Turkish journal of anaesthesiology and reanimation最新文献

{"title":"Effect of Intrathecal Morphine on Postdural Puncture Headache in Obstetric Anaesthesia.","authors":"Meryem Onay,&nbsp;Sema Şanal Baş,&nbsp;Arda Işıker,&nbsp;Ümit Akkemik,&nbsp;Ayten Bilir","doi":"10.4274/TJAR.2023.221140","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221140","url":null,"abstract":"<p><strong>Objective: </strong>Intrathecal morphine is used as an effective component of multimodal analgesia in postoperative analgesia in cesarean section patients. We aimed to analyze the relationship between intrathecal morphine administration and postdural puncture headache (PDPH), pain score and analgesia consumption in the postoperative period, and maternal fetal effects.</p><p><strong>Methods: </strong>One hundred four pregnant women aged ≥18 years (American Society of Anesthesiology physical status I or II, >36 weeks gestation) who were scheduled for elective cesarean section under spinal anaesthesia were included in this study. Spinal anesthesia consisted of bupivacaine with or without morphine (Group M: 10 mg heavy marcaine + 25 mcg fentanyl + 100 mcg morphine; Group F: 10 mg heavy marcaine + 25 mcg fentanyl). The effect of intrathecal morphine on PDPH, postoperative pain score, analgesia consumption, and maternal and fetal effects were recorded for 5 days.</p><p><strong>Results: </strong>PDPH developed in a total of 33 patients (Group M: 18 and Group F: 15, <i>P</i>=0.274). When we evaluated PDPH with the VAS, there was no significant difference between the groups. The postoperative visual analogue scale (VAS) was lower in the morphine group, and no statistically significant difference was found in the VAS 1^st hr and VAS 2^nd hr, whereas the VAS 6^th hr and VAS 24^th hr were found to be statistically significant. There was no difference in terms of PDPH, the first analgesic requirement and postoperative nausea-vomiting, but meperidine consumption was lower in the morphine group.</p><p><strong>Conclusion: </strong>Low-dose intrathecal morphine did not affect the incidence of PDPH. It is an effective method that can be used in cesarean section patients without increasing the maternal and fetal side effects from postoperative analgesia.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"297-303"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Feasible Web-Conference-Style Remote Simulation using Demonstration Video Clips in Anaesthesia under the COVID-19 Outbreaks: A Preliminary Survey Study.","authors":"Taiki Kojima,&nbsp;Yuta Kawatsu","doi":"10.4274/TJAR.2023.221166","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221166","url":null,"abstract":"<p><strong>Objective: </strong>The Coronavirus disease-2019 (COVID-19) outbreak has deprived simulation-based medical education for health care workers. Attendees are strictly prohibited to converge at a simulation training venue because of the COVID-19 outbreaks. To address this issue, we developed a web-conference-style remote simulation program using demonstration video clips. This report introduced the method and described participants' satisfaction.</p><p><strong>Methods: </strong>This preliminary survey study evaluated learners' satisfaction in multiple institutions. The Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation (SSHF) by a 5-degree scale was used to evaluate participants' satisfaction. The survey was conducted immediately after completing the simulation sessions.</p><p><strong>Results: </strong>Ten (100%) participants (7 anaesthesia individuals, 2 anaesthesia residents and 1 nurse anaesthetist) from nine institutions responded to the survey. All median values of the satisfaction scores were ≥4.0, whereas the median values of scores for environmental fidelity and psychological insecurity were 3.5 and 3.0, respectively (<i>P</i>=0.005).</p><p><strong>Conclusion: </strong>A web-conference-style remote simulation using demonstration video clips is a feasible method for conducting simulation-based medical education under COVID-19 that showed high satisfaction scores. Further, additional studies are required to explore the internal and external validity and the effectiveness of mastery learning.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"341-346"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Factors Affecting the Preference of Pain Medicine Subspecialty Choices and Training Course in Turkey: A Cross-Sectional Survey Study.","authors":"Tural Bayramov,&nbsp;Halil Çetingök,&nbsp;Gül Köknel Talu","doi":"10.4274/TJAR.2023.221071","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221071","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to assess the factors affecting the preference for the Pain Medicine subspecialty and the fellowship training programs by the pain specialists who have completed or continued the Pain Medicine fellowship training program from 2014 to 2021 in Turkey.</p><p><strong>Methods: </strong>The study was conducted in October 2020 and March 2021. By reaching out to the pain specialists who completed their fellowship or had been continuing their training by getting the right to receive a Pain Medicine fellowship. Via e-mail or WhatsApp application, an e-questionnaire link was sent to the participants, and data were collected on demographics, factors affecting the choice of Pain Medicine subspecialty, level of realization of the expectations during the training course and the level of proficiency in the field of pain specialization. Data analysis was performed using IBM SPSS Statistics 20.0 software, and tests were considered statistically significant if <i>P</i> < 0.05.</p><p><strong>Results: </strong>Participants reported that the factors that most affected their preferences were personal interest (55.1%), more comfortable working conditions (43.6%), and interest in an academic career (38.5%). Seventy-six participants answered the level of realization of expectations about performing interventional pain procedures using ultrasound imaging, and 31.6% reported that their expectations were not met, and 25% reported that their expectations were partially realised.</p><p><strong>Conclusion: </strong>We hope that our findings will lead to improving Pain Medicine subspecialty training programs, upgrading standards, and more comprehensive studies on these issues.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"311-317"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Dural Puncture Epidural Performed by 27-gauge Whitacre Needle in Labour Epidural Analgesia: Randomized Single-Blinded Controlled Study.","authors":"Iva Pažur,&nbsp;Ognjen Ožegić,&nbsp;Lada Lijović,&nbsp;Katarina Kličan Jaić,&nbsp;Maja Pešić","doi":"10.4274/TJAR.2023.221085","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221085","url":null,"abstract":"<p><strong>Objective: </strong>Dural puncture epidural technique is refinement of standard epidural technique. Its goal is to overcome drawbacks of standard epidural. We assessed whether dural puncture epidural technique performed by 27-gauge spinal needle would provide higher quality of labour epidural analgesia by using 10 mL epidural bolus of 0.125% bupivacaine. Additionally, the impact of dural puncture epidural on epidural analgesia onset, course of labour and occurrence of maternal side effects was examined.</p><p><strong>Methods: </strong>We designed prospective, randomized, single-blind study. A total of 76 healthy nulliparous parturients were randomly allocated to dural puncture or standard epidural group. After identification of epidural space, spinal Whitacre needle was used for dural puncture. Intrathecal drug administration was omitted at that point. Both groups received a bolus of local anaesthetic mixture, followed by a continuous infusion of diluted local anaesthetic via epidural catheter. Pain was assessed by numeric pain rating scale. The number of top-ups and mode of delivery were recorded in both groups.</p><p><strong>Results: </strong>After 10 minutes, there was a statistically significant difference in numeric pain rating scale ≤3 reported (<i>P</i>=0.028), with 97.4% subjects in dural puncture epidural group achieving adequate analgesia after 10 minutes. There was no statistically significant difference in the number of additional boluses, time to delivery, Bromage scale achieved or maternal outcomes between groups.</p><p><strong>Conclusion: </strong>Dural puncture epidural technique appears to be effective in providing faster onset of epidural analgesia. However, the need for additional boluses remains unchanged. It can be safely used in obstetrics, without deleterious effect on the course of labour.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"304-310"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Media Use Amongst Regional Anaesthesia and Pain Practitioners and Residents: Standardization and Ethical Considerations.","authors":"Serkan Tulgar,&nbsp;Ali Ahıskalıoğlu,&nbsp;David Terence Thomas,&nbsp;Alessandro De Cassai,&nbsp;Yavuz Gürkan","doi":"10.4274/TJAR.2023.231211","DOIUrl":"https://doi.org/10.4274/TJAR.2023.231211","url":null,"abstract":"","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"366-367"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Anemia and Female Gender are Risk Factors for Transfusion in Patients Undergoing Coronary Artery Bypass Grafting with a Restrictive Transfusion Strategy.","authors":"Özgen Ilgaz Koçyiğit,&nbsp;Muharrem Koçyiğit,&nbsp;Ahmet Ümit Güllü,&nbsp;Şahin Şenay,&nbsp;Fevzi Toraman,&nbsp;Cem Alhan","doi":"10.4274/TJAR.2023.22856","DOIUrl":"https://doi.org/10.4274/TJAR.2023.22856","url":null,"abstract":"<p><strong>Objective: </strong>Red blood cell (RBC) transfusion in cardiac surgery is associated with increased morbidity and mortality. Even when using patient blood management methods, blood transfusions may still be needed in cardiac surgery. This study examined the risk factors for blood transfusion in isolated coronary artery bypass graft (CABG) surgery with a restrictive transfusion strategy, along with individualized patient blood management.</p><p><strong>Methods: </strong>We enrolled 198 patients (age, 61.8 ± 9.9 years; 28 females and 170 males) who underwent isolated CABG surgery in a single private hospital using a restrictive transfusion strategy between April 2015 and October 2020. Pre-, intra-, and postoperative parameters were compared between patients with and without RBC transfusions. The risk factors for transfusion and transfusion probability were analyzed.</p><p><strong>Results: </strong>Patients who received RBC transfusions had higher European System for Cardiac Operative Risk Evaluation values (13.60 ± 18.27%). Preoperative hematocrit (Hct) [odds ratio (OR)=0.752; 95% confidence interval (CI) 0.639-0.884; <i>P</i>=0.001] and female gender (OR=7.874; 95% CI 1.678-36.950; <i>P</i>=0.009) were significant independent risk factors for RBC transfusion in logistic regression analysis. When the preoperative Hct was 30%, the RBC transfusion probability was 61.08% in females and 16.6% in males. Patients who received RBC transfusions had longer intensive care unit (31.40 ± 25.42 hours) and hospital (11.18 ± 6.75 days) stays.</p><p><strong>Conclusion: </strong>Risk factors for RBC transfusion in isolated CABG surgery with a restrictive blood transfusion strategy were preoperative anemia and female gender.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"324-330"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10075830","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}

{"title":"Comment on: \"Transversus Thoracic Muscle Plane Block for Attenuating the Haemodynamic Response to Median Sternotomy\".","authors":"Raghuraman M Sethuraman","doi":"10.4274/TJAR.2023.221172","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221172","url":null,"abstract":"","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"362-363"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinical Performance of C-MAC Video Laryngoscope Guided vs Blind Placement of I-Gel® in Paediatric Patients: A Randomized Controlled Open-Label Trial.","authors":"Rakesh Kumar,&nbsp;Pooja Bihani,&nbsp;Sadik Mohammed,&nbsp;Rashmi Syal,&nbsp;Pradeep Bhatia,&nbsp;Rishabh Jaju","doi":"10.4274/TJAR.2023.221010","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221010","url":null,"abstract":"<p><strong>Objective: </strong>Placement of the supraglottic airway devices under direct vision has been shown to decrease the incidence of malposition in adults. This study was designed to compare the clinical performance of C-MAC guided and blind placement of i-gel® in paediatric patients.</p><p><strong>Methods: </strong>The present prospective, randomized controlled study was conducted on 102 paediatric patients scheduled to undergo elective infraumbilical surgeries under general anaesthesia. Patients were randomly divided into group \"B\" (blind) and group \"C\" (C-MAC) based on the technique used for placement of i-gel®. The primary objective of the study was to compare the incidence of malposition based on the fiberoptic bronchoscope (FOB) score of the glottic view. Oropharyngeal leak pressure (OPLP), hemodynamic parameters, and insertion characteristics (time taken to insert and the number of attempts) were secondary objectives. Categorical data were presented as ratio or percentage and continuous data were presented as mean ± standard deviation or median [95% confidence interval (CI)].</p><p><strong>Results: </strong>The incidence of malposition (Brimacombe score 1 or 2) was significantly lower in group C compared to group B (7.8% vs 49% respectively) (<i>P</i> < 0.001); implying a relative risk reduction of 2.42 (95% CI 1.72 to 3.40) with C-MAC. On FOB assessment, the median (interquartile range) Brimacombe score was significantly better in group C [4 (4-4)] compared to group B [3 (2-3)] (<i>P</i> < 0.001). The OPLP was significantly higher in group C compared to group B. Other insertion characteristics were comparable in both the study groups.</p><p><strong>Conclusion: </strong>Compared to blind placement, C-MAC guided placement ensures proper alignment of i-gel® with periglottic structures and proper functioning of i-gel®.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"347-353"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasoplegic Syndrome and Anaesthesia: A Narrative Review.","authors":"Begüm Nemika Gökdemir,&nbsp;Nedim Çekmen","doi":"10.4274/TJAR.2023.221093","DOIUrl":"https://doi.org/10.4274/TJAR.2023.221093","url":null,"abstract":"<p><p>Vasoplegic syndrome (VS) is defined as low systemic vascular resistance, normal or high cardiac output, and resistant hypotension unresponsive to vasopressor agents and intravenous volume. VS is a frequently encountered complication in cardiovascular and transplantation surgery, burns, trauma, pancreatitis, and sepsis. The basis of the pathophysiology is associated with an imbalance of vasodilator and vasoconstrictive structure in vascular smooth muscle cells and is highly complex. The pathogenesis of VS has several mechanisms, including overproduction of iNO, stimulation of ATP-dependent K+ channels and NF-κB, and vasopressin receptor 1A (V1A-receptor) down-regulation. Available treatments involve volume and inotropes administration, vasopressin, methylene blue, hydroxocobalamin, Ca++, vitamin C, and thiamine, and should also restore vascular tone and improve vasoplegia. Other treatments could include angiotensin II, corticosteroids, NF-κB inhibitor, ATP-dependent K+ channel blocker, indigo carmine, and hyperbaric oxygen therapy. Despite modern advances in treatment, the mortality rate is still 30-50%. It is challenging for an anaesthesiologist to consider this syndrome's diagnosis and manage its treatment. Our review aims to review the diagnosis, predisposing factors, pathophysiology, treatment, and anaesthesia approach of VS during anaesthesia and to suggest a treatment algorithm.</p>","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"280-289"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simple and Novel Modification of the Nebulization Mask to Improve Nebulization in the Supine Position.","authors":"Ashutosh Kaushal,&nbsp;Harish Kumar,&nbsp;Vaishali Waindeskar,&nbsp;Jai Prakash Sharma","doi":"10.4274/TJAR.2022.221120","DOIUrl":"https://doi.org/10.4274/TJAR.2022.221120","url":null,"abstract":"Dear Editor, Nebulization therapy is commonly used for pre-hospital and in-hospital (operating theatre, intensive care unit and emergency area) patient care.1 For this purpose, a nebulisation mask device is widely used, which consists of a Hudson mask, a medicine cup and an oxygen tube (Figure 1A). It is necessary to pass oxygen flow from the bottom of the medicine cup so that oxygen can go through the medicine and the medicine can change from liquid to mist form.","PeriodicalId":23353,"journal":{"name":"Turkish journal of anaesthesiology and reanimation","volume":"51 4","pages":"368-369"},"PeriodicalIF":0.5,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}