The effect of upper transabdominal plane block on diaphragm thickness in adult patients after laparoscopic cholecystectomy operation.

INTRODUCTION: In this prospective and observational study, our objective was to examine the impact of subcostal transversus abdominis plane (SubTAP) block, along with intravenous analgesia techniques, on diaphragm thickness and post-operative pain following laparoscopic cholecystectomy. PATIENTS AND METHODS: This study examined laparoscopic cholecystectomy patients aged 18-60 years with an American Society of Anesthesiologist score of 1-2. This study divided patients into Group 1 for SubTAP block and Group 2 for intravenous analgesia. This study had 67 patients, at least 30 from each group. Thus, diaphragm thicknesses and Visual Analogue Scale (VAS) values were compared between regional anaesthesia and intravenous analgesia groups. RESULTS: Pre-operative data showed no statistically significant changes between the groups, although post-extubation inspiratory thickness was closer to baseline in Group 1 patients who received regional block. The groups had different outcomes after extubation and at the post-operative 30th min (P = 0.028 and P = 0.001, respectively). There was also a significant difference in post-operative oxygen saturation and VAS scores (P = 0.001). Our receiver operating characteristic analysis determined that the threshold values for VAS parameters of 2 or 3 were 0.28 cm in inspiration, 0.18 cm in expiration and 1.29 as i/e ratio. Significant discomfort was defined as diaphragm parameter values below these limits. CONCLUSIONS: We found that the earlier return of diaphragmatic functions to baseline was associated with diaphragm thickness. According to the measurements made in the post-operative care unit, the regional block group effectively prevented the loss of diaphragm function.

Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial.

BACKGROUND: Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. METHODS: Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. RESULTS: The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). CONCLUSION: The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.

Development and Validation of a Turkish Version of Obstetric Quality of Recovery-10.

OBJECTIVE: The 10-item Obstetric Quality-of-Recovery 10 scale is a validated patient-reported outcome questionnaire that measures the quality of recovery following delivery. This study aims to develop a Turkish version of the Obstetric Quality of Recovery 10 to evaluate its validity, reliability, and clinical feasibility. METHODS: Term parturients who underwent vaginal delivery or elective caesarean delivery were asked to complete a Turkish version of Obstetric Quality-of-Recovery 10 scoring tool and EuroQol 5-dimension 3L scores (including a global health visual analogue scale) 24 hours after delivery. To validate the Obstetric Quality of Recovery 10-Turkish, we assessed validity, reliability, and clinical feasibility and compared it with the EQ-5D-3L questionnaires. RESULTS: One hundred parturients completed the questionnaire in 24 hours (100% response rate). Obstetric Quality of Recovery 10-Turkish correlated highly with EQ-5D-3L score (r=-0.611) and global health visual analogue scale score (r = 0.652) at 24 hours and discriminated well between good versus poor recovery (global health visual analogue scale score ≥70 vs <70; median interquartile range were 86 [80-90] and 68 [59-75] (P < .001), respectively). Scores were similar for caesarean and vaginal deliveries, 83 (76-89) and 82.5 (69-90), respectively (P = .5). Twenty-four-hour Obstetric Quality of Recovery 10-Turkish scores did not correlate with any baseline demographic and clinical data parameters. Internal consistency was good (Cronbach's alpha=0.87 and inter-item correlation=0.41), and split-half reliability was very good (Spearman-Brown prophesy reliability estimate=0.86). Test-retest reliability was excellent (intra-class correlation coefficient=0.99). No floor or ceiling effects were demonstrated. CONCLUSION: The Obstetric Quality of Recovery 10-Turkish is a valid, reliable, and clinically feasible measure of inpatient postpartum recovery following caesarean and vaginal delivery modes.

Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial.

OBJECTIVES: This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon's direct vision for providing postoperative pain relief after thoracic surgeries. METHODS: Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia + continued RISS block; n = 20) and group C (intravenous patient-controlled analgesia; n = 20). Numeric rating scale at rest and cough, at post-anaesthetic care unit, 1, 2, 6, 9, 12, 24 and 48 h, was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions and the overall satisfaction with pain management. RESULTS: Numeric rating scale scores both at rest and during coughing were significantly lower in group R than in group C at all time intervals (P < 0.001 in each). Tramadol consumption at 24 and 48 h was significantly lower in the group R block than in group C (P < 0.001 for each). None of the patients in group R requires rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (P = 0.047 and P = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than that in group C (P < 0.001). CONCLUSIONS: Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function and patient satisfaction.

Visceral adiposity index in kidney stone patients who have undergone surgery.

Introduction: The visceral adiposity index (VAI) is a gender-specific metabolic index that indirectly measures visceral adipose function and distribution using waist circumference, body mass index (BMI), and triglyceride and high-density lipoprotein (HDL) cholesterol values. To assess visceral fat in the diagnostic pathway of urinary stone patients, we investigated the relationship between the VAI and nephrolithiasis as well as the relationship between the VAI and stone and surgery-related parameters. Material and methods: Patients who underwent percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones were included in the study. The control group comprised of healthy individuals who volunteered to take part in study and did not have urolithiasis as confirmed by abdominal computed tomography imaging. A total of 148 patients were divided into the nephrolithiasis (n = 103) and the control (n = 45) groups. Weight, height, BMI, waist circumference measurements, and VAI were among the metabolic parameters measured. Stone and surgical parameters were evaluated. Results: VAI (4.57 vs 2.76), waist circumference (92.1 vs 87.1), and BMI (28.31 vs 26.51) values were higher in the nephrolithiasis group(p = 0.02,p = 0.04, p <0.001,respectively). The VAI was statistically significant in the multivariate analysis for the presence of nephrolithiasis (p <0.001). The VAI negatively correlated with the stone Hounsfield unit (HU) and positively correlated with very-low-density lipoprotein (VLDL), blood creatinine, and calcium levels. The relationship between VAI and surgical parameters was not significant. Conclusions: A significant relationship was detected between nephrolithiasis and VAI, a new gender-specific metabolic index that distinguishes between subcutaneous and visceral adipose mass and demonstrates metabolic syndrome. No significant effect of this relationship on surgical parameters was demonstrated in the present study.

Anaesthesia-Related Pediatric Neurotoxicity: A Survey Study.

OBJECTIVE: Millions of children are exposed to anaesthetic drugs every day; however, the possible adverse effects of these agents on the central nervous system remain controversial. This study evaluated anaesthesiologists' and pediatric surgeons' knowledge and daily practices regarding anaesthesia-induced neurotoxicity. METHODS: A survey consisting of 12 questions was sent to members of the Turkish Anaesthesiology and Reanimation Association and the Turkish Pediatric Surgery Association via the Google forms program. RESULTS: A total of 202 anaesthesiologists and 51 pediatric surgeons participated in this survey. The results demonstrate that anaesthesiologists and surgeons are aware of the risk of anaesthesia-related neurotoxicity and are willing to take action. Approximately, half of the anaesthesiologists and pediatric surgeons expected to postpone operations lasting at least 3 hours for patients <3 years of age. Also, one-third of the anaesthesiologists would seek feasible and more reliable alternative anaesthetic strategies. CONCLUSIONS: More than two-thirds of the participants knew about the US Food and Drug Administration neurotoxicity warning; however, uncertainty about anaesthesia-related neurotoxicity is ongoing. Many questions remain unanswered. The results of large-scale prospective randomized studies to evaluate the effect of anaesthetics and surgery on the cognitive development of pediatric patients are needed.

Can "YouTube" help healthcare workers for learning accurate donning and doffing of personal protective equipments?

INTRODUCTION: Healthcare workers have a high risk of cross-infection during the care of Covid-19 cases. Personal protective equipment can reduce the risk. However, healthcare workers must be trained for the proper use of personal protective equipment to decrease exposure risk. This study aimed to investigate whether videos available on YouTube, presenting procedures of donning and doffing personal protective equipment, can be a useful learning resource for healthcare workers. METHODS: A search of YouTube was conducted using the keywords "Covid-19, personal protective equipment, donning, doffing". Two investigators reviewed each video and collected the basic video information. Total videos were assessed independently as educationally useful and non-useful categories using a valid tool. The relationship of each video's usefulness with viewers' preferences and the upload source were analyzed. RESULTS: A total of 300 videos were assessed; 66 (22%) fulfilled the inclusion criteria. Total video scores of educationally useful videos were higher than non-useful ones; the differences were significant. Healthcare/government agencies and hospitals mostly created educationally useful videos, e-learning platforms, and individuals mainly created non-useful videos. Significant correlations were observed between the video's usefulness and the total view and views per day. CONCLUSIONS: During a pandemic, YouTube might be a resource for learning donning and doffing of personal protective equipment for healthcare workers if an appropriate selection process applied for determining educationally useful videos.

Can “YouTube” help healthcare workers for learning accurate donning and doffing of personal protective equipments? / ¿Puede «YouTube» ayudar a los trabajadores de la salud a aprender a ponerse y quitarse con precisión los equipos de protección personal?

IntroductionHealthcare workers have a high risk of cross-infection during the care of Covid-19 cases. Personal protective equipment can reduce the risk. However, healthcare workers must be trained for the proper use of personal protective equipment to decrease exposure risk. This study aimed to investigate whether videos available on YouTube, presenting procedures of donning and doffing personal protective equipment, can be a useful learning resource for healthcare workers.MethodsA search of YouTube was conducted using the keywords “Covid-19, personal protective equipment, donning, doffing”. Two investigators reviewed each video and collected the basic video information. Total videos were assessed independently as educationally useful and non-useful categories using a valid tool. The relationship of each video's usefulness with viewers’ preferences and the upload source were analyzed.ResultsA total of 300 videos were assessed; 66 (22%) fulfilled the inclusion criteria. Total video scores of educationally useful videos were higher than non-useful ones; the differences were significant. Healthcare/government agencies and hospitals mostly created educationally useful videos, e-learning platforms, and individuals mainly created non-useful videos. Significant correlations were observed between the video's usefulness and the total view and views per day.ConclusionsDuring a pandemic, YouTube might be a resource for learning donning and doffing of personal protective equipment for healthcare workers if an appropriate selection process applied for determining educationally useful videos.

IntroducciónLos trabajadores de la salud tienen un alto riesgo de infección cruzada durante la atención de los casos de COVID-19. El equipo de protección personal puede reducir el riesgo. Sin embargo, los trabajadores de la salud deben estar capacitados para el uso adecuado del equipo de protección personal para disminuir el riesgo de exposición. Este estudio tuvo como objetivo investigar si los videos disponibles en YouTube, que presentan procedimientos para ponerse y quitarse el equipo de protección personal, pueden ser un recurso de aprendizaje útil para los trabajadores de la salud.MétodosSe realizó una búsqueda en YouTube utilizando las palabras clave «COVID-19, equipo de protección personal, ponerse, quitarse». Dos investigadores revisaron cada video y recopilaron la información básica del mismo. Los videos totales se evaluaron de forma independiente como categorías educativas útiles y no útiles utilizando una herramienta válida. Se analizó la relación de la utilidad de cada video con las preferencias de los espectadores y la fuente de carga.ResultadosSe evaluaron un total de 300 videos; 66 (22%) cumplieron los criterios de inclusión. Los puntajes totales de videos útiles para la educación fueron más altos que los no útiles; las diferencias fueron significativas. Las agencias de salud/gubernamentales y los hospitales en su mayoría crearon videos útiles para la educación, plataformas de aprendizaje electrónico y las personas crearon principalmente videos no útiles. Se observaron correlaciones significativas entre la utilidad del video, la vista total y las vistas por día.ConclusionesDurante una pandemia, YouTube podría ser un recurso para aprender a ponerse y quitarse el equipo de protección personal para los trabajadores de la salud si se aplica un proceso de selección apropiado para determinar videos útiles desde el punto de vista educativo.

Are body roundness index and a body shape index in the first trimester related to foetal macrosomia?

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126-1.917, p = .005; OR = 4.289, % CI: 0.178-1.030, p = .012, OR = 6.277, %Cl: 1.233-31.948, p = .027, and OR = 1.393, %Cl: 1.060-1.832, p = .017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women.Impact statementWhat is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution.What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women.What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women.

Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: a prospective double-blind study.

BACKGROUND: Laparoscopic cholecystectomy is a common surgical procedure that frequently results in substantial postoperative pain. Erector spinae plane block (ESPB) has been shown to have beneficial postoperative analgesic effects when used as a part of multimodal analgesia. The aim of this study was to determine whether ESPB improves postoperative recovery quality in patients undergoing laparoscopic cholecystectomy. Evaluation of the effects of ESPB on postoperative pain, opioid consumption, and nausea and vomiting was the secondary objective. METHODS: In this prospective double-blind study, 82 patients undergoing laparoscopic cholecystectomy were randomised into one of two groups: a standard multimodal analgesic regimen in Group N (control) or an ESPB was performed in Group E. Preoperative and postoperative recovery quality was measured using the 40-item quality of recovery (QoR-40) questionnaire; postoperative pain was evaluated using the numerical rating scale scores. RESULTS: Postoperative mean (standard deviation) QoR-40 scores were higher in Group E (181 [7.3]) than in Group N (167 [11.4]); P<0.01. With repeated measures, a significant effect of group and time was demonstrated for the global QoR-40 score, P<0.01, indicating better quality of recovery in Group E. Pain scores were significantly lower in Group E than in Group N, both during resting and motion at T1-T8 times (P<0.01 at each time). The total amount of tramadol consumed in the first 24 h was lower in Group E [median 0 mg, inter-quartile range (IQR) (0-140)], than in Group N [median 180 mg, IQR (150-240); P<0.01]. CONCLUSIONS: ESPB improved postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy. Moreover, ESPB reduced pain scores and cumulative opioid consumption. CLINICAL TRIAL REGISTRATION: NCT04112394.

Organ Donation on the Internet: Quality and Readability in English.

BACKGROUND: Many websites do not appear to be sources from which the public will learn reliable information about organ donation (OD). We visited websites related to OD and analyzed the quality of their content and the readability of the texts in English. METHODS: OD websites were identified using the search terms "organ donor" or "organ donation" on Google. A relevant websites list was compiled consisting of the 100 top-ranking ".gov" websites, the top 100 ".edu" websites, and the 100 top-ranking ".org" websites concerning their domain suffixes. We generated a scoring system to identify the quality of information about OD. Flesch-Kincaid grade formula, FOG index, Flesch Reading ease test, and a Fry graph test were used to assess the readability grade. RESULTS: Of 300 websites, 50 were eligible for evaluation. Only 3 (27.3%) of the relevant 11 ".gov" websites were of high quality. Seven (43.8%) of 16 ".edu" websites and only 9 (39.1%) of 23 ".org" websites were deemed as being high quality. None of these websites had fairly easy, easy, or very easy readability levels. The median readability score was 11.5 (interquartile range, 10.25-13.50) grade level. Quality scores and readability grades were not different among the website sources containing ".edu", ".gov", and ".org" (P = .795, P = .218, respectively). CONCLUSION: In the present study, the most important finding was that the content of websites related to OD far exceeds current readability grade recommendations, and they do not have a satisfactory quality.

The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: A double-blind randomized controlled trial.

STUDY OBJECTIVE: Laparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC. DESIGN: Prospective, randomized, controlled trial. SETTING: University of Health Science. PATIENTS: Sixty-eight adult patients undergoing LC. INTERVENTIONS: Both groups received a standardized analgesia protocol. Patients assigned to the ESP block group received an additional bilateral ESP block. MEASUREMENTS: The primary outcome was assessed as postoperative pain intensity associated with a lower opioid requirement and significant respiratory function improvement. MAIN RESULTS: Numerical rating scale (NRS) scores both at rest and during coughing were significantly lower in the ESP block group than in the control group at all time intervals (p < 0.001 in each) except for hour 2 postoperatively (p = 0.06 and p = 0.13, respectively). Tramadol consumption at 2 h and 24 h postoperatively was significantly lower in the ESP block group than in the controls (p < 0.001 for each). There was significant preservation in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in the ESP group in comparison to the control group at 2 and 24 h after surgery (p < 0.05 in each). FEV1/FVC and peak expiratory flow rate (PEFR) values were similar in each time interval. CONCLUSIONS: Bilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Elective and Emergency Procedures in Turkey?

BACKGROUND: Informed consent is an important aspect of ethical medical practice. In legal terms, making an intervention without informed consent may mean negligence or malpractice and may lead to legal action, maltreatment, and even attack against the doctor. This study aims to evaluate the readability of informed consent forms (ICFs) used for elective (urology and general surgery) and emergency procedures (emergency medicine and intensive care) by comparing through readability formulas. METHOD: Elective and emergency ICFs were accessed through the web sites of national health care associations. A total of 387 consent forms were evaluated and the same forms were included only once. A total of 35 consent forms were evaluated for emergency procedures, while a total of 55 consent forms were evaluated for elective procedures. Atesman and Bezirci-Yilmaz formulas defined for determining the readability level of Turkish texts and Gunning fog and Flesch Kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Even though elective ICFs are more readable compared to those of emergency procedures according to Bezirci-Yilmaz formulas, this was statistically insignificant ([Formula: see text]). The readability of elective consent forms was found to be at a significantly more difficult level to read compared to Atesman, Gunning fog, and Flesch Kincaid formulas ([Formula: see text], [Formula: see text], [Formula: see text], respectively). CONCLUSION: Even though the procedure is emergency or elective, a difficult readability level may cause problems for the doctor in legal phases. Readable and understandable consent forms should be available to be able to explain morbidity and mortality and improve prognosis. Education level of our country should also be considered while preparing these consent forms.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.