Turkish journal of anaesthesiology and reanimation最新文献

Objective: We compared magnesium sulphate pre-treatment with rocuronium at a dose of 0.9 mg kg^-1 to the standard succinylcholine (1 mg kg^-1) in rapid sequence induction to see if this combination had an onset of paralysis comparable to succinylcholine.

Methods: This was a prospective, single-centre, double-blinded, parallel-arm, randomized controlled trial on patients aged 18-60 years, either sex, the American Society of Anesthesiologists I and II. Patients received a 100 mL normal saline infusion followed by either succinylcholine at 1 mg kg^-1 (Group S), or rocuronium 0.9 mg kg^-1 (Group R), or a 100 mL normal saline infusion containing magnesium sulphate 60 mg kg^-1, followed by rocuronium 0.9 mg kg^-1 (Group MgR). The primary outcome was the time of onset of paralysis evidenced by fading of train-of-four (TOF). Secondary outcomes were the intubation conditions, and the laryngoscopy response.

Results: Data from 135 patients showed TOF fading times differed significantly across the groups, with Group S showing a median (interquartile range-IQR) of 65 (61-70) seconds, Group R 102 (98-108) seconds, and Group MgR 82 (79-85) seconds (P < 0.001). The ease of laryngoscopy and response to cuff inflation showed no significant difference (P=1.000). Analysis of the position of the vocal cords suggested a significant difference (P < 0.001). Finally, the total intubating conditions indicated a significant difference among the groups (P < 0.001), favouring Group MgR for excellent intubating conditions.

Conclusion: The onset of action was significantly faster with succinylcholine than with magnesium sulphate-rocuronium. Nevertheless, it was significantly faster with magnesium sulphate-rocuronium than with rocuronium alone. However, the intubation conditions were better when magnesium was added to rocuronium.

Objective: Robot-assisted laparoscopic radical prostatectomy (RALP) is increasingly used in the treatment of prostate cancer due to its minimally invasive nature, reduced perioperative bleeding, and shorter hospital stays. However, the steep Trendelenburg position and CO₂ pneumoperitoneum required for the procedure present unique anaesthetic challenges, particularly in elderly patients with comorbidities. This study aimed to determine the incidence of anaesthetic complications during RALP and identify independent risk factors associated with these events.

Methods: A retrospective observational study was conducted at Ankara Bilkent City Hospital between 2019 and 2024. A total of 1,020 patients who underwent RALP were evaluated. Collected data included demographic characteristics, the American Society of Anesthesiologists (ASA) physical status classification, comorbidities, and intra- and postoperative outcomes. Anaesthetic complications were analyzed, and multivariate logistic regression was performed to identify independent predictors.

Results: The mean patient age was 65.0±6.3 years, with 65.3% classified as ASA II and 61.6% having at least one comorbidity. Anaesthetic complications occurred in 4.4% of patients. Those with complications were significantly older (67.9±6.2 vs. 64.9±6.3 years, P=0.004), had longer hospital stays (8.98±4.45 vs. 6.83±3.18 days, P < 0.001), and were more frequently admitted to the post-anaesthesia care unit (PACU) (73.3% vs. 46.8%, P < 0.001). Multivariate analysis identified age, hospital stay duration, and PACU admission as independent risk factors.

Conclusion: RALP can be safely performed in experienced centers with individualized anaesthetic management. However, older age, longer hospitalization, and PACU admission significantly increase the risk of anaesthetic complications. These findings emphasize the need for preoperative risk stratification and tailored perioperative care to improve safety outcomes. Prospective, multicenter studies are needed to confirm these results and guide future anaesthetic strategies in robotic urologic surgery.

We report the unanticipated intraoperative complication of a guidewire knot during central venous line insertion in the left internal jugular vein (IJV), in a child scheduled for a left pneumonectomy for leiomyosarcoma of the left lung under general anaesthesia. After an uneventful guidewire placement in the left IJV under ultrasound guidance, difficulty was encountered in advancing the central venous catheter over the guidewire. Resistance was felt when initiating the removal of the guidewire. The guidewire knot was identified with intraoperative fluoroscopic imaging. After consultation with the surgical team, the knot in the guidewire was removed by immediate venotomy. Intraoperative lung isolation and tracheal extubation after the surgery were uneventful. This report emphasises the importance of vigilance during central venous catheterisation in paediatric patients whose anatomical variations and smaller vessels exacerbate the risk of such complications. Ultrasound-based preprocedural Rapid Central Venous Assessment, and intra-procedural guidewire-tip navigation may help prevent coiling/knotting. Furthermore, it highlights the need for rapid recognition and surgical readiness to resolve unexpected issues during routine procedures.

Kinsbourne syndrome, also known asor opsoclonus-myoclonus-ataxia syndrome, is a rare paediatric neurological disorder characterised by abnormal eye movements, myoclonus, and ataxia. Its anaesthetic management presents significant challenges, especially when one-lung ventilation (OLV) is required in the prone position. This case report describes the anaesthetic management of a two year-old child with Kinsbourne syndrome undergoing T9-T11 paravertebral neuroblastoma excision. Because of the patient's size and the need for lung isolation, a Fogarty embolectomy catheter was used for OLV. Anaesthesia was induced with intravenous fentanyl, propofol, and atracurium, followed by the insertion of a 4.0 mm cuffed endotracheal tube to facilitate Fogarty catheter insertion. The catheter was positioned in the right bronchus under fibre-optic guidance; after which, a 4.5 mm cuffed tube was inserted, and the patient was placed in the prone position. Continuous fibre-optic monitoring ensured proper catheter placement. Anaesthesia was maintained with oxygen, air, and isoflurane. The patient remained haemodynamically stable, was extubated postoperatively, was observed in the paediatric intensive care unit for 24 hours, and was subsequently transferred to the ward. This case highlights the challenges of OLV in paediatric patients and demonstrates the effectiveness of a Fogarty catheter for lung isolation when traditional devices are unsuitable, emphasising the importance of multidisciplinary collaboration and continuous monitoring.

Objective: This study aims to compare the performance of artificial intelligence (AI) chatbot ChatGPT with anaesthesiology and reanimation residents at a major hospital in an exam modelled after the European Diploma in Anaesthesiology and Intensive Care Part I.

Methods: The annual training exam for residents was administered electronically. One day prior to this, the same questions were posed to an AI language model. During the analysis, the residents were divided into two groups based on their training duration (less than 24 months: Group J; 24 months or more: Group S). Two books and four guides were used as references in the preparation of a 100-question multiple-choice exam, with each correct answer awarded one point.

Results: The median exam score among all participants was 70 [interquartile range (IQR) 67-73] out of 100. ChatGPT correctly answered 71 questions. Group J had a median exam score of 67 (IQR 65.25-69), while Group S scored 73 (IQR 70-75) (P < 0.001). Residents with less than 24 months of training performed significantly worse across all subtopics compared to those with more extensive training (P < 0.05). When ranked within the groups, ChatGPT placed eighth in Group J and 47^th in Group S.

Conclusion: ChatGPT exhibited a performance comparable to that of a resident in an exam centred on anaesthesiology and critical care. We suggest that by tailoring an AI model like ChatGPT in anaesthesiology and resuscitation, exam performance could be enhanced, paving the way for its development as a valuable tool in medical education.

Objective: We aimed to evaluate the effectiveness of sugammadex on renal tissue for against ischemia-reperfusion injury.

Methods: Twenty-one Wistar albino strain female rats were divided into three groups. The first group functioned as the control cohort for comparison. In Groups 2 and 3, a renal ischemia-reperfusion model was established. Moreover, following the cessation of ischemia, the rats in Group 3 were intravenously administered sugammadex at a dose of 4 mg kg^-1. Blood and tissue samples were subsequently collected for analysis.

Results: Biochemical analyses revealed a notable increase in the enzymatic activities of glutathione peroxidase and superoxide dismutase in Group 3 relative to Group 2 (P < 0.001 and P=0.015, respectively). Additionally, the concentration of malondialdehyde was found to be significantly reduced in Group 3 relative to Group 2 (P=0.004). Group 3 exhibited a substantial decrease in tumor necrosis factor-alpha, interleukin 6, and interleukin 1 beta levels when compared to Group 2 (P=0.021, P=0.006, and P=0.016 respectively). Group 2 exhibited the highest concentrations of neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 (P < 0.001 and P=0.015, respectively). Similarly, the histopathologic tissue damage was the most prominent in Group 2 (P < 0.001).

Conclusion: Sugammadex plays a protective role against ischaemia-reperfusion injury in renal tissue.

Objective: Parameters that can provide information about patients' current status are very important in preoperative evaluation. The systemic immune inflammation index (SII), and systemic inflammation response index (SIRI) can be easily calculated with a simple hemogram test, and this testing is frequently requested in preoperative preparation. The aim of this research was to examine the relationship between the SII, and SIRI, along with the demographic characteristics and postoperative clinical course of the patient.

Methods: In the study, the records of patients who presented to the anesthesia outpatient clinic for preoperative preparation were retrospectively reviewed. In this study, the relationships between the SII, and SIRI and each patients' demographic characteristics, and the American Society of Anesthesiologists (ASA) score, comorbid disease, and length of hospital stay were examined.

Results: For the SII value, there was a statistically significant difference between the ASA1 and ASA2 groups and between the ASA2 and ASA3 groups there was no significant difference between the ASA3 and ASA4 groups (P < 0.001, P < 0.001, P=0.17, respectively). There were statistically significant differences between the ASA1 and ASA2, ASA2 and ASA3, and ASA3 and ASA4 groups for the SIRI value (P < 0.001, P < 0.001, P < 0.001, respectively).

Conclusion: The findings showed relationships between the SII, SIRI, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio and an increase in patients' ASA scores. In multivariate analysis, some demographic characteristics of the patients, comorbidities, and the postoperative course were found to be independent risk factors predicting SII and SIRI.

The introduction of neuromuscular blockers (NMBs) has revolutionized the practice of general anaesthesia, ushering in a new era where anaesthesia is conceptualized as a triad comprising narcosis, analgesia, and muscle relaxation. NMBs play a vital role in surgeries by facilitating tracheal intubation, preventing the movement of body and diaphragm, control of ventilation at normal partial pressure of carbon dioxide and counteraction of narcotic-induced truncal rigidity. However, the absence of specific guidelines for the selection and utilization of particular NMBs in various surgical contexts has led to inconsistencies within the healthcare system. Thus, a deep and thorough understanding of pharmacological aspects of NMBs is required for the selection and usage of particular NMB in clinical setting. Ideal NMBs are characterized by rapid onset, non-cumulative effects, independence from renal or hepatic function for elimination, rapid reversibility, and minimal adverse side effects. Among several NMBs, cisatracurium, an isomer of atracurium is a non-depolarizing intermediate-acting with characteristic features of high potency, smaller dosage requirement, no histamine release, no cardiovascular effects and elimination via organ-independent Hofmann reaction. Innumerable clinical experiments and trials suggest cisatracurium as safe, cost-effective, and better molecule with predictable recovery and no postoperative residual paralysis in comparison to other NMBs such as rocuronium, vecuronium, and pancuronium. In this review, we aimed to provide critical insights on the properties of NMBs first and then focused on the use of cisatracurium in cardiac surgeries.