Turkish journal of anaesthesiology and reanimation最新文献

Objective: Air-Q intubating laryngeal airway (ILA) is associated with a 58-77% success rate in blind intubation. The newer laryngeal mask airway (LMA) blockbuster is specially designed to facilitate easier endotracheal intubation and may have a higher success rate. The current study aimed to compare the success rate of endotracheal intubation using the Air-Q ILA and LMA blockbuster.

Methods: After ethics committee approval and informed written consent, 140 adult patients with normal airways who were scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were recruited for this randomized controlled trial. Blind endotracheal intubation was performed using the Air-Q ILA in group A and the LMA blockbuster in group B with special maneuvers and/or tubes in the second attempt. Fibreoptic bronchoscope (FOB) guidance was used in the third attempt if required. The primary outcome was the success rate of intubation without FOB assistance. The number of attempts for supraglottic airway (SGA) insertion, the time taken for SGA insertion, and the overall intubation time was also noted.

Results: The success rate of intubation without FOB guidance was significantly higher in group B than in group A [91.4% vs 55.7%; relative risk (RR) 1.68; (95% confidence interval (CI) 1.34, 2.11); p<0.0001]. The number of attempts for SGA insertion was similar in groups A and group B [87% vs 90%; RR 1.03; (95% CI-0.92, 1.16); p=0.60]. The times for successful SGA insertion and endotracheal intubation were also similar between the groups.

Conclusion: The LMA blockbuster offers a significantly higher success rate for endotracheal intubation without FOB guidance than the Air-Q ILA in adult patients with normal airways. However, an increased success rate was achieved with the use of a specially designed flexible endotracheal tube and maneuvers.

Supraglottic masses can be an anaesthesiologist's nightmare due to the difficult airway scenario and bleeding risk during airway manipulation. Awake fibreoptic intubation is the primary method to secure the airway in such cases. However, most practising anaesthesiologists are not experts at handling the fibreoptic scope, especially in cases with a floppy supraglottic mass where it becomes difficult to displace the mask with the thin flexible bronchoscope. A hybrid technique of intubation in supraglottic masses using Bonfils rigid scope and C-MAC is often described but frequently not available. Here we describe a case of an elderly patient in their 80s presenting with a floppy supraglottic mass where an awake fibreoptic bronchoscope failed to secure the airway. Without access to a rigid Bonfils scope, we intuitively used a C-MAC to visualize the larynx and a yankauer suction catheter to displace the mass and perform a bougie-guided endotracheal intubation.

Objective: Intraoperative mechanical ventilation practices can lead to ventilator-induced lung injury (VILI) and postoperative pulmonary complications in healthy lungs. Mechanical power (MP) has been developed as a new concept in reducing the risk of postoperative pulmonary complications as it considers all respiratory mechanics that cause VILI. The most commonly used intraoperative modes are volume control ventilation (VCV) and pressure control ventilation (PCV). In this study, VCV and PCV modes were compared in terms of respiratory mechanics in patients operated in the supine and prone positions.

Methods: The patients were divided into 4 groups (80 patients), volume control supine and prone, pressure control supine and prone with 20 patients each. MP, respiratory rate, positive end-expiratory pressure, tidal volume, peak pressure, plato pressure, driving pressure, inspiratory time, height, age, gender, body mass index, and predictive body weight data of the patients included in the groups have been obtained from "electronic data pool" with Structured Query Language queries.

Results: The supine and prone MP values of the VCV group were statistically significantly lower than the PCV group (P values were 0.010 and 0.001, respectively).

Conclusion: Supine and prone MP values of the VCV group were calculated significantly lower than the PCV group. Intraoperative PCV may be considered disadvantageous regarding the risk of VILI in the supine and prone positions.

Perioperative fluid management remains a challenging aspect of paediatric liver transplantation (LT) because of the risk of postoperative complications and haemodynamic instability. Limited research has specifically investigated the impact of fluid management and transfusion on mortality and morbidity in pediatric LT patients. This systematic review summarizes the evidence regarding perioperative fluid management and its clinical outcomes in paediatric LT patients. All primary studies published in English evaluating perioperative fluid management in paediatric LT patients were eligible. PubMed, EBSCOHost, Embase, Proquest, and Google Scholar databases were searched from inception to December 19, 2023. Risks of bias were assessed using the Joanna-Briggs Institute checklist. The results were synthesized narratively. Five retrospective cohort studies of good-excellent quality were included in this review. Two studies evaluated intraoperative fluid administration, one study compared postoperative fluid balance (FB) with outcomes, and two studies compared massive versus non-massive transfusion. A higher mortality rate was associated with intravenous lactated ringer's (LR) than with normal saline, but not with massive transfusion (MT). Longer hospital stays were correlated with MT, >20% positive FB in the first 72 hours, and greater total intraoperative blood product administration. Higher intraoperative fluid administration was associated with a greater thrombotic risk. Additionally, intraoperative MT and lR infusion were associated with an increased risk of 30-day graft loss and graft dysfunction, respectively. Fluid management may impact the outcomes of paediatric LT recipients. These findings underscore the need for more studies to explore the best fluid management and evaluation strategies for children undergoing LT.

Objective: Peroral endoscopic myotomy (POEM) has proven to be a successful treatment method for achalasia in both adult and pediatric patients. Yet, there is a lack of evidence for anaesthetic management of pediatric patients who underwent POEM procedure. In this study, we aim to present perioperative and postoperative management strategies for pediatric patients with achalasia from in anaesthesia aspect.

Methods: Medical records were reviewed for 16 pediatric patients at a single center who underwent POEM procedure for achalasia between 2017 and 2020. Patients' data regarding demographics, preoperative diet, body mass index, perioperative monitoring and vitals, airway management, anaesthesia maintenance, mechanical ventilation settings duration of recovery, length of stay, pain management and adverse events were evaluated.

Results: The study cohort included 7 female and 9 male patients with a mean age of 5.5 years. Anaesthesia maintenance was provided with 0.8-1.2 minimum alveolar concentration sevoflurane in a 40-60% O2-air mixture, Remifentanil infusion and bolus doses of Rocuronium. The median age was 3 years for patients ventilated in pressure controlled ventilation mode and 10 years in volume controlled ventilation mode. Respiration rate and minute ventilation were adjusted to maintain end tidal carbon dioxide (ETCO2) below 45 mmHg. Needle decompression was applied for 14 patients (87.5%) for treatment of capnoperitoneum. The mean procedure duration and recovery room duration were 66 (±22.9) minutes and 62 (±21) minutes, respectively. Postoperative pain management is provided with paracetamol and tramadol in total 8 patients (50%). There was no adverse event during postoperative period and all patients discharged in a mean time of 3 days.

Conclusion: POEM has demonstrated encouraging outcomes in terms of safety and effectiveness in pediatric patients. Due to challenging nature of the pediatric patients, it is important to acknowledge that the procedure requires specialized anaesthesia management. Management of perioperative complications of increased ETCO2 requires understanding the physiologic results of pneumo-mediastinum and pneumo-peritoneum. Beside the known anaesthetic management strategies, a tailored approach should be adopted for each patient. Further investigations should be conducted to develop standardized management.

Objective: Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS.

Methods: A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 μg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off.

Results: The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2^nd, 4^th, 6^th, and 12^th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated.

Conclusion: As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Objective: Postoperative nausea (PN) and vomiting (PONV) in cardiac surgery increases adrenergic stimulation, limits mobilization and oral intake, and can be distressing for patients. The primary aim of our study was to investigate the effect of sevoflurane and propofol anaesthesia on the incidence of PONV in cardiac surgery patients undergoing Enhanced Recovery After Surgery (ERAS) protocol.

Methods: Following ethics committee approval, 62 patients undergoing elective coronary artery bypass surgery with ERAS protocol were included in this prospective randomized study. After standard induction of anaesthesia, Group S received 1.5-2% sevoflurane and Group P received 50-100 μg kg^-1 min^-1 propofol infusion as maintenance anaesthetic agent with a bispectral index of 40-50. The incidence of PN and PONV between 0-6 hours (early) and 6-24 hours (late) after extubation was compared as the primary outcome. The incidence of delirium was analyzed as a secondary outcome for similar periods.

Results: In the propofol group, 3 patients were excluded due to postoperative tamponade revision and prolonged mechanical ventilation. PN in the early post-extubation period (29% vs. 7.1%, P=0.031) was significantly higher in Group S. The incidence of delirium was similar between the groups in both periods.

Conclusion: Propofol may reduce the incidence of PN in the first 6 hours after extubation compared with sevoflurane. We believe that this period will be beneficial for gastrointestinal tolerance as it is the period when oral intake is initiated in patients. In conclusion, propofol maintenance in cardiac surgery patients may facilitate patient rehabilitation as part of the ERAS protocol.

Objective: Different anaesthetists for sedation or monitored anaesthesia care have been used for colonoscopy. The target of this research was the ability to perform colonoscopy under a painless degree of sedation and the prevalence of undesired proceedings.

Methods: A total of 60 patients were randomly divided into two groups: Group D received dexmedetomidine and Group PF received propofol-fentanyl. Patients in both groups received the same infusion ratio. The minimum infusion amount of dexmetatomidine is (0.1 to 0.4 μg kg^-1 h^-1) in Group D, whereas fentanyl is administered at a rate of 0.01 to 0.05 μg kg^-1 min^-1 in the PF group during the approximately 45-min colonoscopy.

Results: Group D exhibited significantly lower modified Observer's Assessment of Alertness/Sedation (OAA/S) scores at intraoperative time points T1-T12. Group D also exhibited significantly lower visual analog scale scores for pain at intraoperative time points T4 and T7. The mean arterial pressure was significantly lower in Group D at intraoperative times T6-T8 and T11-T12, as well as upon admission to the post-anaesthesia care unit (PACU) and 30 min after admission to the PACU. The results of the ANOVA tests revealed a significantly lower heart rate in Group D. The respiratory rate exhibited a notable decrease during time intervals T8 and T10 in the PF group.

Conclusion: The administration of dexmetatomidine and propofol-fentanyl during colonoscopy was found to be safe. In addition, dexmetatomidine may present significant benefits in this context because of its lower occurrence of adverse respiratory events.

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need for opioids postoperatively. Recent developments in drug and monitoring technologies have also been developed and can be effective for obese and morbidly obese patients undergoing urological procedures and perioperative surgery, thus improving the likelihood of safety in this higher risk population.

For patients monitored in intensive care units in the aftermath of a cardiac arrest, one of the well-established difficulties of care after resuscitation is the ability to perform the necessary prognostic assessments as accurately and early as possible. Although current guidelines include algorithms to determine prognosis, there are still missing links and uncertainties. Biomarkers obtained from peripheral blood are generally non-invasive and easy to obtain. Although the potential to use microRNA as a prognostic biomarker after cardiac arrest has received less interest recently, its popularity has increased in the last few years. By identifying prognostic biomarkers within 24 h of cardiac arrest, clinicians in intensive care could gain valuable insights to guide patient outcomes and predict both mortality and survival rates.