PECS II block for cardiac implantable electronic device insertion: A pilot study.

AIM: Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion. METHODS: PECS II blocks were performed on the left side using the ultrasound-guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block-related complications. RESULTS: Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4-10 [2.5-12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure. CONCLUSIONS: PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.

Unexpected Bradycardia Related to Surgical Manipulation During Thoracolumbar Spinal Surgery.

BACKGROUND: Although spinal surgery can offer pain relief and functional improvements in daily life, it is often associated with various perioperative complications. The incidence of cardiac complications associated with spinal surgery is relatively low. We evaluated frequency and causes for bradycardia incidents in posterior thorocolumbar spinal surgeries. METHODS: We retrospectively evaluated posterior thoracolumbar spinal surgeries between 2018-2022 for bradycardic events in our tertiary general hospital. Patients operated for degenerative changes or disk herniations are included, other cases for tumors, trauma, arteriovenous (AV) fistulae or previously operated are excluded. RESULTS: The study reached 6 eligible patients (4 female and 2 male) aged between 45-75 years (mean: 63.3) among 550 patients operated between 2018-2022. The rate of bradycardia was 1.09%. Of these, 5 patients (lumbar discectomy: one; posterior stabilization:4) exhibited it following L2 and L3 root manipulation and one presented it following L4-5 discectomy. In each of these cases, bradycardia occurred during surgical manipulation and ceased upon removal of the insult. None of the cases exhibited accompanying hypotension. The patient's heart rates were seen to drop to lowest the of 30 beats/min, and all patients exhibited favorable outcomes and no postoperative cardiac complications over a mean follow-up period of 20 months (range: 10-40 months). CONCLUSIONS: The current study examines the occurrence of unexpected bradycardia events associated with thoracolumbar spinal surgery during surgical handling of the dura mater. Awareness of such incidents among surgeons and anesthesiologists can help prevent catastrophic outcomes caused by adverse cardiac events.

A cross-sectional study analyzing the quality of YouTube videos as a source of information for COVID-19 intubation.

INTRODUCTION: There are many possible sources of medical information; however, the quality of the information varies. Poor quality or inaccurate resources may be harmful if they are trusted by providers. This study aimed to analyze the quality of coronavirus disease 2019 (COVID-19)-related intubation videos on YouTube. METHODS: The term "COVID-19 intubation" was searched on YouTube. The top 100 videos retrieved were sorted by relevance and 37 videos were included. The video demographics were recorded. The quality of the videos was analyzed using an 18-point checklist, which was designed for evaluating COVID-19 intubation. Videos were also evaluated using general video quality scores and the modified Journal of the American Medical Association score. RESULTS: The educational quality was graded as good for eight (21.6%) videos, moderate for 13 (35.1%) videos, and poor for 16 (43.2%) videos. The median safe COVID-19 intubation score (SCIS) was 11 (IQR = 5-13). The SCISs indicated that videos prepared in an intensive care unit were higher in quality than videos from other sources (p < 0.05). The length of the video was predictive of quality (area under the curve = 0.802, 95% CI = 0.658-0.945, p = 0.10). CONCLUSIONS: The quality of YouTube videos for COVID-19 intubation is substandard. Poor quality videos may provide inaccurate knowledge to viewers and potentially cause harm.

Regional anesthesia in two consecutive surgeries in a patient with mitochondrial neurogastrointestinal encephalomyopathy: a case report.

Mitochondrial Neurogastrointestinal Encephalomyopathy (MNGIE) is a rare autosomal-recessive disorder which is due to mutations in TYMP. The case reported here is of an 18-year-old male with MNGIE syndrome who presented for two different operations on two different occasions under regional anesthesia. The patient presented with urinary incontinence and abdominal pain. A cystoscopy under spinal anesthesia was scheduled. At 3 months after discharge, gastric perforation was diagnosed and combined spinal-epidural anesthesia, surgical repair was planned. Surgical and perioperative periods were uneventful. Based on this experience, we believe that regional anesthesia can be considered safe for use in patients with MNGIE disease.

[Labor analgesia: Comparison of epidural patient-controlled analgesia and intravenous patient-controlled analgesia]. / Dogum analjezisi: Epidural hasta kontrollü analjezi ile intravenöz hasta kontrollü analjezinin karsilastirilmasi.

OBJECTIVES: In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) were compared for VAS, and also their side effects on mother and newborn. METHODS: In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and PCEA (Group 1). Bupivacaine 1.25 mg/ml and fentanyl 2 mcg/ml in 100 ml epidural solution were prepared for Group 1. The infusion dose was 15 ml, 5 ml divided doses. We set 5 ml/h basal infusion, 5 ml patient-controlled bolus and 20 min lock time. We prepared 2 mg remifentanil in 100 ml intravenous solution for Group 2. We set 20 mcg/h infusion, 0.05mcg/kg patient-controlled bolus and five min lock time. VAS, maternal-fetal heart rate, blood pressure, oxygen saturation, nausea-vomiting and sedation were recorded during labor. We recorded Apgar scores and maternal satisfaction at the end of labor. RESULTS: The findings showed that both groups could provide adequate analgesia. However, VAS scores were higher in Group PCIVA. The mother satisfaction and newborn's Apgar scores were similar. In both groups, desaturation, which is requiring oxygen support, was not determined. The oxygen saturations were lower in Group 2. The side effects and patient satisfaction were similar in both groups. CONCLUSION: Although PCIVA was found to be satisfactory concerning maternal satisfaction, VAS after 2nd hour were higher compared to PCEA. PCEA is the gold standard in labor analgesia. However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated or where the patient does not want an epidural.

[The use of neurostimulation with ultrasound-guided brachial plexus block: Does it increase success?] / Ultrasonografi esliginde brakial pleksus blogunda nörostimülasyonun kullanilmasi: Basariyi arttiriyor mu?

OBJECTIVES: Infraclavicular brachial plexus blockade is an anesthetic technique used for operations of the hand, wrist, and elbow. Ultrasound (US)-guidance is a recent addition to the surgical technique. The aim of this study was to compare the use of US alone and US with a nerve stimulator in an infraclavicular brachial plexus blockade in terms of the performance time, successful blockade rate, and the quality of sensory block. METHODS: A total of 40 patients who were scheduled for hand, wrist, or elbow surgery were included in the study. The patients were divided into 2 groups: US and USSS (ultrasonography + neurostimulation). A dose of 40 mL, containing 100 mg bupivacaine and 200 mg prilocaine was administered with the guidance of US or USSS in the infraclavicular regions. Performance time was measured and recorded. Motor and sensory blockade was assessed within 30 minutes after the block. RESULTS: The mean performance time for Group US and Group USSS was 6.68+-0.75 and 6.9+-1.02 minutes, respectively, without significant difference between groups (p>0.05, p=0.62, respectively). A complete blockade was seen in 16/20 patients in Group US and in 14/20 patients in Group USSS in 20 minutes, which did not yield a significant difference. During the surgery, local anesthetic infiltration was required in 2/20 patients in Group US and in 1/20 patients in Group USSS. CONCLUSION: The results of this study revealed no additional benefit to USSS in block success in comparison with US alone. Considering the feeling of discomfort and pain due to nerve stimulation, it was concluded that use of US alone may be preferred to combination use.