Turkish journal of anaesthesiology and reanimation最新文献

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.

Objective: Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management.

Methods: In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over).

Results: The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively).

Conclusion: In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.

Non-invasive ventilation application in neurocritical care with risk of pneumocephalus is controversial. Non-invasive ventilation-related increased intrathoracic pressure increases intracranial pressure via direct transmission of intrathoracic pressure to the intracranial cavity. In addition, increased thoracic pressure decreases venous return to the heart and increases vena jugularis interna pressure, thereby increasing cerebral blood volume. Pneumocephalus is one of the major concerns after non-invasive ventilation application in head/brain trauma patients. Non-invasive mechanical ventilation may be performed in limited conditions in head trauma/brain surgery with appropriate and close monitoring. High-flow nasal cannula oxygen therapy can provide higher FiO2 as manifested by a larger increase in PaO2/FiO2 ratio and provide the theoretical basis in pneumocephalus because augmenting the PaO2 more effectively would accelerate nitrogen (N2) washout. As a result, non-invasive mechanical ventilation may be performed in limited manner in head trauma/ brain surgery with appropriate and close monitoring.

Objective: Patients' airway assessment is one of the foremost responsibility of every anaesthesiologist. Several preoperative predictive methods have been studied by various authors to find the best difficult airway predictor. We conducted this study to compare three methods to predict difficulty of laryngoscopic endotracheal intubation viz Ratio of patient Height to Thyro-Mental Distance (RHTMD), Ratio of Neck Circumference to Thyro-Mental Distance (RNCTMD) and Thyro-Mental Height (TMHT) in adult patients.

Methods: This prospective observational study was conducted on 330 adult patients, ASA staus I and II, aged 18-60 years of either sex, weighing 50-80 kg scheduled for elective surgeries under general anaesthesia. Patient's height, weight, Body Mass Index (BMI) was recorded and thyromental distance, neck circumference, TMHT were measured preoperatively. Laryngoscopic view was graded according to Cormack- Lehane (CL) Grade. Predictive indices and optimal cut-off values were calculated using ROC curve analysis.

Results: Difficulty in laryngoscopic endotracheal intubation was encountered in 12.42% patients. The sensitivity, specificity, positive predictive value, negative predictive value and Area Under Curve (AUC) for TMHT were 100%, 95.2%, 75.54%, 100%, 0.982; for RHTMD were 75.6%, 72.7%, 28.18%, 95.45%, 0.758 and for RNCTMD were 82.9%, 65.4%, 25.37%, 96.42%, 0.779 respectively. There was no statistically significant difference to predict difficulty of laryngoscopic intubation between any of them (P < .05).

Conclusions: Among these 3 parameters, TMHT was found to be the best preoperative method to predict difficult laryngoscopic endotracheal intubation with highest predictive indices and AUC. The RNCTMD was found to be more sensitive and useful method than RHTMD to predict difficulty of laryngoscopic endotracheal intubation.

Headache is a common symptom in the postpartum period, which can have a varied aetiology. Although rare, cerebral venous thrombosis can be a fatal complication in the parturient. Dural puncture is considered as one of the risk factors for cerebral venous thrombosis and the proposed mechanism pathogenesis can be explained by the components of Virchow's triad: stasis of the blood, hypercoagulability, and endothelial damage. Headache is usually the most frequent symptom and can mimic those of postdural puncture headache, which can delay the diagnosis. We will report a case of an 18-year-old woman that develops a postpartum headache after an accidental dural puncture during epidural catheter placement for labour analgesia. Our patient was initially managed for postdural puncture headache, but later the character changed, which made us look for a differential diagnosis. After a multidisciplinary approach, neuroimaging confirmed the diagnosis of cerebral venous thrombosis. This case report emphasises the importance of a careful differential diagnosis of postpartum headache particularly if the headache persists or changes its character. Brain imaging and multidisciplinary evaluation can lead to prompt diagnosis and initiation of appropriate treatment.

Objective: Adductor canal block has been used for effective post-operative analgesia; however, the optimal location of adductor canal block placement is still controversial. We aimed to assess the opioid consumption and pain intensity in patients undergoing proximal, mid, and distal adductor canal block after knee arthroscopy.

Methods: A total of 90 patients who had undergone an arthroscopic knee surgery and proximal, mid, or distal adductor canal block for postoperative analgesia were examined. All groups received 20 mL of bupivacaine (0.375%) to the adductor canal. Post-operative pain scores, tramadol consumption, Bromage scores, additional analgesic need, and other complications were recorded.

Results: Our results demonstrated that proximal adductor canal block group significantly reduced opioid consumption compared to the midadductor canal block group (P < .001), and mid-adductor canal block group provided significantly decreased opioid consumption than the distal adductor canal block group (P = .004). The visual analog scale values were significantly lower in the proximal adductor canal block group compared to the mid-adductor canal block group at 0, 2, 4, 8, 12, and 24 hours, except in resting visual analog scale values at 24 hours. When the proximal and distal groups were compared, visual analog scale values were significantly lower in the proximal adductor canal block group. The Bromage score was 0 in all groups at each follow-up point. Post-operative nausea was observed in only 3 (3.3%) patients, all of these patients were in the distal adductor canal block group.

Conclusion: Ultrasound-guided adductor canal block can be applied reliably at proximal, mid, and distal locations. The proximal adductor canal block approach provides significantly lower tramadol consumption and post-operative visual analog scale values than the mid- and distal adductor canal block groups.