Pub Date : 2023-07-31DOI: 10.54875/jarss.2023.35492
E. M. Şimşek, Ş. M. Aksoy, Nurettin Nurettin Manti, O. Erel, S. Neşelioğlu, A. Fırat
Objective: Surgical trauma causes serious neuroendocrine and cytokine activity. In addition, the free oxygen radicals formed because of the ischemia/reperfusion injury resulting from applying and releasing the tourniquet (TQ) cause oxidative stress. Thiol and disulfide are among the new oxidative stress parameters used reliably in recent years. The aim of this study was to compare thiol-disulfide balance in general and spinal anesthesia, which are frequently used in total knee replacement (TKR) surgery. Methods: Fifty six patients aged 60-74 years scheduled to undergo TKR were randomly allocated to the general anesthesia (n=26) and spinal anesthesia (n=30) groups. The tourniquet (TQ) was applied for the TKR procedure after collecting a preanesthetic blood sample (T1). Blood samples were also collected at 5 minutes (T2) and 40 minutes (T3) after TQ release and at postoperative 24 hours (T4) to analyze native thiol, total thiol, disulfide, disulfide/native thiol ratio, disulfide/total thiol ratio, and native thiol/total thiol ratio. All patients had intravenous patient-controlled analgesia during the postoperative period. Mean arterial pressure, TQ times, and Visual Analogue Scale (VAS) scores were recorded. Decrease in thiol and increase in disulfide in the thiol-disulfide balance were recorded as oxidative stress indicators. Results: There was no difference between the groups in terms of VAS and analgesic consumption at the end of 24 hours. The general anesthesia group had higher native thiol, total thiol, and native thiol/total thiol ratio and lower disulfide, disulfide/native thiol ratio, and disulfide/total thiol ratio at all time points compared to the spinal anesthesia group. Conclusion: Assessment in terms of thiol-disulfide balance suggests that general anesthesia had a favorable effect on oxidative stress. Keywords: General anesthesia, oxidative stress, spinal anesthesia, thiol-disulfide, tourniquet time, visual analogue scale
{"title":"The Effect of Spinal and General Anesthesia on Thiol-Disulfide Balance During Ischemia/Reperfusion of the Leg in Patients Undergoing Knee Replacement Surgery","authors":"E. M. Şimşek, Ş. M. Aksoy, Nurettin Nurettin Manti, O. Erel, S. Neşelioğlu, A. Fırat","doi":"10.54875/jarss.2023.35492","DOIUrl":"https://doi.org/10.54875/jarss.2023.35492","url":null,"abstract":"Objective: Surgical trauma causes serious neuroendocrine and cytokine activity. In addition, the free oxygen radicals formed because of the ischemia/reperfusion injury resulting from applying and releasing the tourniquet (TQ) cause oxidative stress. Thiol and disulfide are among the new oxidative stress parameters used reliably in recent years. The aim of this study was to compare thiol-disulfide balance in general and spinal anesthesia, which are frequently used in total knee replacement (TKR) surgery. Methods: Fifty six patients aged 60-74 years scheduled to undergo TKR were randomly allocated to the general anesthesia (n=26) and spinal anesthesia (n=30) groups. The tourniquet (TQ) was applied for the TKR procedure after collecting a preanesthetic blood sample (T1). Blood samples were also collected at 5 minutes (T2) and 40 minutes (T3) after TQ release and at postoperative 24 hours (T4) to analyze native thiol, total thiol, disulfide, disulfide/native thiol ratio, disulfide/total thiol ratio, and native thiol/total thiol ratio. All patients had intravenous patient-controlled analgesia during the postoperative period. Mean arterial pressure, TQ times, and Visual Analogue Scale (VAS) scores were recorded. Decrease in thiol and increase in disulfide in the thiol-disulfide balance were recorded as oxidative stress indicators. Results: There was no difference between the groups in terms of VAS and analgesic consumption at the end of 24 hours. The general anesthesia group had higher native thiol, total thiol, and native thiol/total thiol ratio and lower disulfide, disulfide/native thiol ratio, and disulfide/total thiol ratio at all time points compared to the spinal anesthesia group. Conclusion: Assessment in terms of thiol-disulfide balance suggests that general anesthesia had a favorable effect on oxidative stress. Keywords: General anesthesia, oxidative stress, spinal anesthesia, thiol-disulfide, tourniquet time, visual analogue scale","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45629433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.54875/jarss.2023.35693
Bilge Olgun Keleş, M. Kaya, Serpil Şavlı, Fatih Arslan, Cemile Açıkgöz Yıldız, Elvan Tekir Yılmaz
Objective: Sedoanalgesia is an anesthesia method that is preferred mostly in outside the operating room interventions and some short-term surgeries, allowing the procedure to be performed by using sedative and dissociative agents alone or together. Closed technique septoplasty operation is also an operation that can be performed with sedoanalgesia. The aim of this study is to compare the sedative and analgesic effects of ketamine and propofol combination and midazolam and fentanyl combination, surgical satisfaction and patient satisfaction in patients who underwent closed technique septoplasty operation. Methods: After ethics committee approval, 60 ASA I and II patients were included in the study by dividing into 2 groups. Patients who used ketamine and propofol for sedoanalgesia were named Group 1 (ketofol), and patients who used midazolam and fentanyl were named Group 2 (midafenta). The data of the patients were recorded from the intraoperative anesthesia forms and the postoperative recovery unit forms. Complications, side effects, surgery and patient satisfaction were questioned. Results: Mean arterial pressure was found to be significantly lower in the ketofol group at the 3rd minute after induction than in the midfenta group. The sedation score in the midafenta group at the 10th and 20th minutes intraoperatively was significantly lower than in the ketofol group. There was no significant difference in patient satisfaction, but surgical satisfaction was significantly higher in the midafenta group. Conclusion: In closed technique septoplasty operations, sedoanalgesia applied with ketofol and midafenta methods can be used without the need for general anesthesia. However, ketofol, which is highly preferred for sedoanalgesia, did not provide sufficient surgical satisfaction in patients who underwent closed technique septoplasty. We attributed this to the dissociation of the patients and their inability to comply with surgical commands. Keywords: Propofol, ketamine, midazolam, fentanyl
{"title":"Septoplasti Operasyonlarında Ketofol ile Midazolam-Fentanil Sedoanaljezi Yöntemlerinin Karşılaştırılması","authors":"Bilge Olgun Keleş, M. Kaya, Serpil Şavlı, Fatih Arslan, Cemile Açıkgöz Yıldız, Elvan Tekir Yılmaz","doi":"10.54875/jarss.2023.35693","DOIUrl":"https://doi.org/10.54875/jarss.2023.35693","url":null,"abstract":"Objective: Sedoanalgesia is an anesthesia method that is preferred mostly in outside the operating room interventions and some short-term surgeries, allowing the procedure to be performed by using sedative and dissociative agents alone or together. Closed technique septoplasty operation is also an operation that can be performed with sedoanalgesia. The aim of this study is to compare the sedative and analgesic effects of ketamine and propofol combination and midazolam and fentanyl combination, surgical satisfaction and patient satisfaction in patients who underwent closed technique septoplasty operation. Methods: After ethics committee approval, 60 ASA I and II patients were included in the study by dividing into 2 groups. Patients who used ketamine and propofol for sedoanalgesia were named Group 1 (ketofol), and patients who used midazolam and fentanyl were named Group 2 (midafenta). The data of the patients were recorded from the intraoperative anesthesia forms and the postoperative recovery unit forms. Complications, side effects, surgery and patient satisfaction were questioned. Results: Mean arterial pressure was found to be significantly lower in the ketofol group at the 3rd minute after induction than in the midfenta group. The sedation score in the midafenta group at the 10th and 20th minutes intraoperatively was significantly lower than in the ketofol group. There was no significant difference in patient satisfaction, but surgical satisfaction was significantly higher in the midafenta group. Conclusion: In closed technique septoplasty operations, sedoanalgesia applied with ketofol and midafenta methods can be used without the need for general anesthesia. However, ketofol, which is highly preferred for sedoanalgesia, did not provide sufficient surgical satisfaction in patients who underwent closed technique septoplasty. We attributed this to the dissociation of the patients and their inability to comply with surgical commands. Keywords: Propofol, ketamine, midazolam, fentanyl","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42242065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.54875/jarss.2023.63496
B. Gokdemir, N. Çekmen
Laparoscopic surgery (LS) is superior to conventional laparotomy due to its advantages, such as less trauma, early mobilization, minimal blood loss, less scarring, reduced postoperative pain, shorter postoperative recovery time and hospital stay, and lower mortality and morbidity. Significant hemodynamic, cardiopulmonary, and physiological changes occur in the systems due to increased intra-abdominal pressure and hypercarbia after carbon dioxide insufflation is applied for pneumoperitoneum (PP) during LS. The main goals in anesthesia management are understanding the primary pathophysiology, optimizing functional status and hemodynamics, and managing comorbidities. To minimize the effects and impacts of PP in patients who will undergo LS, as in every patient, comprehensive preoperative evaluation should be carried out by multidisciplinary approach that includes an anesthesiologist and surgeon. Our review emphasizes the importance of pathophysiological and systemic changes during LS performed by applying PP and summarizes the recovery and postoperative complications of anesthesia methods applied in clinical practice. Keywords: Laparoscopic surgeries, pneumoperitoneum, hemodynamic and cardiopulmonary changes, anesthesia
{"title":"Laparoscopic Surgery and Anesthesia","authors":"B. Gokdemir, N. Çekmen","doi":"10.54875/jarss.2023.63496","DOIUrl":"https://doi.org/10.54875/jarss.2023.63496","url":null,"abstract":"Laparoscopic surgery (LS) is superior to conventional laparotomy due to its advantages, such as less trauma, early mobilization, minimal blood loss, less scarring, reduced postoperative pain, shorter postoperative recovery time and hospital stay, and lower mortality and morbidity. Significant hemodynamic, cardiopulmonary, and physiological changes occur in the systems due to increased intra-abdominal pressure and hypercarbia after carbon dioxide insufflation is applied for pneumoperitoneum (PP) during LS. The main goals in anesthesia management are understanding the primary pathophysiology, optimizing functional status and hemodynamics, and managing comorbidities. To minimize the effects and impacts of PP in patients who will undergo LS, as in every patient, comprehensive preoperative evaluation should be carried out by multidisciplinary approach that includes an anesthesiologist and surgeon. Our review emphasizes the importance of pathophysiological and systemic changes during LS performed by applying PP and summarizes the recovery and postoperative complications of anesthesia methods applied in clinical practice. Keywords: Laparoscopic surgeries, pneumoperitoneum, hemodynamic and cardiopulmonary changes, anesthesia","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42287167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.54875/jarss.2023.21704
Fatma Erseven
Valproic acid is frequently given to individuals who suffer from a variety of psychological and neurological conditions, including bipolar disorder, manic-depressive psychosis, major depressive disorder, post-traumatic stress disorder, and epilepsy. Because of its narrow therapeutic spectrum, it is one of agents that frequently cause toxicological emergencies. This case presents an adult patient who had valproic acid overdose, required intubation, hemodialysis, and concurrent treatment with carbapenem group antibiotics. Keywords: Valproic acid, intoxication, hemodialysis, carbapenem
{"title":"Ağır Valproik Asit Zehirlenmesinde Kombine Tedavi","authors":"Fatma Erseven","doi":"10.54875/jarss.2023.21704","DOIUrl":"https://doi.org/10.54875/jarss.2023.21704","url":null,"abstract":"Valproic acid is frequently given to individuals who suffer from a variety of psychological and neurological conditions, including bipolar disorder, manic-depressive psychosis, major depressive disorder, post-traumatic stress disorder, and epilepsy. Because of its narrow therapeutic spectrum, it is one of agents that frequently cause toxicological emergencies. This case presents an adult patient who had valproic acid overdose, required intubation, hemodialysis, and concurrent treatment with carbapenem group antibiotics. Keywords: Valproic acid, intoxication, hemodialysis, carbapenem","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48438584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.54875/jarss.2023.55822
Duygu Kayar Çalılı, Ali Yasin Özercan, Halil Demirçakan, S. Ünal, Serdar Başboğa, Y. Aslan, D. Erdem, Demet Bölükbaşı, Seval Izdeş
Objective: Our study aimed to investigate whether primarily hemostasis parameters and secondarily demographic, clinical, and laboratory values could predict the mortality of critically ill Coronavirus Disease 2019 (COVID-19) patients. Methods: We retrospectively examined 180 laboratory-confirmed adult intensive care unit (ICU) patients with COVID-19. A total of 145 patients with complete records were included in the study. The patients were divided into two groups: deceased (n=58) and discharged (n=87). The demographic and clinical characteristics of the two groups, use of vasopressor therapy, requirement for invasive mechanical ventilation (IMV), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, and the relationship between laboratory values on ICU admission and mortality were evaluated using cutoff values. Results: Among hemostatic parameters, only D-dimer>1.08 mg L-1 was found to be a significant predictor of mortality (p=0.04), while platelet, prothrombin time (PT), activated partial thromboplastin time (aPTT), International Normalized Ratio (INR) and fibrinogen values were not significantly associated with mortality (p>0.05). In addition, age >76 years, hypertension (HT), need for IMV, APACHE II score >23, procalcitonin (PCT) >0.21 μg L-1, lymphocytes <0.4 109 L-1, interleukin 6 (IL-6) >93 pg mL-1 were found to be predictors of mortality (p<0.05). Neutrophil and C-reactive protein (CRP) values were not significantly associated with mortality (p>0.05). ABSTRACT Conclusion: Our study determined that advanced age, HT, high APACHE II score, requirement for IMV, vasopressor therapy, PCT, lymphocyte count, IL-6, and D-dimer levels could serve as predictors of mortality. Identifying predictors of mortality in COVID-19 is valuable for early recognition of disease progression and management of potential complications. Keywords: COVID-19, mortality, hemostasis, clinical markers, laboratory markers
{"title":"Yoğun Bakımdaki COVID-19 Hastalarında Prognostik Belirteçler: Hemostatik Parametreler Mortaliteyi Öngörebilir mi?","authors":"Duygu Kayar Çalılı, Ali Yasin Özercan, Halil Demirçakan, S. Ünal, Serdar Başboğa, Y. Aslan, D. Erdem, Demet Bölükbaşı, Seval Izdeş","doi":"10.54875/jarss.2023.55822","DOIUrl":"https://doi.org/10.54875/jarss.2023.55822","url":null,"abstract":"Objective: Our study aimed to investigate whether primarily hemostasis parameters and secondarily demographic, clinical, and laboratory values could predict the mortality of critically ill Coronavirus Disease 2019 (COVID-19) patients. Methods: We retrospectively examined 180 laboratory-confirmed adult intensive care unit (ICU) patients with COVID-19. A total of 145 patients with complete records were included in the study. The patients were divided into two groups: deceased (n=58) and discharged (n=87). The demographic and clinical characteristics of the two groups, use of vasopressor therapy, requirement for invasive mechanical ventilation (IMV), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, and the relationship between laboratory values on ICU admission and mortality were evaluated using cutoff values. Results: Among hemostatic parameters, only D-dimer>1.08 mg L-1 was found to be a significant predictor of mortality (p=0.04), while platelet, prothrombin time (PT), activated partial thromboplastin time (aPTT), International Normalized Ratio (INR) and fibrinogen values were not significantly associated with mortality (p>0.05). In addition, age >76 years, hypertension (HT), need for IMV, APACHE II score >23, procalcitonin (PCT) >0.21 μg L-1, lymphocytes <0.4 109 L-1, interleukin 6 (IL-6) >93 pg mL-1 were found to be predictors of mortality (p<0.05). Neutrophil and C-reactive protein (CRP) values were not significantly associated with mortality (p>0.05). ABSTRACT Conclusion: Our study determined that advanced age, HT, high APACHE II score, requirement for IMV, vasopressor therapy, PCT, lymphocyte count, IL-6, and D-dimer levels could serve as predictors of mortality. Identifying predictors of mortality in COVID-19 is valuable for early recognition of disease progression and management of potential complications. Keywords: COVID-19, mortality, hemostasis, clinical markers, laboratory markers","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47207559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.54875/jarss.2023.40327
Nadide Örs Yıldırım, A. K. Yıldırım, V. Yıldırım
Massive arterial gas embolism is a complication that has a low probability of occurring during cardiac surgery but can cause high mortality and morbidity. It is very important that the surgical, anesthetic, and perfusion teams cooperate in the management of massive gas embolisms. In this article, we discuss the successful management of a massive air embolism that occurred during cardiopulmonary bypass. The patient was discharged from the hospital without complications on the 7th postoperative day. The article emphasizes the importance of a careful anesthesiologist monitoring the surgical field during surgery. Keywords: Massive arterial air embolism, cardiac surgery, neuroprotection
{"title":"A Successful Anesthesia Management in Patient with Massive Arterial Air Embolism During Cardiac Surgery","authors":"Nadide Örs Yıldırım, A. K. Yıldırım, V. Yıldırım","doi":"10.54875/jarss.2023.40327","DOIUrl":"https://doi.org/10.54875/jarss.2023.40327","url":null,"abstract":"Massive arterial gas embolism is a complication that has a low probability of occurring during cardiac surgery but can cause high mortality and morbidity. It is very important that the surgical, anesthetic, and perfusion teams cooperate in the management of massive gas embolisms. In this article, we discuss the successful management of a massive air embolism that occurred during cardiopulmonary bypass. The patient was discharged from the hospital without complications on the 7th postoperative day. The article emphasizes the importance of a careful anesthesiologist monitoring the surgical field during surgery. Keywords: Massive arterial air embolism, cardiac surgery, neuroprotection","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.54875/jarss.2023.06977
Okan Ermiş, D. Akçalı
ABSTRACT Chemotherapy induced peripheral neuropathy is a syndrome with distal symmetrical sensorial-dominant pain, tingling and numbness caused by neurotoxic chemotherapeutic agents. The severity increases with cumulative doses of chemotherapy, besides decrease in quality of life, may lead to cessation of treatment which may effect survival. Neurotoxicity causes large fiber and small fiber neuropathy through many pathologic mechanisms including mitochondrial dysfunction and oxidative stress. Dose related neuropathic pain is most commonly seen with taxanes, platins, vinca alkaloids, bortezomib and brentuximab. There is a limited effect of anticonvulsant and antidepressant medication for treatment. In this review awareness about chemotherapy induced peripheral neuropathy, prevention and treatment are discussed. Keywords: Chemotherapy, pain, neuropathy, small fiber neuropathy
{"title":"Chemotherapy-Induced Peripheral Neuropathy and Treatment","authors":"Okan Ermiş, D. Akçalı","doi":"10.54875/jarss.2023.06977","DOIUrl":"https://doi.org/10.54875/jarss.2023.06977","url":null,"abstract":"ABSTRACT Chemotherapy induced peripheral neuropathy is a syndrome with distal symmetrical sensorial-dominant pain, tingling and numbness caused by neurotoxic chemotherapeutic agents. The severity increases with cumulative doses of chemotherapy, besides decrease in quality of life, may lead to cessation of treatment which may effect survival. Neurotoxicity causes large fiber and small fiber neuropathy through many pathologic mechanisms including mitochondrial dysfunction and oxidative stress. Dose related neuropathic pain is most commonly seen with taxanes, platins, vinca alkaloids, bortezomib and brentuximab. There is a limited effect of anticonvulsant and antidepressant medication for treatment. In this review awareness about chemotherapy induced peripheral neuropathy, prevention and treatment are discussed. Keywords: Chemotherapy, pain, neuropathy, small fiber neuropathy","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43491763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.54875/jarss.2023.19942
Aslıhan Aykut, N. Salman, Z. A. Demir
Objective: As part of multimodal analgesia regimen in cardiac surgery, the serratus anterior plane block (SAPB) is a technique regularly used in minimally invasive surgical interventions with thoracotomy. The aim of our study is to determine the analgesic efficacy of SAPB for cardiac surgery performed with sternotomy. Methods: A total of 99 patients who underwent SAPB (Group SAP, n=43) and conventional analgesia (Group C, n=56) for coronary artery bypass graft (CABG) surgery were compared retrospectively. Demographic data, postoperative opioid use, highest pain scores, nausea-vomiting, time to start oral intake, extubation time, lenght of intensive care unit and hospital stay were recorded. Results: Total opioid requirement, expressed in oral morphine equivalent within the first 24 hours after extubation, was found to be significantly lower in patients with SAPB (p=0.022). Similarly, both the highest reported pain scores at rest and during mobilization and also the nausea scores were found to be significantly lower in Group SAP during the same period (p=0.007, p=0.048, p=0.004). Extubation (p=0.025) and oral intake initiation time p=0.030) were shorter in Group SAP. Conclusion: By providing analgesia of the chest tube drain site, SAPB application was associated with lower opioid consumption, pain, and nausea-vomiting among patients who underwent CABG with median sternotomy. Because of this benefit, superficial SAPB may be part of opioid-reducing multimodal analgesia in cardiac surgery. Keywords: Serratus anterior plane block, fascial plane blocks, coronary artery bypass surgery, postoperative analgesia
{"title":"Ultrasound-Guided Superficial Serratus Anterior Plane Block for Cardiac Surgery with Median Sternotomy: A Retrospective Study","authors":"Aslıhan Aykut, N. Salman, Z. A. Demir","doi":"10.54875/jarss.2023.19942","DOIUrl":"https://doi.org/10.54875/jarss.2023.19942","url":null,"abstract":"Objective: As part of multimodal analgesia regimen in cardiac surgery, the serratus anterior plane block (SAPB) is a technique regularly used in minimally invasive surgical interventions with thoracotomy. The aim of our study is to determine the analgesic efficacy of SAPB for cardiac surgery performed with sternotomy. Methods: A total of 99 patients who underwent SAPB (Group SAP, n=43) and conventional analgesia (Group C, n=56) for coronary artery bypass graft (CABG) surgery were compared retrospectively. Demographic data, postoperative opioid use, highest pain scores, nausea-vomiting, time to start oral intake, extubation time, lenght of intensive care unit and hospital stay were recorded. Results: Total opioid requirement, expressed in oral morphine equivalent within the first 24 hours after extubation, was found to be significantly lower in patients with SAPB (p=0.022). Similarly, both the highest reported pain scores at rest and during mobilization and also the nausea scores were found to be significantly lower in Group SAP during the same period (p=0.007, p=0.048, p=0.004). Extubation (p=0.025) and oral intake initiation time p=0.030) were shorter in Group SAP. Conclusion: By providing analgesia of the chest tube drain site, SAPB application was associated with lower opioid consumption, pain, and nausea-vomiting among patients who underwent CABG with median sternotomy. Because of this benefit, superficial SAPB may be part of opioid-reducing multimodal analgesia in cardiac surgery. Keywords: Serratus anterior plane block, fascial plane blocks, coronary artery bypass surgery, postoperative analgesia","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46046827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.54875/jarss.2023.50103
F. Atar, G. Keskin, F. Akaslan, A. Donmez
Objective: The study aims to evaluate the Proseal laryngeal mask airway (PLMA) position with ultrasonographic imaging. Methods: The study included American Society of Anesthesiologists I-III patients with Mallampati scores I-II and operated using PLMA as an airway device. Before PLMA insertion, the glottic aperture was assessed by ultrasonography (USG). After PLMA placement, the USG evaluation was repeated. The symmetry of the arytenoid cartilages was examined. Asymmetry of an arytenoid to the glottic midline and the other arytenoid was graded 0 to 3 (USG arytenoid grade). After PLMA was placed, fiber optic bronchoscopy (FOB) was done to evaluate the PLMA position (FOB LMA grade). The relationship between USG arytenoid grade and FOB LMA grade was examined. Results: Forty-eight patients were included in the study. The mean age was 49 ± 15.8 (19-82), and 25 were female. It was determined that PLMA was in the correct position in 81.3% of the evaluation with USG and 68.8% of the assessment with FOB. USG arytenoid grade correlated with FOB LMA grade (r= -.582, p<.001). To detect a rotated LMA, USG had a sensitivity of 100% (%95 CI, 39.8 – 100.0) and a specificity of %80 (%95 CI, 22.8 – 99.8). The positive and negative predictive values were %97.7 (%95 CI, 88.0 – 99.9) and %100 (%95 CI, 91.8 – 100.0), respectively. The accuracy was %97.9 (%95 CI, 86.3 – 99.3). Conclusion: Ultrasonografi can be a simple, noninvasive, and reliable method to confirm PLMA placement in anesthesia practice. Keywords: Laryngeal mask airway, ultrasonography, airway management
{"title":"The Role of Ultrasonography in Confirming the Position of the Laryngeal Mask Airway in Adult Patients","authors":"F. Atar, G. Keskin, F. Akaslan, A. Donmez","doi":"10.54875/jarss.2023.50103","DOIUrl":"https://doi.org/10.54875/jarss.2023.50103","url":null,"abstract":"Objective: The study aims to evaluate the Proseal laryngeal mask airway (PLMA) position with ultrasonographic imaging. Methods: The study included American Society of Anesthesiologists I-III patients with Mallampati scores I-II and operated using PLMA as an airway device. Before PLMA insertion, the glottic aperture was assessed by ultrasonography (USG). After PLMA placement, the USG evaluation was repeated. The symmetry of the arytenoid cartilages was examined. Asymmetry of an arytenoid to the glottic midline and the other arytenoid was graded 0 to 3 (USG arytenoid grade). After PLMA was placed, fiber optic bronchoscopy (FOB) was done to evaluate the PLMA position (FOB LMA grade). The relationship between USG arytenoid grade and FOB LMA grade was examined. Results: Forty-eight patients were included in the study. The mean age was 49 ± 15.8 (19-82), and 25 were female. It was determined that PLMA was in the correct position in 81.3% of the evaluation with USG and 68.8% of the assessment with FOB. USG arytenoid grade correlated with FOB LMA grade (r= -.582, p<.001). To detect a rotated LMA, USG had a sensitivity of 100% (%95 CI, 39.8 – 100.0) and a specificity of %80 (%95 CI, 22.8 – 99.8). The positive and negative predictive values were %97.7 (%95 CI, 88.0 – 99.9) and %100 (%95 CI, 91.8 – 100.0), respectively. The accuracy was %97.9 (%95 CI, 86.3 – 99.3). Conclusion: Ultrasonografi can be a simple, noninvasive, and reliable method to confirm PLMA placement in anesthesia practice. Keywords: Laryngeal mask airway, ultrasonography, airway management","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46100015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.54875/jarss.2023.60024
P. Ayvat
Objective: As a result of the negative events experienced, the patient becomes the first victim, while the healthcare provider becomes the second victim. This situation is frequently experienced in the operating room (OR) and intensive care unit (ICU). Our aim is to reveal the problems and experiences of the anesthesia personnel working in OR / ICU regarding the second victim phenomenon (SVP) and to propose solutions. Methods: The research was conducted with the qualitative research method. Focus group interviews were conducted with six volunteer healthcare personnel working in OR / ICU. The data was written down and thematic content analysis was done through MAXQDA 22. Results: 5 main themes and 21 subthemes were reached. These main themes can be counted as the frequency of experiencing SVP, the main problems, emotions/feelings, coping methods, and suggestions/requests. The anesthesia team encountered the SVP frequently and this could be due to medical, violent, or technical reasons. In this situation, they felt worthlessness, helplessness, injustice, anger, and aggression. In order to cope with the SVP, they use methods such as self-suggestion, taking a break, calming down, and sharing with colleagues. As suggestions, they demanded psychological, legal, technical, managerial, physiotherapy, peer, and academic support as well as free time, elimination of patient complaints, and increased hospital security. Conclusion: The operating room and intensive care units are the busiest departments, and the frequency of adverse events is very high. Some of the situations that cause to feel SVP are preventable problems. Being aware of what you feel and how to overcome it will increase the quality of health service delivery and reduce the burnout status of health workers. Keywords: Patient safety, anesthesia, critical care
{"title":"The Second Victim Phenomenon Experience of the Anesthesia Team: A Focus Group Study","authors":"P. Ayvat","doi":"10.54875/jarss.2023.60024","DOIUrl":"https://doi.org/10.54875/jarss.2023.60024","url":null,"abstract":"Objective: As a result of the negative events experienced, the patient becomes the first victim, while the healthcare provider becomes the second victim. This situation is frequently experienced in the operating room (OR) and intensive care unit (ICU). Our aim is to reveal the problems and experiences of the anesthesia personnel working in OR / ICU regarding the second victim phenomenon (SVP) and to propose solutions. Methods: The research was conducted with the qualitative research method. Focus group interviews were conducted with six volunteer healthcare personnel working in OR / ICU. The data was written down and thematic content analysis was done through MAXQDA 22. Results: 5 main themes and 21 subthemes were reached. These main themes can be counted as the frequency of experiencing SVP, the main problems, emotions/feelings, coping methods, and suggestions/requests. The anesthesia team encountered the SVP frequently and this could be due to medical, violent, or technical reasons. In this situation, they felt worthlessness, helplessness, injustice, anger, and aggression. In order to cope with the SVP, they use methods such as self-suggestion, taking a break, calming down, and sharing with colleagues. As suggestions, they demanded psychological, legal, technical, managerial, physiotherapy, peer, and academic support as well as free time, elimination of patient complaints, and increased hospital security. Conclusion: The operating room and intensive care units are the busiest departments, and the frequency of adverse events is very high. Some of the situations that cause to feel SVP are preventable problems. Being aware of what you feel and how to overcome it will increase the quality of health service delivery and reduce the burnout status of health workers. Keywords: Patient safety, anesthesia, critical care","PeriodicalId":36000,"journal":{"name":"Anestezi Dergisi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43711679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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