Anesthetic approach to trauma patients in the city hospital after the 2023 Maras earthquake.

BACKGROUND: The February 6, 2023, Kahramanmaras earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. METHODS: We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. RESULTS: A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. CONCLUSION: The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Effect of the Gupta Score on Pre-operative Cardiology Consultation Requests in Noncardiac Nonvascular Surgery.

Objective: Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects. Methods: This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs. Results: A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019). Conclusion: Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Massaging as a pain-relieving intervention before performing intravenous access.

PURPOSE: Pain is "an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of damage". Stimulating the skin by rubbing, stroking, massaging, or applying pressure near the injection site is pain-relieving. Needle-related procedures induce anxiety, distress, and fear in children and adults. The present study aimed to test the effectiveness of massaging the access site in reducing pain associated with intravenous access. DESIGN: After obtaining institutional ethics committee approval, this prospective randomized single-blinded study was performed on 250 ASA I-II patients 18 to 65 years old, scheduled for elective minor general surgery under general anaesthesia. METHODS: Patients were randomized into the Massaging Group (MG) and the Control Group (CG). A Situational Trait Anxiety Inventory (STAI) was conducted to evaluate the anxiety levels of the patients. In addition, the skin adjacent to the intravenous access site was massaged for 15 s in circular motions with moderate intensity by the investigator's right thumb before performing the intravenous access in the MG. The CG did not receive any massage adjacent to the access site. The primary endpoint, the intensity of perceived pain, was rated on a non-graduated 10-cm Visual Analogue Score (VAS). FINDINGS: The groups' demographic data and STAI I-II scores were similar. There was a significant difference between the VAS scores of the two groups (p < 0.05). CONCLUSIONS: Our results support massaging as an effective pain-relieving technique before intravenous intervention. As massaging is a universal and non-invasive intervention that requires no advanced preparation, we recommend massaging before each intravenous cannulation to reduce pain caused by intravenous access.