The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry.

OBJECTIVES: Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. STUDY DESIGN: Among the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. RESULTS: Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. CONCLUSION: We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

Evaluation of injury-related under-five mortality in Turkey between 2014-2017.

BACKGROUND: Injury is the most common cause of preventable morbidity and mortality among children. The aim of this study was to determine the epidemiological characteristics and trends of injury-related mortality in children under five and to provide evidence for future preventive strategies. METHODS: Our study was designed as a descriptive cross-sectional study. National under-five mortality data from the Death Notification System database, entered between January 1st, 2014, and December 31th, 2017, was included in the study. RESULTS: Among all under-five deaths registered in the system, 2,560 injury-related death cases were included in the study. Overall, deaths related to injuries accounted for 4.1% of all deaths in children under five years old. Of all injury deaths, 59.9% of cases were male, 52.7% occurred at home or its close vicinity, and 80.3% were children aged 12-59 months. Injury-related under-five deaths were mainly attributed to traffic injuries (36.5%), falls (12.0%), and suffocation (10.2%). Traffic injuries were the most common cause of injury-related deaths both in infants 0-11 months and children 12-59 months old. The second and third most common causes of injury-related deaths among infants 0-11 months were suffocation and falls, while these were falls and drowning in children aged 12-59 months, respectively. The injury-related under-five mortality rate dropped from 11.3 per hundred thousand in 2014 to 9.1 in 2017. Causes of all unintentional injury-related deaths were associated with season except for other unintentional injuries and exposure to mechanical forces (p < 0.001). CONCLUSIONS: The injury-related mortality rate among children under five years declined from 2014 to 2017, however it is still high. To prevent injuries in children under five, it is important to raise awareness and increase the supervision of children by their caregivers. At the national level, multisectorial cooperation with a holistic approach will be of key importance.

Comparison of an ultrasound-guided technique versus a landmark-guided technique for internal jugular vein cannulation.

Central venous cannulation is a commonly preformed procedure in many branches of medicine, particularly in anaesthesia and intensive care medicine. The purpose of this study was to compare the landmark-guided technique to the ultrasound-guided technique for internal jugular vein cannulation in cardiovascular surgery patients. One hundred cardiovascular surgery patients, of whom 65 were male and 35 were female with ages ranging from 22 to 65, who had internal jugular cannulation between December 2010-March 2011 in our clinic were investigated prospectively. Patients were randomized into two groups; ultrasound guided internal jugular cannulation cases in group U (n=50), and anatomic landmark guided cases in group A (n=50). The number of attempts until successful catheterization, the time required for successful catheterization, arising complications, the demographics and the duration of catheterization were recorded for each patient. There were no significant differences found in the demographic features between the two groups. The number of attempts for successful catheterization was statistically lower in group U (1.1±0.5) than in group A (2.2±1.6). The time required for successful catheterization was statistically lower in group U (109.4±30.4) than in group A (165.9±91.5). There were no significant differences found in the total complications of the two groups (p=0.092). Four patients had an arterial punction [group U (n=0) and group A (n=4)] and two patients had a hematoma [group U (n=1) and group A (n=1)]. Arterial punction complication was increased significantly in landmark group (p=0.041). The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of attempts.

Intravenous regional analgesia in a patient with Glanzmann thrombastenia.

Glanzmann thrombastenia (GT) is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR. and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27-year-old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia (IVRA). The use of platelet transfusion and the recombinant factor VIIa, are stressed.