tomography scan illustrates and plots the needle path creating a 3-dimensional image of the vertebral body rotation, needle trajectory, and the distance from the skin to the intervertebral foramina. Severe scoliosis is defined as a lateral curvature (Cobb's angle) of more than 50 degrees. It was proposed in severe idiopathic scoliosis that interventional pain management techniques are managed with fluoroscopic imaging or an alternative form. However, after a computed tomography evaluation of the scoliotic spine, we assumed that the intervertebral foraminal anatomy would facilitate a safe and efficient epidural needle and subsequent catheter positioning in severe scoliotic patients.

Objective: Perfusion index has shown to be helpful in the operative and critical care settings to monitor peripheral tissue perfusion. Randomised controlled trials quantifying different agents' vasodilatory properties using perfusion index has been limited. Therefore, we undertook this study to compare the vasodilatory effects of isoflurane and sevoflurane using perfusion index.

Methods: This is a pre-specified sub-analysis of a prospective randomised controlled trial on the effects of inhalational agents at equipotent concentration. We randomly allocated patients scheduled for lumbar spine surgery to either isoflurane or sevoflurane groups. We recorded values of perfusion index at age-corrected 1 Minimum Alveolar Concentration (MAC) concentration at baseline, pre- and post-application of a noxious stimulus. The primary outcome of interest was the measure of vasomotor tone with perfusion index, and the secondary outcomes which were analysed were mean arterial pressure and heart rate.

Results: At age-corrected 1.0 MAC, there was no significant difference in the pre-stimulus haemodynamic variables and perfusion index between both groups. During the post-stimulus period, there was a significant increase in heart rate in the isoflurane group compared to the sevoflurane group, with no significant difference in the mean arterial pressure values between both groups. Though the perfusion index decreased during the post-stimulus period in both groups, there was no statistically significant difference between the 2 groups (P = .526, repeated-measures analysis of variance).

Conclusion: In a steady state of age-corrected 1.0 MAC, isoflurane and sevoflurane had a similar perfusion index before and after a standardised nociceptive stimulus, which suggests that both of these agents have similar effect on peripheral perfusion and vasomotor tone.

The persistent left superior vena cava may complicate the placement of vascular access. It rarely occurs with an absence of the right superior vena cava. We present a chest X-ray of a patient with this rare anomaly that was demonstrated incidentally with an unusual course of a pulmonary artery catheter course.

Objective: Code blue is one of the important practices for preventing mortality and morbidity and increasing the quality of care in hospitals. The aim of this study was to evaluate the blue code notifications and their results, emphasise their importance, and determine the effectiveness and deficiencies of the application.

Methods: In this study, all code blue notification forms recorded between January 1 and December 31, 2019, were examined retrospectively.

Results: It was determined that code blue calls were made for 108 cases, including 61 females and 47 males, and the mean age of the patients was 56.47 ± 20.73. The accuracy rate of the code blue calls was determined as 42.6%, and 57.4% of them were made during non-working hours. Also, 15.2% of the correct code blue calls were made from dialysis and radiology units. The mean time for the teams to reach the scene was 2.83 ± 1.30 minutes, and the mean time to respond to correctly made code blue calls was 33.97 ± 17.95 minutes. It was found that 15.7% of the patients in correctly made code blue calls were exitus after the intervention.

Conclusion: Early diagnosis of cardiac or respiratory arrest cases and quick and correct intervention are very important in achieving patient and employee safety. For this reason, it is necessary to continuously evaluate code blue practices, educate the staff, and organise improvement activities constantly.

Objective: The aim of this study was to present our experience in liver transplantation recipients and renal transplantation recipients during caesarean section.

Methods: Retrospective data regarding liver transplantation recipients and renal transplantation recipients who underwent caesarean section between January 1997 and January 2017 have been collected from the hospital records.

Results: Fourteen live births occurred from 5 liver transplantation recipients and 9 renal transplantation recipients, all of them from caesarean section. The mean maternal age (28.4 ± 4.0 years vs. 29.2 ± 4.1 years, P = .38), body weight before conception (57.4 ± 8.8 kg vs. 64.5 ± 8.2 kg, P = .48), and the time from transplantation to conception (99.0 ± 50.7 months vs. 101.0 ± 57.5 months, P = .46) were similar for 5 liver transplantation recipients and 9 renal transplantation recipients, respectively. Four caesarean sections were performed under general anaesthesia, whereas spinal anaesthesia was used in 10 patients. The mean birth weight was similar (2502 ± 311g vs. 2161 ± 658 g, P = .3). There were 3 premature deliveries in liver transplantation recipients versus 6 premature deliveries in renal transplantation recipients and 2 low-birth-weight infants (<2500 g) in liver transplantation recipients versus 4 in renal transplantation recipients among 14 newborns. Infants small for gestational age were diagnosed in 9/14 (3 liver transplantation recipients versus 6 renal transplantation recipients, P = 1).

Conclusion: General and regional anaesthesia can be safely used during caesarean delivery of liver transplantation recipients and renal transplantation recipients without increased risk of graft losses. Prematurity and low birth weight were mainly due to the cytotoxic drugs for immunosuppression. There are no differences in liver transplantation recipients and renal transplantation recipients for maternal and foetal complications according to our data.

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.

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.

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.

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.