Anti-fibrotic Treatment for Pulmonary Fibrosis Induced by COVID-19: A Case Presentation.

Coronavirus disease 19 infection clinical presentation varies from asymptomatic cases to acute respiratory distress syndromes. In some cases, pulmonary fibrosis is observed after or during the disease. Pirfenidone is an agent approved for the treatment of idiopathic pulmonary fibrosis. Here we report a patient treated with pirfenidone for pulmonary fibrosis related to coronavirus disease 19.

Impact of the COVID-19 Pandemic on Anaesthesiology and Reanimation Residency Training in Turkey.

OBJECTIVE: The purpose of this study was to evaluate the impact of the pandemic on clinical practice and education of anaesthesiology and reanimation residents in Turkey. METHODS: A 33-question web-based survey was sent to anaesthesiology and reanimation residents in Turkey. Residents were asked about their clinical practice and education before and during the pandemic and personal perspectives on working conditions and training. RESULTS: A total of 223 residents participated. Median working time in the intensive care unit of 2.5 months/year before the pandemic increased to 6 months/year during the pandemic (P < .001). Median working time in the operating room of 9 months/year decreased to 6 months/year (P < .001). The time working in the algology and anaesthesiology outpatient clinic decreased significantly (both P < .001). Neuraxial and peripheral nerve block practices decreased (P = .002 and P = .023, respectively). The number of night shifts per month increased (P < .001). While the average number of beds in intensive care units was 14, it increased to 19.5 beds (P < .001). The education time for lecture and clinical case discussion decreased (P < .001), but medical meeting attendance did not change (P = .174). Eighty-seven percent of the residents reported that night shifts were very intense and intense during the pandemic. For 87.3% of the respondents, the workload increased, and 71.6% of the respondents reported a decrease in theoretical education and 66.7% in practical training. Sixty-three percent of last year residents reported that they were negatively and very negatively affected in making the thesis. CONCLUSION: The pandemic had a negative impact on anaesthesiology and reanimation residency training programs in Turkey.

Mothers Level of Education and Preoperative Informative Story Book Reading Helps Reduce Preoperative Anxiety in Children in Turkey.

PURPOSE: This study aimed to evaluate the use of a standard story book, compared to an informative story book, as preoperative preparation to relieve anxiety. DESIGN AND METHODS: A total of 120 children with ASA I-II, aged 6-8 years, scheduled to undergo elective adenoidectomy, tonsillectomy, and adenotonsillectomy were enrolled in this randomized controlled study. The control group received a non-medical, colorful story book, while the intervention group received an informative story book appropriate for their age. The book was either read by literate children or the mothers of illiterate children. The book was read aloud at least once before the surgery while they were together. The patients' baseline anxiety level was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) immediately after entering the preoperative holding area (T0). Mothers' anxiety level was assessed using the State and Trait Anxiety Inventory (STAI). Information about the reader, how many times the book was read, the age and education level of the mother, and the presence of a surgical history in the patients' siblings was obtained from the mother through a questionnaire. After premedication with oral midazolam, patients' anxiety level was assessed while entering the operation room (T1). RESULTS: The intervention group had significantly lower mYPAS scores at T0 and T1 than the control group. Those who read the intervention book ≥3 times had significantly lower mYPAS values than those who read 2 times or less. Mothers with a low education level had higher anxiety levels in both groups. CONCLUSIONS: Repeatedly informing children by reading an informative story book and higher education level of mothers are the most important factors for relieving preoperative anxiety in children. PRACTICE IMPLICATIONS: Reducing preoperative anxiety is an important factor for children and their families.

Which is good for pre-operative anxiety? Midazolam, video games or teaching with cartoons: A randomised trial.

BACKGROUND: Pre-operative anxiety in children has been associated with adverse clinical outcomes such as difficulty in anaesthesia induction, emergence delirium and negative postoperative behavioural changes. Therefore, pre-operative anxiety should be alleviated in both children and clinicians. OBJECTIVE: We investigated the effect on pre-operative anxiety of premedication with midazolam, playing video games or watching a cartoon about anaesthesia. DESIGN: A prospective randomised trial. SETTING: Single-centre study performed between August 2018 and June 2019. PATIENTS: We enrolled 138 patients aged 5 to 8 years undergoing elective surgery. INTERVENTIONS: After evaluating baseline (T0) anxiety levels using the modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-operative holding area, 0.5 mg kg-1 oral midazolam was given to Group M, a tablet with videogame applications was given to Group T, and Group S watched the cartoon 'Süko Is Being Operated'. mYPAS values were recorded a further three times: 20 min after the intervention (T1), while entering the operating room (T2), and during mask induction of anaesthesia (T3). MAIN OUTCOME MEASURES: The primary endpoint was the change in children's anxiety levels from baseline. The secondary endpoint was cooperation during mask induction. RESULTS: The baseline mYPAS scores were comparable (40.7, 42.6 and 40.7 in groups M, S and T respectively). The mean mYPAS scores at T1 were 32.6, 34.7, 26.8 and at T2 were 38.6, 42.7, 35 in groups M, S and T, respectively. There were significant differences between groups S and T at T1 and T2 (P < 0.001, P = 0.010). A significant decrease was found in Group T compared with both groups M and S from T0 to T1 (P = 0.002). mYPAS values at T3 were 38.3, 43.7, 39.5 in groups M, S and T, respectively, with no difference between the groups (P = 0.224). Mask acceptance scores were similar in all groups (P = 0.912). CONCLUSIONS: The passive teaching technique of watching a video for reducing anxiety levels was not effective. However, active distraction with videogames was found to be a valuable method to reduce pre-operative anxiety. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03530670.

Comparison of the effect of rocuronium dosing based on corrected or lean body weight on rapid sequence induction and neuromuscular blockade duration in obese female patients.

OBJECTIVES: To compare onset time, duration of action, and tracheal intubation conditions in obese patients when the intubation dose of rocuronium was based on corrected body weight (CBW) versus lean body weight (LBW) for rapid sequence induction.  METHODS: This prospective study was carried out at Numune Education and Research Hospital, Ankara, Turkey between August 2013 and May 2014. Forty female obese patients scheduled for laparoscopic surgery under general anesthesia were randomized into 2 groups. Group CBW (n=20) received 1.2 mg/kg rocuronium based on CBW, and group LBW (n=20) received 1.2 mg/kg rocuronium based on LBW. Endotracheal intubation was performed 60 seconds after injection of muscle relaxant, and intubating conditions were evaluated. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis. Onset time, defined as time to depression of the twitch tension to 95% of its control value, and duration of action, defined as time to achieve one response to train-of-four stimulation (T1) were recorded. RESULTS: No significant differences were observed between the groups in intubation conditions or onset time (50-60 seconds median, 30-30 interquartile range [IQR]). Duration of action was significantly longer in the CBW group (60 minutes median, 12 IQR) than the LBW group (35 minutes median, 16 IQR; p less than 0.01). CONCLUSION: In obese patients, dosing of 1.2 mg/kg rocuronium based on LBW provides excellent or good tracheal intubating conditions within 60 seconds after administration and does not lead to prolonged duration of action.