The management of children aged 0-5 years with suspected foreign body aspiration: a prospective study.

INTRODUCTION: A simple algorithm for bronchoscopy was prepared in very young children. METHODS: The patients aged 0-5 years who were applied with bronchoscopy because of suspected foreign body aspiration (FBA) analysed. RESULTS: Evaluations were made of 89 patients, as 55 (61.7%) in the FBA (+) group and 34 (38.3%) in the FBA (-) group. FBA was determined most in the 1-2 years age group (28 patients, 50.9%, p = 0.04) due to organic hard foodstuffs (94.5%, p < 0.001). The parameters found to be significant were witnessing the event (OR 12.133, 95% CI 3.147-46.774, p < 0.001) and not obtaining unilateral respiratory sounds (OR 7.556, 95% CI 2.681-21.292, p < 0.001). The most significant diagnostic finding was the determination of unilateral hyperventilation on X-ray (OR 16.730, 95% CI 4.541-61.632, p < 0.001). The operating time and length of stay in hospital was significantly shorter in the FBA (-) patients (p < 0.001). CONCLUSION: The presence of a witness, not obtaining unilateral respiratory sounds, and unilateral hyperventilation seen on X-ray are indications for bronchoscopy. In FBA (-) patients applied with bronchoscopy, the complication rate associated with the procedure is low, and the operating time and length of stay in hospital are short.

The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia.

Purpose: Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy. Methods: Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period. Results: PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2. Conclusion: PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.

Are high fresh gas flow rates necessary during the wash-in period in low-flow anesthesia?

In low-flow anesthesia (LFA), there is a wash-in period in which usually high fresh gas flow (FGF) rates are used to achieve the required initial concentration of anesthetic agent in the alveoli. The aim of this study was to compare the efficiency, safety and the consumption of desflurane in LFA using constant FGF (1 L/min) and conventional LFA using high FGF (4 L/min) during the wash-in period. Eighty patients, who were scheduled for elective surgery under general anesthesia with endotracheal intubation, were enrolled in the study. Wash-in was accomplished with 1 L/min FGF (50% O2, 50% air) and 18% desflurane in group 1; and by 4 L/min FGF (50% O2, 50% air) and 6% desflurane in group 2. Throughout the surgery, the vaporizer was adjusted to maintain 0.6 to 0.8 minimum alveolar concentration (MAC). The time required to reach 0.7 MAC was shorter in group 1 (160 seconds [135-181] vs 288 seconds [240-500], P < .001). In 6 patients in group 1 and 13 in group 2, vaporizer settings were adjusted to maintain 0.6 to 0.8 MAC (P = .048). Desflurane consumption in the first hour and total desflurane consumption were higher in group 2 (P < .001 and P = .012, respectively). The efficiency of anesthesia in both the first hour and in total was higher in group 1 (P < .001). It is safe, more efficient, and economical to use 1 L/min FGF during the wash-in period in LFA.

Ultrasound-Guided Bilateral Erector Spinae Block Versus Tumescent Anesthesia for Postoperative Analgesia in Patients Undergoing Reduction Mammoplasty: A Randomized Controlled Study.

PURPOSE: The aim of this prospective, randomized, double-blind study was to compare the tumescent anesthesia method and erector spinae block with respect to postoperative analgesia consumption, pain scores and patient satisfaction, in patients receiving breast reduction surgery under general anesthesia. METHODS: The study included 44 females, aged 20-65 years, who were to undergo breast reduction surgery, without adjunctive liposuction on the breast. Using the closed envelope method, the patients were randomly separated into two groups to receive tumescent anesthesia or erector spinae block (ESB). Patients in the ESB group received the block before general anesthesia by a single anesthetist (G.Ö.). RESULTS: The 24-h tramadol consumption with PCA, which was the primary outcome of the study, was determined to be statistically significantly less in the ESB group (p < 0.001). The NRS scores were compared at 30 min postoperatively and then at 1, 2, 4, 6, 12 and 24 h. At all the measured time points, the pain scores of the ESB group were statistically significantly lower (p < 0.001). Additional analgesia was required by one patient in the ESB group and by seven patients in the tumescent group and was applied as 1 g paracetamol. The requirement for additional analgesia was statistically significantly lower in the ESB group (p < 0.024). Patient satisfaction was statistically significantly better in the ESB group (p < 0.001). CONCLUSIONS: According to the results of this study, bilateral ESB performed under ultrasound guidance in breast reduction surgery was more effective than tumescent anesthesia concerning postoperative analgesia consumption and pain scores. ESB could be an appropriate, effective and safe postoperative analgesia method for patients undergoing reduction mammoplasty surgery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Low-flow anaesthesia with a fixed fresh gas flow rate.

During the wash-in period in low flow anaesthesia (LFA), high fresh gas flow is used to achieve the desired agent concentration. In this study, we aimed to evaluate the safety of fixed 1 L/min fresh gas flow desflurane anaesthesia in both the wash-in and maintenance periods in patients including the obese ones. 104 patients undergoing surgery under general anaesthesia were included. After endotracheal intubation, fresh gas flow was reduced to 1 L/min and the desflurane vaporizer was set at 18%. The time from opening the vaporizer to end-tidal desflurane concentration reaching 0.7 MAC was recorded (MAC 0.7 time). Throughout the surgery, hemodynamic variables, FIO2, MAC and BIS values were observed. MAC 0.7 time, BIS and MAC values at the start of surgery, number of adjustments in vaporizer settings, desflurane consumption were recorded. The average MAC 0.7 time was 2.9 ± 0.5 min. MAC and BIS values at the start of the surgery were 0.7 (0.6-0.8) and 39 ± 8.5 respectively. No individual patient had a BIS value above 60 throughout the surgery. Hemodynamic variables were stable and FIO2 did not fall below 30% in any patient. The number of adjustments in vaporizer settings was 56. Average desflurane consumption was 0.33 ± 0.05 mL/min. We demonstrated that LFA without use of initial high fresh gas flow during the wash-in period is an effective, safe and economic method which is easy to perform.

Anesthesia Procedure for Congenital Insensitivity to Pain in a Child with Anhidrosis Syndrome: A Rare Case.

Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a neuropathy characterized by insensitivity to pain, impaired thermoregulation, anhidrosis, and mental retardation. A 9-year old boy with CIPA syndrome, underwent 2 operations for a calcaneal ulcer. During the first operation standard monitorization was performed. In the second operation, Bispectral Index (BIS) monitoring was added and temperature was monitored with an esophageal probe. In the first operation, in which anesthesia induction was applied with ketamine and midazolam, extremity movements with surgical stimuli were seen. Despite pain insensitivity, as extremity movements were seen with surgical stimuli, propofol was administered in the second operation. Throughout the operation, the BIS values varied from 19-58 and body temperature was measured as 36.1°C-36.9°C. In conclusion, despite the absence of pain sensitivity in CIPA syndrome cases, there is an absolute need for the administration of anesthesia in surgical procedures because of tactile hyperesthesia.

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. METHODS: Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block. All blocks were performed under general anesthesia before surgery. Pain levels were assessed using an FLACC (Face, Legs, Activity, Cry, Consolability) scale. RESULTS: The study included 50 patients, after excluding 3 patients who were not eligible. The number of patients who required analgesia in the first 24 hours postoperatively was significantly lower in the quadratus lumborum block group (P < 0.05). In the quadratus lumborum block group, the postoperative 30-minute and 1-, 2-, 4-, 6-, 12-, and 24-hour FLACC scores were lower compared with those of the transversus abdominis plane block group (P < 0.05). Parent satisfaction scores were higher in the quadratus lumborum block group (P < 0.05). CONCLUSIONS: The results of this study showed that in pediatric patients undergoing unilateral inguinal hernia repair or orchiopexy the quadratus lumborum block provided longer and more effective postoperative analgesia compared with the transversus abdominis plane block. CLINICAL TRIALS REGISTRATION: The trial was registered prospectively at clinicaltrials.gov (NCT02715999).

A comparison of ankle block and spinal anesthesia for foot surgery.

Regional anesthesia methods in the lower extremity include central blocks where spinal and epidural anesthesia are performed as well as peripheral nerve blocks, which are performed by injecting anesthetics locally to nerves. The study aimed to provide a retrospective comparison of unilateral spinal block and ankle block methods in foot operations. Some 60 ASA I-III patients who underwent operation under regional anesthesia were retrospectively examined. Two groups, known as the Unilateral Spinal Block Group (Group S) (n=30) and the Ankle Block Group (Group A) (n=30), were designed. Average blood pressure (ABP), heart rate (HR), block formation time (BFT), time for being ready for operation (TBRFO), total operation duration (TOD), visual analogue scale (VAS), first analgesic need time (FANT) and any complications were all recorded. The BFTs were longer in Group A than Group S, while the FANTs were longer in Group A postoperatively. When these decreases in Group A and Group S were compared with the basal values before the block, all decreases in Group S following the block were considered statistically significant (P<0.05), while the decreases in Group A in the 5(th) and 15(th) minutes were not considered statistically significant. The VASs measured postoperatively at the 6(th), 12(th) and 24(th) hours of Group A were lower than those of Group S (P≤0.05). Despite the longer block formation, the ankle block is safer when compared to the spinal anesthesia, which involves risky hemodynamic changes in patients with associated diseases.