Search

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. [ABSTRACT FROM AUTHOR]

Objective: Although it constitutes a small part of the general waste, medical waste management is important both due to its environmental impact and its cost. Creating education and awareness on reducing the amount of medical waste and increasing the amount of waste-recycling are some of the most important steps. The primary purpose of the study is to determine the role of education in reducing the cost of medical waste belonging to anesthesia, and the secondary purpose is to provide data for the development of educational materials used. Methods: The anesthesia wastes of 22 operating rooms and 3 PACU were evaluated. Anesthetic wastes were collected and weighed at the end of the day without informing 26 anesthesiologists, 37 anesthesia technicians, and 30 anesthesia assistants. On the 2nd day, the education video link was shared with the participants, and afterwards they were asked to watch and answer the questionnaire prepared.The wastes were collected and weighed again after the training. The approximate annual saving cost was calculated over the medical waste disposal cost, which was determined as 3.50 TL kg-1 (excluding VAT). Results: The amount of anesthesia waste obtained from 22 operating rooms and 3 PACU was 36.90 kg for 57 cases before training, and 43.36 kg for 64 cases after training. The amount of medical waste was weighed as 461.2 g per case before the training, and 453.8 g per case after the training.It was observed that although not statistically significant, the amount of medical waste decreased (p=0.949). The cost of medical waste disposal decreased by 1.6%. It was learned that 51.3% of the anesthesia team had received training before, and 60.4% benefited from the training provided. Conclusion: With education, the amount of medical waste can be reduced. Although there is awareness about waste classification in our clinic, we believe that regular training should be done to reduce the amount of medical waste. [ABSTRACT FROM AUTHOR]

Objective: The use of the laryngeal mask airway (LMA) during flexible fiberoptic bronchoscopy (FFB) is more advantageous compared to other airway devices. In this study, it was planned to evaluate, the success rates of the usage of LMA for airway maintenance in pediatric patients in FFB and the postoperative complications encountered, together with demographic characteristics, ASA risk groups, duration of anesthesia and bronchoscopic diagnoses of patients, in the light of the literature. Methods: The files of pediatric patients who underwent FFB between March 2013 and October 2015 were reviewed retrospectively. Demographic data of the patients, airway devices used for airway maintenance in FFB (LMA, endotracheal tube, face mask), indications of bronchoscopy, bronchoscopic diagnoses, duration of anesthesia, postprocedural desaturation, laryngospasm, bronchospasm, and the number of patients requiring reintubation were recorded. Results: A total of 125 children with an age range of 7 days-18 years were included in the study. The median age of the patients was found to be 44 months (interquartile range 11.5-124 months), and median weight was 15 kg (interquartile range 8-30 kg). The most common indication for FFB was recurrent lung infection (26.4%). LMA was successfully performed in 95.9% of the patients. In total, 7 (5.6%) patients had temporary hypoxia and 1 (0.8%) had bronchospasm. Two patients were intubated and transferred into intensive care unit. Multivariate logistic regression test showed that the duration of anesthesia lasting longer than 45 minutes increased the risk of complications 7 times. Conclusion: FFB via LMA is a safe method in the pediatric patient group. The risk of complications increases with the duration of anesthesia, rather than with ASA risk group, age, weight and dimensions of LMA. [ABSTRACT FROM AUTHOR]

Background: Necrotizing enterocolitis (NEC) is a serious, life-threatening pathology seen especially in the neonatal period. It is characterized by inflammation of the intestinal mucosa and ischemic necrosis. When it progresses, intestinal perforation can lead to peritonitis, sepsis, and even to death (50%). We present our anesthesia practices in 5 premature patients with very low birth weight (VLBW) (<=1500 g) who underwent surgery for intestinal perforation after NEC. Case report: All patients were ASA V E and in need of invasive respiratory support with cardiac and respiratory co-morbidities. The demographic and peroperative data of the patients are shown in the table. Gas distention and dilated bowel loops were observed in the abdomen on radiological imaging. Transfers to the operating room were provided in a heated incubator with a transport ventilator and monitor. Inotropic support was continued during transport. The operating room and operating table were preheated. ECG, SpO2, noninvasive blood pressure and body temperature monitoring was achieved. Inotropic support was continued. Fluid management was provided with 3.33% dextrose-0.3% sodium chloride. Four extremities and head circumferences were wrapped with cotton to reduce heat loss. Since the patients were hemodynamically labile, ketamine was generally preferred for anesthesia induction and maintenance. Pressure-controlled mechanical ventilation was administered with neonatal breathing circuits. No patient needed muscle relaxants. After surgery, all patients were successfully transferred to the intensive care unit. Discussion: Many factors may be responsible for the etiology of NEC, but the strongest risk factor is prematurity. The morbidity and mortality rates are higher in patients requiring surgical intervention. Interventions to prevent NEC development are the most effective way to avoid negative consequences. Preventive interventions should start from the maternal period and include the intensive care hospitalization and the arrival to the operating room. The transfers of VLBW prematures between the intensive care and the operating room, operating room preparation and anesthesia applications require more caution. Conclusion: Detailed and careful preparation, communication between teams and a multidisciplinary approach are required to achieve success in these babies with high mortality and morbidity rates. [ABSTRACT FROM AUTHOR]

Injury to major vessels during laparoscopic procedures is an emergency intervention situtaiton. Because it may results with death. During the laparoscopic (endoscopic) surgery of a 14-year-old boy child with the diagnosis of non-palpable testis, aortic injury occurred at the time of insertion of first trocar. Deteriorating of hemodynamic parameters perioperatively alarmed the surgical team and immediately open surgery was decided. Invasive monitoring and cathetherization of internal jugular vein were performed. Adequate blood and blood product replacement were performed. Bleeding focus at the abdominal aorta was repaired through median laparotomy. The patient remained stable during postoperative period and was discharged with full recovery. In laparoscopic surgical interventions, it should be remembered that laparoscopic experience of the anesthesia team and close monitoring of hemodynamic parameters perioperatively could ease early recognition of complications, thereby decreasing morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Background: In 2023, due to two earthquakes with high destructive power, over 46000 people died and a very high number of injured people admitted to the hospitals in Türkiye. Especially child victims were mostly transferred to our hospital from the disaster regions.Thus hours after the two earthquakes, we performed anesthesia. The purpose of this study is to represent our anesthetic and analgesic managements of children victims of the earthquake aged between 10 days- and 18- years old children who underwent several consecutive surgeries. Material and Method: This current study was analyzed retrospectively using the medical data of all pediatric patients operated in the pediatric anesthesia department's operating rooms of our hospital. Demographic data, surgical procedures, anesthesia and analgesia methods, consecutive surgical practices, intensive care needs, presence of crush syndrome and acute renal failure, applied hemodialysis, mortality and morbidity of pediatric patients were reviewed. Results and Discussion: It was determined that a total of 216 surgical procedures were performed in 78 children. Anesthesia and clinical followups of a total of 78 pediatric patients who were operated in our hospital due to two earthquakes were analyzed. Surgeries of the children started on the 2nd day of the earthquakes and continued until the first month with gradually decreasing number. The most commonly performed surgeries are orthopedic surgeries such as fasciotomy for compartment syndrome, multiple fractures and limb amputations at different levels. In this process, patients who were included in the hemodialysis program also underwent consecutive surgical procedures. Demographical data, operations performed, analgesic managements, laboratory results and presence of crush syndrome are shown in the table. Conclusion: In such massive disasters, anesthesia and analgesia practices are challenging especially in children, who are the most affected group. It would be appropriate to follow-up and treat these children who need repetitive surgery and anesthesia in fully equipped and multidisciplinary hospitals as soon as possible. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Anesthesia & Reanimation is the property of Turkish Society of Anaesthesiology & Reanimation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)