Effect of acupressure applied to L4 point on the severity of fistula needle pain in patients: A randomised control trial.

BACKGROUND: Patients usually feel pain when a needle is inserted into the fistula. This acute pain can be relieved by acupressure, which is a nonpharmacological application method. OBJECTIVE: This study was designed to explore the effect of acupressure application to the Hegu point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula. DESIGN: It is a randomised control study. PARTICIPANTS: The study was conducted with 32 intervention and 32 control patients, recruited from a dialysis centre of a foundation university in Turkey between October 2021 and January 2022. MEASUREMENTS: Acupressure was applied 3 min before needle placement in the fistula area of the patients in the experimental group. RESULT: While there was no decrease in the severity of acute pain during fistula needle insertion in the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose Hegu point acupressure was applied. CONCLUSION: The results of this study support the effectiveness of Hegu point acupressure as an effective and low-cost way to reduce the acute pain of needle insertion put on dialysis patients with a fistula. In addition, the results provide a practical reference for acute pain management for dialysis nurses.

Alarm fatigue among nurses working in intensive care and other inpatient clinics.

BACKGROUND: Alarm fatigue is an important technological hazard that adversely affects patient safety and the healthcare team. Nurses can be exposed to an excessive amount of alarms during their work which may lead to alarm fatigue. OBJECTIVE: To determine the experiences of alarm fatigue among nurses working in intensive care units and other inpatient clinics. METHODS: This descriptive study was conducted in university hospitals in five cities in Turkey between August and December 2019. A total of 592 nurses participated in this study. The data was collected using questionnaires and the Visual Analog Scale (0 to 10 points) was used to determine the level of alarm fatigue. RESULTS: More than half of the nurses experienced problems, especially false alarms, caused by devices. Alarm fatigue decreased with increasing age and working years. Nurses reported appropriate actions in solving problems, but also had practices that may increase the risk of error, such as turning off or muting alarms or turning off equipment. CONCLUSION: Alarm fatigue is mostly caused by false alarms. It can lead to physical fatigue, increased workload and decreased concentration, resulting in an increased possibility of error. Management of alarm fatigue is necessary in preventing a compromise in patients' safety and improving quality of care.

Opinions of Cancer Patients, Their Relatives, and Nurses on Good Death.

The study sample consists of participants as the patient, patient relatives, and nurse. In our study, a significant relationship was found between the ages of patients, and fear of death, avoidance of death, accepting approach, non-acceptance, and the DAP-R scale total score. A positive moderate correlation was found between the fear of death and death avoidance among my nurses who participated in the study. The nurse, the patient, and patient relatives had a good perception of death and had a higher attitude toward death. Additionally, that found to nurses' fear of death and death avoidance behavior are higher than patients and their relatives.

Turkish validity and reliability of the Cancer Stigma Scale (CASS-T).

OBJECTIVES: This study is aimed to evaluate the validity and reliability of the Cancer Stigma Scale for the Turkish population (CASS-T). METHODS: The sample of the study consisted of 412 students of a foundation university located in Ankara, Turkey. The reliability of the CASS was evaluated using the Cronbach alpha reliability coefficient and item-total score correlations. Exploratory factor analyses were applied to examine the factor structure of the scale and its construct validity. To test the time invariance of the scale, the relationships between the scores obtained from the first and second applications were examined using the intraclass correlation coefficient (ICC). RESULTS: The Cronbach's alpha coefficient of CASS-T was 0.83. In the factor analysis, it was confirmed that the scale has a six-dimensional structure in parallel to original version, namely Avoidance, Severity, Responsibility, Policy opposition, Awkwardness, and Discrimination. The ICC values all remained in the range that indicates the reliability of the 0.63-0.71 to be substantial. The contribution of the six factors of the CASS-T scale to the variance is 57.8. SIGNIFICANCE IN RESULTS: The Turkish version of the CASS was confirmed to have good reliability and validity for evaluating stigma toward cancer in Turkish society.

Determination of thermal comfort among nurses working with personal protective equipment in COVID-19 clinics.

AIMS: This study aimed to determine thermal comfort among nurses working with personal protective equipment in COVID-19 clinic. METHODS: In this study, a descriptive design was carried out between June and September 2020. Sample of the study consisted of 246 nurses (77.6%) who worked in the COVID-19 clinics with personal protective equipment. We used a questionnaire to determine thermal comfort of nurses; a follow-up form to determine the factors affecting thermal comfort; and the ASHRAE Thermal Sensation Scale. Four measurements and follow-ups were made three times. RESULTS: More than half of nurses complained of ambient temperature and ventilation, one-third complained of humidity and nearly half complained of poor air quality. The mean thermal comfort score of nurses working in COVID-19 clinics was 1.19 (SD = 0.75). The thermal comfort of the nurses was negatively affected in all measurements except before wearing personal protective equipment. The highest scores were measured leaving the patient room and before removing personal protective equipment (M = 2.65, SD = 0.58). CONCLUSION: The thermal comfort, work performance and stress levels of the nurses were negatively affected by working with personal protective equipment. This study reveals the necessity of improving the working conditions of nurses, including working hours, environment and personal protective equipment.

The Effect of Sugammadex on Time of Sciatic Block by Perineural Bupivacaine in Rats.

OBJECTIVES: We aimed to investigate the effect of sugammadex on the motor, sensory and deep sensory block in the sciatic nerve created by bupivacaine in rats. MATERIALS AND METHODS: 18 Sprague-Dawley adult male rats treated with unilateral sciatic nerve block by bupivacaine (0.2 ml) were randomly divided into three groups. Control group (Group C, n = 6, 1.5 mL saline) perineural sugammadex group (Group PNS, n = 6, 16 mg/kg) and intraperitoneal sugammadex group (Group IPS, n = 6, 16 mg/kg) Motor, sensory, and deep sensory functions were evaluated every 10 minutes by a blind researcher. 6 tissue samples each belonging to the sciatic nerve, 1.5 cm in length and 0.2 cm in diameter, were taken from paraffin blocks. Sections of 3-4 micrometers were stained with Hematoxylin + Eosin, Masson Trichrome dyes and examined under a light microscope. RESULTS: There was no statistically significant difference between 3 groups in terms of the time to return to normal motor, sensory and deep sensory function. There was also no significant difference in edema, extracellular matrix, and myelin. Inflammatory cells were seen in all groups, mainly epineurium, epineurium, and perineurium. CONCLUSION: There are findings of no histological effects or effects on local block of sugammadex in rats undergoing sciatic nerve block.

The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective cross-sectional study.

Background: Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19 patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave. The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients. Methods: All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021. All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness (Acute Physiology and Chronic Health Evaluation -APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital's electronic database. The Charlson Comorbidity Index (CCI) was assessed for all patients. Results: A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II. Conclusions: In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.

The effects of pre-emptive intravenous ibuprofen on the thiol/disulfide homeostasis and C-reactive protein level as the markers of oxidative stress and inflammation during gynecologic laparoscopy: A randomised clinical trial.

AIMS: In this study, we aimed to investigate the anti-inflammatory and antioxidant effects of intravenous ibuprofen by using the C-reactive protein level and thiol/disulfide homeostasis as the oxidative stress marker. MATERIALS AND METHODS: This study was conducted on 70 patients aged between 30 and 65 who were scheduled for elective laparoscopic hysterectomy. The patients were divided into two groups to receive either pre-emptive 800mg of intravenous ibuprofen plus 1000 mg of intravenous paracetamol (Group IP) or only 1000 mg of intravenous paracetamol as a control group (Group P). The blood samples for thiol/disulfide homeostasis were collected as follows: before induction of anesthesia (T0), before pneumoperitoneum (T1), following postdeflation and discontinuation of anesthesia (T2), and postoperative 24th hour (T3). Simultaneous blood samples for C-reactive protein (CRP) were also collected. The pre- and postoperative urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured. RESULTS: A total of 69 patients were included in the study. The patient's characteristics and intraoperative variables were comparable between groups (P > .05). The number of patients requiring rescue analgesia, the total amount of analgesic used, Visual Analog Scale (VAS) scores, and postoperative side effects were significantly lower in Group IP (P < .001). The decrease in native and total thiol levels at T1, T2, and T3 measurement points was significant in Group IP (P < .001). In both groups, the comparison to baseline values demonstrated no significant changes in terms of disulfide level (P > .05). The simultaneous CRP levels indicated a significant increase at the postoperative 24 hour in both groups (P < .001). The difference between groups was insignificant (P > .05). There was a significant increase in urea and creatinine levels in patients of Group IP (P < .05). CONCLUSION: The pre-emptive administration of ibuprofen provided effective pain control after gynecologic laparoscopy. However, ibuprofen changed the thiol/disulfide homeostasis in favor of oxidation and had no beneficial effect in surgically induced oxidative stress.

Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study.

STUDY OBJECTIVE: The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy. DESIGN: Prospective, randomised, controlled. SETTING: Tertiary hospital. PATIENTS: A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 patients in each group. INTERVENTIONS: Standardised postoperative analgesia was performed in all groups. In addition, ultrasound-guided ACB (same volume/two different concentrations of bupivacaine: 0.25% vs 0.16%) was applied to the experimental groups. MEASUREMENTS: Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). MAIN RESULTS: Tramadol requirement in the first 24 hours was significantly higher in the control group (209.5 ± 23.27 mg) (P < .001), and there was no difference between the experimental groups (63 ± 42.06 mg vs 80.5 ± 36.63 mg). Although the mean NRS scores in the first three hours were higher in the control group when compared with both block groups, it was similar in all groups in the following measurements. CONCLUSION: In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics when compared with the control group.

The effect of ultrasonographic measurement of vena cava inferior diameter on the prediction of post-spinal hypotension in geriatric patients undergoing spinal anaesthesia.

AIMS: In our study, we aimed to investigate whether end-expiratory vena cava inferior (expVCI) diameter and vena cava inferior collapsibility index predicted post-spinal hypotension in geriatric patients undergoing spinal anaesthesia (SA), the correlation between them and other parameters. MATERIAL AND METHODS: Our prospective study included the American Society of Anesthesiologists (ASA) I-4, 73 patients over 65 years of age, who were scheduled for operation using SA. According to the expVCI diameter displayed with ultrasonographic (USG) before SA, patients with an expVCI diameter less than 1.8 cm previously determined as the threshold value are grouped as 1 (small-VCI) group, those greater than 1.8 cm as 2 (large-VCI) group. Demographic characteristics of the patients, comorbidities, duration and type of operation, basal (preoperative) heart rate, systolic, diastolic, mean blood pressure, peripheral oxygen saturation values before SA and after SA in supine position (0 minute) and 5th, 10th, 15th, 20th, 25th, 30th min and preoperative arterial blood gas parameters, amount of preoperative urine and bleeding, inotropic and fluid requirement, complications were recorded. RESULTS: Hypotension developed in 28 (38.4%) patients and bradycardia in 14(19.2%) of patients. The patients who developed hypotension had more ASA2 and ASA3 (P = .01), shorter height (P = .02) and smaller expVCI diameter (P = .004). It was observed that they had higher lactate (P = .03), lower pH (P = .006) values and more inotropic agents were administered (P < .001). While the rate of developing hypotension was 51.1% (n = 23) in the patients in the small-VCI group, this rate was 17.9% (n = 5) in the patients in the large-VCI group (P = .004). CONCLUSION: It was concluded that the expVCI diameter value measured by USG before SA in older adults is effective in predicting post-spinal hypotension with lactate and pH values, which are among the blood gas parameters, and expVCI can be preferred to invasive methods because of its noninvasive, easy and fast application.

Stress response in vertebra surgery by total intravenous and inhalation anaesthesia.

OBJECTIVE: We compared inhalational and total intravenous anaesthesia about haemodynamic stability and oxidative stress response in vertebral surgery. BACKGROUNDS AND METHODS: Fifty-nine elective vertebral surgery patients were randomly divided into propofol (Group P) and desflurane (Group D) groups. Intraoperative haemodynamic parameters, preoperative and post-operative native thiol, total thiol, disulfide, C-reactive protein (CRP), albumin, cortisol and catalase levels were studied. RESULTS: Post-operative native thiol and total thiol values in Group P were higher (P = .044 and P = .031). Post-operative albumin value in Group P was lower than the preoperative value (P < .001). The post-operative CRP and albumin values in Group D were lower than the preoperative value. The cortisol value was high (P = .03, P < .001 and P < .001). The post-operative albumin value in Group P was higher (P = .03). There is a positive correlation between CRP and disulfide values (P = .017), between albumin and native thiol values (P < .001), between total thiol value (P < .001), between the cortisol value and the disulfide/native thiol value (P = .002) and between native/total thiol value (P = .003) and a negative correlation between disulfide/native thiol value (P = .005), between disulfide/total thiol value (P = .003) and between the native/total thiol value (P = .001). CONCLUSION: Dynamic thiol/disulfide haemostasis reflects oxidative stress. Propofol positively contributes to oxidative stress in elective vertebral surgery.

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems.

Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients' APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were ​​calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5

Factors affecting organ donation rate during devastating brain injuries: a 6-year data analysis.

OBJECTIVES: The discrepancy between organ donation rate and the number of patients waiting transplantation has been a common problem in Turkey. Intracerebral hemorrhage (ICH), traumatic brain injury (TBI), anoxic encephalopathy, stroke, and brain tumors comprise the majority of the causes of brain death. This study thus aimed is to analyze potential brain deaths and factors associated with organ donation among such patients. MATERIAL AND METHODS: Medical records of 629 intensive care unit (ICU) patients with potentially devastating cerebral lesions from 01/2013 to 12/2018 were retrospectively analyzed. Clinical characteristics and the prevalence of consent for organ donation were then assessed. RESULTS: Although possible brain death was considered in 102 patients, 21 (18%) died before diagnostic tests could be performed. Accordingly, the 81 potential organ donors had a donor conversion rate (DCR) of 30%. Causes of non-organ retrieval among potential donors included refusal of consent by relatives (89.5%), indecision of the family regarding donation or no relatives present (7%), and medical unsuitability for donation (3.5%). CONCLUSIONS: Our findings showed that refusal by the family was the most common reason for failure of deceased organ donations. To maximize the number of procured organs, transplant communities need to focus on increasing awareness regarding brain death and organ donation and establish strategies to increase consent obtained from the families.

Emergency surgery in geriatrics: A retrospective evaluation in a single center.

BACKGROUND: As life expectancy increases in humans, surgical procedures applied to the elderly people are also increasing in parallel with the developments in surgery and postoperative care. A significant number of studies investigating the morbidity-mortality of geriatric patients are related to patients who are undergoing emergency operations. The present study aims to investigate the factors affecting mortality and morbidity after emergency surgery in elderly people. METHODS: The data of 200 patients aged 65 years and over who were operated under emergency conditions in the University of Health Sciences Kartal Dr. Lütfi Kirdar Training and Research Hospital between January and December 2018 were evaluated retrospectively. RESULTS: Patient's demographic information, including age, gender, ASA physical status, comorbidities, functional dependency or non-dependency of patients, types of operation, anesthesia technique, duration of operation, intraoperative blood transfusion, the changes of hematocrit levels (during the perioperative period), the outcome after surgery (intensive care admission or ward transfer), were recorded. The risk prediction of short-term mortality has been estimated using CCI and APACHE II scoring systems. CONCLUSION: The mean age of the patients was 74.8±6.7 and the number of females (n=134, 67%) outweighed the males. Higher ASA physical status scores, dependent living conditions, long operation time, general anesthesia, intraoperative blood transfusion, low Htc values (<25%), high APACHE II scores and lower scores of 10-years survival by CCI were the factors that affected the acceptance into ICU.

The effect of acupressure on upper extremity pain and quality of life in patients hemodialysis treatment: A Randomized Controlled Trial.

BACKGROUND AND AIMS: Acupressure is a commonly used method to reduce the severity of pain. This study was conducted to determine the effect of acupressure on pain severity and quality of life in patients with upper extremity pain due to hemodialysis. METHOD: The study was completed with a total of 50 patients, consisting of 25 intervention group and 25 control group patients. In the intervention group, acupressure was applied to five acupressure points on the arms and shoulders in the first half of the dialysis sessions carried out for six weeks and for three days per week. RESULTS: There was a significant decrease (p < .05) between the VAS pain score median values of the preliminary monitoring of patients in the intervention group and their VAS pain score median values recorded six weeks later. CONCLUSIONS: Acupressure reduces extremity pain and increases the quality of life in dialysis patients.

Retrospective Investigation of Grafted Kidney Function After Reversal of Neuromuscular Blockade Using Neostigmine or Sugammadex.

INTRODUCTION: Sugammadex has the steroid-encapsulating effect that reverses neuromuscular block induced by aminosteroid neuromuscular-blocking agents. Sugammadex can interact with other drugs that have the same steroidal structure with rocuronium, such as corticosteroids. Corticosteroids play a crucial role in the immunosuppression of kidney transplantation. The purpose of this study was to determine if there are any differences in grafted kidney function in recipients of kidney transplantation when sugammadex or neostigmine is given to the recipient. METHODS: The study included 42 recipients of kidney transplant, with complete, readable medical charts and anesthetic records. Fourteen recipients' neuromuscular block was reversed with sugammadex (group S) and 28 recipients' neuromuscular block was reversed with neostigmine (group N). We tested noninferiority for serum creatinine during the preoperative period and 5 days after transplantation. Short-term (28 days) outcomes of kidney transplantations were assessed by the incidence of acute rejection episodes, graft failure, length of stay at hospital, and mortality. RESULTS: There were no significant differences in demographic characteristics, serum creatinine values, short-term outcomes, and graft survival rates at 28 days' postoperatively between group S and group N (P > .05). CONCLUSIONS: Our data showed no difference in risk of serious adverse effects on short-term graft functions in patients who underwent kidney transplantation. However, considering the sugammadex-corticosteroids interaction, the immunosuppression and long-term effects on grafted kidney functions, current safety experience is insufficient to support the recommendation of routine sugammadex use in this population. These results need to be confirmed by sufficiently powered, controlled, pharmacokinetic, and pharmacodynamic studies on larger patient populations.

Normal Saline Versus Balanced Crystalloid Solutions for Kidney Transplantation.

INTRODUCTION: The ideal crystalloid solution to be used during the perioperative period in patients undergoing kidney transplantation remains unclear. Normal saline (NS), the intravenous fluid commonly using during the perioperative period, contains a high chloride content, which may be associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid (BC) solutions have a lower chloride content. The purpose of the study was to determine if a BC solution prevents the incidence of hyperchloremia and hyperkalemia during renal transplantation. METHODS: NS and BC given during kidney transplantation are compared. The primary outcome was hyperchloremia and hyperkalemia within 24 hours after surgery. Secondary outcomes were levels of serum creatinine at preoperative and within 5 days after transplantation, the incidence of acute rejection episodes, graft failure, length of stay at hospital, and mortality. RESULTS: A total of 60 patients were included in the study (30 in the BC group and 30 in the NS group). The mean postoperative chloride was 103.0 mmol/L (95% CI, 101-105) in the NS group and 100 mmol/L (95% CI, 98-102) in the BC group (P < .05). There were no significant differences in demographic characteristics, serum creatinine values within 5 days, short-term outcomes, and graft survival rates at 28 days postoperatively between groups (P > .05). CONCLUSIONS: Our results suggest that a moderate volume (approximately 1500.0 mL) of NS infusion causes hyperchloremia rather than adverse clinical outcomes. A moderate amount of NS infusion can be used safely during uncomplicated living-donor kidney transplantations.

Factors Affecting Wound Healing in Individuals With Pressure Ulcers: A Retrospective Study.

Owing to the number and severity of concomitant factors, pressure ulcers remain a significant problem. A retrospective study of data from adult patients with a pressure ulcer was conducted to identify factors that may affect their healing. Data from patients who were hospitalized between January 1, 2011, and December 31, 2015, in a private Turkish university hospital who had a Stage 2, Stage 3, Stage 4, or unstageable pressure ulcer that was assessed using the Bates-Jensen Wound Assessment Tool (BWAT) were abstracted. The following variables were examined: demographic characteristics (gender, age, hospital unit, duration of hospitalization), health status and disease data (vital signs, mobility, nutrition, diagnosis, chronic diseases, medication), laboratory values (albumin, hemoglobin, blood glucose), and pressure ulcer characteristics (stage, location, healing status, duration) and pressure ulcer risk status as determined by patient Braden Scale score. Seventy-eight (78) patient records were identified. Patient mean age was 70.8 ± 13.47 years, and length of hospitalization was on average 32.52 ± 27.2 days. Most ulcers (62; 79.5%) were Stage 2 and located in the sacral area (59; 75.6%). Thirty-four (34) patients (43.6%) were discharged and 44 (56.4%) died. At the time of discharge or death, 65.4% of the ulcers had not healed. Patients whose wounds were healed were significantly more likely to have higher hemoglobin and mean arterial pressure, better mobility, received oral nutrition, and discharged from the hospital than patients whose ulcers did not heal. The results suggest that these variables, including Braden Scale and BWAT scores, might be considered when developing a treatment plan of care. Additional studies examining risk factors for nonhealing pressure ulcers, including studies with large samples to facilitate multivariate analyses, are needed.

Procedural sedation and analgesia for pediatric shock wave lithotripsy: a 10 year experience of single institution.

The aim of this study was to evaluate anesthesia practice for pediatric extracorporeal shock wave lithotripsy (ESWL) according to the age groups and discuss the anesthetic management of these patients. Pediatric patients treated with ESWL because of urolithiasis under anesthesia in our department between December 2007 and January 2017 were evaluated retrospectively. A total of 251 patients were divided into two groups as Group PS: preschool children (<6 years) and Group S: school children (≥6 years). Groups were compared according to ketamine and midazolam doses, extra anesthetic agent requirement, duration of procedure, procedural and postprocedural complications due to anesthesia, as well as mean number of sessions and calculus diameter. A total of 408 sessions of ESWL were applied to 251 children included in the study. Overall, mean age of the patients was 4.5 ± 3.2 years (7 months-14 years). In school children (Group S), mean ketamine and midazolam doses were significantly higher than the preschool group (p < 0.01 and p = 0.04, respectively). There was no statistically significant difference in additional anesthetic agent requirement (p = 0.35) as well as mean number of SWL sessions (p = 0.23), duration of anesthesia (p = 0.93), stone size (p = 0.20), and stone laterality (p = 0.71) in both preschool and school children. No severe complications were observed in both groups. In pediatric ESWL patients, ketamine-midazolam combination is an effective and safety choice for outpatient anesthesia. Appropriate dose adjustment in a monitorized and well-equipped setting is essential.

Extracorporeal Shock Wave Lithotripsy Management of Renal Stones in Children: Does Anesthesia Affect the Treatment Outcomes on an Age-based Manner?

OBJECTIVE: To evaluate beneficial effect of anesthesia on extracorporeal shock wave lithotripsy (SWL) in children older than 9 years. PATIENTS AND METHODS: A total of 61 children (aged between 9 and 17 years) treated with SWL for renal stones were included. Depending on the use of general anesthesia, the children were divided into 2 groups: cases treated with SWL under anesthesia (group 1, n = 27) and cases treated with SWL without anesthesia (group 2, n = 34). The patients in both groups were comparatively evaluated with respect to treatment-related parameters (stone size, stone laterality, stone location, mean number of sessions, mean number of shock waves applied, residual fragments size, stone-free rate [SFR], clinically significant residual fragment complications, and need for additional intervention). The efficacy quotient was also evaluated. RESULTS: The overall mean stone size was 10.48 ± 4.27 mm. Although there was no significant difference regarding the stone size (P = .924), stone laterality (P = .240), stone localization (P = .084), mean number of sessions (P = .392), SFR (P = .666), clinically significant residue (P = .526), size of residual fragments (P = .315), complication rates (P = 1.000), and need for additional intervention (P = 1.000), the mean number of shock waves applied was significantly higher in patients treated without anesthesia (group 2) (P = .001). The efficacy quotient was 41.7% and 35.4% for groups 1 and 2, respectively. CONCLUSION: Our findings indicate that anesthesia-free SWL for renal stones in children aged older than 9 years is feasible and successful with similar treatment outcome data observed in cases with the same age range being treated under anesthesia. We believe that SWL without anesthesia can be applied in a safe and successful manner in relatively older and cooperative children.