A Randomized, Double-Blind, Graded Dose-Response Study of Norepinephrine Administration for Prevention of Post-Spinal Hypotension during Elective Cesarean Delivery.

Norepinephrine has been recently introduced for prophylaxis against post-spinal hypotension during cesarean delivery; however, no data are available regarding its optimum dosing scheme. The primary objective of this study is to compare three different infusion and bolus dose combinations of norepinephrine for prophylaxis against post-spinal hypotension during cesarean delivery. This randomized, double-blind study was performed between February 2021 and May 2022. The study protocol was registered at Clinicaltrials.gov with the identification number NCT04701190. A total of 192 parturients were enrolled into this study. Patients were assigned to three groups-Zero-Bolus High-Infusion (Group ZBHI, 0 µg/0.1 µg kg-1 min-1, n = 61), Moderate-Bolus Moderate-Infusion (Group MBMI, 5 µg/0.075 µg kg-1 min-1, n = 61) and High-Bolus Low-Infusion (Group HBLI, 10 µg/0.05 µg kg-1 min-1, n = 61)-according to different combinations of norepinephrine infusion and bolus doses. All patients received spinal anesthesia with 10 mg hyperbaric bupivacaine plus 12.5 µg fentanyl. Immediately after cerebrospinal fluid was obtained, patients underwent a norepinephrine protocol corresponding to the randomized group. The primary outcome was the incidence of post-spinal hypotension. Secondary outcomes were post-delivery hypotension, frequency of post-spinal hypertension and bradycardia, and neonatal outcomes. The incidence of post-spinal hypotension was 11.7% in Group HBLI, 6.7% in Group ZBHI and 1.7% in Group MBMI (p = 0.1). The overall incidence of post-delivery hypotension in parturients was 41.1% (p = 0.797). The lowest frequency of post-spinal bradycardia (8.3%) and hypertension (11.7%) was seen in Group HBLI. The neonatal APGAR scores at 1st minute were higher in Group MBMI than in Group ZBHI (8.58 vs. 8.23, p = 0.001). All three infusion and bolus dose combinations of norepinephrine effectively reduced the incidence of post-spinal hypotension. However, high-dose bolus (10 µg) followed by low-dose infusion (0.05 µg kg-1 min-1) of norepinephrine can be preferred due to the reduced frequency of bradycardia and hypertension during cesarean delivery under spinal anesthesia.

Patient Safety during Propofol Sedation before and after Implementation of Capnography Monitoring.

Endoscopic procedures are routinely applied to cancer screening programs and surveillance. The preferred technique is usually deep sedation with propofol being a convenient agent allowing for a quicker patient recovery while maintaining a similar safety profile compared to traditional agents. However, adverse events, including respiratory depression and consequent undesirable cardiovascular side effects, may occur. The goal of this work is to evaluate the patient safety impact of adding capnography during endoscopic procedures under deep propofol sedation. Data were retrospectively collected from patients undergoing deep, procedural sedation for gastrointestinal (GI) endoscopy in October 2019 to January 2021 in a single Turkish university hospital. Included in the analysis were all adult patients classified by the American Society of Anesthesiologists (ASA) as I-IV, who were scheduled for GI endoscopy utilizing propofol alone or in combination. Data on 1840 patients were collected, of whom 1610 (730 pre- and 880 post-capnography implemention) met inclusion criteria. The primary outcome was a change in the composite incidence of mild oxygen desaturation (SpO2 75-90% for <60 s), severe oxygen desaturation (SpO2 < 75% anytime or <90% for >60 s), bradycardia (<60 ppm), and tachycardia (>25% from baseline). Without capnography, on average, 7.5 events of the primary endpoint were observed per 100 procedures and 2.9 with additional capnography monitoring (p < 0.001). A significant reduction was observed for mild oxygen desaturation, with a resulting odds ratio of 0.25 (95% CI 0.14 to 0.46). ASA I patients had the highest difference in combined incidence of any oxygen desaturation of 5.85% in the pre-capnography group and 0.64% in the post-capnography group. Although procedural sedation using propofol is not associated with severe adverse events, the incidence of composite adverse events could be reduced with the addition of capnography monitoring.

The impact of COVID-19 on health care-associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings.

BACKGROUND: This study examines the impact of the COVID-19 pandemic on health care-associated infection (HAI) incidence in low- and middle-income countries (LMICs). METHODS: Patients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre-COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS). RESULTS: A total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively. DISCUSSION: This study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study.

OBJECTIVE: To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. DESIGN: International, multicentre cohort study. SETTING: 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. PARTICIPANTS: The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. MAIN OUTCOME MEASURES: Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. RESULTS: Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). CONCLUSIONS: ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03009929.

[Influence of methylprednisolone on the reversal time of sugammadex: a randomized clinical trial]. / Influência da metilprednisolona no tempo de reversão do sugammadex: estudo clínico randomizado.

BACKGROUND AND OBJECTIVES: Sugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway oedema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1 mg.kg-1 methylprednisolone or saline. METHOD: This single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18-65, an ASA physical status I-II, a BMI less than 30 kg.m-2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg.kg-1 of methylprednisolone in 5mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg.kg-1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study. RESULTS: Median time to TOFr = 0.9 was for 130.00 s (range of 29-330) for Group C and 181.00 s (100-420) for Group M (p < 0.001). The differences between the two groups were statistically significant. CONCLUSION: When using 2 mg.kg-1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1 mg.kg-1 of intraoperative methylprednisolone, demonstrated delayed recovery times.

Influence of methylprednisolone on the reversal time of sugammadex: a randomized clinical trial / Influência da metilprednisolona no tempo de reversão do sugammadex: estudo clínico randomizado

Abstract Background and objectives: Sugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway edema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1 mg kg-1 methylprednisolone or saline. Method: This single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18 to 65, an ASA physical status I-II, a BMI less than 30 kg m-2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg kg-1 of methylprednisolone in 5 mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg kg-1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study. Results: Median time to TOFr = 0.9 was for 130.00 s (range of 29-330) for Group C and 181.00 s (100-420) for Group M (p < 0.001). The differences between the two groups were statistically significant. Conclusion: When using 2 mg kg-1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1 mg kg-1 of intraoperative methylprednisolone, demonstrated delayed recovery times.

Resumo Justificativa e objetivos: Sugammadex é uma gama-ciclodextrina modificada que reverte os efeitos de agentes de bloqueio neuromuscular aminoesteroides. Da mesma forma, algumas moléculas esteroides, como toremifene, ácido fusídico e flucloxacilina, podem ser encapsulados pelo sugammadex. A metilprednisolona, esteroide sintético usado geralmente para a profilaxia de edema de vias aéreas, também pode ser encapsulada pelo sugammadex. O objetivo do estudo foi comparar os tempos de recuperação do sugammadex na reversão de bloqueio neuromuscular moderado induzido pelo rocurônio em pacientes em que foi administrado 1 mg.kg-1 de metilprednisolona ou solução salina no período intraoperatório. Método: Este estudo prospectivo, randomizado, controlado, unicêntrico incluiu 162 pacientes adultos (idades de 18-65, ASA I-II, IMC abaixo de 30 kg.m-2, e não usando medicação esteroide) submetidos à anestesia geral para procedimento eletivo de otorrinolaringologia com propofol, remifentanil, rocurônio e sevoflurano. A monitorização neuromuscular foi realizada usando aceleromiógrafo calibrado. O grupo controle (Grupo C) recebeu 5 mL de solução salina, enquanto o grupo metilprednisolona (Grupo M) recebeu 1 mg.kg-1 de metilprednisolona em 5 mL de solução salina logo após a indução. Ao término da cirurgia, em relação à contagem do número de respostas à sequência de quatro estímulos (TOFc), dois pacientes mostraram recuperação espontânea e todos os pacientes receberam 2 mg.kg-1 de sugammadex. A recuperação da razão T4/T1 (TOFr) para 0,9 foi registrada nos dois grupos, e o desfecho primário do estudo foi o tempo estimado de recuperação, momento em que a razão TOFr alcançou o valor de 0,9 (TOFr = 0.9). Resultados: O tempo mediano para TOFr = 0,9 foi 130 s (29-330) para o Grupo C e 181s (100-420) para o Grupo M (p < 0,001). As diferenças entre os dois grupos foi estatisticamente significante. Conclusões: Pacientes que receberam 1 mg.kg-1 de metilprednisolona no intraoperatório apresentaram tempo de recuperação mais prolongado após o uso de 2 mg.kg-1 de sugammadex para reverter o bloqueio neuromuscular induzido pelo rocurônio.

Extended left hepatectomy for intrahepatic cholangiocarcinoma: hepatic vein reconstruction with in-situ hypothermic perfusion and extracorporeal membrane oxygenation.

BACKGROUND: Liver resection for intrahepatic cholangiocarcinoma (ICC) with invasion of the inferior vena cava (IVC) and hepatic veins (HV) is a challenging procedure. CASE PRESENTATION: We report a case of a 63-year-old woman with a 6-cm, centrally located liver mass. Her biochemistry results were normal except for a Ca19-9 level of 1199 U/ml. The liver biopsy was consistent with ICC and 60% macrosteatosis. Abdominal CT scans revealed a large central mass invading the left HV, middle HV and right HV, infringing on their junction with the vena cava. An operation was planned using a 3-dimensional (3D) computer simulation model using dedicated software. We also describe a novel veno-portal-venous extracorporeal membrane oxygenation (VPV-ECMO) support with in-situ hypothermic perfusion (IHP) during this procedure. We aimed to perform an extended left hepatectomy and reconstruct 3 right HV orifices with an interposition jump graft to the IVC with total vascular exclusion (TVE) and IHP A supplemental video describing the preoperative planning, the operative procedure with the postoperative follow-up in detail is presented. After the patient was discharged, she developed a hepatic venous outflow obstruction 3 months postoperatively, which was effectively managed with hepatic venous stenting by interventional radiology. She is currently symptom free and without tumour recurrence at the 1-year follow-up. CONCLUSIONS: This report demonstrates that extended left hepatectomy for IHC with IHP and VPV-ECMO is safe and feasible under the supervision of a highly experienced team.

Outcomes of Antepartum and Postpartum Obstetric Admissions to the Intensive Care Unit of A Tertiary University Hospital: An 8-Year Review.

OBJECTIVE: Although their rates are decreasing, pregnancy-related mortality and morbidity are problems worldwide. In this study, we aimed to review the characteristics, diagnoses, required interventions and outcomes of obstetric patients admitted between 2006 and 2014 to the Intensive Care Unit (ICU) of a tertiary university hospital to provide an indicator for improving the management of critically ill obstetric patients. METHODS: A retrospective study of hospital records of obstetric admissions to the ICU was conducted. RESULTS: The pregnancy-related ICU admission rate was 0.21% among all deliveries during the study period. Nine antepartum (mean gestational age: 23 weeks) and 48 postpartum (mean gestational age: 34 weeks) obstetric ICU admissions were included. Most obstetric patients admitted antepartum were primiparous (88.8%), whereas those admitted postpartum were multiparous (64.6%). The mean ICU stay was 7 days among the patients admitted antepartum and 6 days among those admitted postpartum. Common medical reasons for ICU admission were respiratory failure and HELLP syndrome in both groups; DIC and eclampsia were also medical reasons causing ICU admission among the postpartum patients. Mechanical ventilation and blood derivative transfusion were the most common interventions required during the ICU stay of the obstetric patients. Maternal death was unique to the patients admitted postpartum (6 patients, 12.5%). CONCLUSION: We reviewed obstetric admissions to our institution over an 8-year period. We believe that a nationwide study in Turkey that provides an indicator of the frequency, reasons of ICU admission and outcome of obstetric patients is required to improve the quality of intensive care.

[The effect of intra-articular levobupivacaine on shoulder cartilage at different doses-experimental study]. / O efeito de levobupivacaína intra­articular na cartilagem do ombro em doses diferentes­estudo experimental.

BACKGROUND AND OBJECTIVES: In this study it was aimed to examine the histological and morphometric effects on cartilage structure of intra-articular application of levobupivacaine to the shoulder joint. METHODS: In twenty New Zealand adult male rabbits, 35 shoulders were used for the study and prepared in 5 groups of 7. These groups were defined as Groups L1, L2, L3 and L4 which were right shoulders administered with 0.25% and 0.5% levobupivacaine, Group C which were left shoulders as the control group and Groups S1 and S2 which were left shoulders administered with 0.9% saline. On the 2nd and 15th days the animals were killed, the glenohumeral joints were evaluated macroscopically then cartilage samples were taken. These samples were evaluated with Mankin score, and histomorphometrically by measuring the thickness of the cartilage between the superficial cartilage layer and the tidemark and the thickness of calcified cartilage between the tidemark and the subchondral bone. RESULTS: Macroscopically, on the 15th day the joint fluid was seen to have reduced in all the groups. After microscopic evaluation, the highest Mankin score (mean: 3.14±2.1/14) was in the L4 group (15th day 0.5% levobupivacaine) and was found to be statistically significant (p<0.05). No statistically significant difference was determined between the other groups. CONCLUSIONS: Histologically, as the highest Mankin score was in the L4 group, this indicates that in a single intra-articular injection of levobupivacaine a low concentration should be selected. LEVEL OF EVIDENCE: Level 5, animal study.

The effect of intra-articular levobupivacaine on shoulder cartilage at different doses-experimental study.

BACKGROUND AND OBJECTIVES: In this study it was aimed to examine the histological and morphometric effects on cartilage structure of intra-articular application of levobupivacaine to the shoulder joint. METHODS: In twenty New Zealand adult male rabbits, 35 shoulders were used for the study and prepared in 5 groups of 7. These groups were defined as Groups L1, L2, L3 and L4 which were right shoulders administered with 0.25% and 0.5% levobupivacaine, Group C which were left shoulders as the control group and Groups S1 and S2 which were left shoulders administered with 0.9% saline. On the 2nd and 15th days the animals were killed, the glenohumeral joints were evaluated macroscopically then cartilage samples were taken. These samples were evaluated with Mankin score, and histomorphometrically by measuring the thickness of the cartilage between the superficial cartilage layer and the tidemark and the thickness of calcified cartilage between the tidemark and the subchondral bone. RESULTS: Macroscopically, on the 15th day the joint fluid was seen to have reduced in all the groups. After microscopic evaluation, the highest Mankin score (mean: 3.14±2.1/14) was in the L4 group (15th day 0.5% levobupivacaine) and was found to be statistically significant (p<0.05). No statistically significant difference was determined between the other groups. CONCLUSIONS: Histologically, as the highest Mankin score was in the L4 group, this indicates that in a single intra-articular injection of levobupivacaine a low concentration should be selected. LEVEL OF EVIDENCE: Level 5, animal study.

The airway device preference may affect the overlapping of the common carotid artery by the internal jugular vein.

BACKGROUND: Anatomical variation in the internal jugular vein (IJV), as well as its small size, tendency to collapse, and proximity to the common carotid artery (CCA) makes central venous cannulation via the IJV a technically challenging procedure, especially in pediatric patients. AIM: We evaluated the effects of laryngeal mask airway insertion and endotracheal intubation (ETT) on the anatomical relationship between the IJV and the CCA in neutral and 40° head away positions. METHOD: After parental consent 92 patients with ASA physical status I-II, aged 0-17, undergoing elective urological surgery were enrolled and divided into two groups according to the airway management device used for anesthesia: Group laryngeal mask airway (n = 63) and Group ETT (n = 29). An ultrasonographic evaluation was performed before and after airway instrumentation at neutral and 40° head rotation. The IJV position in relation to the CCA was noted, and the overlap percentage of the CCA was calculated as the ratio of the CCA length covering by the internal jugular vein to the transverse diameter of the CCA. RESULTS: With no airway device insertion, the position of the IJV was found to be anterolateral to the CCA in the majority of patients (48.8% vs 35.3%, right vs left IJV) in the neutral head position. While there was no significant change in the overlap percentages of the CCA after laryngeal mask airway insertion in the neutral head position [48.71% vs 57.30% for the right IJV (difference in median: -21.20; 95% confidence interval (CI) of difference: -56.92 to 14.52; P = 0.133); 52.54% vs 60.36% for the left IJV (difference in median: -10.3; 95% CI of difference: -41.49 to 20.89; P = 0.128)], it increased significantly in the 40° head away position on both sides [50.11% vs 64.83% for the right IJV (difference in median: -55; 95% CI of difference: -84 to -25.24; P = 0.01); 53.82% vs 71.20% for the left IJV (difference in median: -46; 95% CI of difference: -86.85 to -5.15; P = 0.004)]. However, the overlap percentages of CCA decreased significantly on the right side with patients in a neutral head position (31.23% vs 6.27%, difference in median: 19; 95% CI of difference: -5.68 to 43.68; P = 0.002) and on both sides in the 40° head away position [29.50% vs 16.19%, difference in median: 26; 95% CI of difference: 2.84 to 49.16; P = 0.03 and 47% vs 31.94%, difference in median: 9.50; 95% CI of difference: -40.87 to 59.87; P = 0.03 for the right and left sides, respectively] after ETT insertion. CONCLUSIONS: Laryngeal mask airway with 40° head rotation increases, whereas ETT decreases, the overlap percentage of CCA by IJV. Both head position and airway management methods have an influence on the overlap of the CCA by the IJV in pediatric patients.

Does Type of Pharyngeal Packing during Sinonasal Surgery Have an Effect on PONV and Throat Pain?

OBJECTIVE: Postoperative nausea and vomiting (PONV) is a common problem that affects up to 30% of all surgical patients after general anaesthesia, which increases in sinonasal surgery due the very potent emetic effect of ingested blood that is swallowed during the procedures. Therefore, a hypo/oropharyngeal packing is commonly placed in an effort to prevent blood ingestion. The primary aim of this study was to compare the efficacy of 3 packing types in preventing PONV and to compare the results with patients who received no packing. The secondary aim was to compare the postoperative throat pain in all 4 groups. STUDY DESIGN: A prospective double-blind randomized controlled study. SETTING: A university hospital. SUBJECTS AND METHODS: After Institutional Review Board approval and informed consent, 201 adult patients scheduled for sinonasal surgery were randomized to 4 groups to have dry packing (n = 52), packing soaked with water (n = 48), packing soaked with chlorhexidine gluconate and benzydamine hydrochloride (n = 51), or no packing (n = 50). Postoperative PONV and throat pain were assessed. RESULTS: Demographic data, procedural characteristics, and PONV risk scores were similar among groups. The PONV incidences, throat pain scores, and analgesic use were comparable in all 4 groups. CONCLUSION: Despite commonly used practices, usage of different types of pharyngeal packing did not affect incidence of PONV and throat pain, nor did usage of no packing.

The effects of ventilation with high density oxygen on the strength of gastrointestinal anastomosis.

PURPOSE: The aim of our study is to evaluate the effects of administration of perioperative supplemental oxygen on anastomoses. METHODS: Forty male Wistar albino rats were used in the study and randomized into 4 groups. Ischemia-reperfusion models were built in groups 3 and 4. Jejunojejunostomy was performed in all rats and assigned to an oxygen/nitrous oxide mixture with a fraction of inspired oxygen of 30% in groups 1 and 3 and 80% in groups 2 and 4. The measurements of perianastomotic tissue oxygen pressure, bursting pressure, level of hydroxyproline were evaluated and compared in all groups. RESULTS: The perianastomotic tissue oxygen pressures, bursting pressures and levels of hydroxyproline were identified as significantly high in groups 2 and 4, administered a fraction of inspired oxygen of 80%, compared to groups 1 and 3, administered a fraction of inspired oxygen of 30%. CONCLUSION: Perioperative supplemental oxygen contributes positively to the anastomotic healing.

Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study.

PURPOSE: The aim of this study was to compare the combined ultrasound-guided supraclavicular brachial plexus block (SCB) and distal median, radial, and ulnar nerve blocks, with the supraclavicular block alone. METHOD: Sixty-two patients undergoing upper extremity surgery were randomized to supraclavicular only (Group S, n = 31) or supraclavicular + distal (Group SD, n = 31) group. Patients in Group S received 32 mL of 1.5 % lidocaine + epinephrine 5 µg/mL, while those in Group SD received 20 mL of 1.5 % lidocaine + epinephrine 5 µg/mL followed by distal median, radial, and ulnar nerve blocks using equal volumes of 2 % lidocaine + 0.5 % levobupivacaine (4 mL/nerve). Sensory and motor blocks of the ulnar, median, radial and musculocutaneous nerves were assessed every 5 min starting at the 10th minute. The imaging, needling and performance times were recorded. Also, the onset and anesthesia-related times, need for analgesic and first analgesic times, were noted. RESULTS: In Group SD, the anesthesia onset [15 (10-25) vs. 20 (15-30) min, p < 0.001] and anesthesia related times [16.6 (10.7-28.2) vs. 22 (15.9-33.7) min, p < 0.001] were significantly shorter than those of Group S. Additionally, the analgesic requirement was lower in Group SD (56.7 vs. 88.5 %, p = 0.009), while among the patients who required analgesic, the first analgesic time was longer in Group SD in comparison to Group S [625 (347-1764) vs. 315 (233-746) min p < 0.001]. CONCLUSIONS: The addition of distal median, radial, and ulnar nerve blocks to SCB shortens anesthesia-related time and anesthesia onset time when compared with a SCB alone.