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.

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.

Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial.

Introduction In this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels. Methods A total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US­guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes. Results The block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups. Conclusion Based on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.

A dose study of remifentanil in combination with propofol during tracheobronchial foreign body removal in children.

STUDY OBJECTIVE: To assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy. DESIGN: Prospective, randomized, clinical comparison study. SETTING: Operating room of a university hospital. PATIENTS: 70 ASA physical status 1 and 2 children, aged 3-12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy. INTERVENTIONS: Children were divided equally into two groups to receive either a 0.1 µg/kg/min (Group R1) or 0.2 µg/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 µg/kg/min of remifentanil and 100-250 µg/kg/min of propofol in Group R1 and 0.2 µg/kg/min of remifentanil and 100-250 µg/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O(2) via a "T" piece connected to the side arm of the bronchoscope. MEASUREMENTS: Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O2 saturation (SpO2) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate. MAIN RESULTS: Groups were similar in demographics and duration of bronchoscopy and anesthesia (P > 0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P < 0.01). Propofol consumption was significantly higher in Group R1 (63.6 ± 30.1 mg) than Group R2 (39.8 ± 26.6 mg; P < 0.01). Time to spontaneous eye opening was 8.6 ± 1.3 minutes in Group R1 and 6.3 ± 1.1 minutes in Group R2 (P < 0.05). The time to recovery to an Aldrete score of 9 was greater in Group R1 (19.8±3.0 min) than Group R2 (16.1±3.0 min; P < 0.01). CONCLUSION: A remifentanil 0.2 µg/kg/min infusion with propofol provides hemodynamic stability and early recovery in children undergoing foreign body removal during rigid bronchoscopy.

Effect of intramuscular and intravenous lidocaine on propofol induction dose.

OBJECTIVE: Our purpose was to study whether or not intravenous (IV) administration of lidocaine reduces propofol dose requirement as intramuscular (IM) lidocaine in a placebo-controlled manner. SUBJECTS AND METHODS: Seventy-five adult patients with American Society of Anesthesiologists physical status I and II, aged 20-60 years who were scheduled for surgery under general anaesthesia were included in the study. The patients were randomly allocated to 3 groups: IM: intramuscular administration; IV: intravenous administration and C: control. There were 25 patients in each group. The patients in group IM received lidocaine 1.5 mg · kg(-1) administered into the deltoid muscle 10 min before anaesthesia induction. In group IV, the patients received IV lidocaine 1.5 mg · kg(-1), 2 min before anaesthesia induction. Group C patients served as control group who received only propofol injection. Hypnosis after propofol administration was measured with response to verbal commands. RESULTS: There were no statistical differences between group IM (100.8 ± 26.1 mg) and group IV (110.8 ± 30.1 mg) regarding the induction dose of propofol (p > 0.05). In group C, the required propofol dose (151.2 ± 27.4 mg) for anaesthesia induction was significantly higher than in the other groups (p < 0.001). No side effect was observed in any patients. CONCLUSION: In this study, both IV and IM lidocaine administration were effective in reducing the hypnotic dose of propofol without any side effects. In addition, IV lidocaine may be more comfortable for awake patients.

Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia.

BACKGROUND: The factors affecting the thermal status in neonates and infants undergoing general anesthesia are not yet investigated in detail. We evaluated the factors leading to intraoperative hypothermia in 60 neonates and infants. METHODS: The initial body temperatures and the core temperatures at the 10th, 30th, 60th and 90th minute of anesthesia, as well as at the end of the operation were recorded. The patients were divided into the groups according to the age, type of surgery (minor vs major), operating room (OR) temperatures (low '<23 degrees C' vs high '>23 degrees C') and the initial core temperature of the patients. RESULTS: In 31 neonates and 29 infants, the mean core temperatures decreased 10 min after anesthesia induction. In all neonates and in infants with 'low OR temperature' (<23 degrees C), these decreases continued to the end of the surgery. Except infants undergoing minor surgery, in all patients, the core temperatures at the end of surgery were lower than the baseline temperature. The greatest decrease in core temperatures occurred in neonates undergoing major surgery and with low OR temperature. In low OR temperature, the decrease of core temperature is higher in patients with major surgery. In patients undergoing minor surgery, the decrease of core temperature is more in neonates than infants. Major surgery increased the chance of decrease of the core temperature by 2.66 times and operating room temperature less than 23 degrees C by 1.96 times. CONCLUSION: The type of surgery and the OR temperature are the main factors for decrease of the core temperature in neonates and infants. In neonates, the core temperatures are less stable, regardless of OR temperature and type of surgery. In high OR temperature, infants can stabilize their core temperature better than neonates.

Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain.

OBJECTIVE: The analgesic effect of bupivacaine/fentanyl with epinephrine given interpleurally after thoracotomy was investigated in a randomized placebo and intravenous controlled study. DESIGN: Prospective clinical study. SETTING: University teaching hospital. PARTICIPANTS: Sixty American Society of Anesthesiologists physical status II and III patients scheduled for posterolateral thoracotomy with general anesthesia. INTERVENTIONS: Patients were randomly divided into 4 groups to receive either 0.5% bupivacaine/1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine (n = 15, group IPBF), 0.5 % bupivacaine with 5 microg/mL of epinephrine (n = 15, group IPB), or saline (n = 15, group IPS) in a total volume of 15 to 20 mL in 60 seconds by an interpleural catheter placed at the end of surgery by direct vision. The same volume of bupivacaine 0.25% and 1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine to group IPBF, bupivacaine 0.25% with 5 microg/mL of epinephrine to group IPB or saline to group IPS was injected through the interpleural catheter every 6 hours for 48 hours postoperatively. Intravenous fentanyl (n = 15, group IVF) and interpleural saline groups received 1.5 microg/kg of fentanyl intravenously at the first complaint of pain. All patients also received patient-controlled analgesia (PCA) with fentanyl for 48 hours postoperatively. Metamizol sodium was used as a rescue analgesic. MEASUREMENTS AND MAIN RESULTS: Adequacy of pain relief was evaluated with the "Prince Henry Pain Scale" and visual analog pain scale. Fentanyl consumption via PCA and complications were evaluated for 48 hours. Visual analog scale scores were significantly higher in the interpleural saline group at 4 and 12 hours (6.6 +/- 1.2 and 5.0 +/- 2.1, respectively) postoperatively. Significantly more patients in the IPBF group had lower pain scores during coughing and deep breathing. Fentanyl consumption via PCA device was significantly higher in the intravenous fentanyl group (1,069 +/- 96.9 microg) than the interpleural groups (577.3 +/- 72.2 microg, 651.1 +/- 61.9 microg, and 601.0 +/- 22.6 microg in IPBF, IPB, and IPS groups, respectively). CONCLUSION: It is concluded that total fentanyl consumption via PCA decreased in all interpleural groups, but pain during coughing and deep breathing was significantly reduced in only the interpleural bupivacaine/fentanyl with epinephrine group.

Is tissue coring a real problem after caudal injection in children.

BACKGROUND: The aim of this study was to determine whether tissue coring occurs with 22-G hollow needle and 22-G caudal block needle during caudal injection in children, as well as evaluating the nature of the coring material if it did occur. METHODS: Seventy children were randomly allocated to two groups and caudal block was performed with either 22-G hollow (group I) or 22-G caudal block (group II) needle under general anesthesia. The needles and guides were washed with 0.5 ml of 70% ethanol in a sterile tube and were evaluated by a pathologist blinded to the type of needle used, for the type and number of cells. RESULTS: Nucleated cells, which have no mitotic activity, were present in 8.5% in each study group and bloody material was present in 8.5 and 2.8%, in group I and II, respectively. Non-nucleated epidermal cells were detected in 94.2 and 97.1% of the patients in group I and II, respectively. However, cells with mitotic activity from the stratum basale were not detected in any slides. CONCLUSIONS: The incidence of transporting nucleated epidermal cells with no mitotic activity from stratum spinosum during puncture for caudal block is low and no differences exist between different types of needle used. However, it may also suggest that transporting nucleated cells with mitotic activity from the stratum basale may be possible during caudal puncture.

Anaesthetic and airway management in a child with Hanhart's syndrome.

Hanhart's syndrome (oromandibular-limb hypogenesis syndrome) is a rare disease characterized by hypoglossia/aglossia, various distal limb defects and micrognathia. Difficult airway due to micrognathia may complicate anaesthetic management in this syndrome. We describe the anaesthetic management of a child with Hanhart's syndrome undergoing plastic reconstructive surgery.