The Prognostic Value of Inflammatory Indices in Predicting Poor Postoperative Outcomes in Isolated Coronary Artery Bypass Graft Surgery.

BACKGROUND: This study aimed to analyze the predictive effect of various inflammatory indices and inflammatory biomarkers on prognosis after coronary artery bypass grafting (CABG). METHODS: In this retrospective observational study, data were recorded from 99 patients who underwent isolated elective CABG between January 2019 and June 2021 and met the inclusion criteria. The patients were divided into two main groups according to the postoperative clinical results: "favorable outcome" and "poor outcome." Preoperative inflammatory parameters, inflammatory indices (such as systemic inflammation index (SII), neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR)), and clinical variables were compared between the groups. RESULTS: Poor postoperative outcomes developed in 31 (31.3%) patients. In the univariate analysis, white blood cell count (p=0.008), neutrophil count (p=0.002), SII (p=0.018), NLR (p=0.003), and dNLR (p=0.003) were found to be significant predictors for poor outcomes. In the multivariate analysis, only the presence of chronic obstructive pulmonary disease (COPD) (OR=8.765; 95% CI 1.308-58.702; p=0.025) and high creatinine levels (OR=1.049; 95% CI 1.005-1.094; p=0.027) were independent risk factors for poor outcomes. Optimal cut-off values were 603.08 (areas under the curve (AUC)=0.632, p=0.036) for SII, 2.34 (AUC=0.669, p=0.007) for NLR, and 1.76 (AUC=0.667, p=0.008) for dNLR. CONCLUSION: SII, NLR, dNLR, and inflammatory markers, such as white blood cell and neutrophil counts, are feasible markers for predicting poor outcomes following CABG procedures. These parameters may aid in the development of early therapeutic interventions to improve patient outcomes.

A prospective study for an alternative probe site for pulse oximetry measurement in male patients with severe burn trauma: penile shaf.

BACKGROUND: Authors widely use pulse oximetry in clinical monitoring of heart rate (HR) and peripheral oxygen saturation (SpO2) by attachment to the fingers; however, there can be a need for an alternative attachment site, especially for burned patients. We investigate the availability of a pulse oximeter probe attached to the penile shaft as an alternative site in pediatric male patients if all extremities became unavailable for pulse oximetry measurement due to severe burn and/or trauma. METHODS: We designed a prospective comparative study in a training and research hospital. After local ethical committee approval, pediatric male cases eligible for penile and extremity pulse measurements were evaluated during general anesthesia for medical dressing and/or grafting due to severe burns. One probe was attached to the fingers of the unburned extremity, and the other was to the penile shaft. Furthermore, we recorded SpO2and HR values at 5-min intervals; 0th (baseline), 5th, 10th and 15th minutes. We compared HR and SpO2values measured by the finger probe with those measured by the penile probe. RESULTS: Data of 51 patients (median age, 2.9 years (interquartile range, 2.0-5.0 years)) in whom the duration of dressing was at least 15min were analyzed. There was no significant difference either in comparisons of hemodynamic measurements (HR and SpO2 ) obtainedby finger probe and by a penile probe for each measurement time. The Bland-Altman plot analysis reveals agreement for penile and finger probes with a mean bias value between 0.20 and 0.37 on HR and between 0.43 and -0.20 on SpO2. DISCUSSION: This clinical trial demonstrated that pulse oximetry measurement under nonhypoxic conditions we could perform confidently using penile probes in pediatric male patients whose extremities are unavailable for measurement.

Effects of 5 µg/kg intrathecal morphine for postoperative analgesia in pediatric patients undergoing major surgery.

BACKGROUND: The effects and analgesic adequacy of intrathecal morphine (ITM) administration have been studied less frequently than other regional analgesia techniques in pediatric surgical procedures. OBJECTIVE: To evaluate the efficacy and adverse event rate of 5 µg/kg ITM administration for postoperative analgesia according to age group. METHODS: We retrospectively evaluated the medical records of patients who underwent major pediatric surgery and were administered ITM for postoperative analgesia. Patients were divided into three age groups: ≤ 5 years (group I), 5.1-13 years (group II) and > 13 years (group III). All patients received ITM 5 µg/kg (max 300 µg) through the L4-5 or L5-S1 interspace. Postoperative pain (modified pediatric objective pain score > 4), need for rescue analgesics, sleep interruption due to pain, sedation (Ramsay sedation scale score > 3), opioid-related postoperative adverse events (at 0, 4, 8, 12, and 24 h after intervention), hemodynamic data and nurse satisfaction with the analgesic method were compared between groups. RESULTS: The analysis included 100 children (47 girls, 9 ± 5.4 years). Groups were similar regarding postoperative rescue analgesia consumption and sleep interruption (p = 0.238, p = 0.958), 96% of the children did not require rescue analgesia, and sleep interruption was not observed in 97%. Postoperative adverse events were pruritus in 14 and nausea/vomiting in 9 patients (p = 0.052). Overall, nurses were satisfied or very satisfied in 99% of the cases. CONCLUSION: Administration of 5 µg/kg ITM can be used for postoperative analgesia in pediatric surgery in all age groups, with no severe adverse events and high nurse satisfaction with analgesic management.

Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient?

BACKGROUND: The primary objective of the present study was to determine the rate and the independent predictors of the difficult peripheral intravascular access (PIVA) in the operating room (OR). The secondary objective was to validate the ability of the difficult intravenous access (DIVA) scoring system in the detection of difficult PIVA in the operating room. METHODS: In this prospective observational study, patients between 0 and 18 years old who were operated in the pediatric hospital were evaluated. Peripheral intravenous cannulation performed during inhalation induction in 1008 patients were recorded. The following data were collected: demographic characteristics, the presence of a chronic disease, the DIVA score, operating room temperature, the area of PIVA application, the duration of PIVA and the number of PIVA attempts. The independent determinants of the difficult PIVA were determined with multivariate logistic regression. RESULTS: A total of 1008 patients (82% boys) with a median age of 4 (range 0.04-17 years) were included in the study. The median number of PIVA attempts was 1 whereas the median duration for successful PIVA was 15 s (range 4-2100). PIVA was successful at the first attempt in 75.3% of patients. Among patients who required more than two PIVA attempts, the most common adjunctive method was to seek help from another operator (80.8%). In the multivariable logistic regression model, only the presence of chronic disease, being underweight, and DIVA score ⩾4 (OR 6.355, CI 4.57-9.486) remained to be the significant determinants of difficult PIVA. CONCLUSION: The success rate of anesthesiologist-performed PIVA at the first attempt in the OR was 75.3%. Having a chronic disease, a DIVA score ⩾4 and being underweight appeared as the independent predictors for difficult PIVA.

Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome - an observational multicentre study.

BACKGROUND: Patients' demographic and epidemiological characteristics, local variations in clinicians' knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients' care and implementation of Patient Blood Management (PBM). MATERIALS AND METHODS: This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients' outcomes were analysed. RESULTS: Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC), fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Specific procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications. CONCLUSIONS: These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey.

Assessment of Some Public Hospitals in Turkey Regarding Anaesthetist, Anaesthesia and Intensive Care Equipment.

OBJECTIVE: Every year, 230 million patients undergo major general surgery with anaesthesia worldwide, and 7 million resulted with major complications. Monitorisation and equipment has a great role in increasing patient safety and safe surgery during anaesthesia. METHODS: Turkey is divided into 12 Eurostut-NUTS regions and 26 subregions statistically. Totally, 303 hospitals that are included in these regions were enrolled in this descriptive trial. The hospitals were contacted by telephone between October 2012 and August 2013. Data collecting forms were e-mailed to any of the anaesthetists or anaesthesia technicians of the hospital and they were requested to fill the forms and forward them to one of the investigators. RESULTS: Data were obtained from 221 of 303 hospitals (73%). Twenty-three hospitals were tertiary (university and education and research), 21 were city and 177 were county hospitals. No anaesthetist, operating rooms or intensive care units were available in 114 of the county hospitals. Anaesthetists were responsible for 61% of these active working theatres. Electrocardiogram, heart rate, non-invasive blood pressure and saturation could be monitored in 97% of them. End-tidal carbon dioxide could be monitored in 91% of at least one operating room in these hospitals. However, if the subject became to end-tidal carbon dioxide monitoring in every room, this ratio decreased to 63%. Defibrillators were absent in 6% of these rooms. Adult intensive care units were available in 33% of the hospitals and paediatric intensive care units were available in 32.4%; the responsibility of these intensive care units were carried out by anaesthetists at a 91.4% ratio. End-tidal carbon dioxide could be monitored in 54% of these units; invasive monitorisation could be applied in 68.4% if needed. CONCLUSION: It was observed that hospitals have different standards according to their infrastructures of anaesthesia and intensive care unit equipment. We think that the elimination of these differences is an important step with respect to increasing patient safety and enhancement of the service quality in hospitals.

Antioxidant effects of propofol on tourniquet-induced ischemia-reperfusion injury: an experimental study.

PURPOSE: This experimental study aimed to investigate the antioxidant effects of propofol anesthesia at induction doses in a rat skeletal muscle ischemia/reperfusion injury model. METHODS: Twenty-six rats were randomly divided into three groups to receive one of the following interventions: sham operation (n = 6), ischemia/reperfusion (I/R) injury (n = 10), or propofol administration in addition to I/R injury (n = 10). I/R injury was attained by 2-h clamping of femoral artery followed by 3-h perfusion. Then blood and tissue samples were collected for biochemical analysis and histopathologic examination. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activities and nitric oxide (NO) and malondialdehyde (MDA) levels were measured in both plasma and muscle tissue. In addition, catalase (CAT) activity and protein carbonyl (PC) content were measured in muscle tissue. RESULTS: I/R group had significantly higher SOD activity (9.05 versus 5.63 and 6.18 U/mL, P < 0.05) and NO level (46.77 versus 30.62 and 33.90 µmol/L, P < 0.05) compared with sham-operated group and I/R plus propofol group. In addition, GSH-Px activity of the I/R group was significantly higher than sham-operated group (1.26 versus 1.05 U/mL, P < 0.05). I/R group had significantly higher tissue activities of CAT (0.11 versus 0.06 and 0.04 k/g protein, P < 0.05) and SOD (0.12 versus 0.08 and 0.07 U/mg protein, P < 0.05) compared with the sham and I/R plus propofol group. Histopathologic examination showed that I/R plus propofol group had significantly lower degeneration (P = 0.021) and inflammation (P = 0.028) scores compared with I/R group. CONCLUSION: Propofol anesthesia seems to enhance the antioxidant capacity against tourniquet induced ischemia-reperfusion injury.

Comparison of three different analgesic protocols during shockwave lithotripsy.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is one of the most important treatment modalities for urinary stone disease. The procedure may cause pain, and patient relaxation and cooperation are crucial in maintaining stone localization for optimal fragmentation and patient comfort during the procedure. As yet, there is not a standard analgesic protocol for patients undergoing SWL. We aimed to use three different analgesic agents and compare their efficacy during SWL in this study. PATIENTS AND METHODS: Written informed consents were obtained from 95 patients with kidney stones, and they were randomized to receive lornoxicam (group L, n=32 patients), paracetamol (group P, n=31 patients), and tramadol with a patient-controlled analgesia device (group T, n=32 patients). All groups received patient-controlled analgesia with tramadol during the SWL procedure. The intensity of pain was evaluated with a visual analog scale (VAS). RESULTS: The mean age of the patients was 41.87 ± 16.53 years, 44.07 ± 11.48 years, and 41.24 ± 14.82 years in group L, group P, and group T, respectively. No significant differences were found between the three groups concerning patient age, stone location, or session duration (P>0.05). The mean VAS scores and analgesic consumption were lower in group L compared with other groups (P<0.05). CONCLUSION: The results of this study showed that additional administration of analgesics was decreased with intravenous lornoxicam in comparison with paracetamol and only tramadol.

A novel operative technique for concealed penis secondary to penoscrotal web: a case report.

Contemporary surgical techniques for concealed penis defined in the literature are sophisticated and, because of this, we decided to perform a simple technique. A child with penoscrotal web was admitted to our Pediatric Surgery Clinic. The patient had recurrent urinary tract infections without urinary tract disease and, therefore, web reconstruction was thought to be useful. A modified unfurling technique and penoscrotal angle reconstruction was used. The main characteristic of our procedure can basically be described as an oblique incision of the outer foreskin leaf which guides the next steps. We report the operative and clinical course of the patient. We demonstrated that the penoscrotal web was treated simply and effectively as an outpatient procedure. In addition, in the follow-up period, we found that the patient had acceptable and cosmetic penile skin.

Torsion of an encysted fluid collection.

Torsion of a cyst within the tunica vaginalis is a rare entity and clinical course can easily be confused with other diseases that cause acute scrotum. We report a 6-year-old child with 3 days of acute scrotum findings. Patient had surgery with the suspicion of testis torsion. Torsion of a cyst within the tunica vaginalis was found intraoperatively. In pathologic evaluation, a necrotic funicular cyst was diagnosed. Two different mechanisms were reported for the reason of this disease: hernia sac protrusion in the hydrocele sac and bell-clapper deformity. Our observations were on the side of bell-clapper deformity. We aimed to share our findings with this report.

A case of bladder exstrophy and thoracal intramedullary teratoma.

Exstrophic bladder and intramedullary teratomas are rare congenital anomalies. To the authors' knowledge, the coexistence of these 2 anomalies has not been reported previously. The authors report on a newborn with thoracal intramedullary teratoma and exstrophic bladder. The possible embryogenetic background also is discussed.