Turkish journal of anaesthesiology and reanimation最新文献

Paediatric neurosurgery has seen significant increases and improvements because of advancements in technology and monitoring techniques. This type of surgery presents unique challenges to the anaesthesiology team because of the general characteristics of paediatric patients and the complexity of the procedures. Managing paediatric patients undergoing complex neurosurgery requires profound knowledge of age-related normal physiology and the principles of common paediatric neuroanaesthesia. This review focuses on updated information about various critical topics in paediatric neurophysiology, bleeding management, acute pain treatment, intraoperative neuromonitoring, the specifics of the sitting position, and the general principles of paediatric neuroanaesthesia.

Multiple endocrine neoplasia type 2A (MEN2A), is associated with pheochromocytoma and medullary carcinoma of the thyroid. A surgical procedure in these patients can be complicated if they have any congenital heart disease (CHD). Nowadays, CHD patients are increasingly presenting at advanced age for non-cardiac surgeries, posing unique challenges to anesthesiologists. We hereby present a 44-year-old male with Eisenmenger syndrome (ES) and MEN2A, scheduled for bilateral adrenal excision and thyroidectomy. Patients with ES require meticulous and goal-directed management during non-cardiac surgery, depending upon pulmonary hypertension, cyanosis, and right ventricular dysfunction.

Objective: Delirium is a common condition that can significantly worsen a patient's clinical status. Timely and accurate detection of this often-overlooked condition is essential for effective prevention and treatment. This study aims to validate the Turkish version of the 3-Minute Diagnostic Interview for Confusion Assessment-defined Delirium (3D-CAM-TR), which has been culturally adapted for surgical intensive care patients.

Methods: This study was conducted in surgical intensive care units and wards at three academic hospitals, including 133 surgical intensive care patients. The 3D-CAM was culturally adapted and translated into Turkish. The 3D-CAM-TR was administered by trained clinicians from the first to the third postoperative day. During this period, delirium diagnosis was made by experienced psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria as the reference standard. All assessors were blinded to each other's assessment results. The 3D-CAM delirium diagnosis was compared with the reference standard in all patients.

Results: A total of 133 adult patients were assessed over three consecutive days, findings in 399 paired assessments. Compared to the DSM- 5-based reference standard, the sensitivity and specificity of the 3D-CAM-TR assessment were found to be 95% and 97%, respectively, for rater 1, and 93% and 99%, respectively, for rater 2, with good inter-rater reliability (Kappa coefficient=0.898, confidence interval=0.84, 0.96).

Conclusion: Our resultings indicate that the 3D-CAM-TR is a dependable and precise instrument for assessing delirium in postoperative intensive care patients.

Objective: With the regional anaesthetic technique used for brachial plexus block, the phrenic nerve (C3-C5) can be blocked due to its anatomical proximity to the brachial plexus and the effect of a significant volume of local anaesthetic deposited near the nerve roots. The goal of this study was to compare the incidence of hemi-diaphragmatic paralysis (HDP) following infraclavicular and supraclavicular approaches for brachial plexus block, using a low-volume local anaesthetic.

Methods: A total of 60 patients were enrolled in this study: 30 patients were assigned to the supraclavicular brachial plexus block group, and 30 patients were assigned to the infraclavicular brachial plexus block group. Under aseptic precautions and ultrasound guidance, both groups received 20 mL of 0.5% bupivacaine. The diaphragmatic excursion was measured using ultrasound before the block and 2 hours afterward in the postoperative care unit. A reduction in excursion of more than 75% compared with pre-block values was considered complete paralysis, whereas a reduction of 25-75% was considered partial paralysis.

Results: Infraclavicular brachial plexus block (3.33%) had a lower incidence of HDP compared with supraclavicular brachial plexus block (36.66%). The complications in both groups were not significant, and there was no need to use general anaesthesia.

Conclusion: The incidence of phrenic nerve palsy in the supraclavicular and infraclavicular brachial plexus groups was low, with a lower incidence of HDP in the infraclavicular group.

Enhanced recovery after surgery (ERAS) is a set of methods that provide early recovery with a multimodal approach in the perioperative care pathway. ERAS protocols are widely used worldwide in major surgery to improve surgical outcomes and require multidisciplinary collaboration. Using ERAS protocols means better pain management, earlier mobilization, improved oral nutrition, shorter hospital stays, and cost-effectiveness. ERAS protocols were introduced into renal transplant programs quite late. Transplantation patients are challenging and should be well prepared and followed up for ERAS. This review article highlights preoperative, intraoperative, and postoperative important points for preparing patients for renal transplantation for early recovery.

Objective: Modified thoracoabdominal nerve block with a perichondrial approach (M-TAPA) provides effective analgesia in the anterior and lateral thoracoabdominal regions. Previous studies have shown the efficacy of M-TAPA in laparoscopic surgery. The primary aim of this study was to investigate the efficacy of M-TAPA block in patients undergoing open major abdominal surgery.

Methods: This study was designed as a prospective, randomized, single-blind, controlled study. A total of 43 patients were included in the study. In group M-TAPA, the block was performed bilaterally at the end of the surgery. Local wound infiltration was performed on the control group. Postoperative analgesia was provided with patient-controlled intravenous morphine. When numeric rating scale (NRS) pain scores exceeded 4, rescue analgesia with tramadol was administered. The primary outcome of this study was to compare the 24-hour total morphine consumption. The secondary outcomes included comparing pain scores, rescue analgesia requirements, and patient satisfaction.

Results: Regarding our primary outcome, median morphine consumption during the first 24 hours was lower in the M-TAPA group [16 (14-18)] than in the control group [24.5 (19.5-27)] (P < 0.01, 95% confidence interval: -9, 42 and -3.01). Additionally, NRS scores were significantly lower and patient satisfaction was significantly higher in the M-TAPA group. The need for rescue analgesics in the first 24 hours was comparable among the study groups.

Conclusion: The M-TAPA block is an effective abdominal wall block that can be considered part of multimodal analgesia in open major abdominal surgery.

Glutaric aciduria type 1 (GA-1) presents unique challenges for anaesthetists. This case report discusses anaesthesia management in a pregnant woman with GA-1 undergoing cesarean delivery. Based on a cautious consideration of potential complications, combined spinal-epidural anaesthesia was preferred in this case. Maintenance of normoglycemia, normothermia, low-protein diet, carnitine supplementation, and proper hydration were prioritized. A healthy baby was delivered without complications. This case underscores the importance of comprehensive preoperative assessment and individualized anaesthesia strategies for achieving optimal outcomes in pregnant patients with GA-1. The cautious management of anaesthesia-related risks is important to ensure patient safety and decrease stress responses. Neuraxial anaesthesia and analgesia may be advantageous in specific cases.

Objective: Analgesia management following breast surgery is a critical concern. The erector spinae plane block (ESPB) is a regional anaesthesia technique that is frequently used for analgesia after breast surgery. However, there is no consensus on the volume. Therefore, the aim of this study was to compare ESPB performed using 20 mL vs. 30 mL.

Methods: The study included 43 female patients with American Society of Anesthesiologist class I-II physical status. Participants were randomized into two groups: 20 mL ESPB and 30 mL ESPB. Ibuprofen (400 mg) 3x1 was ordered, and a fentanyl patient-controlled analgesia device was attached intravenously to the participants. If the pain score was ≥4, meperidine (0.5 mg kg^-1) was administered.

Results: Postoperative fentanyl use was similar between the groups. There was no difference in the amount of rescue analgesic use between the groups. The static and dynamic numerical rating scores were similar between the groups. No statistical difference was noted in terms of nausea, vomiting, or itching between the groups.

Conclusion: A similar analgesic effect is achieved by performing ESPB using 20 or 30 mL of local anaesthetic at the same concentration.

Peripheral artery disease (PAD) is quite prevalent, and its incidence will increase with aging of population. Pain is a key diagnostic feature of symptomatic PAD and has been linked to disease progression and poor quality of life. Symptom improvement is of utmost importance in PAD; therefore, optimal and comprehensive pain therapy is mandatory. However, the management of acute pain in PAD remains challenging due to the lack of high-quality evidence, the complex pathophysiological mechanisms of pain, and the high comorbidity of patients. On the other hand, inadequate pain control leads to several pathophysiological deviations, such as the aggravated neuroendocrine stress response, which may be detrimental in patients with PAD. Experts suggest that the management of acute pain in patients with vascular diseases should be oriented toward the underlying pathophysiological mechanisms of each modality and should follow a multifactorial approach. Although the exact pain pathways in PAD are still poorly understood and more probably multifactorial, they may be key to an effective, individualized, patient-centered, multimodal pain strategy. The aim of this review was to provide a holistic, beyond-opioids, individualized multimodal pain approach for patients with PAD.