Efficacy of High-Voltage Pulsed Radiofrequency of the Dorsal Root Ganglion for Treatment of Chronic Lumbosacral Radicular Pain: A Randomized Clinical Trial.

BACKGROUND: Pulsed radiofrequency (PRF) is an efficacious treatment for patients with lumbosacral radicular pain, but the optimal radiofrequency parameters are inadequately described. We hypothesized that high-voltage radiofrequency therapy around the dorsal root ganglion can be more effective and enduring than the standard voltage PRF therapy. MATERIALS AND METHODS: This was a prospective and randomized study. Patients were divided into two groups. In group 1 (high-voltage group), PRF was applied at 60 V to the patients. Patients in group 2 (low-voltage group) received PRF treatment at 45 V. The patients were evaluated using a numeric rating scale (NRS) and the Oswestry Disability Index (ODI). Evaluation scales were repeated before the intervention and at the first and sixth months after the treatment. RESULTS: The study included 41 analyzed patients. There was no statistically significant difference between the groups at the first-month NRS (p > 0.05). Sixth-month NRS scores were lower in the high-voltage group (p = 0.016). The groups showed no statistically significant differences in the one-month ODI scores (p > 0.05). When the NRS values were analyzed with linear regression, a positive correlation was found between the sixth-month NRS values and high-voltage PRF (odds ratio: 0.385; p = 0.013). Comparison of the treatment success in terms of time showed statistically significant results in both groups in the first and sixth months (p < 0.05). CONCLUSIONS: The results of our study revealed that both low- and high-voltage PRF are effective. Because of the lower sixth-month NRS values in the high-voltage group and the similar complication rate, it was considered that high-voltage PRF can be a promising application.

Anesthetic management of scoliosis operation in a pediatric patient with Frank-ter Haar syndrome: a case report.

Frank-ter Haar syndrome is a rare disorder characterized by multiple skeletal, cardiovascular abnormalities, and facial features. Some of these characteristic facial features are important for anesthesiologists to predict the difficult airway. We present the anesthesia management of an 8-year-old boy with Frank-ter Haar syndrome who underwent posterior spinal instrumentation operation for scoliosis. In these patients, it is vital to anticipate possible difficult intubation before surgery and make all necessary preparations.

The Associations Between Cognitive Dysfunction, Stress Biomarkers, and Administered Anesthesia Type in Total Knee Arthroplasties: Prospective, Randomized Trial.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a serious complication associated with total knee arthroplasty (TKA) and has been shown to increase the length of hospital stay, cause functional impairment, and morbidity. OBJECTIVES: We aimed to determine whether POCD is associated with the use of general or regional anesthesia in patients undergoing TKA. Our hypothesis was that POCD would be reduced in the group that received regional analgesia without any sedations. Our secondary hypothesis was POCD would be associated with biomarkers of surgical stress. STUDY DESIGN: Randomized controlled study between general and spinal anesthesia. SETTING: Single-centered, university hospital, from January to October 2017. METHODS: A total of 112 patients were assessed for eligibility, and a total of 57 patients completed the study. We divided the patients into general and regional anesthesia groups. Blood samples were obtained preoperatively at the first intraoperative, the third and the 24th postoperative hour. C-reactive protein (CRP), cortisol, insulin, and blood glucose levels were tested. We used 4 neurocognitive tests that were administered 1 day before operation, 7 days and 30 days after operation. Main outcome measures were neurocognitive tests scores for regional anesthesia without sedation and general anesthesia groups. Cortisol, glucose, insulin, and CRP levels. RESULTS: Patients who received regional anesthesia showed significantly higher Mini-Mental State Examination (MMSE) scored compared with the general anesthesia at the seventh day (P = 0.037). In the general anesthesia group, patients showed significantly higher variations for the Stroop number difference. There were negative correlations between MMSE scores measured at postoperative day 7 and the 1-hour intraoperative cortisol measurements (r = -0.302; P = 0.022) and 3-hour postoperative cortisol measurements (r = -0.295; P = 0.026). LIMITATIONS: A limitation was the small number of patients. CONCLUSIONS: We demonstrate that regional anesthesia results in better neurocognitive test scores than general anesthesia in patients undergoing TKA. Patients who received regional anesthesia showed lower cortisol, higher insulin, and lower glucose levels. We recommend that patients who undergo arthroplasty surgeries should receive regional anesthesia to avoid POCD at the early stages of the postoperative period. KEY WORDS: Cognitive dysfunction, stress biomarkers, acute pain, regional anesthesia, spinal anesthesia.

Evaluation of preoperative anxiety and fear of anesthesia using APAIS score.

BACKGROUND: Preoperative anxiety is one of the most important problems for the patients, because it causes emotional and psychiatric problems as well as physical problems. It is crucial to detect the patient's existing anxiety to assist patients. Our primary aim in this study is to investigate how the patient's age, gender, the operation, surgical briefing, type of anesthesia recommended for the operation ahead, and patient's prior anesthesia experience affect the patient's anxieties. Our secondary aim is to reveal the causes of the patient's anxieties regarding anesthesia. METHODS: Our study was conducted as a prospective cohort study between May 2016-2017. Interviews with the patients were performed in the anesthesia clinic for preoperative examination. For the study, The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has been used. The answers were evaluated in two scales: the anxiety score and the desire for information score. Answers to the statements were evaluated with Likert Scale. In addition, our patients were asked whether they had received prior anesthesia, if so, the type of anesthesia, whether they received surgical briefing and anesthetic method we recommended. We also asked our patients about the cause of their anxiety regarding the anesthesia. RESULTS: A total of 637 patients were recruited to the study, after excluding the patients who do not meet the criteria for inclusion, and 499 patients were included. Between the age and desire for information sub-scores, a negative significant correlation was detected (r: - 0.241; p = 0.001). We found that the scores of graduates of university and higher were statistically significant than the primary school graduates (p = 0.003) and secondary school graduates (p = 0.034). Anxiety sub-scores of the patients who underwent general anesthesia were found to be significantly higher than the patients who underwent regional anesthesia (p = 0.029). Anxiety sub-scores of females were found to be significantly higher than the males (p = 0.001). CONCLUSIONS: We think that being aware of the patients' anxiety and finding appropriate approaches for their anxieties can be valuable. APAIS is an effective method to measure patient anxiety and it might be beneficial to use during preoperative visits. Patient satisfaction and superior outcomes can be achieved in this way. Trial registration ISRCTN43960422. Registered 19/02/2018-Retrospectively registered. http://www.isrctn.com/ISRCTN43960422.

Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation.

Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitted to neonatal intensive care unit and intubated due to severe respiratory insufficiency. He showed signs of severe pulmonary hypoplasia and his echocardiography revealed a cardiac dextroversion. The patient was relatively stabilized after four days under combined high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO). A corrective surgical intervention was sustained with dopamine, dobutamine, fentanyl and midazolam infusions. Ventilator settings were: 9 cmH2O MAP; 15-Hz frequency; 30 cmH2O amplitude and 55% FiO2. Venous-blood gas analysis indicated pH:7.38 pO2:36.2, pCO2:39.2 with SpO2:98%. We believe that HFOV and iNO combination is an effective alternative for the anesthetic management of CDH cases as it provides better gas exchange and less volutrauma.

Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study.

OBJECTIVE: The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). MATERIAL AND METHOD: 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. RESULTS: The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584). CONCLUSION: A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.

Two-year experience with cell salvage in total hip arthroplasty.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

[Two-year experience with cell salvage in total hip arthroplasty]. / Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

Anesthetic Approach for a Patient with Jeune Syndrome.

Jeune syndrome (JS) is an autosomal recessive disease also known as asphyxiating thoracic dystrophy. A narrow bell-shaped thoracic wall and short extremities are the most typical features of the syndrome. Prognosis in JS depends on the severity of the pulmonary hypoplasia caused by the chest wall deformity. Most patient deaths are due to respiratory problems at early ages. Herein, we report a case of JS patient, who was scheduled for femoral extension under general anesthesia. The severity of respiratory problems in JS patients is thought to diminish with age. Our case supported this theory, and we managed the anesthetic process uneventfully.