Comparison of Ultrasound-Guided Thoracic Paravertebral Block and Erector Spinae Plane Block for Postoperative Analgesia After Laparoscopic Cholecystectomy - Cyprus Journal of Medical Sciences

Objectives: To evaluate the effect of an informational video on spinal anesthesia in reducing preoperative anxiety and postoperative analgesic requirements in patients undergoing TURP surgery.Materials and methods: This clinical trial was conducted on 93 urologic patients, who underwent transurethral resection of prostate with spinal anesthesia. The patients were randomly divided into two groups using a website: Group 1 who received informational video about spinal anesthesia at least 2 h before the operation in addition to standard verbal and written information, Group 2 who received standard verbal and written information. The baseline anxiety levels of all patients were evaluated in the preoperative anesthesia outpatient clinic (T0). A second time, anxiety levels were measured in the preoperative preparation room (T1). Intraoperative sedation levels were monitored with an OAASS score of 3–4. The amount of the additional dexmedetomidine administered was recorded. Postoperative 0th, 2nd, 4th, 6th, 12th, and 24th hour VAS scores and the rescue analgesic time and amount were recorded.Results: No significant difference was found between the groups in terms of STAI-T, STAI-S0, APAIS-Anxiety0, APAIS-Information0 measured in the preoperative outpatient clinic evaluation (p > 0.05). STAI-S1, APAIS-Anxiety1, and APAIS-Information1 results assessed in the preoperative preparation room were found to be significantly lower in Group 1 (p = 0.001, for each). When the median amount of additional dexmedetomidine per kilogram was compared, 0.10 μg/kg (IQR: 0.09) were used in Group-1, while 0.30 μg/kg (IQR: 0.17) were used in Group-2. Intraoperative additional dexmedetomidine requirement was significantly lower in Group 1 (p = 0.001). Although the amount and timing of rescue analgesic use did not differ between the groups, the proportion of patients requiring rescue analgesia within 24 h was significantly lower in Group 1 (p = 0.284, p = 0.926, p = 0.033, respectively).Conclusion: In the preoperative period, the spinal anesthesia information video reduces preoperative anxiety more than standard verbal and written information. Additionally, the spinal anesthesia information video also reduces the amount of sedative agents used intraoperatively.

Endotracheal intubation is a relatively easy procedure, however, complications may occur due to this easy procedure. Practitioners should be ready for unexpected difficult intubation and treat in the lights of guidelines. We herein describe a 48 years old female tracheal rupture case which was diagnosed intraoperatively and treated immediately after diagnosis. Although tracheal rupture after intubation is very rare; respiratory insufficiency, emphysema, even death may happen as a result. Clinical suspicion is the first and the most important step at the diagnosis of the ruptures. An emergency bronchoscopy, chest X-ray and computerized tomography of thorax are necessary for diagnosis of the type and the extention of the laseration. In the literature conservative and surgical therapies are both appropriate for treatment of membranous tracheal rupture. In this case report, the causes of tracheal rupture after unexpected difficult intubation and its treatment approach are explained.

To investigate the effects of deep sedation and general anesthesia on postprocedural recovery and cardiorespiratory complications in pediatric patients undergoing nonoperative transesophageal echocardiography (TEE). A retrospective study of consecutive anesthesia-assisted TEE interventions performed between January 2017 and December 2023. A single institution. Pediatric patients who underwent TEE under deep sedation or general anesthesia. Patients were divided into two groups: Group 1 consisted of patients who underwent deep sedation, and group 2 consisted of patients who underwent general anesthesia. In group 1, patients were divided into 3 subgroups as patients who used ketamine (group K), ketofol (group KF) and propofol (group P). In group 2, subgroups were examined as those receiving desflurane (group D) and sevoflurane (group S). A total of 147 pediatric patients undergoing nonoperative TEE were retrospectively analyzed, including 87 females (59.2%) and 60 males (40.8%). The mean duration of recovery was significantly longer in group 2 (10.98 ± 2.14 minutes) compared with group 1 (7.26 ± 1.94 minutes) (p < 0.001). Postprocedural hypotension, hypoxia, bronchospasm and laryngospasm occurred similarly between groups 1 and 2 (p > 0.05 for each). No significant difference was observed in the duration of recovery between the subgroups of group 1 (p = 0.504) Additionally, the incidence of hypotension, hypoxia, bronchospasm, and laryngospasm was similar between groups K, KF, and P (p > 0.05, for each) When subgroups of group 2 were compared, the duration of recovery was shorter in group D (p = 0.012). Hypotension, hypoxia, bronchospasm, and laryngospasm occurred similarly in both general anesthesia subgroups (p > 0.05). Deep sedation was associated with a significantly shorter duration of procedure and recovery compared with general anesthesia, without an increase in the incidence of periprocedural complications.

AMAÇ: Bu çalışmanın amacı travma sonucu gelişen ekstremite ve pelvis kırıkları nedeni ile ameliyathanemizde opere olan hastaların yatış sırasındaki hemoglobin düzeyi ve eritrosit transfüzyonu gereksinimi ile yoğun bakım ünitesinde (YBÜ) yatışı ve mortalite arasındaki ilişkinin araştırılmasıdır.GEREÇ VE YÖNTEM: Travma sonucu gelişen ekstremite ve pelvis kırıkları nedeni ile 01.01.2018 - 31.12.2018 tarihleri arasında ameliyathanemizde opere olan hastalar çalışmaya alındı. Hastaların medikal arşiv ve anestezi kayıtları retrospektif olarak incelenmiştir. Birinci aşamada anemisi olan ve olmayan hastalar ortalama geliş hemoglobin düzeyi, eritrosit transfüzyon ihtiyacı, hastanede yatış süresi, YBÜ’de yatış ihtiyacı, YBÜ’de yatış süresi, mortalite oranları açısından karşılaştırılmıştır. Çalışmanın ikinci aşamasında tüm hastalar eritrosit transfüzyonu alan ve almayan olarak iki gruba ayrılmış ve iki grup ortalama geliş hemoglobin düzeyi, hastane yatış süresi, YBÜ’de yatış ihtiyacı, YBÜ’de yatış süresi, 1. ay ve 3. ay mortalite oranları açısından karşılaştırılmıştır.BULGULAR: Çalışmamıza 222 hasta alındı. Hastaların yaş ortancası 61 (18 - 97) yıl ve %64,4’ü (143 hasta) erkek idi. Hastanede yatış süreleri 2 ile 120 gün arasında değişmekte olup, ortalaması 8,87±14,44 gündür. Hastalardan 24’ü (%10,8) YBÜ’de yatmıştır. YBÜ’de yattıkları süre 1 ile 46 gün arasında değişmekte olup, ortalaması 9,33±11,52 gündür. Hastaların 9’unda (%4,1) 1. ayda mortalite, 10 hastada (%4,5) 3.ayda mortalite gelişmiştir. Anemik hasta grubundakı hastalar anemik olmayan gruba göre istatistiksel olarak daha yaşlı olup, anemik grupta hastanede kalış günü (p<0,001), ve mortalite oranları (p<0,001) istatistiksel olarak anlamlı yüksek saptanmıştır. Anemik hastalarda YBÜ’de yatış oranları anlamlı olarak yüksek (p<0,001) saptanırken, YBÜ’de yatış günü açısından iki grup arasında istatistiksel olarak anlamlı fark saptanmamıştır (p=0,444). Çalışmamızda eritrosit transfüzyonu alan hasta grubunda hastanede kalış günü (p<0,001), 1. ay (p=0,003) ve 3. ay (p=0,001) mortalite oranları istatistiksel olarak anlamlı yüksek saptanmıştır. Transfüzyon yapılan hasta grubunda hem YBÜ’de yatış oranları hem de YBÜ’de yatış gün sayısı anlamlı olarak yüksek saptanmıştır (p<0,001).SONUÇ: Travma sonrası hastaneye ilk gelişte aneminin olması yanı sıra eritrosit transfüzyonu da mortalite için risk faktörüdür. Her hastanın bireysel değerlendirilerek transfüzyon kararı verilmesi gerektiğini düşünmekteyiz.

OBJECTIVE: The aim of this study was to investigate the effect of music therapy on patients' anxiety and pain levels during knee replacement surgery. MATERIAL AND METHODS: This prospective, randomized, controlled study was performed at the Afyonkarahisar Sağlık Bilimleri University “Department of Anesthesiology and Reanimation After approval was obtained from the Afyonkarahisar Sağlık Bilimleri University Ethics Committee. Forty-two patients who underwent elective knee replacement surgery under spinal anesthesia were divided into two groups: music group (Group M, n=21) and control group (Group K, n=21). Group M listened to Turkish classical music during the operation, while Group K was exposed only to operating room ambient sounds. Anxiety levels of the patients were measured preoperatively and postoperatively with the Beck Anxiety Inventory (BAI) Intraoperative sedation was assessed with OAA/SS and pain was assessed with VAS scores, and intraoperative midazolam and fentanyl requirements were recorded. RESULTS: Group M required less amount of additional sedative during the intraoperative period than Group K (p=0.002). Although the number of patients that required additional fentanyl was less in Group M, the amount of fentanyl use was similar between the groups (p=0.891). In the postoperative period, anxiety scores of Group M were significantly lower than Group K (p=0.003). Pulse rate values were lower in Group M during and after the operation. CONCLUSIONS: Intraoperative music therapy is an effective method to reduce the number of patients using analgesics and the need for additional sedative agents during knee replacement surgery performed under spinal anesthesia.