Is Preoperative Anxiety Affected by Watching Short Videos on Social Media? A Prospective Randomized Study.

PURPOSE: The purpose of this study was to investigate the impact of watching short videos in the preoperative waiting room on preoperative anxiety in children. DESIGN: This study was designed as a prospective, randomized trial including 69 ASA I-II patients aged 5 to 12 years who were scheduled for elective surgery. METHODS: The children were randomly allocated to two groups. The experimental group browsed short videos on a social media platform (eg, YouTube short, TikTok, Instagram reels) for 20 minutes in the preoperative waiting room, but the control group did not. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: on arrival in the preoperative waiting room (T1), right before being taken to the operating room (OR) (T2), on entering the OR (T3), and during anesthesia induction (T4). The primary outcome of the study was children's anxiety scores at T2. FINDINGS: The mYPAS scores at T1 were similar in both groups (P = .571). The mYPAS scores at T2, T3, and T4 were significantly lower in the video group than in the control group (P < .001). CONCLUSIONS: Watching short videos on social media platforms in the preoperative waiting room lowered preoperative anxiety levels in pediatric patients aged 5 to 12.

The Effect of Fluid Challenge Test on Optic Nerve Sheath Diameter.

OBJECTIVE: To investigate the effect of the fluid challenge test on the optic nerve sheath diameter (ONSD) change. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Anesthesiology and Reanimation, Ondokuz Mayis University Hospital, Samsun, Turkey, from January to November 2021. METHODOLOGY: A fluid challenge was defined as a 500 mL crystalloid infusion administered over 10 minutes, and fluid responsiveness was defined as a subsequent increase in stroke volume of at least 15% administered to the ICU patients. The ONSD and hemodynamic variables were measured by ultrasonography before (T0), at the end (T1), and 30 min after the fluid challenge (T2). The primary outcome of the study was the change in ONSD measurements associated with the fluid challenge, and the secondary outcome was the relationship between fluid responsiveness and the change in ONSD. RESULTS: A total of 60 patients were included. The ONSD (mm) value was significantly higher at T1 compared to T0 (mean ± standard deviation: 5.12±0.30 mm vs. 5.10±0.32 mm; p=0.011). However, at T2, the ONSD was similar to that at T0 (5.10±0.31 mm vs. 5.10±0.32 mm; p=0.662). The stroke volume (mL) was also significantly higher at T1 and T2 compared to T0 [median IQR 60 (6) mL vs. 60 (4.7) mL vs. 52 (5) mL, respectively, p <0.01]. No significant relationship was found between the ONSD and the change in fluid responsiveness (p=0.621). CONCLUSION: The fluid challenge test increases ONSD and may cause an increase in intracranial pressure. KEY WORDS: Fluid therapy, Stroke volume, Intracranial pressure, Ultrasonography, Optic nerve sheath diameter.

Evaluation of intra-cranial pressure changes by measuring the optic nerve sheath diameter during the lung recruitment maneuver in patients with acute respiratory distress syndrome: A prospective study.

Background: The lung recruitment maneuver (LRM) applied in acute respiratory distress syndrome (ARDS) may increase the intra-cranial pressure (ICP). Aims: This study evaluated the effect of LRM on intra-cranial pressure changes in patients with ARDS by measuring the optic nerve sheath diameter (ONSD). Patients and Methods: LRM was applied to patients undergoing follow-up for ARDS, with a positive pressure of 30 cmH2O for 30 s. ONSD on ultra-sonography, dynamic lung compliance (Cdyn), oxygen saturation (SpO2), and hemodynamic parameters were measured before (T0), immediately after (T1), and 10 min after (T2) LRM. The primary endpoint was the effect of LRM on ONSD changes. The secondary endpoints included the effect of LRM on Cdyn, SpO2 change, and relationship between Cdyn and ONSD changes. Results: The study included 60 patients. ONSD was higher at T1 than at T0 (median [interquartile range]: 5.13 [0.4] vs. 5.3 [0.3] mm, P < 0.001) but was similar at T0 and T2 (5.13 [0.4] vs. 5.09 [0.37] mm, P = 0.36). Cdyn and SpO2 were significantly higher at T1 and T2 than at T0 (Cdyn: 22.3 [5.8] vs. 23.7 [7.5] vs. 19.4 [6.6] mL/cmH2O, P < 0.001; SpO2: 90[2] vs. 92[4] vs. 88[4] %, P = 0.013). A significant correlation existed between Cdyn and ONSD changes, which increased at T2 compared to T0 (P < 0.001). Conclusion: LRM applied in ARDS causes a short-term increase in ONSD. However, Cdyn increases 10 min after LRM and causes ONSD, thereby leading to a decrease in ICP.

Red blood cell transfusion and hemoglobin level on neurological outcome in the first 24 hours of traumatic brain injury.

OBJECTIVES: Target hemoglobin (Hb) level is not clearly determined in patients followed up in the intensive care unit (ICU) for traumatic brain injury (TBI). This study aims to investigate the impact of red blood cell (RBC) transfusion and Hb level on the neurological outcome in the first 24 h in patients with TBI. METHODS: In this retrospective study, we reviewed the 2-year organizational database. We evaluated data from patients who underwent RBC transfusion and whose Hb values were 7-9 g/dL and >9 g/dL in the first 24 h. We considered that a Glasgow Outcome Score (GOS) of 1-3 at the time of discharge from the ICU was a poor neurological outcome (PO) and that a GOS > 3 was a good neurological outcome (GO). RESULTS: A total of 147 patients were included in the study 28.6% of whom were discharged from the intensive care unit with PO. The Hb (g/dL) values of PO patients in the first 24 h were lower compared to those of GO patients (median [interquartile range]; 9.2 [2.5] vs 11 [3.4], p < 0.01). RBC transfusion of PO patients in the first 24 h was also less compared to that of GO patients (median [interquartile range]; 15 [35.7] vs. 19 [18.1], p = 0.038). In logistic regression analyses, neither RBC transfusion (OR [95%CI]; 0.786 (0.108-5.740), p = 0.81) nor Hb level (OR [95% CI]; 0.50 (0.057-4.362), p = 0.53) was an independent risk factor for PO. CONCLUSION: In patients followed up in the ICU due to TBI, RBC transfusion and Hb values in the first 24 h are not associated with PO at the time of discharge from the ICU.

Investigating the Effects of Protective Face Masks on the Respiratory Parameters of Children in the Postanesthesia Care Unit During the COVID-19 Pandemic.

PURPOSE: The purpose of this study was to investigate the effect of protective face mask usage during the postoperative period on carbon dioxide retention in children during the COVID-19 pandemic. DESIGN: This study was designed as a prospective, randomized trial including 40 ASA I-II patients aged 3 to 10 years who were scheduled for elective surgery. METHODS: Patients were randomly allocated to two groups. The first group (group 1) received O2 treatment over the protective face mask. In the second group (group 2), the protective face mask was worn over the O2 delivery system. Heart rate, oxygen saturation (SPO2) level, end-tidal carbon dioxide (EtCO2) level, and respiratory rate were measured using a patient monitor at 0, 5, 10, 15, 30, and 45 minutes and recorded. The primary outcome of the study was the determination of the EtCO2 levels, which were used to assess the safety of the mask in terms of potential carbon dioxide retention. FINDINGS: None of the participants' SPO2 levels fell below 92% while wearing masks. There was no statistically significant difference between the groups in terms of EtCO2, heart rate, SPO2, and respiratory rate (P > .05). CONCLUSIONS: During the COVID-19 pandemic, protective surgical face masks can be used safely in the postoperative period for pediatric patients aged 3 to 10 years.

Effects of personality traits on severity of sepsis.

INTRODUCTION: The aim of this study was to reveal the effect of the individual's lifestyle and personality traits on the disease process in patients with sepsis and to have clinical predictions about these patients. MATERIALS AND METHODS: The study was planned as a multi-center, prospective, observational study after obtaining the approval of the local ethics committee. Patients were hospitalized in different intensive care units. Besides demographics and personal characteristics of patients, laboratory data, length of hospital and ICU stay, and mortality was recorded. Two hundred and fifty-nine patients were followed up in 11 different intensive care units. Mortality rates, morbidities, blood analyses, and personality traits were evaluated as primary outcomes. RESULT: Of the 259 patients followed up, mortality rates were significantly higher in men than in women (p= 0.008). No significant difference was found between the patients' daily activity, tea and coffee consumption, reading habits, smoking habits, blood groups, atopy histories and mortality rates. Examining the personal traits, it was seen that 90 people had A-type personality structure and 51 (56.7%) of them died with higher mortality rate compared to type B (p= 0.038). There was no difference between personalities, in concomitant ARDS occurrence, need for sedation and renal replacement therapies. CONCLUSIONS: Among individuals diagnosed with sepsis/septic shock, mortality increased significantly in patients with A-type personality trait compared to other personality traits. These results showed that personal traits may be useful in predicting the severity of disease and mortality in patients with sepsis/septic shock.

Early extubation after liver transplantation: Is dexmedetomidine a good option?: A retrospective cohort study.

BACKGROUND: Dexmedetomidine is a potent and highly selective alpha-2 adrenoceptor agonist with sympatholytic, sedative, anxiolytic and analgesic properties. The aim of this study is to determine the effect of a dexmedetomidine infusion in liver transplant recipients in the early postoperative period on early and smooth extubation. METHODS: We performed a retrospective chart review of 21 patients undergoing liver transplantation between December 1, 2018 and February 31, 2020. Patients were divided into the dexmedetomidine and midazolam groups. The primary outcome was the extubation time. Secondary outcomes were mean arterial pressure and heart rate before and after extubation. The collected data included the patients' age, gender, surgery time, Model for End-stage Liver Disease score, cold ischemia time, blood transfusion amount and extubation visual analogue scale (VAS) scores. RESULTS: Extubation time was significantly shorter in the dexmedetomidine group than in the midazolam group (median [minimum-maximum], 4 [0-6], 8 [4-13] hours, respectively, P = .000). Extubation VAS scores were statistically significantly lower in dexmedetomidine group (P = .000). Mean arterial pressure values before and after extubation were significantly higher in patients' midazolam group than the dexmedetomidine group (P = .003, P = .005, respectively). CONCLUSIONS: Dexmedetomidine infusions provided early and smooth extubation with stable haemodynamics in our patients.

[Hemophagocytic syndrome in a patient followed for IgG4-related disease in intensive care unit]. / Yogun bakimda IgG4 iliskili hastalik nedeniyle takip edilen hastada gelisen hemafagositik sendrom.

IgG4-related disease (IgG4-RD) is a set of diseases that can affect multiple organs, produce an immune-mediated fibroinflammatory response, and lead to tissue destruction and organ failure. Hemophagocytic syndrome is a life-threatening hyperinflammatory fatal disease caused by defect and excessive macrophage activity in natural killer cells. The disease can often be confused with other immune-mediated diseases such as cancer, infection, interstitial lung disease, sjogren's syndrome, wegener's vasculitis, or temporal arteritis. Hemophagocytic syndrome is defined as hemophagocytic lymphohistiocytosis (HLH) which is a pathological and clinical condition caused by phagocytosis of erythrocyte, leukocyte, platelet and precursor cells which are the cellular elements of the macrophages which are activated due to various reasons. Although there are two types as primary (familial) and secondary (depending on infections), the clinical findings are the same. Presence of familial disease/known gene defect and/or at least 5 of 8 clinical and laboratory diagnostic criteria is required for diagnosis. The first target is the suppression of hyperinflammation urgently, the second is the elimination of the stimulus triggering the event. In secondary HLH, treatment should be planned according to the underlying cause. As a rare complication of a rare disease, a case with the diagnosis of IgG4-related disease complicated with hemophagocytic syndrome is presented with the literature.

Acute Respiratory Failure in Cardiac Transplant Recipients.

OBJECTIVES: This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients. MATERIALS AND METHODS: Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included. RESULTS: Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure. CONCLUSIONS: A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.

Postoperative effects of intraoperative hyperglycemia in liver transplant patients.

OBJECTIVES: The aim of this study was to determine the effects of intraoperative hyperglycemia on postoperative outcomes in orthotopic liver transplant recipients. MATERIALS AND METHODS: After ethics committee approval was obtained, we retrospectively analyzed the records of patients who underwent orthotopic liver transplant from January 2000 to December 2013. A total 389 orthotopic liver transplants were performed in our center, but patients aged < 15 years (179 patients) were not included in the analyses. Patients were divided into 2 groups based on their maximum intraoperative blood glucose level: group 1 (patients with intraoperative blood glucose level < 200 mg/dL) and group 2 (patients with intraoperative blood glucose level > 200 mg/dL). Postoperative complications between the 2 groups were compared. RESULTS: There were 58 patients (37.6%; group 1, blood glucose < 200 mg/dL) who had controlled blood glucose and 96 patients (62.3%; group 2, blood glucose > 200 mg/dL) who had uncontrolled blood glucose. The mean age and weight for groups 1 and 2 were similar. There were no differences between the 2 groups regarding the duration of anhepatic phase (P = .20), operation time (P = .41), frequency of immediate intraoperative extubation (P = .14), and postoperative duration of mechanical ventilation (P = .06). There were no significant differences in frequency of patients who had postoperative infectious complications, acute kidney injury, or need for hemodialysis. Mortality rates after liver transplant were similar between the 2 groups (P = .81). CONCLUSIONS: Intraoperative hyperglycemia during orthotopic liver transplant was not associated with an increased risk of postoperative infection, acute renal failure, or mortality.

A Case of Compartment Syndrome in the Hand Secondary to Intravenous Fluid Application.

Compartment syndrome of the extremities is a rare but potentially devastating condition. Anaesthetic and analgesic drugs used in the perioperative period may cause a delayed diagnosis by preventing the symptoms from appearing, and irreversible complications can occur. In this report, a case of compartment syndrome secondary to vascular access and its treatment in a morbidly obese patient who underwent abdominoplasty was presented.

Percutaneous dilational tracheotomy for airway management in a newborn with Pierre-Robin syndrome and a glossopharyngeal web.

Pierre-Robin syndrome (PRS) is often associated with difficulty in endotracheal intubation. We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day-old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from the base of the tongue to the posterior pharyngeal wall. The infant was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation was impossible, and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.71 mm guide wire was introduced through this catheter. Using 5 French, 7 French, 9 French, and 11 French central venous catheter kit dilators, staged tracheotomy stoma dilation was performed. By inserting a size 3.0 tracheotomy cannula, PDT was successfully completed in this newborn. This case describes the successful use of PDT for emergency airway management of a newborn with PRS and glossopharyngeal web.