Turkish journal of anaesthesiology and reanimation最新文献

Objective: The effect of postoperative analgesia on the quality of recovery (QoR) after major lumbar spine surgery is understudied. We hypothesized that continuous epidural morphine and ketamine administration would provide effective analgesia, thereby improving QoR compared to continuous intravenous morphine and ketamine using the QoR-15 questionnaire.

Methods: A total of 40 patients were randomised to receive either continuous low-dose epidural morphine and ketamine via an intraoperatively placed epidural catheter (Group A) or intravenous morphine and ketamine using a patient-controlled analgesia system (Group B) for 48 hours. All patients were anaesthetized using standard anaesthesia drugs. The primary outcome was QoR at 24 and 48 hours after surgery using the QoR-15 questionnaire. The secondary outcomes were pain score at various time points during the first 48 hours, rescue analgesic requirements, ambulation time, length of hospital stay, and patient satisfaction.

Results: Forty patients were recruited (20 in each group), and all patient data were included in the analysis. The total QoR-15 scores for Group A and Group B at 24 hours were 134.8±6.65 and 128.9±6.12, respectively (P=0.006). The QoR-15 scores at 48 hours for groups A and B were 136.7±6.02 vs 132.10±6.8 (P=0.029), respectively. The pain score was lower in Group A than in Group B at rest and during movement, with P=0.015 and 0.001, respectively, and all the other secondary outcomes were comparable between the groups.

Conclusion: Postoperative analgesia with continuous low-dose epidural morphine and ketamine via an intraoperatively placed epidural catheter provides superior QoR after major lumbar spine surgery as compared to intravenous morphine and ketamine.

Objective: The use of ultrasonography (USG) in arterial catheterization, in which the comfort of the practitioners and hand-eye coordination are very important, is frequently needed by anesthesiologists in daily practice. We aimed to investigate whether radial artery catheterization with smart glasses-integrated USG would increase success and satisfaction.

Methods: One hundred twenty patients who were >18 years old and would have undergone elective surgery with an indication for radial artery catheterization between August and December 2022 were included in this prospective randomized study. Patients who underwent catheterization in the last month and had contraindications were excluded. In the Standard USG Group, catheterizations were performed with standard USG, and in the Smart Glass Group, with smart glasses-integrated USG. Two anesthetists, a junior practitioner with experience with 20-50 catheterizations and a senior practitioner with experience with over 50 catheterizations, performed the catheterizations. The subcutaneous distance, radial artery depth, and diameter in short axis, catheterization time, and ergonomic satisfaction were recorded.

Results: Sixty patients in standard USG group and 59 patients in Smart Glass Group, with similar demographics, were included in statistical analysis. The mean first catheterization time by junior practitioners, with smart glasses integrated USG, was shorter than standard USG (49.07±29.91 sec vs. 99.73±75.18 sec, P <0.001). The junior practitioner was more satisfied with smart glasses-integrated USG. There was no significant difference between groups in terms of interventions made by the senior practitioner.

Conclusion: Radial artery catheterization with smart glasses integrated USG shortens catheterization time, and increases satisfaction by increasing the comfort of USG use for junior practitioners.

Artificial intelligence (AI) is rapidly transforming anaesthesiology through advances in machine learning, deep learning, and large language models. AI-driven tools now contribute to nearly every phase of perioperative care, including preoperative risk stratification, intraoperative monitoring, imaging interpretation, airway assessment, regional anaesthesia, and critical care. Applications such as automated American Society of Anesthesiologists classification, prediction of postoperative complications and intensive care unit needs, electroencephalography-based depth-of-anaesthesia estimation, and proactive haemodynamic management are reshaping clinical decision-making. AI-augmented echocardiography enhances chamber recognition and functional measurements, whereas computer vision systems support airway evaluation and ultrasound-guided regional anaesthesia by providing real-time anatomical identification and facilitating training. In critical care, AI models facilitate the early detection of sepsis, organ dysfunction, and haemodynamic instability, while improving workflow efficiency and resource allocation. AI is increasingly used in academic writing, data processing, and medical education, offering opportunities for personalised learning and simulation but raising concerns about accuracy and hallucinations. In this review, we aimed to summarise the current applications of AI in anaesthesiology, highlight the methodological, ethical, and practical challenges that limit its integration, and discuss future directions for its safe and effective adoption in perioperative care.

Objective: In recent years, there has been growing interest in the potential effects of anaesthetic agents in cancer surgery. Although the impact of anaesthetic management on long-term oncological outcomes has yet to be definitively established, emerging studies are increasingly exploring interactions with the tumour microenvironment and epigenetic mechanisms. This bibliometric analysis aims to evaluate the existing literature on the use of general and regional anaesthesia in cancer surgery, thereby identifying prevailing trends and informing future research directions.

Methods: This was a retrospective bibliometric study designed to examine publications addressing both "cancer" and "anaesthesia" between 2005 and 2024. A search of the Web of Science database using specified keywords retrieved relevant articles, which were subsequently analysed based on parameters such as publication year, authors, journal, citation count, and country. Data were visualized using software, with network analyses conducted to reveal trends, collaboration networks, and research foci in the literature.

Results: The analysis reviewed 391 articles; the highest number of publications was recorded in 2021 and 2022. These articles collectively garnered 9,068 citations. The most frequently cited studies came from Ireland and the United States, with Dr. Donal Buggy emerging as the leading researcher in the field. The mapping analysis indicated that journals such as Anesthesiology and the British Journal of Anaesthesia were the dominant publication venues.

Conclusion: This study provides valuable insights into the evolving relationship between cancer and anaesthesia over the past two decades. The findings provide a significant foundation for future research and guide scientific development in this field.

Objective: The efficacy and safety of sedation administered by non-anaesthesia healthcare professionals should be evaluated within the framework of evidence-based protocols, and approaches should be adopted to ensure patient safety at the highest level. We aimed, with a scientific approach, to evaluate non-operating-room anaesthesia applications performed by non-anaesthesia health professionals in terms of patient safety, quality, and consistency, and to identify areas of deficiency.

Methods: After obtaining ethical approval, a questionnaire was prepared to evaluate practitioners' awareness of the anaesthesia and sedation processes administered to patients during procedures performed in their clinics. An electronic questionnaire (Google Form) was used to collect data.

Results: This study revealed that non-operating-room sedation applications are widely practiced across various specialties in our country, but levels of knowledge and skill regarding these applications are not standardized. Extending in-service training, developing practical skills in managing complications, and using objective criteria for patient follow-up after sedation are of great importance for patient safety and clinical efficacy.

Conclusion: Standardization of sedation practices can be achieved through multidisciplinary cooperation and the adoption of protocols based on current guidelines. In this context, it is recommended that structured training programs and clinical guidelines be established for non-anaesthesia healthcare professionals.

Objective: This study was designed to determine why anaesthesiologists working in various institutions in our country prefer current regional anaesthesia methods and to evaluate the use and prevalence of ultrasonography in these methods.

Methods: A questionnaire created on SurveyMonkey.com was sent electronically or face-to-face to anaesthesiology and reanimation physicians working in different provinces of our country, and they were asked to fill it out. The survey was intended to be administered to at least 200 volunteer anaesthesiologists. The questionnaire consisted of 34 questions, including demographic characteristics, neuraxial block and peripheral nerve block (PNB) applications, drug choices, preferences in paediatric cases, training, and safety measures.

Results: A total of 215 anaesthesiologists participated in our questionnaire. 39.2% were working in a university hospital, and 38.2% were working in a training and research hospital. PNB training was received by 89.2% of the participants during specialty training. For analgesic purposes, the interscalene block was preferred for shoulder surgery (57.4%), the axillary block for elbow, forearm, and hand surgery (49.8%), the erector spinae plane block for thoracic surgery (33.8%), and the transverse abdominis and rectus block for open abdominal surgery (51.5%).

Conclusion: Regional anaesthesia is an essential part of multimodal analgesia and is used both as an anaesthetic and analgesic in routine practice. In recent years, many new techniques have been utilized as a result of advancements. However, for these to be implemented in practice, up-to-date information should be closely followed, and anaesthetists should be supported in terms of training and equipment.

Anaesthetics are commonly used agents during medical interventions and surgeries. Exposure to anaesthetic agents in late intrauterine life or early childhood may cause neurodegeneration in developing brains. Neuroapoptosis and neural inhibition provided by several mechanisms and microRNAs (miRNAs) have crucial roles in this milieu. miRNAs have critical roles in response to anaesthetic exposure. Through this review, we performed a systematic search of the PubMed database for studies on the role of anaesthetics in the brain and their relation with miRNAs. The terms "anesthetic", "miRNA", and "brain" were searched. Here we summarized the roles and interactions of miRNAs under exposure to anaesthetics in vivo and in vitro studies. Anaesthetic agents studied included sevoflurane, isoflurane, ketamine, and propofol. Many microRNAs were identified to have regulatory roles in anaesthesia-induced neurotoxicity. The literature study supports the idea that miRNAs play crucial functions in neuroprotection and neurotoxicity in anaesthesia administration. The exact role and implication of miRNA in anaesthesia neurotoxicity needs to be elucidated to gain more knowledge about the area. Several gaps in knowledge should be filled by conducting basic, clinical, and translational analyses in the future to decipher the definite role of miRNAs and their functions in the context of anaesthesia-induced neurotoxicity.

Hereditary angioedema (HAE) causes recurrent angioedema attacks in the oropharynx, larynx, face, and other regions due to bradykinin overproduction as a result of C1 esterase inhibitor deficiency. Surgical interventions requiring general anaesthesia might trigger HAE attacks. Laryngeal angioedema is the most important cause of perioperative mortality. Tracheal dilatation was performed by rigid bronchoscopy in our patient with type 1 HAE, because of tracheal stenosis due to prolonged intubation, which occurred after the attack. The patient was administered 2x500 IU C1 esterase inhibitor approximately 24 hours before rigid bronchoscopy. No complication developed after the first procedure. Two months later, tracheal dilatation was repeated and 2x500 IU C1 esterase inhibitor was administered. While the patient was followed up in the intensive care unit, significant oedema developed in the facial area, especially the tongue and lips, approximately 10 hours after the procedure. Our patient also had stridor due to airway obstruction. The patient was treated with 1000 IU C1 esterase inhibitor and 3 units of fresh frozen plasma (FFP). After FFP, edema started to regress. The patient was discharged after symptoms improved. The patient should be monitored in the intensive care unit for a minimum of 48 hours to monitor for postoperative laryngeal oedema.

Objective: Paediatric airway management is challenging due to anatomical differences, making effective endotracheal intubation crucial during surgery. While direct laryngoscopy (DL) has been the standard method, video laryngoscopy (VL) has emerged as a promising alternative. This study compared the effectiveness of King Vision aBlade non-channeled VL (KVL) with Miller/Macintosh DL for intubation in children.

Methods: In this prospective, randomized, single-blinded study, 150 children aged 2-10 years undergoing elective surgery were randomly assigned to either Group DL (n = 75) or Group KVL (n = 75). Data was collected on intubation success, time, glottic view, external maneuvers, and hemodynamic parameters [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SpO₂)] at various intervals.

Results: The mean age of patients was similar in both groups (P=0.15). The DL group had a higher success rate on the first attempt (P < 0.001) and shorter intubation times (9.97±3.12 sec vs. 14.35±2.99 sec, P < 0.001) compared to KVL. Although KVL provided a better glottic view, this difference was not statistically significant (P=0.059). Hemodynamic parameters (SBP, DBP) were significantly higher in the DL group post-intubation (P < 0.05), with no significant differences in HR or SpO₂ between groups. The DL group required more external maneuvers for intubation (P=0.022).

Conclusion: DL showed a higher success rate, faster intubation times, and greater hemodynamic stability compared to KVL. While KVL offered better glottic views, it had longer intubation times and lower success rates. Further studies with larger sample sizes are recommended to validate these findings.

Advanced hemodynamic monitoring has revolutionized perioperative medicine and critical care by providing comprehensive insights into cardiovascular physiology and facilitating precise assessment and management of complex parameters such as cardiac output, systemic vascular resistance, fluid responsiveness, and tissue perfusion. These technologies enhance the capacity of clinicians to detect subtle physiological alterations, enabling timely interventions and individualized therapeutic strategies, particularly for critically ill patients and those undergoing major surgical procedures. This two-part review offers a comprehensive analysis of hemodynamic monitoring. Part I examined the fundamental principles of macrohemodynamics and microhemodynamics. Part II focuses on advanced hemodynamic monitoring tools, tracing the evolution of cardiac output measurement techniques from Fick's oxygen consumption method in 1870 to contemporary innovations, such as pulse contour analysis, bioimpedance/bioreactance, and real-time non-invasive modalities like advanced echocardiography. By examining the underlying principles, devices, invasiveness, clinical applications, advantages, and limitations of various monitoring techniques, this review elucidates the clinical utility of advanced tools in addressing the limitations of standard monitoring and optimizing patient outcomes in modern anaesthesia and critical care practices.