Turkish journal of anaesthesiology and reanimation最新文献

Objective: Percutaneous nephrolithotomy (PCNL) is accompanied by somatic and visceral pain intraoperatively and postoperatively. However, pain management strategies lack a decisive consensus. Erector spinae plane block (ESPB) is a novel paraspinal fascial block that can be used in PCNL patients, and we aimed to investigate whether ESPB will reduce intraoperative and postoperative opioid consumption and postoperative pain scores in PCNL patients.

Methods: The study was randomized, controlled, and open-label. Two groups were formed as the control group (GCont) and block group (Gblock), and patients received total intravenous anaesthesia. GBlock received an ESPB catheter in addition in the prone position. Intraoperative parameters and infusion doses, postoperative rescue analgesic doses, and pain scores were recorded. The primary endpoint was intraoperative analgesic consumption, and the secondary endpoints were postoperative pain scores and analgesic consumption.

Results: Sixty-four patients were analyzed. Remifentanil consumption of GCont was found to be significantly higher (GBlock: 0.0865 ± 0.030 vs GCont: 0.1398 ± 0.034, μg kg^-1 min^-1, P < 0.001). The control group reported higher pain scores between the 30^th min and 24^th hours and needed more analgesics between the 1^st and 6^th hours postoperatively. GBlock received local anaesthetics via ESPB catheter before nephrostomy tube removal and fewer patients needed analgesics [5 patients (15.6%) vs. 28 patients (87.5%), P < 0.001]. GCont consumed more tramadol postoperatively (262.5 mg vs. 75 mg, P < 0.001).

Conclusion: We found that ESPB reduced intraoperative opioid consumption. It also reduced the need for rescue analgesia and postoperative pain scores during nephrostomy tube removal. We concluded that the ESPB catheter may effectively be used in analgesia management during and after PCNL operations.

Fryns syndrome cases with variable characteristics require careful preoperative evaluation and have challenges for airway management. Craniofacial anomalies can complicate both ventilation and intubation. Extubation can also be problematic because of limited pulmonary reserves.

Objective: CD-8 T-cells are responsible for the clearance of virally infected cells. In patients with Coronavirus disease-2019 (COVID-19) pneumonia, there are quantitative reductions and functional impairments in T-cells. Low CD-8 T-cell levels cause worse clinical situations. In this study, the relationship between decreased CD-8 T-cells and mortality in patients with COVID-19 pneumonia in the intensive care unit (ICU) was investigated.

Methods: In this multicenter retrospective study, 277 patients were analyzed. Demographic data, ICU admission scores, blood gas levels, laboratory samples, and outcomes were recorded. Statistical Package for the Social Sciences version 28 was used for statistical analysis.

Results: Two hundred forty of 277 patients were included in the study. The mortality rate was 43.3%. In non-survivors, median values of age, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II (APACHE-II), procalcitonin, leukocyte count, neutrophil count, neutrophil-lymphocyte count ratio, and duration of invasive mechanical ventilation were significantly higher, whereas median values of PaO₂-FiO₂ ratio, lymphocyte count, CD-4, and CD-8 T-cells were significantly lower than those in survivors. In the multivariate Cox regression model, the risk of mortality increased 1.04-fold (1.02-1.06) and 1.05-fold (1.01-10.8) by every one unit increase in age and APACHE-II, respectively, whereas it decreased 0.71-fold (0.58-0.87) by every hundred increase in CD-8 T-cells P < 0.001, P=0.007 and P=0.001 respectively.

Conclusion: According to our findings, age, APACHE-II, and CD-8 T-cell levels seem to be independent risk factors for mortality in patients with COVID-19 pneumonia in the ICU.

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergency that needs prompt diagnosis and treatment with endovascular coiling or surgical clipping of the aneurysm to prevent re-bleeding. In addition to neurologic manifestations, aSAH can cause respiratory and cardiovascular complications. The prevention of hypoxemia and hypercarbia, control of intracranial pressure, and restoration of cerebral perfusion pressure should be the primary aims of early management. Secondarily, the most important causes of persistent neurological deficits and physical dependence in aSAH are vasospasm and delayed ischemia following bleeding. During that period, a focus on the detection, prevention, and treatment of vasospasm should be the rule. Transcranial Doppler allows detection and follow-up of vasospasm, especially in severe cases. Nimodipine is the only drug that has proven efficacy for treating vasospasm. Balloon angioplasty is performed in cases of resistance to medical treatment. Along with angioplasty, intra-arterial vasodilators can be administered. New diagnostic and therapeutic advances will hopefully improve outcomes in the near future.

A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study.

Objective: The present study aimed to compare the effects of two different fresh gas flows (FGFs) (0.5 L min^-1 and 2 L min^-1) applied during maintenance of anaesthesia on recovery from anaesthesia and early cognitive functions in geriatric patients.

Methods: In this prospective, randomised, double-blind study, sixty patients were divided into two groups according to the amount of FGF. Minimal-flow anaesthesia (0.5 L min^-1 FGF) was applied to group I and medium-flow anaesthesia (2 L min^-1 FGF) was applied to group II during maintenance of anaesthesia. Following the termination of inhalation anaesthesia, recovery times were recorded. The evaluation of cognitive functions was performed using the Addenbrooke's Cognitive Examination (ACE-R).

Results: There was no significant difference between the two groups in terms of demographic characteristics and recovery (P > 0.05). There was no significant difference between the two groups in terms of the preoperative day, the first postoperative day, and the third postoperative day; ACE-R scores (P > 0.05). In group II, on the third postoperative day ACE-R scores were found to be significantly lower than the preoperative ACE-R scores (P=0.04). In group II, third postoperative day ACE-R memory sub-scores (14.53 ± 3.34) were found to be significantly lower than preoperative ACE-R memory sub-scores (15.03 ± 3.57) (P=0.04).

Conclusion: In geriatric patients, minimal-flow anaesthesia was not superior to medium-flow anaesthesia in terms of recovery properties and cognitive functions. Keeping in mind that hypoxaemia and changes in anaesthesia levels may occur with the reduction of FGF, both minimal- and medium-flow anaesthesia can be applied with appropriate monitoring without adverse effects on recovery and cognitive functions.

Objective: Despite various pain management methods, chronic pain is still a challenging issue after thoracotomy. This retrospective study was designed to determine the possible factors affecting the development of chronic pain following open thoracotomy.

Methods: The study included patients who underwent elective open thoracotomy at Ankara University İbni Sina Hospital, between 01.01.2016 and 31.12.2020. The medical files and electronic records of the patients were scanned from the system. Patient history, analgesic methods, and surgical details were recorded. The need for and usage analgesic drugs after the surgery were also recorded.

Results: A total of 229 patients who underwent thoracotomy were included in the study, and 83 (36.2%) patients had chronic pain. Duration of surgery, doses of remifentanil, fentanyl or NSAI drugs, duration or number of chest tubes (more than 4 days, or more than 2 tubes), diabetes, or PCEA usage were found as variables affecting pain. Logistic Regression, Multilayer Perceptron, Naive Bayes, AdaBoost, and Random Forest methods were used to evaluate the prediction performances. According to the model created with logistic regression, the rate of the correct classification was 90.8%. The duration of surgery, remifentanil administration, chest tube for more than 4 days, and diabetes were found to be risk factors for developing chronic pain. Fentanyl bolus, PCEA-bupivacaine, and NSAID bolus were determined as preventive factors.

Conclusion: A careful analysis of risk factors should be performed for each patient to prevent chronic pain after thoracotomy, and preemptive effective analgesia methods should be performed.

Objective: We evaluated whether systemic ondansetron was also useful in the attenuation of propofol injection pain similar to ondansetron pretreatment.

Methods: Eighty patients were enrolled. Patients in group S received ondansetron 4 mg in saline in the right hand followed 30 min later by 5 mL saline in the left hand along with venous occlusion. Group L patients received 4 mL of saline in the right hand followed by 5 mL 4 mg ondansetron in the left hand after 30 min. Two minutes later the occlusion was released. Patients received one-fourth of the calculated total dose of propofol, and their level of pain was graded on a scale of 0 to 3, with 0 denoting no discomfort. Mean blood pressure and heart rates were also recorded. Continuous variables were checked for normality using Shapiro-Wilks test. Normal continuous variables were expressed as mean standard deviation and non-normal continuous variables were expressed as median interquartile range. T-test for the difference in the mean and paired test were used for normally distributed continuous variable whereas Mann-Whitney U test-Wilcoxon test and sign test were used for non-normally distributed variables. Repeated measure analysis of variance was used for a variable measured over different periods of time to control for the baseline effect on subsequent measures.

Results: Our results demonstrated that both systemic administration 30 min before and local venous pretreatment with ondansetron were equally beneficial in reducing pain during propofol injection.

Conclusion: A systemic administration of ondansetron may play a role in the attenuation of propofol injection pain.

Objective: Postspinal hypotension occurs in nearly 50% of women undergoing cesarean section (CS). Although phenylephrine (PE) is currently the vasopressor of choice, severe maternal bradycardia may adversely affect the fetal status due to the reduction in the maternal cardiac output. Norepinephrine (NE) is not associated with bradycardia and is now being evaluated for the treatment of post-spinal hypotension in obstetric patients. The hypothesis of this study was that the prophylactic NE infusion was non-inferior to PE infusion when used for the prevention of postspinal hypotension.

Methods: This was a randomized, double-blinded controlled study conducted in 130 parturients scheduled for CS. The participants received either prophylactic NE (5 μg min^-1) or PE (25 μg min^-1) infusion beginning at the time of spinal injection. The primary outcome was the incidence of hypotension in both groups. Maternal bradycardia, reactive hypertension, nausea and vomiting, requirement of rescue boluses of vasopressor and/or atropine, and neonatal acid base status were also recorded.

Results: The incidence of hypotension was 33.80% (22 of 65) in Group PE and 26.10% (17 of 65) in Group NE (P=0.85). The absolute risk difference [90% confidence interval (CI)] in the incidence of hypotension between the groups was -7.7% (-20.9, 5.4). The upper limit of the CI was less than the non-inferiority margin of 20%, indicating that the NE infusion was non-inferior to PE.

Conclusion: Prophylactic infusion of NE is not inferior to prophylactic PE infusion in the prevention of postspinal hypotension in patients undergoing CS.