As the Turkish Journal of Anaesthesiology and Reanimation Leaves Its 50th Anniversary Behind.

The Turkish Journal of Anaesthesiology and Reanimation, established in 1972, is 50 years old now. The number of citations of the journal and the interest of national and international researchers are high. This success has been achieved by the editorial boards who have contributed to the journal since its establishment and the writers who have contributed to its development, and this success will continue to increase.

Effect of the Gupta Score on Pre-operative Cardiology Consultation Requests in Noncardiac Nonvascular Surgery.

Objective: Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects. Methods: This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs. Results: A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019). Conclusion: Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.

Comparison of Two Different Methods for ProSealTM Laryngeal Mask Fixation.

Objective: This prospective randomized study compared 2 different methods for ProsealTM Laryngeal Mask Airway (PLMA) fixation. Methods: Patients scheduled for ureterorenoscopic lithotripsy surgery in the lithotomy position were included in the study. General anaesthesia with PLMA was administered to the patients. To achieve PLMA fixation, patients were randomly assigned to either adjustable elastic band (Group I) or adhesive tape fixation (Group II). Fiberoptic bronchoscope (FOB) evaluation and glottic image grading (grade 1-4) and lip margin distances of PLMA (M1 and M2) were evaluated before and after the surgical procedure. Results: We enrolled 116 patients. Surgery of 7 patients was postponed. PLMA dislocated in 2 patients in group II during positioning. For another patient who used adhesive tape in Group II, it was removed because it could not adhere to properly, and a new sticking plaster was used. The study was completed with 106 patients. In FOB evaluation, the number of patients with optimal FOB grade (FOB grade 1) after PLMA was inserted and fixed was more in Group I than in Group II (P = 0.01). FOB evaluation was repeated at the end of the operation, and the number of patients with the worst FOB grade (FOB grade 4) was 0 (0%) and 11 (10.5%) in Groups I and II, respectively. PLMA displaced more than 1 cm in 10 (18.9%) patients in Group I and in 30 patients (56.6%) in Group II. Conclusion: The adjustable elastic band method is simple, easy, and convenient and can be used in any surgical procedure for PLMA fixation.

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.

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.

What is Scientific Research and How Can it be Done?

Scientific researches are studies that should be systematically planned before performing them. In this review, classification and description of scientific studies, planning stage randomisation and bias are explained.

Prevention of Withdrawal Movement Associated with the Injection of Rocuronium in Children: Comparison of Paracetamol and Lidocaine.

OBJECTIVE: Pain from rocuronium injection is observed in 50%-80 % of patients. This study aimed to compare the effectiveness of pretreatment with paracetamol and lidocaine in preventing pain-induced withdrawal caused by the intravenous injection of rocuronium during the induction of general anaesthesia in paediatric patients. METHODS: Ninety children were randomized into two groups using a simple drawing from the box method: a paracetamol group (Group P, n=45) and a lidocaine group (Group L, n=45). After anaesthesia induction, venous occlusion was applied by a paediatric cuff inflated to a pressure of 75 mmHg and by 50 mg paracetamol and 0.5 mg kg(-1) lidocaine was injected in Groups P and L, respectively. Venous occlusion was then released, followed by rocuronium injection (0.6 mg kg(-1)). Withdrawal was evaluated using a 4-point scale (1, no response; 2, movement at the wrist only; 3, movement/withdrawal involving arm only (elbow/shoulder) and 4, generalized response, movement/withdrawal in more than one extremity). RESULTS: The incidence of withdrawal movement was 42% and 26% in the Groups P and L, respectively (p=0.120). Although no significant differences were noted in the number of patients who had no withdrawal movement and mild withdrawal movement in Groups P and L, compared with Group L, the incidences of moderate withdrawal movement were significantly higher in Group P (p<0.05). No patient in either group revealed generalized movement. CONCLUSION: Using a venous occlusion technique, pretreatment with 50 mg paracetamol can prevent withdrawal movement caused by rocuronium injection in children but is not as effective as lidocaine to prevent moderate withdrawal movement.

Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesia in pediatric patients.

OBJECTIVES: The aim of this study was to investigate the effect of gabapentin premedication on postoperative 24th hour total analgesic consumption and the incidence of emergence agitation after sevoflurane based anesthesia in pediatric patients undergoingtonsillectomyandadenoidectomy. METHODS: 46 healthy, ASA class I or II, aged 3-12 year old children were included into the study. The patients were randomly assigned to one of the control (Group C) or gabapentin group (Group G) consisting of 23 patients in each. Group C received 10 ml of saline, Group G received gabapentin 15 mg.kg-1 dissolved in 10 ml of saline orally 30 min. before the induction of anesthesia. After anesthesia induction with 8% sevoflurane in 50% O2-N2O. General anesthesia was maintained with 1 MAC sevoflurane in 50% O2-N2O. Emergence agitation was assessed with a 5 point scale and recorded every 10 min. of first 30 min. of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate pain, total analgesic consumption, parent satisfactionandanysideeffect. RESULTS: Agitation scores were significantly lower in group G compared to group C in the postoperative 20th and 30th minutes (p<0.01, 0.05 respectively). Total analgesic requirement in postoperative 24 hour was significantly lower in group G (p<0.01). Satisfaction scores of parents was also higher in group G (p<0.05). CONCLUSION: Gabapentin premedication decreases postoperative 24th hour analgesic consumption and attenuates emergence agitation after sevoflurane anesthesia.

Clinical significance of intestinal type fatty acid binding protein in patients undergoing coronary artery bypass surgery.

OBJECTIVE: The aim of this study was to determine whether serum levels of intestinal type fatty acid binding protein (I-FABP) are related to intestinal ischemia in patients undergoing coronary bypass surgery. METHODS: The study was planned as prospective, observational. Elective coronary artery bypass candidate patients between ages of 50 and 70 were consecutively included in the study. Thirty-five patients scheduled for cardiopulmonary bypass (CPB) were identified as the CPB group and 16 patients not scheduled for CPB were identified as the off-pump coronary artery bypass surgery (OPCAB) group. The variables between and within the groups were analyzed with Student's t, Mann-Whitney U, Friedman and Wilcoxon tests respectively. RESULTS: In both CPB and OPCAB groups, I-FABP level at the end of the operation was significantly higher than that noted at the beginning of the operation (p<0.005). In the CPB group, there was a significant drop in I-FABP from the end of the operation to each of the postoperative time points (12(th) hour and 24(th) hour) (respectively p<0.001, p<0.001). In the OPCAB group, the I-FABP levels at both postoperative time points were lower than that at the end of the operation (p<0.001), and the level at 24-hour post-surgery was significantly lower than at both the end-of-operation I-FABP value (p<0.001) and the 12-hour post-surgery I-FABP value. CONCLUSION: Since we have not observed any intestinal ischemia through our research, slight changes of I-FABP measurements make us believe that I-FABP would be a valuable way to monitor for intestinal ischemia in patients who undergo cardiac surgery.

ABO-incompatible blood transfusion and invasive therapeutic approaches during pediatric cardiopulmonary bypass.

Human error has been identified as a major source of ABO-incompatible blood transfusion which most often results from blood being given to the wrong patient. We present a case of inadvertent administration of ABO-incompatible blood to a 6-mo-old child who underwent congenital heart surgery and discuss the use of invasive therapeutic approaches. Invasive techniques included total circulatory arrest and large-volume exchange transfusion, along with conventional ultrafiltration and plasmapheresis, which could all be performed rapidly and effectively. The combination of standard pharmacologic therapies and alternative invasive techniques after a massive ABO-incompatible blood transfusion led to a favorable outcome in our patient.

Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone.

STUDY OBJECTIVES: To compare the efficacy of injectable lornoxicam with diclofenac, ketoprofen, and dipyrone for acute postoperative pain. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: University hospital. PATIENTS: 200 ASA physical status I patients who were scheduled for elective septoplasty with general anesthesia. INTERVENTIONS: Patients were divided into 5 groups according to the intramuscularly administered analgesic drug: lornoxicam 8 mg (twice daily), diclofenac 75 mg (twice daily), ketoprofen 100 mg (twice daily), dipyrone 1 g (three times daily), and placebo (twice daily). MEASUREMENTS: Pain intensity was evaluated with a 0 to 100 mm Visual Analog Scale (VAS) at the 2nd, 4th, 6th, 8th, 12th, 16th, 20th, and 24th hour postoperatively. Intramuscular pethidine 1 mg/kg was administered to patients requiring additional analgesia, and treatment-related adverse effects were noted. MAIN RESULTS: Pethidine requirement was found to be significantly higher in the placebo group (1.8 mg/kg per 24 hours; 95% confidence interval, 1.5-2.2) than in the other groups (P = 0.001). No significant difference in opioid requirement was found among the treated groups (P > 0.05). Postoperative VAS scores were significantly lower at specific hours in the treatment groups when compared with placebo group (P < 0.05). No statistically significant difference in adverse effects was found among the groups studied (P > 0.05). CONCLUSIONS: Efficacy of lornoxicam in the management of acute postoperative pain was not superior to that of other nonopioid analgesics used in this study.

Sevoflurane induction in cyanotic and acyanotic children with congenital heart disease.

INTRODUCTION: The aim of the study was to investigate the induction characteristics of sevoflurane in cyanotic and acyanotic children with congenital heart disease compared with healthy controls in a prospective, controlled, non-blinded study at a university hospital. METHODS: After placement of standard noninvasive monitors, inhaled induction of anaesthesia was achieved via a facemask by using 7% sevoflurane in 100% oxygen, in all 3 groups (control group, n = 16; acyanotic group, n = 32; cyanotic group, n = 30). Three minutes after induction, tracheal intubation was performed without a muscle relaxant. In each case, the time from mask application to loss of eyelash reflex and to centralisation of the pupils, heart rate, blood pressure and oxygen saturation was recorded. After intubation, intubating conditions were graded and incidences of airway obstruction recorded. The demographic data was similar between the 3 groups except for the sex ratio in Group 1 compared with the other groups (P = 0.005). RESULTS: The durations to loss of eyelash reflex were found to be significant between the patients with acyanotic and cyanotic heart disease (P = 0.044). Centralisation of the pupils, heart rate and blood pressure results, as well as the incidences of airway obstruction and intubation conditions, were similar between the groups (P > 0.05). In addition, oxygen saturation was significantly lower in the cyanotic group at all stages (P < 0.01). CONCLUSION: Induction characteristics of sevoflurane in cyanotic and acyanotic children with congenital heart disease and in healthy children are similar. Sevoflurane induction is an effective and well-tolerated technique for cyanotic and acyanotic children with congenital heart disease.

Pre-emptive analgesia for removal of nasal packing: A double-blind placebo controlled study.

OBJECTIVE: The most frequent complaint of patients after septoplasty is severe pain felt during removal of nasal packing placed on the operation. Various methods have been described to decrease pain and to increase patient comfort during removal of nasal packing. However, these methods are not practical. There has been an increase in the number of studies on pre-emptive analgesia use for postoperative pain relief. The aim of this study was to determine whether pre-emptive analgesia decreased pain during removal of Merocel packs placed in septoplasties. METHODS: This is a double-blind randomized, placebo-controlled study. The study included 121 patients who underwent elective septoplasty in our otorhinolaryngology clinic. The patients were randomly assigned into two groups: study and placebo groups. The study and placebo groups received two tablets of diflunisal 500 mg and placebo, respectively, two and a half hours before removal of nasal packing. Visual analog scale (VAS) values immediately after and 5 min after removal of nasal packing, effects of the procedure on patient comfort and its side-effects were evaluated separately. RESULTS: VAS values immediately after the removal of nasal packs significantly decreased in the study group (p<0.001), but there was no significant difference in VAS values obtained after the procedure between the study and placebo groups. Patient discomforts were significantly lower in the diflunisal group (p<0.001). CONCLUSIONS: It can be concluded that pre-emptive analgesia decreases pain during removal of nasal packing placed in septoplasties and increases patient comfort.

In vivo and in vitro effects of stellate ganglion blockade on radial and internal mammary arteries.

OBJECTIVE: To investigate the effects of stellate ganglion blockade (SGB) on the internal mammary (IMA) and radial arteries (RA) in patients undergoing coronary artery bypass graft (CABG) surgery with in vivo and in vitro studies. DESIGN: Prospective, randomized trial. SETTING: University hospital. PARTICIPANTS: Thirty-seven patients undergoing CABG surgery. INTERVENTIONS: SGB was performed on 19 patients before anesthesia induction. Another group of 18 patients underwent surgery without SGB. Diameters of proximal RA, distal RA, and IMA were determined by Doppler ultrasonography before (T1) and after (T2) anesthesia induction. Control or blocked IMA and RA segments were obtained. Norepinephrine (NE) was applied to determine the contractile force of IMA and RA rings in a concentration-dependent manner. The maximal contractile response and the sensitivity of the vessels were compared. MEASUREMENTS AND MAIN RESULTS: The diameters of IMA and distal RA were statistically larger in the SGB group than those in the control group at T2. NE-induced maximum contraction was higher in the blocked RA rings than those in the control RA and blocked IMA rings. The sensitivity of IMA segments to NE was higher than that of RA segments in the SGB group. The control and blocked IMA segments showed similar sensitivity to NE. CONCLUSION: The present results show that SGB not only increases distal RA and IMA diameters but is also associated with in vitro differences, the mechanism of which remains to be elucidated. Therefore, SGB might be considered as an alternative to topical and systemic vasodilators for reducing vasospasm in patients undergoing CABG.

Effects of ketamine on serum and tracheobronchial aspirate interleukin-6 levels in infants undergoing cardiac surgery.

OBJECTIVE: Corrective surgery for congenital heart defects in children frequently requires cardiopulmonary bypass (CPB). Serum and bronchoalveolar levels of interleukin-6 (IL-6) may be useful in assessing the severity of the systemic inflammatory response after CPB. In the present study, the authors aimed to compare the effects of ketamine anesthesia and isoflurane anesthesia with respect to serum and tracheobronchial aspirate (TBA) IL-6 levels in infants undergoing CPB for cardiac surgery. DESIGN: Prospective and randomized controlled study. SETTING: University-based teaching hospital. PARTICIPANTS: Thirty-four infants aged 2 to 24 months were randomized into 2 groups. INTERVENTIONS: In group K (n = 17), anesthesia was induced with intravenous (IV) ketamine, 1 to 2 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with infusions of ketamine, 25 to 75 microg/kg/min, and fentanyl, 10 microg/kg/h. In group I (n = 17), induction was achieved with IV thiopental sodium, 3 to 5 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with 1% isoflurane and fentanyl, 10 mug/kg/h. Blood and TBA samples were obtained at 6 and 4 stages, respectively. MEASUREMENTS AND MAIN RESULTS: Serum IL-6 and TBA IL-6 levels were similar in the 2 groups at all stages (p > 0.05). CONCLUSION: The present results show that ketamine anesthesia does not provide superiority over isoflurane anesthesia with respect to serum and TBA IL-6 levels.

Remifentanil use in children undergoing congenital heart surgery for left-to-right shunt lesions.

OBJECTIVE: The authors compared the effects of remifentanil with fentanyl on the hemodynamic and respiratory variables in children with left-to-right shunting and pulmonary hypertension. DESIGN: A prospective, randomized, and controlled design. SETTING: University hospital. PARTICIPANTS: Children aged between 3 months and 6 years undergoing pediatric cardiac surgery for correction of left-to-right intracardiac shunting. INTERVENTIONS: Children were assigned to 1 of the 2 opioids for intraoperative use. Fentanyl was given as a 20 microg/kg intravenous bolus followed by infusion at a rate of 20 microg/kg/h in group 1 (control, n=15), and remifentanil was given as a 2 microg/kg intravenous bolus followed by infusion at a rate of 2 microg/kg/min in group 2 (n=18). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressures at 30 to 40 minutes postbypass and the first 2 hours postsurgery were higher in the remifentanil group (p<0.05). Heart rates, pulmonary artery pressures, and airway pressures did not differ at any time between groups. Peripheral oxygen saturation values were lower at 30 and 45 minutes in the prebypass period and higher at 1 to 4 hours in the intensive care unit in the remifentanil group (p<0.05). After protamine administration, transient peripheral oxygen desaturation was observed with 10 children in the remifentanil group and with 3 children in the fentanyl group without any hemodynamic deterioration (p=0.029). CONCLUSION: There were no clinically important differences in hemodynamic and respiratory measurements intraoperatively and during the initial 24 hours postoperatively between fentanyl and remifentanil in pediatric patients undergoing surgical repair of defects with left-to-right shunts.

Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind studyin Turkish patients.

BACKGROUND: Preemptive analgesia used for postsurgical pain management has been shown to reduce the requirements of postoperative analgesics. OBJECTIVE: The aim of this study was to compare the preemptive analgesic effects of diflunisal, naproxen sodium, meloxicam, acetaminophen, and rofecoxin (no longer available in some markets) in patients undergoing ambulatory dental surgery and the need for postoperative pain management in these patients. METHODS: This prospective, randomized, single-blind study was conducted at the Departments of Anesthesiology and Reanimation and Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey. Turkish outpatients aged ≥ 16 years with American Society of Anesthesiologists physical status 1 (ie, healthy) and scheduled to undergo surgical extraction of an impacted third molar were enrolled. Patients were randomly assigned to receive diflunisal 500 mg, naproxen sodium 550 mg, meloxicam 7.5 mg, acetaminophen 500 mg, or rofecoxib 12.5 mg. All medications were administered orally 1 hour before surgery as preemptive analgesia and after surgery if needed, up to the maximum recommended dose. Surgery was performed with the patient under local anesthesia (articaine hydrochloride). Pain intensity was assessed using a 100-mm visual analog scale (VAS) (0 = none to 100 = worst possible pain) at 2, 4, 6, and 12 hours after ambulatory surgery. The use of additional analgesics was recorded for 24 hours using patient diaries. Postoperative adverse events were recorded using the diaries. RESULTS: One hundred fifty patients (108 women, 42 men; mean [SE] age, 26.8 [0.6] years; 30 patients per group) had data available for analysis. Demographic data were similar between the 5 groups. No significant differences in mean VAS scores were found between the 5 groups at any time point. All mean VAS scores indicated minor pain. The rate of additional postoperative analgesics required was significantly lower in the diflunisal group compared with groups receiving naproxen sodium, meloxicam, acetaminophen, and rofecoxib (3 [10%] patients vs 11 [37%], 15 [50%], 15 [50%], and 14 [47%] patients, respectively; all, P < 0.05). Bleeding at the surgical site was reported in 2 patients each in the diflunisal, naproxen sodium, meloxicam, and acetaminophen groups, and in 1 patient in the rofecoxib group; the between-group differences were not significant. No significant differences in the prevalences of other adverse effects (eg, nausea, vomiting, allergy, gastrointestinal symptoms) were found between the 5 treatment groups. CONCLUSIONS: In the present study in patients undergoing third molar extraction, adequate preemptive analgesia, based on VAS scores, was found with all of the nonopioid analgesic agents used. Fewer patients required rescue medication with diflunisal. All 5 study drugs were similarly well tolerated.