An innovative method to prevent infection when measuring the arterial blood gas SpO2 saturation.

Background: Patients are hospitalized for extended periods, particularly in intensive care units (ICUs). As a result, the saturation probe (pulse oximeter) remains attached for an extended period and microorganisms can grow in the wet environment. If the pulse oximeters are not reprocessed, cross-infection may occur. The literature contains several studies in which gloves were used for the measurement while various SpO2 (peripheral arterial oxygen saturation) measurements were compared with each other. However, such comparisons have yet to be made with the results of arterial blood gas SpO2 measurements by pulse oximeter, considered as the gold standard. The present study aimed to compare arterial blood gas values with the fingertip saturation measurement performed by having adult patients wear gloves of different colors, one after the other, on their fingers and determining the effect of the differently colored gloves (transparent, white, black, light blue) on saturation values. Methods: The study was conducted on 54 patients in an ICU. Intra-arterial blood gas SpO2 results were measured. Oxygen saturation was measured while the patient 1. did not wear gloves and 2. sequentially wore a series of gloves of different colors. Paired t-test, correlation analysis, and Bland Altman charts were used to evaluate the results. Results: The mean SpO2% value of the participants' intra-arterial blood gas measurements was 97.76±2.04. The mean SpO2% value obtained from the measurements of the fingers with a transparent glove was 0.43 points lower than the mean SpO2% value of the intra-arterial blood gas measurements (t=0.986, p=0.61). The mean SpO2% value obtained from the measurements of the fingers with a white glove was 0.93 points lower than the mean SpO2% value of the intra-arterial blood gas measurements (t=1.157, p=0.093). Conclusion: Of the measurements performed with a glove, the mean SpO2% value obtained from the measurements of the fingers with a transparent glove was more consistent with the mean SpO2% value of the intra-arterial blood gas measurements than measurement of the fingers without a glove.

Thermodynamics, Environmental and Sustainability Impacts of a Turbofan Engine Under Different Design Conditions Considering Variable Needs in the Aviation Industry.

In this study, thermodynamic analysis is implemented to the kerosene-fuelled high by-pass turbofan (HBP-TF) engine to assess entropy, exergy, environmental, and sustainability metrics for different design variables such as pressure ratio of high-pressure compressor (HPC-PR) ranging from 7.5 to 8.5 and turbine inlet temperature (TIT) varying from 1400 to 1525 K considering variable needs in the aviation industry. As a novelty, entropic improvement potential (EIP) index for turbomachinery components and specific irreversibility production for the whole engine are calculated. Sustainability-based parameters for different cases are compared with the baseline values of the HBP-TF engine. The combustor has the highest entropy production of 44.4425 kW K-1 at the baseline. The higher TIT increases the entropy production of the combustor by 16.56%, whereas the higher HPC-PR decreases it by 5.83%. The higher TIT and HPC-PR favorably affect the sustainable efficiency factor of the engine, which is observed as 1.5482 at baseline and increases by 4.5% and 0.058% with the increment of TIT and HPC-PR, respectively. The higher TIT and higher HPC-PR results in lowering sustainability of the engine. The specific irreversibility production of the engine decreases by 3.78% and 0.1171% respectively, as TIT and HPC-PR reach the highest point considered in the study.

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.

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study.

BACKGROUND: Cesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study. METHODS: We analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18-45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h. RESULTS: There was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2-3] vs. TFPB group, 2 [0-2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2-4] vs. TFPB group 2 [0-3], p = 0.001). CONCLUSIONS: In patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9-24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant.

Optimized modeling of energy and environmental metrics of mixed flow turbofan engine used regional aircraft.

As a kind of gas turbine engines, turbofan engines have powered a number of aero-vehicles in aviation sector. The necessity of turbofan with higher energy efficiency has been greatly drawn attention since these are operating dependent to fossil fuels. In this study, energy and emission metrics of fifty-one mixed flow turbofan engines (MFTE) with different bypass ratio, overall pressure ratio and fuel flow are modeled with multi-regression (MR) method. The obtained models are subjected to metaheuristic approaches involving genetic algorithm (GA) and simulated annealing (SA) so as to decrease error of the models. According to MR findings, rated thrust of MFTEs is estimated with 1.4877 of minimum square error (MSE) whereas GA and SA make it lower as 1.3404 and 1.2524, respectively. On the other hand, NOx emission index of MFTEs is predicted with relatively low coefficient of determination (R2) as 0.8620. However, its accuracy is enhanced to 0.8633 (with GA) and 0.8655 (with SA). Finally, exergy efficiency of MFTEs is estimated the highest model correctness with GA. Namely, R2 of the model is computed as 0.9280 with GA and 0.9277 with SA. Without applying these methods, its R2 is obtained as 0.9263 with MR. When considering these outcomes, thanks to modeling and optimization methods, prediction of performance and emission indexes of mixed flow turbofan engines could be performed with lower error values. It is thought that the study helps in prediction of environmental effect regarding turbofan engines that are utilized at busy airports.

Resistive Warming Mattress, Forced-Air Warming System, or a Combination of the Two in the Prevention of Intraoperative Inadvertent Hypothermia: A Randomized Trial.

PURPOSE: To prevent intraoperative inadvertent hypothermia (IIH), resistive products and forced-air warming systems are often used simultaneously. There is insufficient evidence to show whether this application is clinically more effective than a single active warming device. The aim of this study is to compare the efficacy a single intraoperative active warming method with combined methods in IIH prevention. DESIGN: A randomized, prospective, experimental study. METHODS: This study was conducted between June and October 2021 in the operating room of a training and research hospital. The study sample consisted of 123 patients who underwent scheduled orthopedic surgery under spinal anesthesia, were young (18-64), and had an ASA risk score of I to III. The patients were divided into three groups preoperatively according to the stratified randomization technique. To prevent IIH, a resistive warming mattress was used in group 1; a forced-air warming system was used in group 2; and a combination of the two methods were used in group 3. The body temperatures of the patients were measured and recorded every 15 minutes from admission to the operating room until the end of surgery. FINDINGS: The mean intraoperative body temperature of the patients was 36.6±0.15˚C for group 1; 36.6±0.1˚C for Group 2 and 36.6 ± 0.15˚C for Group 3. There was no difference between the groups in terms of body temperature. The overall incidence of IIH was 8.1%; 9.8% in group 1, 9.8% in group 2 and 4.9% in group 3. There was no statistically significant difference between the groups in terms of IIH (p < .05). CONCLUSIONS: This study supports the efficacy of using resistive warming mattress and forced-air warming systems in preventing IIH. The use of both methods together made no difference in terms of IIH development.

Deep learning approach for prediction of exergy and emission parameters of commercial high by-pass turbofan engines.

Aviation emissions originated from the fuel burn have been hot topics by engineers and policy-makers due to their harmful effects on the environment and thereby human health as well as sustainability. In this study, it is tried that several emission indexes (EIs) involving CO, HC and NOx as well as fuel flow of several commercial aircraft engines (CAEs) are predicted using support vector regression (SVR) and long short-term memory (LSTM) approaches for take-off phase. Moreover, exergo-environmental parameters involving exergy efficiency (ExEFF), wasted exergy ratio (WExR) and environmental effect factor (EEF) pertinent to CAEs are computed employing thermodynamics laws. While establishing the models, rated thrust, by-pass ratio, overall pressure ratio and combustion type of the CAEs are utilized as the model inputs. According to the findings of emission modelling, the coefficient of determination (R2) of EI NOx and EI CO of the CAEs is found as 0.929074 and 0.960277 with SVR, whereas their R2 values are elevated to 0.954878 and 0.989283 with LSTM approach, respectively. However, R2 of EI HC is determined lower with 0.632280 (by SVR) and 0.651749 (by LSTM). On the other hand, exergo-environmental parameters for the CAEs are estimated with high correctness at both models. Namely, R2 of ExEFF and EEF regarding the CAEs are computed as 0.991748 and 0.989067 by SVR; however, these are calculated as 0.994785 and 0.992797 by LSTM method. To model these parameters with low error by using significant design variables as model inputs could help in predicting emission and environmental metrics for new engine designs.

Non-heparin-induced thrombocytopenia in patients after open-heart surgery.

BACKGROUND: Thrombocytopenia (platelet count below 150 x 103/µL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non-heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. MATERIALS AND METHODS: In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 103/µL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. RESULTS: A total of 501 patients were diagnosed as having non-heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 103 vs.117 x 103/µL; p < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757-46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867-5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638-14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923-64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046-1.420]; p = 0.011). CONCLUSION: Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.

Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial.

BACKGROUND: Ultrasound guided costotransverse block (CTB) is a relatively new "peri-paravertebral" block that has been described recently. It has been previously reported that CTB, administered with a single high-volume injection, provides effective analgesia in breast conserving surgery. In this study we evaluated the effect of CTB when used in breast cancer surgery. METHODS: Seventy patients due to undergo breast cancer surgery were included in this blinded, prospective, randomized, efficiency study. Patients were randomized into two equal groups (CTB group and control group) using the closed envelope technique. All patients underwent general anesthesia. In addition to standard analgesia methods, patients in group CTB also received CTB block while the remaining (control group) did not. Numeric rating (pain) scores and opioid consumption was compared between the two groups. RESULTS: Opioid consumption in all time frames and pain scores at 1st and 3rd hours only were found to be significantly lower in Group CTB when compared to the control group. CONCLUSIONS: Ultrasound guided CTB improves analgesia quality in breast cancer surgery. TRIAL REGISTRATION: Clinicaltrials Registration ID: NCT04197206 , Registration Date: 13/12/2019.

The effect of post-reperfusion levosimendan in an experimental intestinal ischemia-reperfusion model.

BACKGROUND: Levosimendan has been reported to have a positive effect on ischemia-reperfusion injury. Herein, we aimed to evaluate the effects of levosimendan applied after reperfusion in an experimental intestinal injury-reperfusion (IR) model. METHODS: Twenty-one Wistar-albino male rats were separated into three groups: Sham group (n = 7): solely superior mesenteric artery (SMA) was dissected after laparotomy; intestinal ischemia-reperfusion group (IIR, n = 7): SMA was clamped for 60 min and unclamped for 120 min to cause ischemia-reperfusion; IIR + levosimendan group (IIR + L, n = 7): levosimendan was administered in ischemia-reperfusion model. The mean arterial pressures (MAP) were measured in all groups. MAP measurements were performed at the end of stabilization, at the 15th, 30th, and 60th minute of ischemia; at the 15th, 30th, 60th, and 120th minute of reperfusion; and at the end of levosimendan bolus application and when levosimendan infusion concluded. Reperfusion injury was evaluated with tissue malondialdehyde (MDA) and by Chiu score. RESULTS: MAP at 15 min, 30 min, and 60 min of reperfusion was lower in IIR and IIR + L groups compared with basal inter-group measurements. Decline in MAP at 30 min after reperfusion was statistically significant in IIR and IIR + L groups when compared with the sham group. There was no significant difference between MDA levels in the groups. Chiu score was significantly lower in the sham group when compared to IIR and IIR + L groups and higher in IIR when compared to the IIR + L group. CONCLUSION: Levosimendan leads to a decrease in intestinal damage although it did not affect lipid peroxidation and MAP when administered after reperfusion in an experimental intestinal IR model.

Innovation in measuring obese patients' blood pressure: measurement with conical wrapping technique.

INTRODUCTION: Accurate measurement of blood pressure (BP) is difficult in obese patients due to their upper arm shape and width. Errors made during BP measurement cause misdiagnosis or lead to wrong treatment. METHOD: The data of this methodological study were collected from 40 patients who were 18 years old or above, with a BMI above 25 kg/m2, and who were followed up with radial catheter arterial pressure in adult intensive care and postoperative care units between March and December 2020. RESULTS: In total 55% of the participants were male with a mean age of 63.9 years, mean height of 165.7 cm, mean weight of 85.2 kg and mean BMI of 31.0 ± 2.1 kg/m2. Intra-arterial BP (IABP) measurement values were found to be correlated with conical wrapping technique and cylindrical wrapping technique (P < 0.001). As a result, a statistically significance was found between conical SBP and intra-arterial SBP (r = 0.921; P < 0.05) and conical DBP and intra-arterial DBP (r = 0.902; P < 0.05). CONCLUSION: It was determined that the SBP and DBP results of the conical wrapping technique were closer to the results obtained by IABP measurements. For this reason, it is more appropriate to measure BP with conical wrapping technique in clinically obese patients.

Evaluation of ultrasound-guided bilateral low thoracic erector spinae plane block for postoperative analgesia in cesarean delivery patients: a prospective, randomized, controlled clinical trial.

BACKGROUND: Erector spinae plane block (ESPB) is a recently described block. In many reports, ESPB has been reported to provide effective postoperative analgesia in patients undergoing cesarean delivery (CD). Herein, we compared the effectiveness of ESPB and control group in postoperative analgesia in patients undergoing CD under spinal anesthesia. METHODS: This assessor-blinded, prospective, randomized, efficiency study was conducted in the postoperative recovery room and ward at a tertiary university hospital. Eighty-six patients ASA II-III were recruited. Following exclusion, 80 patients were randomized into two equal groups (block and control group). Standard multimodal analgesia was performed in the control group while ESPB block was performed in the intervention (ESPB) group. Opioid consumption was measured and pain intensity between groups was compared using Numeric Rating Scores (NRS). RESULTS: NRS was lower in Group ESPB at 3rd and 6th hours. There was no difference between NRS scores at other hours. Opioid consumption was lower in Group ESPB. CONCLUSION: When added to multimodal analgesia, bilateral ultrasound guided low thoracic ESPB leads to improve the quality of analgesia in the first 24 hours in patients undergoing CD.

Comparison of the analgesic effects of two quadratus lumborum blocks (QLBs), QLB type II vs QLB type III, in caesarean delivery: A randomised study.

BACKGROUND: Quadratus lumborum blocks (QLBs) are relatively novel regional anaesthesia techniques, and the efficacy of all three types of QLB for postoperative analgesia in caesarean delivery (CD) has been demonstrated in separate studies. The aim of the present study is to compare the analgesic efficacy of the QLB-II and QLB-III blocks performed at the end of surgery in patients undergoing spinal anaesthesia for CD. METHODS: We conducted a comparative, blinded, prospective, randomised and efficiency study. A total of 80 patients scheduled for elective CD under spinal anaesthesia were randomly allocated to receive either bilateral ultrasound-guided QLB-II or QLB-III block in a 1:1 ratio. The primary outcome was opioid consumption administered by a patient-controlled analgesia in the first 24 hours postoperatively. The secondary outcome of the study was pain intensity. Also, the time of first opioid requirement and the presence of nausea and vomiting were recorded. RESULTS: Morphine consumption was statistically significantly lower in the QLB-III group when compared with the QLB-II group at the 3rd, 6th, 12th and 24th hours (P < .001, P < .001, P = .004, and P = .015, respectively). The QLB-III group showed significantly lower pain scores at rest at the 1st, 3rd, 6th, 9th and 24th hours after surgery (P < .001, P < .001, P < .001, P = .007 and P < .001, respectively). The QLB-III group also showed significantly lower pain score on movement at all measurement times (P < .001). CONCLUSIONS: The analgesic efficacy of QLB-III was superior to QLB-II in patients who had undergone CD under spinal anaesthesia without use of intrathecal opioids and nonsteroidal anti-inflammatory drugs.

Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study.

STUDY OBJECTIVE: Erector Spinae Plane Block (ESPB) is a recently described block. Both ESPB and Quadratus Lumborum block type II (QLB-II) have been reported to provide effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this study, we compared the postoperative analgesic effects of ESPB and QLB-II in patients undergoing LC. DESIGN: Assessor Blinded, prospective, randomized, controlled study. SETTING: Tertiary hospital, postoperative recovery room & ward. PATIENTS: 80 patients (ASA I-II) were recruited. Patients were allocated in to two equal groups (ESB and QLB-II). All patients were included in analysis. INTERVENTIONS: Standard multimodal analgesia was performed in all groups. ESPB and QLB-II were performed under ultrasound guidance. MEASUREMENTS: Mean opioid consumptions and Numeric Rating Scores was measured during the first 24 postoperative hours. MAIN RESULTS: Demographic data was similar between groups. There was no difference between NRS scores and opioid consumption at any hour between the groups. CONCLUSION: While ESPB and QLB-II are not significantly different, they improve analgesia quality in patients undergoing LC.