The Effects of Transversus Abdominis Plane (TAP) Block on Hemodynamic Parameters, Postoperative Analgesia, and Parental Satisfaction in Children.

OBJECTIVE: To evaluate ultrasound-guided transversus abdominis plane (TAP) block, perioperative hemodynamic responses, postoperative analgesic efficacy, length of hospitalisation, and family satisfaction in children undergoing abdominal surgery. STUDY DESIGN: Randomised clinical trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Harran University Hospital, Turkiye, from June 2020 to June 2021. METHODOLOGY: One hundred and eight patients aged 4-12 years in the American Society of Anaesthesiologists (ASA) 1-2 group who will undergo abdominal surgery (intra-abdominal and extra-abdominal) were included in the study. The patients were randomly divided into two groups as TAP to be performed (TAP+) and not to (TAP-) using the closed envelope method. General anaesthesia was given to the patients with standard anaesthesia protocol. Intraoperative and postoperative vitals, analgesic consumption in the first 24 hours postoperatively, length of hospitalisation, pain scores with Wong Baker Facial Pain Rating Scale (WBFPS), and parent satisfaction scores with Likert satisfaction scale were recorded. RESULTS: Perioperative SBP, DBP, and HR were significantly lower in the TAP+group (p <0.005). Postoperative analgesic consumption and Likert satisfaction scores were significantly higher in the TAP-group compared to the TAP+Group (p <0.001). Parental satisfaction was significantly higher in the TAP+Group than in the TAP-Group. CONCLUSION: The application of TAP block to children undergoing abdominal surgery; provided stable hemodynamics in the perioperative period, good analgesia in the postoperative period and increased parental satisfaction. In addition, can also shorten the hospital stays and may be routinely preferred in multimodal analgesia applications. KEY WORDS: Anaesthesia, Regional, Transversus abdominis plane block, Family satisfaction, Pain, Postoperative, Paediatric surgery.

Relationship Between the Coma Scores and Hemogram Parameters Measured by New-generation Devices.

OBJECTIVE: To investigate the relationship between the coma scores-Glasgow coma scale (GCS), Sequential Organ Failure Assessment (SOFA), and Acute Physiological and Chronic Health Assessment (APACHE-II)-in intensive care unit (ICU) patients and the percentage of macrocytosis (%MAC), immature granulocyte (IG), cellular haemoglobin concentration (cHGB), nucleated red blood cell (NRBC), nucleated red cell/ white cell ratio (NR/W), hyperchromic ratio (%HPR), and platelet distribution width (PDW) values. STUDY DESIGN: A descriptive comparative study. Place and Duration of the Study: Medicine Faculty, University of Harran, Turkiye, from December 2020 to May 2022. METHODOLOGY: The hemogram parameters of the patient groups with a GCS of 3-8 (n=51) and a GCS of 9-15 (n=43) and a control group of 55 healthy volunteers were measured using the new-generation hemogram autoanalyzer AlinityHQ (Abbott, USA). These parameters were compared with the coma scores (GCS, SOFA, and APACHE-II) of the patients. RESULTS: There was a statistically significant difference in IG, %MAC and PDW values (p-values were 0.025, 0.011, and 0.004, respectively) and an inverse correlation with GCS scores (correlation coefficients were -0.247, -0.264, and -0.297, respectively) was observed. There was also a significant correlation between the SOFA scores and %HPR and cHGB (correlation coefficients were 0.234, -0.358, p-values were 0.025, 0.001, respectively), and the APACHE-II scores and NRBC and NR/W values (correlation coefficients were -0.270, -0.247, p values were 0.009, 0.017, respectively). CONCLUSION: While other haematological parameters other than PDW were not associated with coma scores, parameters measured using new-generation haematological devices (%MAC, IG, cHGB, NRBC, NR/W, and %HPR) were found to be associated with estimated coma scores. These parameters can therefore be used as simple, rapid prognostic biomarkers and assist researchers in the development of new scoring models. KEY WORDS: ICU, Hyper, Coma, Sofa, Apache.

Dynamic Thiol Disulphide Homeostasis in the Follow-Up of the Prognosis of Patients Treated for COVID-19 in the Intensive Care Unit.

INTRODUCTION: Evaluation of the prognosis in the early period of intensive care patients and arranging the treatment accordingly is of vital importance. In the present study, we investigated whether serum thiol/disulphide concentration can be used in the follow-up of prognosis in the early period in patients with COVID-19 under intensive care. METHODS: The study included 25 patients [their ages were between 19 and 92; 10 (40%) were male and 15 (60%) were female] who were diagnosed with COVID-19 and treated in the intensive care unit (ICU). The patients were followed for four weeks. On the first, third, and fifth days of intensive care treatment, venous blood samples were taken from the patients to analyze the thiol/disulphide parameters, and coma scores were calculated. Statistical analyses were conducted to evaluate the relationship between thiol/disulphide levels and the prognosis of COVID-19 patients. RESULTS: At the end of the four-week follow-up of the patients included in the study, 9 were discharged and 16 died. In patients who died, the relationship between thiol/disulphide homeostasis parameters and coma scores was not statistically significant. Meanwhile, in discharged patients, the relationship between disulphide concentration, total thiol, and coma scores was statistically significant. CONCLUSION: The relationship between thiol/disulphide homeostasis and coma scores in COVID-19 patients treated in the intensive care unit may help to evaluate the prognosis of the disease in the early period, thus the effectiveness of medical intervention.

Comparison of General Anesthesia (Sevoflurane) and Spinal Anesthesia (Levobupivacaine) Methods on QT Dispersion in Inguinal Hernia Operations.

Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.

False Laboratory Test Result Through Colistin Interference in an Intensive Care Patient: Case Report.

BACKGROUND: In blood samples taken for testing purposes during drug infusion in the intensive care unit, there is a risk of interference due to drug-reactive interaction during the analysis. CASE REPORT: A 19-year-old female patient had undergone surgery for intracranial astrocytoma, 12 years ago. Acinetobacter baumannii was found in the blood culture and deep tracheal aspiration fluid of the patient who had a fever (39.2 °C) with a body temperature during the follow-up. The patient was started on colistin 2 * 4.5 million IU. After the colistin infusion, biochemical tests were requested to control the patient's clinical situation. CK-MB mass and ProBNP values were measured in high concentrations. Cardiology consultation was requested to evaluate the increase in the CK-MB mass and ProBNP values. The patient's ECG and echocardiography showed no abnormality. The increase in cardiac markers was neither clinically acceptable nor insignificant. There was no hemolysis in the sample or analytical error in the device. Variability in the tests was thought to be due to the interference. As the bloodletting time was questioned, it was determined that it was taken during colistin treatment. In order to determine the effect of colistin-related interference on the other tests, the laboratory was contacted and additional tests (TSH, FT4, Anti- TPO, B-HCG, Estradiol, Prolactin, CA 125, CA 15-3, CA 19-9, Vitamin B12, C-Peptide, DDimer, PTH, 25 hydroxy vitamin D, PT, INR, APTT) were conducted. During colistin treatment, in many tests, bias was detected between -75 and + 268.80%. CONCLUSION: Clinicians should consider suspicious test results that are incompatible with the diagnosis for the possibility of erroneous measurements due to colistin interference and review the sampling processes.

The Effect of Increased Neutrophil Lymphocyte Ratio on Mortality in Patients Operated on Due to Hip Fracture.

Introduction In this study, we aimed to examine the effect of neutrophil-lymphocyte ratio (NLR) on mortality and morbidity in elderly patients over the age of 65 who presented to our clinic and were operated on due to hip fracture. Methods The study included patients over the age of 65 who were operated on in our hospital between January 2014 and December 2018 due to hip fracture. Those with multiple fractures and those who were operated on due to cancer-related fracture were excluded. Patients' age, gender, American Society of Anesthesiologists (ASA) score, preoperative waiting time, type of anesthesia, operation duration, amount of erythrocyte suspension used, and duration of intensive care unit (ICU) stay were recorded. The effect of increased preoperative and postoperative 5th day neutrophil-lymphocyte ratios (NLR 1 and NLR 5, respectively) on mortality and morbidity was investigated. Results We examined 132 patients operated on due to hip fracture. NLR 5 was higher among patients who were admitted to the ICU (p = 0.007) and among those who died (p = 0.007). Additionally, the rate of increase of NLR 5 was higher among patients who were admitted to the ICU (p = 0.044) and among those died (p = 0.009). Conclusion The rate of increase of NLR in the postoperative period can be used as a criterion for predicting mortality in patients who are operated on due to hip fracture.

The Relationship Between Hematological Parameters and Mortality in Cardiovascular Patients With Postcardiac Arrest Syndrome.

BACKGROUND: Post-cardiac arrest syndrome is the insufficiency of cardiac and cerebral functions caused by ischemia after sudden cardiac arrest. We aimed to determine the hematological parameters associated with mortality in the intensive care follow-up of patients with post-cardiac arrest syndrome. METHODS: The hematological parameters of 285 cardiovascular patients who were admitted to the emergency department of Harran University Medical Faculty between 2013 and 2018 and followed up in the intensive care unit with post-cardiac arrest syndrome were examined. A total of 85 patients were included in the study. These parameters were recorded as the time of arrival to the emergency department (0 hour) and hematological parameters at the 24th and 48th hours of intensive care follow-up. RESULTS: In the mortality group, albumin (P:0.030), hemoglobin (Hg) (P: 0.049), and hematocrit (HCT) (P: 0.020) values ​​in the blood parameters, at the time of admission to the emergency department, were significantly lower than those in the survival group. Red blood cell distribution width (RDW) (P: 0.009) and urea (P <0.001) values ​​at the time of arrival were higher than the survival group. In the 24th and 48th hours, mean hemoglobin (MCHC) (P <0.05) values ​​were lower and RDW (P <0.05) values ​​were higher in the mortality group compared to the survival group. CONCLUSIONS: In this retrospective validation, low albumin, Hg, HCT, MCHC, and high RDW and urea levels may increase mortality in cardiovascular patients who develop post-cardiac arrest syndrome within the first 48 hours. Correcting these values ​​early may reduce mortality.

[Effect of preoperative 900 and 1200 mg single oral dose of gabapentin on postoperative pain relief and tramadol consumption in open cholecystectomy surgery]. / Açik kolesistektomi cerrahisinde preoperatif tek doz oral 900 ve 1200 mg gabapentinin postoperatif agri ve tramadol tüketimi üzerine etkisi.

In this study, the effects of preoperative 900 and 1200 mg single dose of gabapentin on postoperative pain relief and tramadol consumption in elective open cholecystectomies were investigated. Fourty-five ASA I-II patients were randomly divided into three groups. Group I was control group and patients in group II and III received 900 mg or 1200 mg gabapentin 1 hour before the operations respectively. All patients received intravenous tramadol at the end of surgery via a patient controlled analgesia (PCA) device. Pain scores were evaluated at the recovery room (0),1, 2, 3, 4, 6, 8, 12 and 24h postoperatively at rest and movement, using a 10 cm VAS. In the recovery room, VAS scores at rest were three times less (1,4+/-0.6 versus 4,9+/-1.0 and 4.4+/-1.1), and visual analogue scale (VAS) scores at movement were two times less (3.4+/-1.0 versus 6.8+/-1.8 ve 6.1+/-1.6) in group III when compared to group I and II respectively. Mean loading doses were significantly lower in group III (28.3+/-8.7) than group I (66.6+/-20.4) and II (61.6+/-20.8). VAS scores at rest during the postoperative first 6h and at movement during the postoperative first 8h were significantly lower in group III than group I and II. Total tramadol consumption was lower in group III (240.4+/-31.0), than group I (456.0+/-35.5) and group II (438.7+/-35.0). Additional meperidine was necessary for two patients both in groups I and II, although none of the patients needed in group III. Higher patient satisfaction scores were obtained in group III. Adverse effect incidences were higher in group I and II than in group III. As a result, we believe that to improve analgesic quality after open cholecystectomy, preoperative single dose of gabapentin should at least be 1200 mg.