Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.

Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study.

PURPOSE: The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy. MATERIALS AND METHODS: Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h. RESULTS: The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients. CONCLUSION: The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05663658.

Comparison of the Effects of Anaesthesia Methods Used in Caesarean Delivery on Neonatal Cerebral and Renal Oxygenation: A Randomised Controlled Trial.

Background: During a newborn's adaptation to extrauterine life, many changes take place that are influenced by various factors. The type of delivery and anaesthesia strategy utilised during labour can modify these adaptive modifications. In this regard, this study was designed to compare the effects of general and spinal anaesthesia on cerebral and renal oxygenation after elective caesarean deliveries. Methods: This randomised controlled study comprised sixty parturient women who were over 18 years old and had a gestational age between 37 and 41 weeks. All participants had an ASA (American Society of Anesthesiologists) classification of II. Neonatal cerebral (CrSO2) and renal (RrSO2) regional oxygen saturations were assessed using near-infrared spectroscopy. Additionally, the 1st-5th min Apgar scores, preductal and postductal peripheral oxygen saturation (SpO2), and perfusion index were recorded in both the general anaesthesia and spinal anaesthesia groups. Results: There was no statistically significant difference between the two groups in terms of CrSO2 or RrSO2 values. The values of CrSO2 and RrSO2 in both groups showed a significant rise from the 10th to the 15th min, respectively. Conclusions: General and spinal anaesthesia techniques used for cesarean delivery have similar effects on neonatal cerebral and renal oxygenation.

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.

Immediate Extubation in the Operating Room Following Pediatric Liver Transplantation: A Retrospective Cohort Study.

BACKGROUND: Although immediate extubation in the operating room following pediatric liver transplantation can be safe and beneficial for select patients, many surgeons and anesthesiologists are still cautious. The study aimed to evaluate the safety and efficiency of immediate extubation in the operating room following pediatric liver transplantation. METHODS: Sixty-four pediatric liver transplant recipients were included in this retrospective study. Patients were divided into 2 groups: immediate extubation (IE) (those who were extubated in the operating room) and delayed extubation (DE) (those who were extubated in the intensive care unit). Preoperative, intraoperative, and postoperative variables were recorded. RESULTS: Although a total of 19 (29.7%) patients were extubated in the pediatric intensive care unit (group DE), 45 (70.3%) were extubated in the operating room at the end of surgery (group IE). The use of fresh frozen plasma and platelets was statistically higher in group DE (P = .017 and P = .002, respectively). Duration of anesthesia and length of stay in the pediatric intensive care unit was statistically longer in group DE (P = .020 and P = .0001, respectively). Three (15.8%) patients required reintubation in group DE and 2 (4.4%) in group IE. Hospital stay was statistically longer in group DE (P = .012). CONCLUSIONS: The current study demonstrated that immediate extubation in the operating room after surgery for pediatric patients who have undergone liver transplantation was safe. The duration of anesthesia and the intraoperative use of blood products such as platelet and fresh frozen plasma can effectively decide immediate extubation.

Comparison of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels after robot-assisted laparoscopic and retropubic radical prostatectomy: an observational study.

BACKGROUND AND OBJECTIVES: Patients undergoing radical prostatectomy are at increased risk of Acute Kidney Injury (AKI) because of intraoperative bleeding, obstructive uropathy, and older age. Neutrophil Gelatinase-Associated Lipocalin (NGAL) may become important for diagnosis of postoperative AKI after urogenital oncosurgery. The objective of this study was to evaluate and compare the efficacy of NGAL as a predictor of AKI diagnosis in patients who underwent Retropubic Radical Prostatectomy (RRP) and Robot-Assisted Laparoscopic Prostatectomy (RALP) for prostate cancer. METHODS: We included 66 patients who underwent RRP (n = 32) or RALP (n = 34) in this prospective, comparative, nonrandomized study. Patients' demographic data, duration of surgery and anesthesia, amount of blood products, vasopressor therapy, intraoperative blood loss, fluid administration, length of hospital stay, creatinine, and plasma NGAL levels were recorded. RESULTS: Intraoperative blood loss, crystalloid fluid administration, and length of hospital stay were significantly shorter in RALP. There was no statistically significant difference between the groups in terms of intraoperative blood transfusion. Postoperative creatinine and plasma NGAL levels were increased in both groups. The 6-h NGAL levels were higher in RRP (p = 0.026). The incidence of AKI was 28.12% in RRP and 26.05% in RALP, respectively. The NGAL level at 6 hours was more sensitive in the early diagnosis of AKI in RALP. CONCLUSION: Although postoperative serum NGAL levels were increased in both RRP and RALP, the 6-h NGAL levels were higher in RRP. RALP was associated with fewer intraoperative blood loss and fluid administration, and shorter length of hospital stay.

The use of ultrasound guided combined peripheral nerve blocks in a high-risk patient: A case report.

Combined peripheral nerve blocks can be used as an alternative anesthetic technique for lower limb amputations in high-risk patients. The approach may vary according to the clinical condition of the patient. Presently described is the use of a combination of peripheral nerve blocks used for above-the-knee amputation in a high-risk patient: a sciatic nerve block with an anterior approach, a femoral nerve block, and a lateral femoral cutaneous nerve block.

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.

The effect of different levels of pneumoperitoneum pressures on regional cerebral oxygenation during robotic assisted laparoscopic prostatectomy

Background/aim: This study aimed to evaluate the effect of low- and high-pressure pneumoperitoneum pressures applied during robotic-assisted laparoscopic prostatectomy (RALP) using near-infrared spectroscopy (NIRS) on regional cerebral oxygenation saturation (rSO2). Materials and methods: The prospective, comparative, and observational study included patients aged 18­80 years, with the American Society of Anesthesiologists (ASA) physical status I-II, who would undergo elective RALP. The patients were divided into two groups (12 mmHg of pneumoperitoneum pressure group, n=22 and 15 mmHg of pneumoperitoneum pressure group, n=23). Patients' demographic data, durations of anesthesia, surgery, pneumoperitoneum, and Trendelenburg position, intraoperative estimated blood loss, fluid therapy, urine output, hemodynamic and respiratory data, and rSO2 values were recorded at regular intervals. Results: The rSO2 values increased significantly during the pneumoperitoneum combined with steep Trendelenburg position (from t3 to t6) and at the end of the surgery (t7) in both groups, compared to the values 5 min after the onset of pneumoperitoneum in the supine position (t2) (P < 0.05), but no statistical significance was observed between the two groups. No cerebral desaturation was observed in any of our patients. Hemodynamic and respiratory parameters were preserved in both groups. The blood lactate levels were significantly higher in patients operated at high-pressure pneumoperitoneum, compared to those with low-pressure pneumoperitoneum (P < 0.05). Conclusion: We believe that low-pressure pneumoperitoneum, especially in robotic surgeries, such as robotic-assisted laparoscopic prostatectomy (RALP), can be applied safely.

S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study / Nível de S100B e disfunção cognitiva após prostatectomia radical laparoscópica assistida por robô: estudo observacional prospectivo

Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).

Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)

[S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study]. / Nível de S100B e disfunção cognitiva após prostatectomia radical laparoscópica assistida por robô: estudo observacional prospectivo.

BACKGROUND: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). METHODS: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively and at 7 days and 3 months postoperatively. RESULTS: Twenty-four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). CONCLUSIONS: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. TRIAL REGISTRY NUMBER: Clinicaltrials.gov (N° NCT03018522).

Factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery.

BACKGROUND: The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. METHODS: Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). RESULTS: In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. CONCLUSION: Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.

[Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial]. / Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico.

BACKGROUND: It is not clear which mechanical ventilation mode should be used in bariatric surgery, one of the treatment options for patients with obesity. OBJECTIVES: To compare volume-controlled ventilation and pressure-controlled ventilation in terms of respiratory mechanics and arterial blood gas values in patients undergoing laparoscopic bariatric surgery. METHODS: Sixty-two patients with morbid obesity scheduled for gastric bypass were included in this study. Their ideal body weights were calculated during preoperative visits, and patients were divided into two groups, volume-controlled ventilation and pressure-controlled ventilation. The patients were ventilated in accordance with a previously determined algorithm. Mechanical ventilation parameters and arterial blood gas analysis were recorded 5 minutes after induction, 30 minutes after pneumoperitoneum, and at the end of surgery. Also, the dynamic compliance, inspired O2 pressure/fractional O2 ratio, and alveolar-arterial oxygen gradient pressure were calculated. RESULTS: Peak airway pressures were lower in patients ventilated in pressure-controlled ventilation mode at the end of surgery (p = 0.011). Otherwise, there was no difference between groups in terms of intraoperative respiratory parameters and arterial blood gas analyses. CONCLUSIONS: Pressure-controlled ventilation mode is not superior to volume-controlled ventilation mode in patients with laparoscopic bariatric surgery.

Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial / Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico

Abstract Background: It is not clear which mechanical ventilation mode should be used in bariatric surgery, one of the treatment options for patients with obesity. Objectives: To compare volume-controlled ventilation and pressure-controlled ventilation in terms of respiratory mechanics and arterial blood gas values in patients undergoing laparoscopic bariatric surgery. Methods: Sixty-two patients with morbid obesity scheduled for gastric bypass were included in this study. Their ideal body weights were calculated during preoperative visits, and patients were divided into two groups, volume-controlled ventilation and pressure-controlled ventilation. The patients were ventilated in accordance with a previously determined algorithm. Mechanical ventilation parameters and arterial blood gas analysis were recorded 5minutes after induction, 30minutes after pneumoperitoneum, and at the end of surgery. Also, the dynamic compliance, inspired O2 pressure/fractional O2 ratio, and alveolar-arterial oxygen gradient pressure were calculated. Results: Peak airway pressures were lower in patients ventilated in pressure-controlled ventilation mode at the end of surgery (p = 0.011). Otherwise, there was no difference between groups in terms of intraoperative respiratory parameters and arterial blood gas analyses. Conclusions: Pressure-controlled ventilation mode is not superior to volume-controlled ventilation mode in patients with laparoscopic bariatric surgery.

Resumo Justificativa: O modo de ventilação mecânica que deve ser usado em cirurgia bariátrica, uma das opções de tratamento para pacientes com obesidade, ainda não foi definido. Objetivos: Comparar as ventilações controladas por volume e por pressão em termos de mecânica respiratória e dos valores da gasometria arterial em pacientes submetidos à cirurgia bariátrica laparoscópica. Métodos: Foram incluídos neste estudo 62 pacientes com obesidade mórbida programados para bypass gástrico. Seus pesos corporais ideais foram calculados durante as consultas pré-operatórias e os pacientes foram divididos em dois grupos: ventilação controlada por volume e ventilação controlada por pressão. Os pacientes foram ventilados de acordo com um algoritmo previamente determinado. Os parâmetros da ventilação mecânica e as análises da gasometria arterial foram registrados 5 minutos após a indução, 30 minutos após o pneumoperitônio e ao final da cirurgia. Além disso, a complacência dinâmica, a pressão e a fração de oxigênio inspirado e a pressão do gradiente alvéolo-arterial de oxigênio foram calculados. Resultados: As pressões de pico das vias aéreas foram menores nos pacientes ventilados no modo de ventilação controlada por pressão ao final da cirurgia (p = 0,011). Exceto por esse aspecto, não houve diferença entre os grupos quanto aos parâmetros respiratórios intraoperatórios e às gasometrias arteriais. Conclusões: O modo de ventilação controlada por pressão não é superior ao modo de ventilação controlada por volume em pacientes de cirurgia bariátrica laparoscópica.

Minimum effective volume of bupivacaine 0. 5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block / Volume mínimo efetivo de bupivacaína a 0, 5% para abordagem retroclavicular guiada por ultrassom no bloqueio do plexo braquial por via infraclavicular

Abstract Background and objectives: The current study aimed to determine the minimum effective volume (MEV) of bupivacaine 0.5% in 50% of patients for an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block. Methods: A total of 25 adult patients who were scheduled for upper limb surgery received an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block with bupivacaine 0.5%. The needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. Block success was defined as a composite score of 14 at 30 min after local anesthetic (LA) injection. The minimum effective volume in 50% of patients was determined using the Dixon-Massey up-and-down staircase method. Minimum effective volume for a successful block in 95% of the patients was also calculated using logistic regression and probit transformation. Results: The minimum effective volume of bupivacaine 0.5% resulting in successful block in 50% of patients (MEV50) according to the up-and-down staircase method was found to be 9.6 mL (95% confidence interval (CI), 5.7-13.4). The calculated minimum effective volume required for a successful block in 95% of patients (MEV95) using the probit transformation and logistic regression analysis was 23.2 mL (95% CI, 18.8-36.7). Conclusions: The MEV50 of bupivacaine 0.5% for US-guided retroclavicular approach to infraclavicular brachial plexus block was 9.6 mL and the calculated MEV95 was 23.2 mL. Future studies are required for infraclavicular brachial plexus block with different approaches, other LA agents and different concentrations of bupivacaine.

Resumo Justificativa e objetivos: Determinar o volume mínimo efetivo (VE) de bupivacaína a 0,5% em 50% dos pacientes para uma abordagem retroclavicular guiada por ultrassom no bloqueio do plexo braquial por via infraclavicular. Métodos: Um total de 25 pacientes adultos agendados para cirurgia do membro superior receberam abordagem retroclavicular guiada por ultrassom para o bloqueio do plexo braquial por via infraclavicular com bupivacaína a 0,5%. O ponto de inserção da agulha foi posterior à clavícula e a agulha foi avançada de cefálica para caudal. O sucesso do bloqueio foi definido como um escore composto de 14 aos 30 min após a injeção do anestésico local. O VE em 50% dos pacientes foi determinado com o método de escalonamento progressivo-regressivo de Dixon-Massey. O VE para um bloqueio bem-sucedido em 95% dos pacientes também foi calculado com regressão logística e transformação probit. Resultados: O volume mínimo efetivo (VE50) de bupivacaína a 0,5% que resultou em bloqueio bem-sucedido em 50% dos pacientes, de acordo com o método de escalonamento progressivo-regressivo, foi de 9,6 ml (intervalo de confiança de 95%, IC 5,7-13,4). O cálculo do volume mínimo efetivo necessário para um bloqueio bem-sucedido em 95% dos pacientes (VE95) com a análise de transformação probit e regressão logística foi de 23,2 ml (IC 95%, 18,8-36,7). Conclusões: O VE50 de bupivacaína a 0,5% para abordagem retroclavicular guiada por US para o bloqueio do plexo braquial por via infraclavicular foi de 9,6 ml e o VE95 calculado foi de 23,2 ml. Estudos futuros são necessários para o bloqueio do plexo braquial por via infraclavicular com diferentes abordagens, outros anestésicos locais e diferentes concentrações de bupivacaína.

The effects of music on anxiety and pain in patients during carotid endarterectomy under regional anesthesia: A randomized controlled trial.

OBJECTIVE: Music can be used as an alternative method to decrease anxiety in awake patients during surgical procedures. The aim of this study was to test the hypothesis that listening to music during carotid endarterectomy (CEA) under regional anesthesia decreases the patient's anxiety and pain. DESIGN: A multicenter, prospective, randomized controlled trial. SETTING: Patients undergoing carotid endarterectomy under cervical plexus block. INTERVENTIONS: Patients scheduled for carotid endarterectomy under cervical plexus block were randomized into two groups: Music Group and Control Group. MAIN OUTCOME MEASURES: The primary endpoint of this study was the difference in intraoperative anxiety in patients with or without music during CEA under regional anesthesia, and the secondary endpoints were intraoperative and postoperative pain, use of additional local anesthetics, use of intravenous analgesics, patient and surgeon satisfaction and complications. Anxiety was assessed using State Trait Anxiety Inventory (STAI) and numeric rating scale (NRS). Visual analog scale (VAS) was used for pain assessment. RESULTS: The postoperative STAI scores were similar in both groups (p = 0.839). The NRS scores measured immediately after the end of the surgery were statistically higher in Music Group (p = 0.001). The intraoperative anxiety statistically increased in Music Group, when the scores of the intraoperative responses to the questions of "are you relaxed?" and "are you calm?" were compared. (p = 0.0001 and p = 0.0001, respectively). There were no statistical differences in terms of the amount of intraoperative and postoperative analgesic used (p = 0.801, p = 0.773, respectively). The intraoperative VAS scores, postoperative VAS scores, patient and surgeon satisfaction scores were similar in both groups (p = 0.586, p = 0.185, p = 0.302 and p = 0.599, respectively). Systolic, diastolic and mean arterial blood pressure and heart rate were no different between Music Group and Control Group at any of all time points during the intraoperative period. Surgical side and contralateral side cerebral rSO2 values are similar in both groups (p = 0.438, p = 0.397, respectively). CONCLUSIONS: Music use in CEA under regional anesthesia increased intraoperative patient anxiety, and had no effect on intraoperative and postoperative pain or patient satisfaction.

[Minimum effective volume of bupivacaine 0.5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block]. / Volume mínimo efetivo de bupivacaína a 0,5% para abordagem retroclavicular guiada por ultrassom no bloqueio do plexo braquial por via infraclavicular.

BACKGROUND AND OBJECTIVES: The current study aimed to determine the minimum effective volume (MEV) of bupivacaine 0.5% in 50% of patients for an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block. METHODS: A total of 25 adult patients who were scheduled for upper limb surgery received an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block with bupivacaine 0.5%. The needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. Block success was defined as a composite score of 14 at 30min after local anesthetic (LA) injection. The minimum effective volume in 50% of patients was determined using the Dixon-Massey up-and-down staircase method. Minimum effective volume for a successful block in 95% of the patients was also calculated using logistic regression and probit transformation. RESULTS: The minimum effective volume of bupivacaine 0.5% resulting in successful block in 50% of patients (MEV50) according to the up-and-down staircase method was found to be 9.6mL (95% confidence interval (CI), 5.7-13.4). The calculated minimum effective volume required for a successful block in 95% of patients (MEV95) using the probit transformation and logistic regression analysis was 23.2mL (95% CI, 18.8-36.7). CONCLUSIONS: The MEV50 of bupivacaine 0.5% for US-guided retroclavicular approach to infraclavicular brachial plexus block was 9.6mL and the calculated MEV95 was 23.2mL. Future studies are required for infraclavicular brachial plexus block with different approaches, other LA agents and different concentrations of bupivacaine.