Determination of the embryotoxic effects of propofol injected into eggs on the cerebellum and spinal cord using histologic methods: an animal study.

Background/aim: This study aims to determine the possible embryotoxic effects of propofol on the cerebellum and spinal cord using fertile chicken eggs. Materials and methods: A total of 430 fertile eggs were divided into 5 groups: control, saline, 2.5 mg.kg-1, 12.5 mg.kg-1, and 37.5 mg.kg-1 propofol. Injections were made immediately before incubation via the air chamber. On the 15th, 18th, and 21st day of incubation, 6 embryos from each group were evaluated. Serial paraffin sections taken from the cerebellum and spinal cord were stained with hematoxylin-eosin, Kluver-Barrera, toluidine blue, and periodic acid-Schiff's reaction. The outer granular layer and total cortex thickness were measured, and the linear density of the Purkinje cells was determined. The ratios of the substantia grisea surface area to the total surface area of the spinal cord were calculated. The transverse and longitudinal diameters of the canalis centralis were also assessed. Results: No structural malformation was observed in any embryos examined macroscopically. No significant difference was observed between the groups in terms of development and histologic organization of the cerebellum and spinal cord. However, on the 15th, 18th, and 21st day, the outer granular layer (p < 0.001 for all days) and the total cortex thickness (p < 0.01, p < 0.001, and p < 0.001, respectively) decreased significantly in different propofol dose groups in varying degrees in the cerebellum. Similarly, in the spinal cord, there were significant changes in the ratios of the substantia grisea surface area to the total surface area (p < 0.01 and p < 0.001, respectively). Conclusion: It was concluded that the in-ovo-administered propofol given immediately before incubation has adverse effects on the developing cerebellum and spinal cord. Therefore, it is important for anesthesiologists always to remain vigilant when treating female patients of childbearing age.

Duties of Anaesthetists and Assessment of Awareness, Concerns, and Expectations on Anaesthesia Practices.

Objective: Numerous studies performed worldwide indicate that the public has limited knowledge of anaesthesia practices and anaesthetists' duties and responsibilities. This study aimed to identify the level of knowledge about anaesthetists and anaesthesia practices, and to assess the reasons for anxiety about anaesthesia of the population admitted to our hospital, which is tertiary in Turkey. The secondary aim was to analyze their differences according to sex, education level, and acquired anaesthesia experience. Methods: A survey comprising 23 questions was administered to 400 patients and/or their relatives, aged 18-85 years, who presented to our clinic for preoperative anaesthesia evaluation and for whom elective surgery was planned from March through October 2017. Results: Of the 400 participants, 213 were women and 187 were men. Of all participants in the survey, 51.2% were patients and 48.8% were patient relatives; 64.2% had anaesthesia experience and 35.8% had never had anaesthesia before. The survey group's level of knowledge about anaesthesia was generally low. According to education level, there was a statistically significant difference in the anaesthesia recognition level. However, the acquired anaesthesia experience did not affect the anaesthesia recognition level. Conclusion: To raise the level of knowledge about this topic, anaesthetists must provide patients with more detailed information during preoperative and postoperative visits, which would significantly reduce their anxiety levels. Further, we determined that increasing the use of methods such as media-based brochures, booklets, and videos to inform patients may increase knowledge levels and reduce anxiety levels.

Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures.

Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA). Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared. Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group. Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.

Determination of Embryotoxic Effects of In Ovo Administered Propofol on Peripheral Blood Alpha Naphthyl Acetate Esterase and Acid Phosphatase-Positive Lymphocytes.

OBJECTIVE: The aim of this study is to determine the possible embryotoxic effects of propofol, a general anaesthetic agent that is commonly used in clinical practice, on peripheral blood lymphocytes using enzyme histochemical techniques. METHODS: For this purpose, 430 laying hen fertile eggs were used for this study. The eggs were divided into 5 groups as control, solvent-control (saline), 2.5 mg kg-1 propofol, 12.5 mg kg-1 propofol, and 37.5 mg kg-1 propofol, and injections were performed via the air sac just before the incubation. The peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios were determined on the hatching day. RESULTS: No statistically significant difference was found between both alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the control and solvent-control groups. However, when compared with the control and solvent-control groups, statistically significant decreases were observed in the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the chicks from the propofol-injected groups. Besides, the difference between 2.5 mg kg-1 and 12.5 mg kg-1 propofol groups is not significant, whereas the difference between these 2 groups and the 37.5 mg kg-1 propofol group was statistically significant (P < .05). CONCLUSIONS: It was concluded that propofol given to fertilised chicken eggs just before incubation caused significant decreases in both the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios.

Factors affecting the preference of anesthesia residents regarding subspecialty training.

BACKGROUND: There is scant information about the factors that influence the career decisions of anesthesia residents in Turkey. The aim of this study was to determine the preferences of anesthesia residents in Turkey regarding future career and subspecialty training plans and practice location, and to determine the factors that influence those preferences. METHODS: A 21-item e-questionnaire was administered to anesthesia residents who were registered with at least one of the two societies of anesthesiologists in Turkey. Data were collected on demographics and preferences regarding subspecialty training and future practice location. RESULTS: The response rate of the survey was 41.04%. The percentages of participants who intended to pursue a fellowship in intensive care and algology were 12.1 and 23.1%, respectively; 21.7% of participants did not intend to pursue any fellowship training and the decision of 43.1% of the participants was uncertain. The most popular reasons for pursuing a fellowship were to perform compulsory service in a better place (47.2%) and improve earning potential (43.1%). Forty-two percent of participants did not intend to pursue any fellowship training because of their attention to general anesthesiology practice and 15.2% because of the additional compulsory service obligation following the training. CONCLUSIONS: This study showed that the desirability of sub-specialization among anesthesia residents in Turkey could be accepted as low. This result seems to be associated with the additional compulsory service obligation.

Comparison of i-gel, LMA-supreme, LMA-classic and LMAproseal as conduits of endotracheal intubation in newborns and infants: A manikin study.

Ankay-Yilbas A, Basaran B, Üzümcügil F, Akça B, Izgi M, Canbay Ö. Comparison of i-gel, LMA-supreme, LMA-classic and LMA-proseal as conduits of endotracheal intubation in newborns and infants: A manikin study. Turk J Pediatr 2019; 61: 166-173. Many types of supraglottic airway devices (SAD) including the traditional LMA (Laryngeal Mask Airway) are commonly used as conduits for intubation in pediatric patients with difficult airway. The aim of this study was to evaluate the feasibility of four types of commonly used neonatal and infant sized SADs as conduits of intubation. Fiberoptic-guided tracheal intubation with uncuffed, cuffed and armored uncuffed endotracheal tubes (ETT) sized between 2.5 and 4.5 through four commonly used types of size 1 and 1.5 SADs (i-gel, LMA-classic, LMA-supreme, LMA-proseal) were performed by two investigators on an infant manikin. The investigators scored two main outcomes with a 5-point scale: 1) passage of ETT during intubation through the SAD, and 2) passage of SAD over the ETT during SAD removal. The differences between the study groups were evaluated using the Bonferroniadjusted Mann-Whitney U test and p < 0.0083 was considered as statistically significant according to Bonferroni correction. i-gel sizes 1 and 1.5 both performed better as conduits for fiberoptic-guided intubation compared with LMA-proseal, LMA-classic and LMA-supreme with most of the uncuffed ETTs investigated (p < 0.0083). We found i-gel sizes 1 and 1.5 easily feasible to use even with uncuffed ETTs with an inner diameter of 3.5 mm and 4.5 mm, respectively. i-gel was the only SAD that was feasible for use as a conduit for armored ETTs. The passage of cuffed ETTs was problematic with all types of studied SADs. In conclusion; the choice of i-gel as a conduit for intubation could be safer than LMA-classic, LMA-supreme and LMA-proseal.

Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia.

BACKGROUND: The combination of propofol and ketamine is commonly used for total intravenous anesthesia. These drugs can be delivered in different syringes or in the same syringe. We hypothesized that the drugs might separate and different concentrations of each drug could be found in different parts of the syringe during the procedure period when they were mixed in 1 syringe. METHODS: Twelve 60-mL polypropylene syringes were prepared by mixing propofol and ketamine as 4 groups on the basis of propofol/ketamine mixture ratios (5:1 and 6.7:1) and propofol solution concentrations. Syringes were placed upright in the vertical position into a rack and kept at room temperature (21.5-22.5°C), in daylight conditions and were not moved for 360 minutes. Samples of the mixture were taken from both the top and the bottom of the syringe. The first 1 mL of the samples was discarded, the following second 1 mL of the samples was filtered using 0.2-µm polytetrafluoroethylene filters and measured twice (n = 6). Samples were taken at the following time intervals: T0, T10, T30, T60, T90, T120, T180, T240, T300, and T360 min. Syringes were checked visually for any color change and separation lines between the drugs. RESULTS: There were no significant differences between the propofol and ketamine concentrations of the top and bottom samples in all 4 groups. In addition, there were no statistically significant changes of propofol and ketamine concentrations of samples over 360 minutes in any of the 4 groups. No visual changes were observed during 6 hours' observation. CONCLUSION: The results of our measurements demonstrated that mixtures of propofol (1% and 2%) and ketamine at 5:1 and 6.7:1 ratios could be used in terms of mixture homogeneity and stability in a polypropylene syringe during a 6-hour period at room temperature.