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.

Objective: Enhanced recovery after surgery (ERAS) protocols are recognised for improving postoperative outcomes. Integrating structured prehabilitation with the safe brain initiative (SBI) may further enhance these benefits. This study evaluated the impact of an ERAS-SBI programme on postoperative recovery and analgesic requirements in patients undergoing total knee arthroplasty (TKA).

Methods: This retrospective single-centre cohort study included adults classified as American Society of Anesthesiologists I-III who underwent elective TKA at a tertiary-care teaching hospital. Outcomes of patients managed with the ERAS-SBI programme (n = 138; December 2023-2024) were compared with those of patients treated prior to programme implementation (n = 66; December 2022-2023). The primary outcome was the length of hospital stay. Secondary outcomes included timing of postoperative discharge and cumulative rescue opioid analgesia at 24 and 48 hours.

Results: The ERAS-SBI group had a significantly shorter hospital stay than the pre-ERAS-SBI group (P < 0.001). The time to postoperative discharge was also reduced (P < 0.001). Rescue opioid analgesia consumption at 24 and 48 hours was significantly lower in the ERAS-SBI group (P < 0.001 for both comparisons). Perioperative anaemia and blood transfusion rates were reduced in the ERAS-SBI group (P=0.007 and P=0.003, respectively).

Conclusion: Implementing an ERAS-SBI pathway, incorporating a dedicated prehabilitation-focused ERAS outpatient clinic, is associated with shorter hospitalisation and reduced postoperative analgesic requirements following TKA. These findings support the role of enhanced multidisciplinary perioperative optimisation in improving clinical outcomes.

Objective: Preoperative anemia is a common, yet inadequately managed condition in patients undergoing total knee arthroplasty (TKA) and is associated with an increased need for perioperative blood transfusions. However, variability in physicians' transfusion practices remains understudied. This study investigated the influence of preoperative anaemia on transfusion rates and clinical outcomes and examined inter-physician variability in transfusion procedures.

Methods: This study included 265 patients who underwent TKA. Preoperative anaemia was defined as haemoglobin <13 g dL^-1. Demographic characteristics, perioperative variables, laboratory parameters, transfusion data, and postoperative outcomes were recorded. Transfusion rates, complications, and lengths of hospital stay were compared between anemic and non-anemic groups. Inter-physician variability in transfusion decisions was also analysed.

Results: Preoperative anaemia was present in 43% of individuals. Transfusion rates were significantly higher in patients with anaemia (69.3% vs. 54.3%, P=0.013). When postoperative outcomes were analysed according to anaemia and transfusion status, anaemia was not independently associated with postoperative complications (P=0.072). Perioperative blood transfusion was associated with significantly higher complication rates (31.7% vs. 15.4%, P=0.003) and a prolonged hospital stay (P < 0.001). Receiver operating characteristic analysis showed modest discrimination for predicting transfusion (area under the receiver operating characteristic curve =0.61; cut-off =13.15 g dL^-1). Significant inter-physician variability was observed, independent of anaemia status (P < 0.05).

Conclusion: Preoperative anemia is common among TKA patients and has been associated with higher transfusion rates. Transfusion was associated with adverse clinical outcomes, including prolonged hospitalisation and higher complication rates. The substantial physician-related variability observed in transfusion practices underscores the need for standardised, evidence-based perioperative transfusion protocols.

We report the case of a 60-year-old female with adenocarcinoma of the right upper lobe who underwent a video-assisted thoracoscopic surgery (VATS) upper lobectomy and subsequently presented with complete right lung collapse in the immediate postoperative period. Urgent bronchoscopy revealed complete stapling of the right mainstem bronchus. Hence, emergency re-exploration and bronchoplasty of the right mainstem bronchus and the right lower-lobe bronchus were done. While bronchoscopy following VATS lobectomy for lung cancer poses technical challenges and represents an independent risk factor for postoperative pulmonary complications, it remains a valuable tool for the early detection of complications such as lung collapse, which may result from thick mucus, a foreign body, iatrogenic injury, or the tumour itself.

Objective: Serratus posterior superior intercostal plane block (SPSIPB) provides thoracic analgesia. Our objective was to assess the analgesic effectiveness of SPSIPB in reducing pain scores and opioid consumption in patients undergoing breast-conserving surgery (BCS) with axillary dissection or sentinel lymph node biopsy.

Methods: Participants were individuals aged 18-65 years with American Society of Anesthesiologists physical status I-II who were scheduled for elective BCS under general anaesthesia. Participants were randomly assigned to Group SPSIPB (n = 30) or Group Control (n = 30); the control group received local infiltration anaesthesia. A total of 30 milliliters of 0.25% bupivacaine was during the SPSIPB procedure. The primary outcome of the study was the numerical rating scale (NRS) score at 1 hour postoperatively. Secondary outcomes included 24-hour opioid consumption, need for rescue analgesia, and adverse effects.

Results: During the first 24 hours after surgery, the median static and dynamic NRS scores were lower in the SPSIPB group than in the control group (P < 0.005). Fewer patients in the SPSIPB group required rescue analgesia than in the control group (3 vs. 26 patients, P=0.001), and opioid consumption was lower in the SPSIPB group (P=0.001). The incidence of adverse effects was significantly lower in the SPSIPB group (P < 0.005).

Conclusion: Opioid consumption and pain scores in the SPSIPB group were significantly lower compared with those in the control group. SPSIPB provides effective analgesia and reduces opioid requirements, offering a valuable opioid-sparing alternative for anaesthesia in breast surgery.

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.