Turkish journal of anaesthesiology and reanimation最新文献

Objective: We aimed to investigate the effectiveness of the American Society of Anesthesiologists (ASA), the Surgical Outcome Risk Tool (SORT), and age-adjusted Charlson Comorbidity Index (ACCI) scores in determining the requirement for intensive care unit (ICU) admissions in patients aged 65 years and older who underwent hip surgery.

Methods: The study population consisted of 450 patients who underwent orthopedic hip surgery. The patients who were admitted to the ICU were either monitored in the postoperative ICU (Group 1) or transferred to the ward (Group 2). SORT and ACCI scores of all patients were recorded.

Results: The patients of Group 1 were significantly older than those in Group 2. SORT scores of both groups were comparable. The diagnostic sensitivity and specificity of ACCI scores were determined as 42.1% and 70.8%, respectively.

Conclusion: As a conclusion, ACCI scores can predict the need for ICU admissions in patients undergoing hip surgery. Besides, the traditionally used ASA scores are generally higher in this patient group. Determinative criteria for predicting the need for ICU admissions include older age of the patients, presence of comorbidities as hypertension and diabetes mellitus, as well as a long preoperative waiting period.

Objective: In the present study, European Cardiac Operative Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgery (STS) risk scoring systems were used to predict mortality in patients who underwent various types of open-heart surgery, including coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, and combined valve surgery with coronary artery bypass grafting, in the cardiovascular surgery operating room. The aim was to compare risk assessment systems regarding their clinical applicability.

Methods: A total of 469 patients, 141 (30.1%) female and 328 (69.9%) male, were included in the study. All risk factors were retrospectively recorded according to the EuroSCORE II and STS risk assessment systems. Statistical analysis was performed using the receiver operating characteristic (ROC) curve. Predicted and actual mortality rates were compared for each risk-scoring system.

Results: When the ability of the EuroSCORE and STS risk classifications to predict mortality was analyzed using the ROC curve, the area under the curve for the EuroSCORE II risk score was 78.3% (P < 0.001), while the area under the curve for the STS risk score was 82.3% (P < 0.001). In our study, the STS scoring system was found to have a greater predictive value than EuroSCORE II. When the patients' observed and expected mortality rates were examined according to the EuroSCORE II and STS risk scores, no statistically significant relationship was found between the expected and observed mortality rates for each risk group.

Conclusion: In our study, the STS risk scoring system was found to be more accurate in predicting in-hospital mortality than the EuroSCORE. However, there was no statistically significant difference between the expected and observed mortality rates in either risk-scoring system. There is no consensus in the literature regarding which scoring system is more effective. More studies from different societies are needed.

Awake craniotomy (AC) is a surgical technique where the patient stays conscious and interacts with the surgical team throughout part or all of the brain operation. In this case report, a 71-year-old ASA-3 patient with multiple comorbidities scheduled for a stereotactic brain biopsy was treated using AC. Our experience with AC, combined with a scalp block, is described in this case. AC is a safe technique that can be applied in patients with partially impaired communication abilities and may be particularly beneficial for those with multiple chronic conditions.

Objective: Minimal flow anaesthesia reduces costs and environmental pollution, and has a protective effect on the respiratory tract. This study aimed to compare the ease and tolerability of minimal flow anaesthesia in the geriatric and middle-aged patient populations.

Methods: In this prospective study, we enrolled 40 patients between 18 and 50 years (Group Y) and 40 patients 65 years or older (Group E), scheduled for abdominal surgery under general anaesthesia. Following a period of high flow with desflurane in O₂/air, the fresh gas flow was reduced to 350 mL min^-1. Desflurane concentration was adjusted to maintain a bispectral index between 40 and 50. The oxygen concentration in fresh gas flow was titrated by ±10%. Throughout the surgery, gas concentrations, oxygenation parameters, hemodynamic data, and the depth of anaesthesia were monitored. The number of alterations in fresh gas oxygen and desflurane concentrations was recorded.

Results: The depth of anaesthesia and oxygenation parameters were adequately sustained within safe limits among all patients, while the number of changes in the fresh gas flow oxygen levels was found to be significantly lower in geriatric patients. The increase in the number of oxygen level was 1.1±0.8 in Group E and 1.8±1.2 in Group Y (P=0.006). Total alteration in oxygen was 1.2±1 in Group E and 1.9±1.3 in Group Y (P=0.01). Oxygenation parameters consistently remained within clinically acceptable ranges in both groups, and the amount of change in desflurane concentration showed no intergroup difference.

Conclusion: Administering minimal flow anaesthesia at a rate of 350 mL min^-1 in the geriatric population, compared to the younger population, can be performed requiring less manipulation, without inducing hypoxia or inadvertent awareness.

In conclusion, treating increased intracranial pressure is a significant challenge for physicians in intensive care units and emergency departments. If not managed properly, elevated intracranial pressure can lead to brain edema, reduced oxygenation, and, ultimately, death. Intracranial hypertension can be caused by various conditions, including traumatic brain injury, massive intracranial bleeding, and large ischemic stroke, such as middle cerebral artery thrombosis. Treatment consists of both pharmacological and surgical. Surgical treatments include early surgical evacuation and decompressive craniectomy (DC). DC is a critical intervention for managing refractory intracranial hypertension when all conventional therapies fail. It is a decisive step that is intended to save lives and minimize long-term neurological deficits. The procedure must be carefully planned and executed based on the patient's specific clinical scenario and needs. The decision to proceed with DC should be based on a comprehensive assessment of the patient's condition, the effectiveness of other treatments, and the potential benefits and risks of the procedure. If all conventional pharmacological and non-pharmacological therapies fail and intracranial hypertension persists, regardless of the underlying cause, DC is indicated and can be considered a critical intervention. Currently, surgical treatment has gained popularity, and many papers have been published. This review summarizes the tendencies in the literature.

Objective: Due to a lack of high-quality data to guide anticoagulation therapy in extracorporeal membrane oxygenation (ECMO) patients, there is significant variation in practice among centers. We aimed to investigate the safety, anticoagulation efficacy, and cost-effectiveness of using bivaluridine as a primary anticoagulant without unfractionated heparin (UFH) in ECMO patients.

Methods: The study population included patients undergoing Veno-Venous ECMO for acute respiratory distress syndrome. A total of 56 patients were evaluated, 25 were on UFH and 31 were on bivalirudin.

Results: There was no significant difference between the time to reach the target activated partial thromboplastin time (aPTT) interval [6 (3.5-11) UFH, 9 (4-19) bivalirudin, P=0.287]. There was no significant difference between the percentage of time spent in the target aPTT interval (61.48±14.72 UFH, 62.65±11.99 bivaluridine, P=0.745). The median amount of erythrocyte suspension replacement (12.04±8.01; 7.9±4.71; P=0.028) and the median amount of fresh frozen plasma replacement [4 (2-6); 1 (0-4); P=0.001] were higher in the UFH group than in the bivaluridine group. The cost was lower in the UFH group compared to the bivalirudin group [$38.1 (13.5-48.7); $463.7 (194.3-819.8); P < 0.001].

Conclusion: The use of bivaluridine as a primary anticoagulant does not lead to any decrease in anticoagulant efficacy.

Objective: Paediatric airway management poses unique challenges due to anatomical and physiological differences compared to adults. Videolaryngoscopy (VL) has been proposed as a potential improvement over direct laryngoscopy (DL) for tracheal intubation. This study aimed to compare VL and DL in paediatric patients undergoing elective surgery.

Methods: A prospective, randomized study was conducted with 100 paediatric patients aged under 18 years, weighing 10-40 kg, and classified as American Society of Anesthesiologists physical status I-III. Patients were randomized into Group 1 (n = 50) that included patients who underwent laryngoscopic examination using Macintosh laryngoscope or Endolarenx videolaryngoscope (Group 2: n = 50). Data on intubation time, glottic view (Cormack-Lehane grades), first-attempt success rate, need for anterior laryngeal pressure, and complications were collected.

Results: VL was associated with longer intubation time than DL (29.1±5.7 s vs. 20.7±5.1 s, P=0.001). Glottic visualization was better in the VL group (Cormack-Lehane Grade 1: 78% vs. 66%), but first-attempt success rate was lower (74% vs. 98%, P < 0.001). The need for anterior laryngeal pressure was significantly reduced in VL (32% vs. 78%, P=0.01). No complications, such as trauma or hypoxaemia, were observed in either group.

Conclusion: VL improves glottic visualization and reduces the need for airway maneuvers but is associated with longer intubation times and lower first-attempt success. While DL may be more efficient for routine intubation, VL remains valuable in anticipated or emergent difficult airway situations.

Iatrogenic thoracic aortic injury caused by misplaced spinal instrumentation is a rare but potentially fatal complication of posterior spinal fusion and fixation procedures. The close anatomical relationship between the vertebral column and descending thoracic aorta puts the aortic wall at risk, especially when pedicle screws are malpositioned. While such injuries may remain asymptomatic initially, progressive erosion of the aortic wall can lead to catastrophic rupture. This case report highlights a 72-year-old woman with a history of diabetes, hypertension, and Takotsubo cardiomyopathy who developed a thoracic aortic injury following thoracolumbar instrumentation. Imaging revealed a pedicle screw at the T5 level, directly impinging on the aortic wall. A multidisciplinary approach involving cardiovascular, neurosurgery, and anaesthesiology teams was utilized, and thoracic endovascular aortic repair (TEVAR) was performed to stabilize the aorta before hardware removal. Despite successful surgical intervention, the patient later developed a right-sided middle cerebral artery infarction, possibly due to thromboembolism from the TEVAR site. This case underscores the importance of a staged surgical approach with TEVAR in managing aortic injury during spinal instrumentation, especially in high-risk patients with comorbidities such as Takotsubo cardiomyopathy. Careful anaesthesia management and multidisciplinary collaboration are essential to optimize outcomes in such complex cases.

Objective: The aim of this study is to compare the identification of the sacral cornua using palpation and ultrasound, and to evaluate the sacrococcygeal area via ultrasound across different age groups of children.

Methods: This study included 348 children aged 1 to 84 months, who were divided into three age groups: 1-24 months, 25-48 months, and 49-84 months. Sacral cornua were assessed using both palpation and ultrasound imaging. Palpation findings were categorized as "good", "difficult", or "non-palpable". Ultrasound imaging of the sacral cornua was classified as "clear", "unclear", or "invisible". Measurements taken included the inter-cornual distance, the anteroposterior diameter of the sacral canal, the distance from the skin to the sacral canal, and the distance from the dural sac to the cornua level.

Results: Palpation of the sacral cornua was rated as "good" in 75.9% of patients, "difficult" in 22.4%, and "non-palpable" in 1.7%. All patients with "good" cornua palpation were also classified as "clear" on ultrasound imaging. Among the cases with "difficult" palpation, 76% showed a "clear" ultrasound image, while 24% were "unclear". Only one patient had "invisible" cornua on ultrasound. The mean distance from the dural sac to the cornua level was 3.72±1.64 cm, and this distance increased significantly with age (P < 0.01).

Conclusion: Ultrasound is a valuable tool for identifying the sacral cornua, especially when palpation is difficult, and offers reliable, detailed information on sacral anatomy.