New Treatment modality for Burn Injury Related ARDS : High-Flow Nasal Oxygen Therapy in Major Burns.

Pulmonary insufficiency is the primary cause of death in cases of major burns accompanied by inhalation damage. It is important to consider the impact on the face and neck in flame burns. Early implementation of bronchial hygiene measures and oxygenation treatment in inhalation injury can reduce mortality. This case series presents the effects of high-flow nasal oxygen application on patient outcomes in major burns and inhalation injury. This report discusses three different patients. One patient, a 29-year-old male with 35% TBSA burns, received high-flow nasal oxygen (HFNO) treatment for inhalation injury on the sixth day after the trauma. After 72 hours of HFNO application, the patient's pulmonary symptoms improved. The second patient had 60% TBSA burns and developed respiratory distress symptoms on the fifth day after the trauma. After 7 days of HFNO application, all symptoms and findings of acute respiratory distress syndrome (ARDS) were resolved. HFNO has used for the treatment of ARDS releated to major burn ( 60% of burned TBSA) 28 years-old patient and improvement was achived. The use of HFNO in pulmonary insufficiency among burn patients has not been reported previously. This series of patient cases demonstrates the successful application of HFNO in treating inhalation injury and burn-related ARDS. However, further clinical studies are necessary to increase its clinical utilization.

Do pre-burn center management algorithms work? Evaluation of pre-admission diagnosis and treatment adequacy of burn patients referred to a burn center.

Interventions for burn management until the patient is transferred to a burn center affect mortality and morbidity. Therefore, adherence to the developed algorithms is an important issue. This study aimed to determine deficiencies in different aspects of the implementation of these algorithms during the pre-admission diagnosis and treatment processes of patients referred to our burn center. This study involved a 4-year review of patients referred to our burn center. One hundred and seventy burn cases admitted by referral were enrolled in the study. Adequacy of resuscitation within the first 24 hours, adherence to guidelines, and mortality were investigated. Resuscitation performed within the first 24 hours was found to be inadequate in 88 patients (51.8%). When the burned surface area percentages were evaluated all percentages were calculated higher before arrival. There were 78 major burn cases (45.9%), and the frequency of inhalation burns, intubation requirements and renal failure were more common in this group compared to the minor burn group (P < .001). The frequency of intubation without accurate indications was found to be 70.58%. Inadequate escharotomy was detected at a rate of 52.9%, and inadequate fasciotomy at a rate of 66.6%. The mortality rate was 22.4% among all patients. Interventions undertaken during the period until the patients' referral to these centers affect mortality and morbidity. In this study, it was found that the pre-hospital applications generated were insufficient, and it was proposed that burn patient care algorithms be developed with in-service training throughout the country.

Does the preoperative fasting period affect the liver in a distant organ model of renal ischaemia reperfusion?

OBJECTIVES: To experimentally evaluate the effects of preoperative fasting duration on distant organ liver in renal ischaemia-reperfusion (IR) injury. METHODS: This is an experimental study. In the study, 3 groups were formed. In Group A, abdominal laparotomy was carried out after 12 hours of preoperative fasting without any IR damage. In Group B, IR injury was carried out after 12 hours of preoperative fasting, and abdominal laparotomy was carried out, in Group C after 2 hours of fasting after IR injury. Apoptosis, congestion, balloon degeneration, nuclear pleomorphism, and leukocyte infiltration were examined histopathologically and tumor necrosis factor-alpha (TNF-α), interleukin (IL) -1 beta, IL-6, and IL-10 were evaluated biochemically. RESULTS: A statistically significant difference was determined between the groups in respect of postoperative IL-10 levels (p=0.020) with significantly lower levels determined in Group C than in Groups A and B (p=0.021). Similar rates of mild nuclear polymorphism were seen with no statistically significant difference determined between the groups (p>0.167). A statistically significant difference was determined between the groups in respect of the congestion scores (p<0.001), with a lower score in Group C than in Groups A and B, where the scores were similar (p<0.001, p=0.017). CONCLUSION: With this result, it would be correct to say that the short preoperative fasting period has protective effects on the liver tissue.

Surgical treatment of hydatid cyst infiltrating into myocardium and causing mitral valve regurgitation.

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in Asia, Africa, South America, and the Mediterranean region including Turkey. Cardiac involvement is rare. Surgery is the definitive treatment of cardiac hydatid cysts; however, to avoid recurrence after surgery, medical therapy should be also continued. Left ventricular free wall is the most common location, followed by the right ventricle and interventricular septum. Involvement of mitral valve is extremely rare. Herein, we present a case of hydatid cyst with myocardial involvement leading to severe mitral valve regurgitation which was successfully treated with surgery.

Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study.

BACKGROUND: Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions. OBJECTIVES: The objective of this study was to investigate whether preemptive oral administration of gabapentin 800 mg can reduce postoperative pain and modulate the inflammatory cytokine response in comparison to placebo in patients undergoing total knee arthroplasty under general anesthesia. MATERIAL AND METHODS: Fifty-two patients were randomly divided into 2 groups before surgery, either to receive peroral gabapentin 800 mg or placebo drug, 1 h before surgery. All patients had general anesthesia with endotracheal intubation, in a standardized fashion, by the same anesthetist. Thirty min before completion of surgery, intramuscular diclofenac sodium 75 mg was administered. Following extubation, visual analogue pain scale (VAS) scores and additional analgesic requirements were recorded at 15 min at post-anesthesia care unit (PACU), and at 4th and 24th h postoperatively. Plasma levels of interleukin 6 (IL-6), and tumor necrosis factor R (TNF-R) were measured at predetermined time points (T0 1 h before administration of gabapentin, T1 at postoperative the 4th h mark, and T2 at postoperative at the 24th h mark). RESULTS: The VAS scores at postoperative 4th h were significantly higher in placebo and gabapentin groups compared with VAS scores at PACU and at 24th h. The groups did not differ in terms of additional analgesic requirements. In gabapentin group, IL-6 levels at T1 and T2 were significantly lower in comparison to values measured in placebo group at the same time points. This difference was not significant in TNF-R levels between the groups. CONCLUSIONS: Though preemptive oral gabapentin administration did not reduce postoperative pain and analgesic requirements in total knee arthroplasty surgery, it attenuated IL-6 production on the first postoperative day.

A Complication after Percutaneous Nephrolithotomy: Anesthesia Mumps.

Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female. Anesthesia mumps may occur in the immediate postoperative period with no suspicious predisposing factor. The reports of such cases would increase the awareness among anesthesiologists and postoperative caregivers regarding this benign complication.

Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara.

BACKGROUND: Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. METHODS: The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. RESULTS: There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. CONCLUSION: The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital.

Our Anaesthetic Experiences in Patients Undergoing Percutaneous Mitraclip Implantation.

OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68.5±10.2 years) were retrospectively investigated in terms of anaesthetic management. RESULTS: Of the 84 patients undergoing percutaneous mitraclip implantation under general anaesthesia, 84.5% had sodium thiopental and 75% had midazolam for anaesthesia induction. For the maintenance of anaesthesia, 57% of the patients were reported to have sevoflurane, whereas the rest had desflurane. The mean duration of the procedure and anaesthesia was 140.9±48.2 mins and 165.7±50.6 min, respectively. Seventy seven patients were transported to the intensive care unit and intubated after the procedure. The median extubation time was 3 h. Length of stay in the intensive care unit was 2 days, whereas it was 4 days for hospital stay. One patient died during the procedure and six patients died after the procedure. CONCLUSION: Percutaneous mitraclip implantation procedure is quite difficult for anaesthesiologists because of the procedure itself and the population on which the procedure is performed. The primary aim of anaesthesia management is to provide haemodynamic stability. The preoperative preparation and anaesthesia methods should be the same as for patients undergoing cardiac surgery. It is reported that as the experience regarding this subject increases, success of the procedure increases, with better protected haemodynamic stability, less inotropic and vasopressor requirement and shorter length of hospital stay.

Is an 87-Year-Old Grandfather Too Marginal for Being a Kidney Donor? The View of Anesthesiologists.

Living kidney donation has been accepted increasingly as a result of growth in the number of end-stage renal disease patients awaiting organ. In this aspect using grafts from marginal donors such as with advanced age is increasing in worldwide practice and also in Turkey. Therefore, anesthetic management of donors is particularly important. We herein report the anesthetic management of an 87-year-old grandfather donating his kidney to her granddaughter and review the current anesthetic strategies in a geriatric patient.

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy in aortic stenosis patients with high operative risk. Advances in experiences have shifted the choice of anesthesia from general to local anesthesia and sedation for these patients. We compared our anesthetic experiences in our institute in a period of 2.5 years. MATERIALS AND METHODS: A total of 151 (86 females, 65 males, mean age 76 years) symptomatic aortic stenosis patients undergoing transfemoral TAVI under general anesthesia (GA) (n = 79) and local anesthesia and sedation (LAS) (n = 72) were evaluated retrospectively in regards to anesthetic issues. RESULTS: The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) values of patients in the GA and LAS groups were 17 and 12, respectively. The anesthesia duration was significantly shorter in the LAS group (P < 0.001) and 16.7% of the patients in the LAS group were switched to general anesthesia. Length of stay in the intensive care unit was similar in the two groups. CONCLUSION: TAVI, applied in high-risk populations, has many challenges for anesthesiologists. With technological advances, it is possible to perform these procedures under sedation with variable advantages. Thus, future studies in regard to anesthesia are required for the success of the procedure and patient safety.

The Effects of Different Anaesthetic Techniques on Surgical Stress Response During Inguinal Hernia Operations.

OBJECTIVE: The aim of this study is to compare the effects of 3 different kinds of anaesthesia on stress response induced by surgery. METHODS: Sixty patients aged between 25-70 American Society of Anesthesiologists (ASA) I-II group to undergo inguinal herniography were included in this study. Patients were randomly divided into 3 groups of 20. Group 1 received general anaesthesia with sevoflurane/air/remifentanil, patients in Group 2 received total intravenous anaesthesia (TIVA) with propofol/air/remifentanil and Group 3 received spinal anaesthesia induced by hyperbaric bupivacaine, adjoined by remifentanil sedation. Mean arterial pressure (MAP), heart rate and SpO2 values were recorded preoperatively, intraoperatively and postoperatively at certain periods. Cortisol, leptin and glucose levels were preoperatively detected. Intervals were as; 15 minutes prior to the induction of anaesthesia, at intraoperative first hour and at the postoperative third and twenty-forth hours. RESULTS: MAP and heart rate values were similar in the inhalational anaesthesia and TIVA groups but relatively higher in the spinal anaesthesia group. Blood glucose levels were elevated, insulin levels were decreased in all groups, at the intraoperative first hour. Biphasic variation in blood leptin levels was observed in all groups, as the levels were lower than the preoperative control values at the intraoperative first and postoperative third hours and significantly higher at the postoperative twenty-forth hour. There was a significant decrease in cortisol level percentage change in the TIVA group at the intraoperative 1st hour, increasing in the other groups. CONCLUSION: We concluded that TIVA supresses the stress response induced by surgery better by lowering cortisol levels, leading to a lower increase in blood glucose levels and a lower decrease in blood insulin levels when compared to others. Furthermore, leptin levels were increased at the postoperative twenty-forth hour. The lower increase at the postoperative twenty-forth hour in the TIVA group can be correlated with the anaesthetic agent.

The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy.

UNLABELLED: We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to determine whether there is a role of inflammation in the analgesic efficacy of intraarticular piroxicam. Standardized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxicam 20 mg. After microscopic examination of the synovial materials, the patients were divided into two subgroups, inflammation positive (I+) and inflammation negative (I-). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and postoperative analgesic consumption were recorded. Analgesic duration was significantly longer in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of intraarticular piroxicam. IMPLICATIONS: Intraarticular administration of piroxicam along with bupivacaine improves postoperative analgesia in synovial inflammation before surgery.