Comparison of the Effects of Sevoflurane and Desflurane on Endothelial Glycocalyx in Patients Undergoing Laparoscopic Hysterectomy: A Randomized, Double-Blind Trial.

Objective: Various enzymes, reactive oxygen species, inflammatory conditions, and major surgeries cause endothelial glycocalyx breakdown. Inhalation of anaesthetic agents may have protective effects on the endothelium. This study compared syndecan-1 and heparan sulfate levels to evaluate the effects of sevoflurane and desflurane on the endothelial glycocalyx. Methods: This prospective randomized, double-blind study included 46 patients undergoing laparoscopic hysterectomy. The participants were allocated into sevoflurane and desflurane groups. Subsequently, blood samples were drawn at three time points: before anaesthesia induction for a baseline value (T0), after pneumoperitoneum (T1), and after extubation (T2). Heparan sulfate and syndecan-1 levels were measured. Results: There was no statistical difference between the sevoflurane and desflurane groups in terms of heparan sulfate and syndecan-1 levels at any time point. A significant difference was found only in the desflurane group in the intragroup comparisons of the measurements of heparan sulfate levels (χ2=29.826, P < 0.001). Matched pairs of the time points in the desflurane group showed that P=0.036 (Z=-2.099) for T1-T0, P < 0.001 (Z=-3.924) for T2-T0, and P < 0.001 (Z=-4.197) for T2-T1. The change in percentage between T2 and T1 of heparan sulfate in the desflurane group was found to be statistically significant (P=0.034). Conclusion: The damage caused by surgical stress on the endothelial glycocalyx can be reduced by both desflurane and sevoflurane. The protective effect of desflurane is more prominent than that of sevoflurane.

Blind vs. video-laryngoscope-guided laryngeal mask insertion: A prospective randomized comparison of oropharyngeal leak pressure and fiberoptic grading.

PURPOSE: Laryngeal Mask Airway (LMA) insertion may not always be smooth without complications. Controversial results of several studies evaluating ideal insertion conditions have been published. This study compared the oropharyngeal leak pressure values and fiberoptic grading scores between blind and video-laryngoscope-guided LMA insertion. METHODS: Patients were randomly assigned into blind insertion (n = 50) and video-laryngoscope guided insertion (n = 50) groups. The oropharyngeal leak pressure, peak airway pressure, fiberoptic grading score, first attempt success rate, hemodynamic parameters, and complications were recorded. RESULTS: All laryngeal mask airways were successfully inserted in both groups at the first attempt. The fiberoptic staging scores were: grade 1 in 8.2% of patients, grade 2 in 24.4% of patients, grade 3 in 44.8% of patients, grade 4 in 22.4% of patients in the control group. On the other hand, grade 1 in 2.2% of patients, grade 2 in 28.6% of patients, grade 3 in 51% of patients, grade 4 in 8.2% of patients in the VL group (p = 0.260). The peak airway pressure and LMA insertion time were similar between groups. However, the oropharyngeal leak pressure before extubation was significantly higher in the video-laryngoscope-guided insertion than blind insertion (36.29 ± 7.09 vs. 33.79 ± 8.84 cmH2O respectively, p = 0.04). CONCLUSIONS: The findings of our study suggest that the video-laryngoscope-guided LMA-Classic insertion with a standard blade technique may be a helpful alternative to blind insertion.

The effect of different flow levels and concentrations of sevoflurane during the wash-in phase on volatile agent consumption: a randomized controlled trial.

PURPOSE: The standard procedure for low-flow anesthesia usually incorporates a high fresh gas flow (FGF) of 4-6 L/minute during the wash-in phase. However, the administration of a high FGF (4-6 L/min) increases the inhaled anesthetic agent consumption. This study was designed to compare the sevoflurane consumption at 2 rates of flow and vaporizer concentration during the wash-in period. METHODS: Patients were randomly enrolled into high FGF (HFGF) (n = 30) and low FGF (LFGF) (n = 30) groups. During the wash-in, the HFGF group received 4 L/minute FGF with a sevoflurane vaporizer setting of 2.5%, and the LFGF group received 1 L/minute FGF with a vaporizer setting of 8%. Once the wash-in was complete, anesthesia maintenance was performed with 0.5 L/min FGF with a vaporizer setting of 2.5-4.5% in both groups. The patient demographic data, bispectral index values, hemodynamic variables, wash-in time, sevoflurane consumption during the wash-in phase, and total sevoflurane consumption were analyzed. RESULTS: The median sevoflurane consumption in the wash-in phase was 8.2 mL (7.1-9.3) in the HFGF group and 2.7 mL (2.2-3.1) in the LFGF group (p = 0.001). The mean total sevoflurane consumption was 17.41 ± 3.58 mL in the patients who received HFGF and 14.93 ± 3.57 mL in the LFGF group (p = 0.001). The mean wash-in completion time was 12.49 ± 2.79 min in the HFGF group and 3.35 ± 0.67 min in the LFGF group (p = 0.001). CONCLUSIONS: The anesthetic agent consumption during the wash-in phase was approximately 3 times lower with the administration of sevoflurane at 1 L/minute FGF than the use of 4 L/minute FGF.

The impact of video games on training: can it change the game of endotracheal intubation?

In recent years, several studies have demonstrated that the experience derived from video games improves interventions that require technical skills. Airway management is crucial to anesthesiologists, requiring technical and non-technical skills. We evaluated the benefits of video games for video stylet-guided tracheal intubation, which allows the use of video technology in airway management of residents with anesthesiology training. In the present study, the residents working in the Department of Anesthesiology and Reanimation at the Health Sciences University of Kartal Dr. Lütfi Kirdar City Hospital in Istanbul were assigned to two groups. Active users who played video games on a regular basis formed study group (n = 14), while those who did not have video gaming habits were assigned to the control group (n = 15). Female patients with the American Society of Anesthesiologists (ASA) I and II classification undergoing elective open or laparoscopic gynecological surgery through tracheal intubation under general anesthesia were included in the study. Female patients elective open and laparoscopic gynecological surgery under GA were included in the study. Time to intubate the trachea by using video stylet in (Group 1) was found to be 29 s on average, and it was 59.9 s for Group 2 ( p < 0.01) The average number of tracheal intubation attempts was 1.1 in Group 1, and 1.4 in Group 2 (p = 0.19). Video gaming experience improves the visual attention.Those accustomed to playing with video games, video stylet- guided tracheal intubation, performed intubation in less time.

The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study.

OBJECTIVE: : Fear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease. We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital. METHODS: Anesthesiologists, nurses and nurse anesthetists were invited to fill out the survey. The survey was consist of questions from ''The Fear of COVID-19 Scale'', ''Patient Health Questionnaire'' and ''Pittsburgh Sleep Quality Index'' (PSQI). Each question was worth a point. RESULTS: The data of 208 participants were analyzed. Mean age was 29 ± 7.748 years, 72.1% were male, 67.3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone. Moderate depression was the most frequently detected outcome (n = 90, 43.3%). Mean The Fear of COVID-19 Scale for all participants was 18.56 ± 7.731. The mean PSQI of patients was 6.18 ± 4.356 with a 45.7% rate of poor sleep quality. PSQI was found significantly higher in nurses (7.1 ± 4.7, p = 0.000). Nurses were the group with the highest deterioration in sleep quality (53.6%, p = 0.003). The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0.018). PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7.02 ± 4.59 vs. 4.81 ± 3.57 respectively, p = 0.001). A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0.005). CONCLUSION: Depression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak. Intensive care unit nurses were at highest risk.

Determining airway complications during anaesthesia induction: a prospective, observational, cross-sectional clinical study.

BACKGROUND: Although postoperative early airway complications are rarely observed, when they do develop, fatal results such as brain damage and cardiac arrest may occur. The Royal College of Anaesthetists and Difficult Airway Society investigated airway complications developing during anaesthesia over a period of 12 months within the context of the Fourth National Audit Project (NAP4) study. Inspired by that multicentre research project, this study aims to identify early airway complications that can develop in relation to anaesthesia induction in our hospital. METHODS: After our proposed study received approval from the Ethical Council, adult patients undergoing general anaesthesia at our operating theatres within the period of January-July 2018 were included in it. Demographic data, ventilation, American Society of Anesthesiologists (ASA) grade, Cormack-Lehane scores, tools that are used in airway management, and complications were recorded. RESULTS: Out of 909 patients in total, 752 were intubated; a laryngeal mask was placed on 157 of these patients. The complication rate was 5%, and the 3 most frequently observed complications were desaturation, bronchospasm and pharyngeal injuries. In the group having complications, the body mass index value, Cormack-Lehane, Mallampati, and ventilation scores were significantly higher than those with no complications. CONCLUSIONS: During routine general anaesthesia induction at our clinic, major or minor airway complications have developed with a frequency of 5%, and it was determined that desaturation was the most frequent reversible cause.

Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electroconvulsive Therapy?

OBJECTIVE: To evaluate the effects of 2 different dose regimens of propofol (low dose: < 1 mg/kg, high dose: ≥ 1 mg/kg) on the duration of the seizures, the required energy for the seizures, and the seizure threshold over the course of electroconvulsive therapy (ECT). METHODS: The electronic medical records of 165 patients receiving 971 sessions of ECT were analyzed retrospectively. Patients were evaluated in two groups according to the according to propofol doses that they had received for ECT. Group LP (n = 91): patients who received low dose propofol (< 1 mg/kg). Group HP (n = 74): patients who received high dose propofol (≥ 1 mg/kg). RESULTS: The required energy for seizures in Group HP were significantly higher than the Group LP in the 3rd, 4th, 5th, 6th, 7th, 8th, and 9th sessions (p < 0.05). The duration of seizures in the Group HP were significantly lower than the Group LP in the 1st, 2nd, 4th, 5th, 7th, and 8th sessions (p < 0.05). Higher electrical stimulus was needed to acquire a minimum length of seizure (> 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group. CONCLUSION: Higher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.