Turkish journal of anaesthesiology and reanimation最新文献

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.

Objective: This retrospective study aimed to evaluate and compare the clinical efficacy of intradiscal ozone therapy (OT) against a combination therapy of ozone and platelet-rich plasma (PRP) in patients diagnosed with intervertebral disc degeneration (IVDD).

Methods: The study included a cohort of 50 patients, divided equally into two groups of 25, who received either intradiscal OT or ozone + PRP combination therapy between February 2022 and February 2023. The sample comprised 20 females and 30 males, with ages ranging from 19 to 76 years (mean age 48.8). Pain intensity was measured using the visual analog scale (VAS), while disability levels were assessed using the oswestry disability index (ODI) prior to treatment and at 1, 3, and 6 months post-treatment. Additionally, lumbar magnetic resonance imaging was conducted at the 3-month mark post-treatment, with evaluations based on the Pfirrmann disc degeneration classification.

Results: Significant improvement in both VAS and ODI scores was observed in both treatment groups (P < 0.001). The ozone + PRP combination therapy group exhibited no statistically significant difference in VAS and ODI scores compared to the ozone-only group (P > 0.05).

Conclusion: Intradiscal OT and the ozone + PRP combination therapy represent effective minimally invasive treatment options for patients suffering from IVDD, yielding substantial clinical benefits with minimal side effects. That is why it is suggested as a potential preferred therapeutic approach prior to the consideration of surgical interventions.

Objective: Preoperative fasting is a common practice aiming to reduce the risk of pulmonary aspiration during anaesthesia. It is advised to avoid fasting times longer than 6 hours in all children, whenever possible. Prolonged fasting can be uncomfortable for children and may lead to dehydration and other negative outcomes. The primary outcome of the study was the relationship between preoperative duration of fasting and cardiac index (CI) variability, used as a surrogate for intravascular volume status after the induction of anaesthesia, in paediatric patients undergoing surgery.

Methods: Prospective, observational study that included patients over 5 years of age, scheduled for surgery. Passive leg-raising-induced CI variability was evaluated for fluid responsiveness and intravascular volume after anaesthesia induction. Patients were termed fluid responders (Rs) if an increase in CI of >10% was obtained after passive leg raising, and non-responders (NRs) if the CI variability was <10%. CI and aortic peak velocity (V_peak) were measured through the suprasternal notch via an ultrasonic cardiac output monitor.

Results: There were 32 Rs and 53 (NRs). The mean duration of fasting for Rs was 11.53±2.61, while NR had a mean duration of fasting of 10.6±2.93 hours, showing an insignificant difference. Aortic V_peak change was significantly higher in Rs (0.24±0.17) compared to NRs (0.03±0.13) (P < 0.001). Duration of fasting showed no significant correlation with CI variability and peak aortic velocity.

Conclusion: With this study method, it was observed that preoperative fasting time had no effect on intraoperative intravascular volume.

Objective: Postoperative pulmonary complication (PPC) is one of the leading causes of poor surgical outcome leading to longer hospital or intensive care unit stay and mortality especially with upper abdominal surgeries having long duration. High-frequency nasal oxygenation (HFNO) has recently been employed for postoperative oxygenation following extubation in surgical patients.

Methods: Fifty consenting adult patients aged 18-65 years of either sex scheduled for exploratory abdominal surgeries under general anaesthesia (GA) with Assess Respiratory Risk in Surgical Patients in Catalonia score ≥26 i.e., moderate to high risk were enrolled. After instituting all routine the American Society of Anesthesiologists recommended monitoring, baseline haemodynamic parameters were recorded. Patients were preoxygenated with 100% oxygen and GA was administered as per standard institutional protocol. Following extubation, patients were randomly allocated into one of the groups comprising 25 patients each where Group C and Group H received conventional oxygen therapy via simple face mask and HFNO respectively. The FiO₂ was titrated (from 45% to 100%) by the anaesthesiologist to maintain a SpO₂ of 95% or more. Arterial blood samples were collected after extubation at various designated time points i.e. 2^nd, 6^th,12^th and 24^th hr, The P/F ratio, PaO₂, PaCO₂, SaO₂/FiO₂ ratio along with haemodynamic parameters, incidence of PPCs/acute hypoxemic respiratory failure (AHRF), atelectasis and comfort score were also recorded.

Results: Significant improvement in all oxygenation parameters following the use of HFNO for postoperative oxygenation; however, PaCO₂, haemodynamic variables, complications, incidence of PPCs/AHRF and atelectasis remained comparable between the two groups.

Conclusion: Preventive use of HFNO for post operative oxygenation amongst moderate to high-risk patients scheduled for exploratory abdominal surgery improves oxygenation.

Objective: Postoperative nausea and vomiting (PONV) is a significant issue encountered in surgical patients. This study aims to investigate the effects of dextrose infusion timing on PONV incidence.

Methods: Ninety patients undergoing laparoscopic cholecystectomy were included in this randomized controlled trial. Patients were assigned to one of three equal groups. In Group I, patients received an infusion of 400 mL of 0.9% saline 2 hours before surgery. In Group D, patients received 400 mL of 5% dextrose at the same infusion rate. Both Groups I and D received 0.9% saline at 10 mL kg^-1 h^-1 during the intraoperative period. In Group DD, patients received 200 mL of 5% dextrose preoperatively and 200 mL intraoperatively. To ensure the total maintenance fluid volume was the same as in the other groups, an infusion of 0.9% saline was administered along with the 200 mL dextrose. The primary outcome in our study was PONV incidence. Secondary outcomes were postoperative pain and anxiety levels.

Results: Postoperative PONV incidence, antiemetic consumption, and anxiety levels were lowest in Group DD, while they were highest in Group I (P < 0.05).

Conclusion: In this study, we found that dextrose infusion reduced the incidence of PONV, antiemetic consumption, and anxiety levels. We observed that administering the same volumes of dextrose in divided doses during the preoperative and intraoperative periods reduced the incidence of PONV and improved anxiety scores compared to sole preoperative dextrose infusion.

Objective: To compare postoperative pain after different surgical types and grades using the visual analogue scale (VAS) and numeric rating scale (NRS) evaluated by the patient, parent, and nurse.

Methods: After approval from the local ethics committee and written informed consent from the patient and parent, a single-center, prospective, randomized study was designed. A total of 180 children with American Society of Anesthesiologists I-III physical status between the ages of 7-12 (n = 90) and 13-18 (n = 90) years were included in the study who underwent elective surgery at Ankara University Faculty of Medicine Hospitals between January and December 2022. Pain was assessed postoperatively at 2 hours using two pain scales. Patients who underwent mini-intermediate or major surgery were evaluated separately.

Results: Four children from each age group were excluded from the study due to insufficient data recording, and data from 172 children were analyzed. Including all age groups and surgical grades, all children had excellent agreement with the parent [VAS/NRS: intraclass correlation coefficient (ICC)= 0.903/ICC= 0.900] and good agreement was found between the child and nurse (VAS/NRS: ICC= 0.852/ICC= 0.842). For the VAS and NRS, when parent and nurse compliance scores were compared, no significant difference was observed between the two scores. For VAS and NRS, fathers were found to be better at predicting pain for children than mothers.

Conclusion: Self-reported pain is the gold standard for pain evaluation. The parents assessed pain scores that were similar to those of their children using NRS and VAS. Nurses underestimated a child's pain with both scores.

Objective: The Syrian civil war has resulted in one of the largest refugee movements globally, significantly impacting Türkiye due to its geographic proximity. Surgical care represents a critical yet often overlooked aspect of healthcare services required by displaced populations. This study aimed to evaluate the demographic characteristics and surgical procedures performed on migrant patients over a ten-year period at a secondary-level hospital located on Türkiye's southern border.

Methods: A retrospective cohort study was conducted at Kilis State Hospital between March 2010 and January 2020. Surgical procedures were categorized by department, patient nationality, and type of surgery. Patients operated under the "war code" were analyzed separately to identify conflict-related injury patterns.

Results: A total of 52,978 surgical procedures were performed, with 41.76% involving Syrian patients. The mean age was 31.28±20.33 years, and male patients predominated, especially among the war-injured subgroup (91.59%). The most active surgical departments were orthopedics and traumatology (20.63%), gynecology and obstetrics (17.51%), and general surgery (15.67%). Among war-related surgeries, orthopedics, neurosurgery, and plastic surgery departments played major roles.

Conclusions: This study highlights the high surgical demand among migrant populations in border regions, especially in conflict settings. Strengthening healthcare infrastructure, maintaining accurate surgical records, and implementing multidisciplinary approaches are essential for meeting these needs. Our findings can inform future policies aimed at improving surgical care for displaced populations.