Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team.

INTRODUCTION: Tracheostomy care in children may be challenging, due to lack of knowledge of healthcare providers (HCPs). The aim of this study was to determine the level of knowledge of HCP who follow patients with tracheostomy and to increase this level with theoretical training and training in a simulation laboratory. MATERIALS AND METHODS: ISPAT (IStanbul PAediatric Tracheostomy), a multidisciplinary team for tracheostomy care was established and a training program was prepared. Participants were subjected to theoretical and practical pretests which evaluated their knowledge levels and skills for care, follow-up, and treatment of a patient with tracheostomy. After the theoretical and practical training given to the participants with a simulation model, theoretical and practical posttests were applied. RESULTS: Fifty-one HCP from nine tertiary pediatric clinics in Istanbul were enrolled in the training program. Only six (11.8%) of them had received standardized training programs previously. Regarding the theoretical tests, seven of the 33 questions were indicated as essential. The knowledge level of the participants based on the essential questions significantly increased after the training (p < 0.05 for all of the essential questions). The total number of correct answers and correct answers of three subheadings also significantly increased after the practical training (p < 0.001 for all). Ninety-five percent of the participants assessed the course as good or excellent in general. CONCLUSION: Training in a simulation laboratory in combination with theoretical education can improve the knowledge and skills of the HCP enabling improved care of children with a tracheostomy.

The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial.

BACKGROUND: International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students. METHODS: A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups-the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month. RESULTS: The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group. CONCLUSIONS: Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.

Comparison of unilateral spinal and continous spinal anesthesia for hip surgery in elderly patients.

BACKGROUND: Continous spinal anesthesia (CSA) and frequently unilateral spinal anesthesia (USpA) are usually preferred for lower extremity surgeries. In this study, we aimed to compare the effects of these anesthetic techniques, on hemodynamic parameters, quality of anesthesia and complications in elderly patients undergoing hip surgeries. METHODS: Forty patients aged 65 years and older, assigned to receive either CSA or USpA with 7.5 mg (1.5 cc) 0.5% hyperbaric bupivacaine initially. In CSA group, additional doses of 2.5 mg bupivacaine were applied until sensory block reach to T10. Maximum sensorial block level, time to reach the level of T10 (defined as onset time) and to regress to T12, hemodynamic parameters and ephedrine requirements were recorded peroperatively and during 2 h postoperatively. RESULTS: Hemodynamic parameters, ephedrine requirements and regression of sensory block by two levels were similar in two groups. The onset time of anesthesia was significantly longer in USpA group than CSA group. Neuraxial anesthesia had to be converted to general anesthesia in 5 patients (25%) in CSA group and 1 patient (5%) in USpA group. CONCLUSIONS: We conclude that both USpA and CSA techniques have similar effects in elderly high risk patients. On the other hand, USpA is more preferable for surgeries with shorter durations due to its low cost and high success rate.

Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients.

BACKGROUND: Alpha-2 adrenergic agonists are used to premedicate pediatric patients to reduce separation anxiety and achieve calm induction. The clinical effects of clonidine are similar whether via the oral or nasal route. However, oral dexmedetomidine is not preferred because of its poor bioavailability. The objective of this study was to evaluate the effects of nasal versus buccal dexmedetomidine used for premedication in children. METHODS: Sixty-two patients, aged 2-6 years, undergoing minor elective surgery were randomly assigned to two groups to receive dexmedetomidine, either 1 µg·kg(-1) buccally (group B) or 1 µg·kg(-1) intranasally (group N) for premedication 45 min before the induction of anesthesia. Heart rate, peripheral oxygen saturation, and respiratory rate were measured before and every 10 min after administering dexmedetomidine in all children. Level of sedation was assessed every 10 min until transport to operating room. Drug acceptance, parental separation, and face mask acceptance scores were recorded. RESULTS: There was no significant difference between the two groups in patient characteristics, nor was there any significant difference between the two groups in heart rate, respiratory rate, or SpO(2) values at all times after premedication. Levels of sedation, parental separation, and mask acceptance scores were significantly higher in group N than in group B at the various times. CONCLUSIONS: These results suggest that intranasal administration of 1 µg·kg(-1) dexmedetomidine is more effective than buccal administration of 1 µg·kg(-1) dexmedetomidine for premedication in children.

The effects of Different Concentrations and Equivalent Volumes of Levobupivacaine in Epidural Anesthesia.

BACKGROUND: Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. Previous studies have examined different concentrations of levobupivacaine in similar ways. OBJECTIVES: This prospective, randomized, double-blind study was designed to determine the clinical efficacy and hemodynamic effects of different concentrations and equivalent volumes of levobupivacaine in epidural anesthesia. To our knowledge, this is the first study to evaluate the effects of concentration lower than 0.5% levobupivacaine. METHODS: Forty adult patients with an American Society of Anesthesiology (ASA) I-III physical status undergoing transurethral endoscopic surgery were randomly divided into 2 groups to receive either 10 mL of isobaric levobupivacaine (0.5% + 5 mL 0.9% saline [group 1; n = 20]) or 10 mL of isobaric levobupivacaine (0.75% + 5 mL saline 0.9% saline [group 2; n = 20]) for epidural anesthesia. An observer blinded to group division evaluated the time of onset, maximum level, and time to 2-segment regression of sensory block. RESULTS: There were no differences between the 2 groups in terms of hemodynamic parameters and time of onset of the sensory block. There were significant differences, however, between the 2 groups in the maximum level of the sensory block (group 1, T9; group 2, T8; P = 0.010) and the time to 2-segment regression of sensory block (group 1, 46.35 minutes; group 2, 62.94 minutes; P = 0.013). CONCLUSION: This study indicated that 10 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline is a suitable solution for use in epidural anesthesia because it produces a block clinically comparable to that of 10 mL of 0.75% levobupivacaine plus 5 mL of 0.9% saline for transurethral resection of prostate surgery.

Cesarean section under spinal anesthesia in a patient with ankylosing spondylitis--a case report.

INTRODUCTION: It is generally accepted that neuraxial anesthesia is difficult to establish in patients with ankylosing spondylitis. General anesthesia also has some disadvantages, especially with respect to airway control in patients with ankylosing spondylitis. We present herein a gravida with ankylosing spondylitis who had a cesarean delivery performed under spinal anesthesia. CASE: A 30-yr-old gravida at 38 weeks gestation with a 9 yr history of ankylosing spondylitis was admitted to our hospital in labor. She was scheduled for an elective repeat cesarean delivery. Spinal anesthesia was induced using a 22-gauge Quincke spinal needle with 1.8 mL of 0.5% heavy bupivacaine + 0.2 mL (10 microg) of fentanyl at the L3-4 interspace in the left lateral position by the median approach. Adequate sensory and motor blockade were achieved. The postoperative period was uneventful and she was discharged home on postoperative day 3. CONCLUSION: We suggest that spinal anesthesia can be safely and effectively used as an alternative to general anesthesia in patients with ankylosing spondylitis. Neuraxial techniques should not be regarded as unachievable in such patients; however, all necessary precautions should be taken to avoid complications of spinal anesthesia, and facilities to secure the airway should be available.

[Controlled hypotension for tympanoplasty: comparison between remifentanil and combination of alfentanil and sodium nitroprusside]. / Timpanoplasti olgularinda kontrollü hipotansiyon: Remifentanil ve alfentanil-sodyum nitroprusid kombinasyonunun karsilastirilmasi.

OBJECTIVES: We compared the efficacy of remifentanil and the combination of alfentanil and sodium nitroprusside on controlled hypotension and bleeding at surgical site. PATIENTS AND METHODS: Thirty ASA I-II patients undergoing tympanoplasty were randomly assigned to remifentanil and alfentanil-sodium nitroprusside groups, equal in number. Anesthesia was induced with remifentanil or alfentanil combined with propofol and rocuronium, and maintained with remifentanil or alfentanil-sodium nitroprusside infusions combined with propofol. All patients were ventilated with a mixture of 33% O2 and 66% N2O. Invasive mean arterial blood pressure, heart rate, peripheral oxygen saturation, the amount of bleeding at surgical site, and blood gas values were recorded. RESULTS: Controlled hypotension was achieved at a target mean arterial pressure of 60+/-5 mmHg in both groups. Compared to the baseline levels, heart rate values were lower in the remifentanil group (p<0.05), and similar in the sodium nitroprusside group (p>0.05). The amount of bleeding and the dryness of the surgical site were similar in two groups. PaCO2 and pH values differed significantly between the two groups at perioperative 1 and 2 hours and in the postoperative 30th minute (p<0.05), but the difference was not clinically significant. CONCLUSION: Our results suggest that remifentanil is effective in obtaining controlled hypotension without an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.