Impact of COVID-19 pandemic on the circadian rhythm of cesarean section deliveries.

Circadian rhythms synchronize all biological functions, enabling humans to foresee and respond better to periodic environmental changes. The coronavirus disease (COVID-19) lockdown regulations significantly changed the lighting conditions in pregnant women, leading to chronological disruption. This study aimed to investigate the impact of the COVID-19 on the circadian rhythm of cesarean deliveries. We investigated whether the circadian rhythm of cesarean section deliveries changed during the first year of the COVID-19 pandemic at a tertiary hospital in Van Province, eastern Turkey. We analyzed the distribution of birth times for 1476 cesarean deliveries performed between March 01, 2020 and January 20, 2021 (1st year of the COVID-19 pandemic) and compared this information with data from 1194 cesarean deliveries performed during a similar period in the previous year. The primary outcome was the change in the circadian rhythm of cesarean deliveries. Secondary outcomes included cesarean section (CS) delivery rates, indications for CS, 1st and 5th minutes Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration scores, and anesthesia technique use rates. Regarding the time distribution of CS deliveries in the first year of the COVID-19 pandemic, the maximum number of cesarean deliveries (n = 234, 16%) occurred between 14:00 and 16:00 (P = .112). Cesarean deliveries in pre-COVID-19 group were most frequently performed between 10:00 and 12:00, at a rate of 18% (n = 216) (P = .001). In both groups, the time point at which CS deliveries were the least performed was 04:00 to 06:00, and the rates were different (n = 35, 2% and n = 14, 1%, respectively) (P = .022). A 4-hour phase shift was detected at the peak of the birth time in the first year of the COVID-19 pandemic compared to the previous year. These results suggest that the circadian rhythm of cesarean deliveries is affected by the pandemic.

Comparative Sedation with Sevoflurane and Thiopental in Children Undergoing MR Imaging.

OBJECTIVE: To compare the use of propofol and thiopental in children undergoing MRI. STUDY DESIGN: Descriptive, comparative study. PLACE AND DURATION OF STUDY: University of Health Sciences, Van Training and Research Hospital, Van, Turkey, between January 01 and December 31, 2019. METHODOLOGY: One thousand two hundred and twenty two paediatric patients having MRI were included and divided into two groups. Patients aged 2-18 years who were administered Propofol were classified as Group I, and the patients under the age of 2 years who were administered Thiopental were classified as group II. All patients received Sevoflurane insufflation via face mask after induction agent. Patient's demographic data, ASA scores, anaesthesia-procedure-recovery times, comorbidities, type of MRI examination and complications were recorded. RESULTS: Age, body weight and ASA score of the patients in Group I were higher than Group II (p<0.05). Epilepsy, cerebral palsy, mental retardation, speech retardation and autism were more prevalent in Group I than in Group II (p<0.05). Neuromuscular growth retardation, hydrocephalus, and metabolic disease were less common in Group I than in Group II (p<0.05). With this Apnea and desaturation was higher in Group I, and bradycardia was higher in Group II. CONCLUSION: Sevoflurane insufflation with a face mask can be safely used in children after induction of anaesthesia with propofol or thiopental. KEY WORDS: Sedation, Paediatric patients, Propofol, Thiopental, Sevoflurane.

The Effects of Preincisional Levobupivacaine Infiltration on Extubation Comfort, Postoperative Recovery and Visual Analogue Scale in Appendectomy Patients.

OBJECTIVE: The aim of our study was to determine the effect of preincisional 0.25% levobupivacaine infiltration on extubation comfort, postoperative recovery and visual analogue scale (VAS) in appendectomy patients. METHODS: Forty 15-60-year-old patients at American Society of Anaesthesiologists (ASA) physical status I-II, scheduled for appendectomy were included in the study. After routine monitorisation, anaesthesia induction was performed with propofol, fentanyl and rocuronium; later, maintenance was continued with sevoflurane. Patients were divided into two groups randomly. A total 20 mL of 0.25% (50 mg) levobupivacaine was injected around the incision line as a rectangle in Group 1. Levobupivacaine was not administered in Group 2 patients. Heart rate, peripheral oxygen saturation, additional fentanyl requirement and mean blood pressure were recorded during the operation. All patients were evaluated according to difficulties encountered during extubation. RESULTS: Discharge time, necessity of diclofenac and postoperative VAS values at 0-1 hours were statistically lower in Group 1 patients than the Group 2 patients (p<0.05). Difficulties, like straining, cough, laryngo-bronchospasm, vomiting and nausea during extubation, were 5% and 25% in Group 1 and Group 2, respectively, but these differences were not statistically significant (p=0.077). CONCLUSION: Infiltration of 0.25% of levobupivacaine as a rectangle which included the incision line before surgery decreases discharge time, provides analgesia well in the early postoperative period and diminishes the requirement of analgesics in appendectomy patients.