Are Operating Rooms With Laminar Airflow a Risk for Inadvertent Perioperative Hypothermia During Ureterorenoscopic Lithotripsy Under Spinal Anesthesia? A Prospective Randomized Clinical Trial.

OBJECTIVES: Inadvertent perioperative hypothermia (IPH), defined as a core temperature <36°C, is common during a surgical procedure and is associated with high morbidity and mortality. Laminar (LAS) and conventional airflow systems (CAS) are used frequently for clean microenvironmental surgical areas in operating rooms. In LAS, the cold airflow is directed toward the patient, unlike CAS. Does this airflow in LAS cause heat loss from the patient by convection more than CAS? We aimed to compare the IPH frequencies of these airflow systems on patients who underwent ureterorenoscopic lithotripsy (ureterorenoscopic surgery) under spinal anesthesia. METHODS: The study was a prospective, parallel-group, randomized trial. A total of 246 volunteers were included in the study and divided into group LAS (n = 123) and group CAS (n = 123). Randomization of patients was performed using the closed-envelope method (as 1:1).The tympanic membrane temperature of patients was measured before spinal anesthesia ( T0 ) and then every 15 minutes ( T n ) during the procedure. The IPH ratio and the change of the tympanic temperatures (Δ T ) were recorded (clinical trial number: IRCT20180324039145N5). RESULTS: In total, there were no statistical differences between the IPH ratios of group LAS and group CAS (61.2% [71 of 116] versus 49.6% [57 of 115], respectively; P = 0.075). The IPH ratio was 55.4% (128 of 231). The tympanic temperatures of patients decreased about 0.64°C (0.45°C) at the 30th minute. In both groups, Δ 30 was similar (0.62; 95% confidence interval, 0.52-0.72 [ P = 0.65]; 95% confidence interval, 0.55-0.74 [ P = 0.236], respectively). CONCLUSIONS: The risk for IPH of both LAS and CAS in the operating room is similar during ureterorenoscopic surgery.

Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial.

OBJECTIVES: We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anesthesia in laminar airflow systems (LAS-OR) and conventional turbulent airflow systems (CAS-OR). BACKGROUND: Different heating, ventilation, and air-conditioning (HVAC) systems are used in the operating room (OR), such as LAS and CAS. Laminar airflow is directed directly to the patient in LAS-OR. Does laminar airflow in ORs cause faster heat loss by convection? METHODS: This is a prospective, randomized study. We divided 200 patients with simple randomization (1:1), as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. Clinical trial number: IRCT20180324039145N3. The tympanic membrane temperatures of patients were measured (°C) before anesthesia induction (T0) and then every 15 min during surgery (Tn). Changes (Δn) between T0 and Tn were measured. RESULTS: In the first 30 min, there was a temperature decrease of approximately 0.8 °C (1.44 °F) in both groups. Temperature decreases at 45 min were higher in group LAS than in group CAS but not statistically significant, Δ45, respectively, 0.89 (95% confidence interval [CI] [0.77, 1.02]) versus 0.77 (95% CI [0.69, 0.84]; p = .09). IPH occurred in a total of 60.9% (112 of 184) of patients in the entire surgical evaluation period in group LAS and group CAS (58.9% vs. 62.8%, p = . 59). CONCLUSIONS: IPH is seen frequently in both HVAC systems. Clinically, the advantage of HVAC systems relative to each other has not been demonstrated during laparoscopic cholecystectomy.

Comparison of Classic and Inguinal Obturator Nerve Blocks Applied for Preventing Adductor Muscle Contractions in Bladder Tumor Surgeries: A Prospective Randomized Trial.

PURPOSE: Obturator nerve block (ONB) has been performed in surgeries of transurethral resection of bladder tumors (TUR-BT) for the prevention of the development of obturator muscle contraction. Currently, classic and inguinal approaches are frequently being used. In the present study, we aimed to compare the success rate, performance speed, and complication risks of both approaches. MATERIALS AND METHODS: Sixty-six patients who underwent TUR-BT under spinal anesthesia were randomly selected, and ONB was performed on the tumor location side using classic (n = 33) or inguinal (n = 33) approaches. Ten milliliters of 0.25% bupivacaine were administered using a peripheral nerve stimulator in both approaches.Two endpoints were defined in the study: Primary endpoint; the duration of the determination of the obturator nerve and number of interventions when each participant is assessed in at the end of the ONB procedure. Secondary endpoint; development of contractions, and complications each participant is assessed during the TUR-BT and 24 hours after ONB. (Clinical Trial Registration Number: ACTRN12617001050347)Result: General anesthesia was applied to the five patients in the classic ONB group who detected diffuse or bilateral tumors. These patients were excluded from the study. Contractions developed in 4 patients in each group, no statistically significant difference was detected between the groups (14.3%, n = 4 versus 12.1%, n = 4) (P = 1.00). No complications were detected in both groups during the TUR-BT and 24 hours after ONB. We found that the inguinal approach provided a statistically significant advantage regarding the number of punctures (1.9 ± 0.9 versus1.5 ± 0.7) (P = .036), and duration of the procedure (99.1 ± 48.4 seconds versus 76.0 ± 31.9 seconds) (P=.029) compared with the classic approach. CONCLUSION: Although complications and success rates were similar in both groups, the inguinal method may be abetter approach because it is faster and requires fewer punctures.

The role of videolaryngoscope in endotracheal intubation training programs / O papel do videolaringoscópio em programas de treinamento de intubação endotraqueal

Abstract Background Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. Results Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group-VM (p = 0.008). Conclusions The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs.

Resumo Justificativa Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo-MM e Grupo-MV utilizaram laringoscópios Macintosh e o Grupo-VV e Grupo-VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo-MM e Grupo-VM e videolaringoscópios pelo Grupo VV e Grupo-MV. Resultados As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV (p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo-VM (p = 0,008). Conclusões A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal.

[The role of videolaryngoscope in endotracheal intubation training programs]. / O papel do videolaringoscópio em programas de treinamento de intubação endotraqueal.

BACKGROUND: Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. METHODS: Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. RESULTS: Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p=0.011; p=0.021, p=0.290 respectively) whereas a decrease was observed in group-VM (p=0.008). CONCLUSIONS: The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs.

Role of Ultrasonography in Detecting the Localisation of the Nasoenteric Tube.

OBJECTIVE: In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area using ultrasonography (USG) and compare with the commonly used method direct abdominal graphy. METHODS: A single anaesthesiologist placed all the NETs. The NET was visualised by two radiologists simultaneously using USG. The localisation of the tube was confirmed using an abdominal graph in all patients. RESULTS: The blind bedside method was used for NET insertion into 34 patients. Eleven of the tubes were detected passing through the postpyloric area using USG. In one case, the NET could not be visualised in the postpyloric area using USG; however, it was detected in the postpyloric area through control abdominal radiography. In 22 patients, NETs were detected in the stomach using control abdominal radiography. The rate of imaging post pyloric using USG was 91.6%. When all cases were considered, catheter localisation was detected accurately using USG by 97% (33 in 34 patients). CONCLUSION: USG is a reliable and practical alternative to radiography, which can be used to detect localisation of the nasogastric tube and NET.

Anaesthetic Method Preference of Obstetricians for Caesarean Section.

OBJECTIVE: Anaesthesiologists are applying regional anaesthesia for caesarean section at an increasing rate compared to previous years. In our study, we tried to evaluate the perspective of obstetricians towards this trend. METHODS: Questionnaires were sent to e-mail addresses of obstetricians via the internet; 195 obstetricians replied. Sex, age, work place, employer, working durations as consultant, preference of anaesthesia for caesarean section and their bias towards regional anaesthesia were asked with these questionnaires. A 5-point Likert scale was used to evaluate their bias towards regional anaesthesia. RESULTS: While 82.1% of obstetricians (n: 160) preferred regional anaesthesia, 17.9% of obstetricians (n: 35) favoured general anaesthesia for caesarean section for both themselves and their primary relatives. However, 80% of the participants opted for regional anaesthesia for their patients; only 20% of the participants still preferred general anaesthesia for caesarean section. Chi-square tests that were used to evaluate the relationship between demographic data and anaesthesia choices of obstetricians for both themselves, their primary relatives and their patients did not reveal any statistically significant differences (p<0.05). CONCLUSION: A large portion of Turkish obstetricians consider regional anaesthesia a safe procedure and prefer it highly for both themselves and their patients.

Lidocaine intoxication in axillary block: similar pharmaceutical form, different concentration.

Local anesthetic intoxication is a medical emergency with high mortality. These drugs have not spesific antidotes, quick differential diagnosis and supportive treatment required in the case of exposure to toxic doses. We report the complications and anesthetic management of a patient who was scheduled for right carpal tunnel syndrome surgery under regional anesthesia, but mistakenly received injection of 140 mg procaine added to 10% 10 mL lidocaine (10 mL=1000mg) instead of 2% lidocaine (10mL=200 mg) as part of an axillary plexus blockade.