The Impact of Preoperative Dexamethasone Administration on Quality of Recovery Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study.

INTRODUCTION: Recovery from anesthesia is complex and affected by multiple factors. In patient with obesity, the increased prevalence of anxiety and depressive disorders poses a challenge in achieving optimal patient satisfaction. Therefore, strategies to enhance the quality of recovery are crucial for this population. This study aimed to investigate whether administration of dexamethasone to patients undergoing laparoscopic sleeve gastrectomy (LSG) could improve recovery outcomes. METHODS: This prospective observational study was conducted at a tertiary university hospital in Samsun, Turkey. Thirty patients who received dexamethasone prior to LSG (group D) and 30 patients who did not (group C) were included with convenience sampling method. The quality of recovery was assessed using the Quality of Recovery 40 questionnaire (QoR-40). The primary outcome measure was the QoR-40 score at 24 h postoperatively. RESULTS: The dexamethasone group showed a significant improvement in QoR-40 scores (185.4 ± 6.0 vs. 172.0 ± 8.4, p < 0.001), exhibited reduced morphine consumption (11.8 ± 7.8 vs. 21.8 ± 10.9 mg, p < 0.001), opioid demand count (21.50 [9.50-49.00], p = 0.001), the number of patient used antiemetic drug (1 vs. 22, p < 0.001), and achieved earlier mobilization (3 [3-4] vs. 3 [3-4] h, p < 0.0001). However, no significant differences were observed between the two groups concerning intraoperative complications, postoperative wound infections, or time to discharge. CONCLUSIONS: In patients undergoing laparoscopic sleeve gastrectomy, preoperative dexamethasone administration was associated with improved the recovery quality after discharge and reduced early postoperative need for antiemetic medications.

Effect of ultrasound-guided pericapsular nerve group (PENG) block on pain during patient positioning for central nervous blockade in hip surgery: a randomized controlled trial.

BACKGROUND: Most patients with hip fractures are elderly patients with comorbidities, and well-managed pain management is associated with positive postoperative outcomes. In recent years, new indications for regional anesthesia techniques have been defined, and they have found more place in clinical practice. Herein we investigate the effect of US-guided PENG block on positioning pain and compare that effect to intravenous opioid in patients undergoing surgery under spinal anesthesia for hip fractures. Additionally, we sought to investigate the effect of PENG block on pain scores, opioid intake, time to first analgesic requirement, and quality of recovery within the first 24 h following surgery. METHODS: In this study, patients were divided into the PENG (n = 42) and control group (n = 42) one hour prior to surgery. A team who was blinded to the assigned groups, collected and evaluated all data such as spinal anesthesia positioning pain, postoperative pain, opioid requirement. RESULTS: Patients that underwent PENG had statistically significantly lower NRS scores after interventions, immediately before positioning, at positioning and at end of spinal anesthesia. Pain scores during positioning for spinal anesthesia were statistically significantly lower in the PENG group than in the control group (p < 0.001). Total morphine use over the first 24 h was extremely statistically significantly lower in the PENG group (p < 0.001). CONCLUSIONS: Positive outcomes of PENG block in patient positioning pain before spinal anesthesia, postoperative pain scores, and morphine consumption are consistent with similar studies. High patient satisfaction in patients who underwent PENG block contributes to the literature. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04871061.

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.

Comparison of Ketamine, Dexmedetomidine and Lidocaine in Multimodal Analgesia Management Following Sleeve Gastrectomy Surgery: A Randomized Double-Blind Trial.

PURPOSE: The aim of this study was to compare the effects of ketamine, dexmedetomidine, and lidocaine infusions added to the multimodal analgesia regimen on pain scores and analgesic requirement in laparoscopic sleeve gastrectomy. DESIGN: A prospective randomized double-blind trial. Seventy-three patients aged 18 to 65 years (ASA II-III) undergoing laparoscopic sleeve gastrectomy were included. The patients were divided into 3 groups. Intravenous (IV) ketamine (0.5 mg/kg/h), dexmedetomidine (0.5 mcg/kg/h), and lidocaine (2 mg/kg/h) were administered to Groups K, D and L, respectively. Postoperative infusions were continued for 12 hours. METHODS: Visual Analog Scale (VAS) scores (during rest and movement) in the admission to postanesthesia care unit, 1, 3, 6, 12, 24, 48 hours, and on day 15 were assessed postoperatively. Rescue analgesia requirement, the number of patients with nausea, retching, and vomiting, time to mobilization, and hospital length of stay (LOS) were recorded. FINDINGS: VASrest values during all measurements in the first 24 hours, and VASmovement values in the first 6 hours and at 24 hours were lower in Group L when compared to Group K and Group D (P < .001, P < .001, P = .008, respectively). VASrest at 48 hours and VASmovement at 12 and 48 hours were lower in Group L when compared to Group K (P = .044, P = .001 and P = .011, respectively). There was no statistically significant difference between Group D compared to the other two groups at these times (P > .05). The requirement of rescue analgesia on postoperative day 1 was significantly higher in Group K (P < .001). Hospital LOS was shorter in Group L than in the other groups (P = .002). CONCLUSIONS: IV lidocaine added to multimodal analgesia provided better pain control in the early postoperative period compared to dexmedetomidine and ketamine and decreased the hospital LOS.

Pectoserratus plane block versus erector spinae plane block for postoperative opioid consumption and acute and chronic pain after breast cancer surgery: A randomized controlled trial.

STUDY OBJECTIVE: Breast cancer is quite common in women, and surgery is the most effective treatment in most cases. This study compared the effects of ultrasound (US)-guided erector spinae plane block (ESPB) and pectoserratus plane block (PSPB) on the postoperative opioid consumption and acute and chronic pain in patients after breast cancer surgery. DESIGN: Prospective, randomized, single-blind. SETTING: University hospital. PATIENTS: This study included 90 patients (ASA I-II) who underwent segmental mastectomy and sentinel lymph node biopsy at the hospital of Ondokuz Mayis University, Samsun. INTERVENTIONS: The patients were divided into the ESPB group, PSPB group, and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. MEASUREMENTS: The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores of the arm at rest and at abduction in the first 24 h and at 3 months postoperatively, intraoperative remifentanil consumption, number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia. MAIN RESULTS: Postoperative 24-h morphine consumption, visual analog scale scores at rest and at abduction, and intraoperative remifentanil consumption were lower in the ESPB and PSPB groups than in the control group. Time to the first request for analgesia via patient controlled analgesia was longer in the ESPB and PSPB groups than in the control group. In the PSPB group, none of the patients needed rescue analgesia. CONCLUSIONS: US-guided ESPB and PSPB performed in patients who underwent breast cancer surgery showed similar and modest analgesic effects on the postoperative opioid consumption and acute and chronic pain scores.

Cerebral Oximetry after Low Pressure versus Standard Pressure Pneumoperitoneum in Laparoscopic Nephrectomy.

OBJECTIVE: To evaluate whether pneumoperitoneum pressure lower than the standard pressure would allow higher cerebral oxygen saturation (rSO2) during laparoscopic nephrectomy (LN). STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Ondokuz Mayis University Hospital, Samsun, Turkey, from January to November 2020. METHODOLOGY: Sixty-two patients (aged 18-65 years; ASA I-III) scheduled for LN were equally divided into a low-pressure (LP; 8 mmHg) and standard-pressure (SP; 14 mmHg) group. Mechanical ventilator settings were adjusted to maintain 32-37 mmHg ETCO2 and >96% SpO2 throughout the surgery. The rSO2 was evaluated by near-infrared spectroscopy before and one minute after induction and then every five minutes until patient transfer to the recovery unit. Oxygen and carbon dioxide partial pressures, pH, and haemoglobin, recorded at five minutes after induction, five and 30 minutes after insufflation, and 10 minutes after desufflation, were examined for correlations with rSO2. RESULTS: Both groups had similar rSo2, arterial blood gas, and haemoglobin values at all measurement times. The LP group showed no differences between the preoperative values and the values obtained at the different time points. In contrast, the SP group showed significant differences between the preoperative and the measured values (except at 25, 30, and 35 minutes) (p = 0.001). Four patients (12.9%) in both groups showed cerebral desaturation. The rSO2 values were moderately correlated with the CO2 and haemoglobin values. CONCLUSION: Low insufflation pressure offered no advantages over standard pressure in terms of haemodynamics, arterial blood gases, cerebral oxygen saturation during LN, and CO2 insufflation did not change rSO2 levels. Key Words: Pneumoperitoneum, Spectroscopy, Oximetry, Nephrectomy, Surgery, Laparoscopic nephrectomy.

Analgesic efficacy of the bilateral erector spinae plane block for colorectal surgery: a randomized controlled trial.

BACKGROUND: Colorectal cancer is quite common, and surgery is the most effective treatment for most patients. However, postoperative pain management is generally inadequate in most patients. This study aimed to determine the effect of ultrasonography (USG)-guided preemptive erector spina plan block (ESPB), as part of multimodal analgesia, on postoperative analgesia in patients undergoing colorectal cancer surgery.  METHODS: This is a prospective, randomized, single-blind trial. This study included 60 patients (ASA I-II) who underwent colorectal surgery at the hospital of Ondokuz Mayis University. The patients were divided into the ESP group and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores at rest and coughing and deep inspiration in the first 24 h and at 3 months postoperatively; number of patients requesting rescue analgesia; incidence of nausea and vomiting and need for antiemetics; intraoperative remifentanil consumption; postoperative first oral intake; time to first urination, first defecation, and first mobilization; hospitalization time; and incidence of pruritus. RESULTS: Morphine consumption in the first 6 h postoperatively, total amount of morphine consumed in the first 24 h postoperatively, pain scores, intraoperative remifentanil consumption, incidence of pruritus, and postoperative antiemetic requirement were lower in the ESP group than in the control group. First defecation time and hospitalization time were shorter in the block group. CONCLUSIONS: As a part of multimodal analgesia, ESPB reduced postoperative opioid consumption and pain scores in the early postoperative period and in the 3rd month.

The effects of dexketoprofen on renal ischemia-reperfusion injury: an experimental study.

OBJECTIVE: Ischemia/reperfusion (I/R) may cause irreversible damage to tissues and organs. We evaluated the effects of dexketoprofen on a renal I/R model in rats. METHODS: The study included 30 male rats. Control group received 1 mL of saline. Dexketoprofen group received 1 mL (25 mg) of dexketoprofen intraperitoneally. After 60 minutes renal ischemia, 23 hours reperfusion was applied. In Sham group, laparotomy was performed with a medial line incision without any additional procedure. Changes in the plasma malondialdehyde (MDA), renal tissue MDA, plasma glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), BUN, creatinine and albumin levels, and histopathological changes were evaluated. RESULTS: CAT values were significantly lower in Control as compared with the Sham group. Plasma levels of MDA in the Control group were significantly higher than in the Dexketoprofen group. BUN and creatinine values were significantly higher in the Dexketoprofen group. The severity of tissue injury in the Dexketoprofen group was significantly higher than in Control and Sham groups CONCLUSION: Although dexketoprofen reduces the I/R-induced systemic inflammation, it increases renal tissue damage.

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.

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: A randomized, placebo-controlled trial.

STUDY OBJECTIVE: The aim of this study was to evaluate the effect of ultrasound-guided erector spinae plane (ESP) block on postoperative pain in radical prostatectomy, which leads to both visceral and somatic pain. DESIGN: Prospective, randomized, placebo controlled, double-blinded. SETTING: University hospital. PATIENTS: A total of ASA I-III, 50 patients aged 18-65 who were scheduled for elective open radical prostatectomy surgery. INTERVENTIONS: Patients were randomly allocated to receive an ultrasound-guided ESP block, with either local anesthetic (10 mL of 1% lidocaine +10 mL of 0.5% bupivacaine) or placebo bilaterally. MEASUREMENTS: The primary outcome was morphine consumption in the first 24 h after surgery. The secondary outcomes were NRS pain scores at rest and coughing, intraoperative remifentanil consumption and need for rescue analgesic during the first 24 h after surgery. MAIN RESULTS: Both NRS scores for post-anesthesia care unit and NRSrest scores for 1st hours were lower in Group ESPB (p < 0.001 and p = 0.033, respectively). Cumulative morphine consumption at 24 h post-surgery was similar between the groups (p = 0.447). Rescue analgesic requirement was higher in the placebo injection group than in the ESPB group at the 1st postoperative hour (p = 0.002). CONCLUSIONS: In open radical prostatectomies, except for the first hour, ESP block is ineffective for pain scores and on morphine consumption compared to the placebo injection group in the postoperative period.

Attitudes of Anesthesiology Specialists and Residents toward Patients Infected with the Novel Coronavirus (COVID-19): A National Survey Study.

Background: The novel coronavirus (COVID-19) emerged in Wuhan, China, in December 2019. This study aims to evaluate the knowledge of anesthesiology specialists and residents in Turkey about COVID-19 and their attitudes toward the strategies and application methods to be used for a suspected/confirmed COVID-19 case that needs to be operated on or followed up in an intensive care unit, as well as to raise awareness about this issue. Methods: This descriptive study comprised anesthesiology specialists and residents working in various health institutions in Turkey. The data used in this study were obtained online between March 13, 2020 and March 25, 2020 through the website SurveyMonkey (SurveyMonkey, San Mateo, CA) by using a survey form. We contacted members of the Turkish Anaesthesiology and Reanimation Society through the social media platforms Twitter, LinkedIn, and WhatsApp, as well as through their e-mail addresses and invited them to participate in the study. Those who agreed to participate responded to the aforementioned survey. We used SPSS 22.0 (IBM, Armonk, NY) to analyze the survey data statistically. Results: A total of 346 anesthesiology specialists and residents participated in the study. Although the majority of the participants exhibited the correct attitudes toward airway management, research assistants with little professional experience were observed to be undecided or had the tendency to make incorrect decisions. Conclusions: The COVID-19 pandemic is spreading rapidly worldwide. The incidence of COVID-19 cases is increasing daily, and this disease can cause patient death. Anesthesiology specialists and residents who perform emergency operations on these patients in settings other than intensive care units should follow simple and easy-to-understand algorithms to ensure safety. The provision of theoretical and practical training to healthcare providers before they meet patients will help ensure patient-healthcare provider safety and prevent panic, which can cause distress among healthcare providers.

Anaesthetic Management of Patients Undergoing Bariatric Surgery.

OBJECTIVE: To describe perioperative anaesthetic management with laparoscopic sleeve gastrectomy (LSG). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Ondokuz Mayis University, Turkey, between January 2012 and December 2017. METHODOLOGY: Patients who underwent LSG at the study centre were considered. Hospital records were retrospectively reviewed. Information was collected on demographic characteristics, comorbidities, haemodynamic parameters, airway and anaesthetic management and complications. RESULTS: The study included 95 patients (mean age, 37.4±12.1 years; mean body mass index, 46 Kg/m2). Despite high airway assessment scores in some patients, 93 patients (98%) were conventionally intubated using our modified ramp position. Anaesthesia induction involved propofol, and anaesthesia maintenance involved inhalation anaesthetics (remifentanil supplementation). Additionally, rocuronium and sugammadex were used. Postoperative pain was managed with multimodal analgesia. Dose calculations were mostly based on lean/ideal body weight. Significant differences were found in the mean arterial pressure, heart rate and arterial oxygen saturation before induction and 5 min after induction. Intraoperatively, 3 patients (3.2%) developed bronchospasm and 1 (1.1%) developed bradycardia. There were no postoperative complications. CONCLUSION: Inhalational anaesthesia with remifentanil and rocuronium-sugammadex is a safe option in bariatric surgery. Although conventional techniques are sufficient to establish the airway in most cases, preparations for difficult intubation should be made. Furthermore, careful patient selection, preoperative anaesthetic management planning and appropriate postoperative monitoring are necessary.