Monitoring renal oxygenation status by near-infrared spectroscopy during ureterorenoscopy in children.

BACKGROUND: : Near-infrared spectroscopy (NIRS) monitoring demonstrates renal blood flow, perfusion, and oxygenation changes. This study aimed to evaluate the effects of pediatric endourological interventions (PEI) on regional oxygen saturation value (rSO2) usingrenal NIRS monitoring. METHODS: Patients having bilateral inguinal surgery (group I), cystoscopy (group II), and ureterorenoscopy (group III), 20 patients in each group, were included in the study. NIRS values before induction (T0) and at 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), 30 min (T30) of the surgical procedure, and at the postextubation (Tend) were determined. The amount of irrigation fluid was recorded in groups II and III. The ureterorenoscopy group was also evaluated as two subgroups, as group III-R with patients having a "20%↓rSO2" and as group III-NoR, not having a "20%↓rSO2". RESULTS: The mean total volume of irrigation was higher in group III, but the difference was not significant between the subgroups III-R and III-NoR. Renal rSO2 decreased significantly in T25, T30, and T-end values in group III. "20%↓rSO2" was seen in 1 patient in group II and 7 patients in group III. In the subgroups III-R, all patients had an obstructive pathology and significant preoperative hydronephrosis with a mean renal pelvis AP diameter of 21.1 ± 16.4 mm. DISCUSSION: Although rSO2 significantly improves postoperatively, our data may suggest that congenital and acquired obstructive pathologies with hydronephrosis, prolonged operative time with continuous irrigation, and instrument movement in a narrow lumen may increase intrarenal pressure and the risk of renal hypoxia in endourological interventions. Preoperative evaluation of kidney functions and a meticulously well-planned intervention can prevent possible complications.

Anesthetic management of a patient with face hemangioma: case report.

Anesthetic agents and/or surgical positions, the total volume of hemangioma may increase under general anesthesia; thus, airway management of patients with a hemangioma may be very difficult. Our patient in this case report has a periorbital and oropharyngeal hemangioma that reaches down to the esophagus. We observed that the size and volume of the hemangioma increased significantly during elective nephrectomy surgery. After adequate therapy with steroids and beta-blockers, the size of the hemangioma decreased during the postoperative care unit monitoring period. We report this case to show the importance of airway management of hemangiomas with the potential for life-threatening complications.

Sudden cardiac arrest during induction of anaesthesia in paediatric patient with glutaric aciduria type II.

Glutaric aciduria type II (GA2) is an autosomal recessive metabolic disorder of amino acid and lipid metabolism, which is serious and rare. The most serious form is seen in early infancy and is associated with very high mortality rates. Here, we present an 8-month-old male patient with GA2 who had electrocardiographic ST ST-segment depression and sudden cardiac arrest at 10th minute of emergency operation (central venous catheter placement). There is a very scarce amount of data in the literature about anaesthetic management of GA2 patients. There is also no previously published report about cardiac arrest during induction of anaesthesia in this condition. The present report highlights this serious complication.

Nonoperating Room Anesthesia for Interventional Neuroangiographic Procedures: Outcomes of 105 Patients.

BACKGROUND AND AIM: Accurate anesthesia management is of great importance for the success of interventional neuroangiographic procedures (INPs). General anesthesia with endotracheal intubation is the most commonly preferred anesthetic method for these procedures. However, whether laryngeal mask airway (LMA) anesthesia is a suitable and safe option for such cases is unclear. The aims of this study were to report the outcomes of anesthetic management in patients who underwent INP, and to compare endotracheal intubation with LMA anesthesia in terms of anesthesia-related outcomes. METHODS: Data of patients who underwent INP under general anesthesia at interventional neuroangiography unit were retrospectively evaluated. RESULTS: A total of 105 patients with a mean age of 52.9 years were included in the study. All procedures were performed under general anesthesia with using endotracheal tube (n = 79, 75.2%) or laryngeal mask (n = 26, 24.8%). Anesthesia-related complications, including respiratory (laryngospasm,bronchospasm, and desaturation) and circulatory (disrhythmia, hypotension, hypertension), were observed in 20 (19.1%) patients. The 2 airway instruments were similar in age, gender, diagnosis, American Society of Anesthesiologist score, mallampati score, duration of procedure, and duration of anesthesia (P > .05). Anesthesia-related complications were more common in LMA group compared with patients who were intubated using endotracheal tube (P = .003). CONCLUSIONS: Anesthesia management in INPs carries many challenges for anesthesiologists, due to the need of exact immobility during the procedure and potential procedure-related risks such as vasculary perforation and bleeding. General anesthesia using endotracheal intubation seems to be more secure, in comparison to LMA anesthesia.

Internal Jugular Vein Ultrasonography in Prediction of Postspinal Hypotension.

OBJECTIVE: To determine the role of internal jugular vein (IJV) ultrasonography to predict postspinal hypotension in patients undergoing elective surgery. STUDY DESIGN: A prospective observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology and Reanimation, Osmangazi University, Eskisehir, Turkey, from January to September 2020. METHODOLOGY: Patients aged between 18 and 65 years, who underwent elective surgery under spinal anesthesia, were included in the study. Sonographic examination of IJV was performed before spinal anesthesia. Significant postspinal hypotension was defined as a mean arterial pressure less than 65 mmHg or more than 20% decrease compared to the baseline value. The patients were classified as hypotensive and non-hypotensive groups. The association between sonographic IJV measurements and postspinal hypotension was analysed. RESULTS: The evaluation was performed on 47 patients. Twenty-two (46.8%) patients developed postspinal hypotension. The two groups were similar in all baseline characteristics (p>0.05). Among all sonographic measurements, IJV collapsibility index was significantly different between the two groups (p=0.014). Receiver operating characteristic curve analysis showed that IJV collapsibility index had a sensitivity of 64% and a specificity of 63.6% to predict the postspinal hypotension at a cut-off point of 22.6%. Area under curve (AUC) was 0.709. CONCLUSION: Despite the moderate sensitivity and specifity rates, IJV collapsibility index can be considered as an alternative predictor of postspinal hypotension. Key Words: Internal jugular vein, Postspinal hypotension, Spinal anesthesia, Ultrasonography.

Effects of Sleep Quality on Melatonin Levels and Inflammatory Response after Major Abdominal Surgery in an Intensive Care Unit.

Disruption of nocturnal sleep in an intensive care unit may remarkably affect production of melatonin, which is also known to have anti-inflammatory properties. In the present study, we aimed to investigate the effect of sleep quality on melatonin levels and inflammation after surgery. Thus, we compared the patients, who were screened in the side-rooms where the lights were dimmed and noise levels were reduced, with the patients who received usual care. Preoperative and postoperative urine 6-sulphatoxymelatonin, serum interleukin-1 (IL-1), interleukin-6 (IL-6), and c-reactive protein (CRP) levels were measured and data on sleep quality was collected using the Richards-Campbell Sleep Questionnaire. Postoperative CRP and IL-6 levels were greater in the control group than in the experimental group, whereas postoperative 24 h melatonin levels were greater than preoperative levels and the difference was steeper in the experimental group in concordance with sleep quality scores. Thus, the regulation of light and noise in ICUs may help the recovery after major surgeries in patients, potentially by increasing melatonin production, which has anti-inflammatory properties.

Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-.

A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the first case of the combination of sickle cell anemia (SCA), beta (+) thalassemia, and Crohn's disease successful anesthetic management with attention to hemodynamics, particularly with regards to liver dysfunction.