Turkish journal of anaesthesiology and reanimation最新文献

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: 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.

Objective: This study aims to assess the practices of anaesthesiologists in Türkiye regarding paediatric anaesthesia. It focuses on preoperative, intraoperative, and postoperative care protocols.

Methods: Survey data were collected using a web-based electronic platform. The participants were asked to answer the questions based on the available equipment in their hospitals in daily practice. The questionnaire forms were sent to participants by the Turkish Society of Anesthesiology and Reanimation via e-mail.

Results: Three hundred five anaesthesiologists responded to the survey. The specific practices and standards for paediatric anaesthesia in Türkiye along with how anaesthesiologists approach paediatric patients were concluded from the survey results.

Conclusion: There are still gaps in paediatric anaesthesia practice. We believe that further research and dedicated discussions on this topic will play a key role in addressing these drawbacks.

Objective: Appendectomy for acute appendicitis is the most common acute surgical procedure in children. Recent changes in appendicitis management have likely modified the nature and cost of hospitalizations for this condition.

Methods: Using data from the National Inpatient Sample from 2001 to 2017, we performed a cross-sectional study and identified the temporal changes in hospitalization for appendectomy. Changes in relative hospitalization cost and length-of-stay were also studied to assess their associations with the changes in procedure incidence. Patient and hospital characteristics were considered to understand outcome disparities between groups. Geographic variation in the outcomes was also identified at the United States region and division levels.

Results: The incidence of appendectomy hospitalization decreased from 11.2 to 6.4 per 10,000 person-years between 2001 and 2017. Conversely, the median procedure cost increased 61% during this same period. The temporal changes in appendectomy hospitalization varied according to patient and hospital characteristics, as well as geographic locations.

Conclusion: The overall incidence of appendectomies in children decreased substantially from 2001 to 2017, yet the trend for costs was in the opposite direction. The data on the clinical factors driving these trends can be useful in guiding policies with evidence-based guidelines that help optimize clinical decisions and the effective use of resources in the management of appendicitis.

Standard monitoring guidelines by the American Society of Anesthesiologists and European Society of Anaesthesiology and Intensive Care have not been updated for over a decade, despite rapid advancements in monitoring technology and the growing complexity of surgical patients. Traditional parameters such as blood pressure and pulse oximetry often fail to detect critical intraoperative conditions, emphasizing the need for comprehensive hemodynamic assessment. This review, the first of a two-part series, explores the fundamental elements of hemodynamics, including cardiac output, stroke volume, blood pressure, and oxygen delivery, with a focus on their physiological basis, clinical significance, and perioperative applications. This article provides a detailed foundation for understanding hemodynamic monitoring, setting the stage for the second article, which addresses advanced monitoring tools and their applications in contemporary anaesthesia practice.