Evaluation of clinical results of esmarch bandage application in giant saphenous vein closure during endovenous glue ablation.

BACKGROUND: In recent years, the endovenous technique has been presented as a good alternative to surgery in the treatment of patients with lower extremity varicose veins. However, its effectiveness in very advanced saphenous vein diameters is controversial. In this study, we investigated the results of an endovenous glue ablation closure system applied with an esmarch bandage in saphenous veins with very large diameters. METHODS: Eighty-nine patients who were operated on for varicose veins were divided into three groups according to their saphenous vein diameters: less than 10 mm (group 1), between 10 and 15 mm (group 2), and larger than 15 mm (group 3). Endovenous closure was performed with n-butyl cyanoacrylate in all patients. An esmarch bandage was applied during the procedure to all patients, except for the group with a diameter of less than 10 mm. This group underwent the standard procedure. All patients were followed up for six months after the procedure and postoperative symptoms, complications and closure rates were recorded. RESULTS: There was complete closure of all veins in the first month postoperatively. While no thrombophlebitis was observed in group 3, thrombophlebitis was detected in two patients in groups 1 and 2. In the third month, minimal saphenofemoral reflux was observed in two (4.2%) patients in group 1 and in one (4.3%) in group 2. In the sixth month, minimal saphenofemoral reflux was detected in three (6.3%) patients in group 1 and in one (4.3%) in group 2. No residual leakage was observed in group 3 (p = 0.001). In all groups, the severity score regressed significantly in the postoperative sixth month. However, the most significant symptomatic regression was observed in group 3, which had the largest saphenous diameters and we used an esmarch bandage during closure (p = 0.000). CONCLUSION: Our findings support the idea that the application of an esmarch bandage during endovenous closure improves clinical outcomes, especially in saphenous veins with larger diameters.

Anaesthesia-Related Pediatric Neurotoxicity: A Survey Study.

OBJECTIVE: Millions of children are exposed to anaesthetic drugs every day; however, the possible adverse effects of these agents on the central nervous system remain controversial. This study evaluated anaesthesiologists' and pediatric surgeons' knowledge and daily practices regarding anaesthesia-induced neurotoxicity. METHODS: A survey consisting of 12 questions was sent to members of the Turkish Anaesthesiology and Reanimation Association and the Turkish Pediatric Surgery Association via the Google forms program. RESULTS: A total of 202 anaesthesiologists and 51 pediatric surgeons participated in this survey. The results demonstrate that anaesthesiologists and surgeons are aware of the risk of anaesthesia-related neurotoxicity and are willing to take action. Approximately, half of the anaesthesiologists and pediatric surgeons expected to postpone operations lasting at least 3 hours for patients <3 years of age. Also, one-third of the anaesthesiologists would seek feasible and more reliable alternative anaesthetic strategies. CONCLUSIONS: More than two-thirds of the participants knew about the US Food and Drug Administration neurotoxicity warning; however, uncertainty about anaesthesia-related neurotoxicity is ongoing. Many questions remain unanswered. The results of large-scale prospective randomized studies to evaluate the effect of anaesthetics and surgery on the cognitive development of pediatric patients are needed.

Assessment of Postoperative Cognitive Dysfunction: Results From a Survey of Turkish Anaesthesiologists.

OBJECTIVE: Postoperative cognitive dysfunction (POCD) is one of the most common complications in elderly surgical patients. We conducted a survey study to evaluate the perspectives of Turkish anaesthesiologists on postoperative cognitive disorders. METHODS: We conducted a prospective online survey with questions and answers were recorded either in a Likert scale from 1 to 5 (completely disagree to completely agree) or as yes/no/do not know types of answers. Potential participants were contacted through an e-mail that included a brief introductory note, instructions, a link to the survey and the authors' contact information. RESULTS: We analysed 129 surveys (9.9% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anaesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (74.4%). When caring for an agitated and confused patient postoperatively, 56.6%, protocols to screen and manage postoperative cognitive disorders were rarely used. Nearly all respondents believe that postoperative delirium and POCD are neglected areas in anaesthesiology. CONCLUSION: Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anaesthesia. They are aware of the main risk factors for their development but may lack information on the prevention and management postoperatively.

Evaluation of ultrasonography probe disinfection habits in peripheral and/or central regional blocks applied with ultrasound guidance.

OBJECTIVES: Ultrasonography-guided regional anesthesia (UGRA) applications are important in the practice of the anesthesiology and algology in our country as well as in the world. Despite the positive effect on the patient care of the UGRA, there is concern that ultrasound probes may be used repeatedly and assume a vector role in pathogen transport. There is no standard protocol in our country to provide basic hygiene before UGRA techniques, which is a part of the daily practices of anesthesiologists. In the study, it was aimed to investigate the probes and skin disinfection habits applied by the anesthesiologists. METHODS: After the approval of the ethics committee, random selection was made from the UGRA-administered clinics in our country and the questionnaire consisting of 14 questions was e-mailed (e-mail) to 430 participants. RESULTS: Distribution of preferred agents for USG probe disinfectant: povidone iodine 45.5%, octenidine 8%, chlorhexidine 5.4%, alcohol solutions 7.1 %. The rate of participants who indicated that they had received a disinfection course or certificate to engage in UGRA-related initiatives was 39.3%. CONCLUSION: Although the most commonly used disinfectant povidone iodide and disinfection training rate is less than 50%, the incidence of UGRA-associated infection is very low. In our country, we believe that the study has provided data on the preferences of disinfection methods of anesthetists in UGRA applications. However, we believe that it is required to be worked in larger study groups that include more anesthesiologists, in order to provide more generalizable data.

Hyoscine N-Butylbromide for Preventing Propofol Injection Pain: A Randomized, Placebo-Controlled and Double-Blind Study.

OBJECTIVE: In this study, the aim was to investigate the effect of hyoscine N-butylbromide (HnBB) pretreatment on pain during propofol injection. SUBJECTS AND METHODS: In this prospective, randomized, placebo-controlled and double-blind trial, 60 patients scheduled to undergo routine outpatient surgery under general anesthesia were randomly allocated to 2 groups, the HnBB (n = 30) and sodium chloride (n = 30) groups. Twenty seconds after the injection of 20 mg HnBB or 0.9 % sodium chloride, a 50-mg dose of propofol was injected in 2-3 s. Ten seconds later, the pain intensity was assessed using a 4-point scale: no pain (0), mild (1), moderate (2), and severe (3) pain. The Student t test was used for the analysis of parametric data and the Pearson χ2 test for categorical data. RESULTS: The occurrence of pain in the HnBB group (43.3%) was significantly lower than the control group (73.3%) (p < 0.018). Of the 30 patients in each group, 10 in the control group and 3 in the HnBB group experienced severe pain (p = 0.001). CONCLUSIONS: Pretreatment with 20 mg HnBB significantly reduced propofol injection pain compared to placebo.

Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy.

BACKGROUND: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. AIM: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. METHODS: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. RESULTS: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). CONCLUSIONS: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.