General anaesthesia for laparoscopic umbilical hernia repair in a patient with pseudocholinesterase deficiency: a case report

Pseudocholinesterase deficiency is a condition that causes prolonged muscle weakness when succinylcholine or mivacurium is used as a neuromuscular blocking agent. It can be either inherited or acquired. The practice of not using these two muscle relaxant agents may suggest that PED is not a significant problem for general anesthesia. This case report describes the successful discharge of a patient with a preexisting diagnosis of PED who underwent laparoscopic umbilical hernia repair under GA with neuromuscular monitoring without complications

Vasoplegic Syndrome and Anaesthesia: A Narrative Review

Vasoplegic syndrome (VS) is defined as low systemic vascular resistance, normal or high cardiac output, and resistant hypotension unresponsive to vasopressor agents and intravenous volume. VS is a frequently encountered complication in cardiovascular and transplantation surgery, burns, trauma, pancreatitis, and sepsis. The basis of the pathophysiology is associated with an imbalance of vasodilator and vasoconstrictive structure in vascular smooth muscle cells and is highly complex. The pathogenesis of VS has several mechanisms, including overproduction of iNO, stimulation of ATP-dependent K+ channels and NF-κB, and vasopressin receptor 1A (V1A-receptor) down-regulation. Available treatments involve volume and inotropes administration, vasopressin, methylene blue, hydroxocobalamin, Ca++, vitamin C, and thiamine, and should also restore vascular tone and improve vasoplegia. Other treatments could include angiotensin II, corticosteroids, NF-κB inhibitor, ATP-dependent K+ channel blocker, indigo carmine, and hyperbaric oxygen therapy. Despite modern advances in treatment, the mortality rate is still 30-50%. It is challenging for an anaesthesiologist to consider this syndrome’s diagnosis and manage its treatment. Our review aims to review the diagnosis, predisposing factors, pathophysiology, treatment, and anaesthesia approach of VS during anaesthesia and to suggest a treatment algorithm

Pulmonary Hypertension and Weaning

Pulmonary hypertension is a patophysiologic state of pulmonary circulation that mean pulmonary arterial pressure is measured as equal to or greater than 25 mmHg at rest via right heart cateterization. Although this disease is very common in intensive care unit (ICU) patients and determines the clinical course, the diagnoses cannot be made or cannot be noticed typically. Pulmonary hypertension, due to being the cause of heart failure and progressive vascular remodelling in lung, leads to an increase in respiratory load. This result effects weaning process directly in these patients. Pulmonary hypertension which is not yet diagnosed should be considered in ICU who are in difficult or prolonged weaning group. For a successful in these patients, an optimal fluid management and avoiding factors trigerring increase in pulmonary vascular resistance (hypoxi, hypercarbia, high positive end-expiratory pressure, asidosis and hypothermia) are essential

A pulmonary aspergillosis case with fatal course in a patient with SIRS clinic

A 77-year-old male patient with a history of tuberculosis applied to emergency service with complaints of confusion, shortness of breath, tachycardia, hypothermia and hypotension. A bronchoalveolar lavage culture was collected because a fungus ball was seen on repeat chest X-ray and thoracic CT of the patient. Aspergillus fumigatus grew and voricona-zole treatment was started, but the patient was lost from multiple organ failure (MOF). In diagnosis of patients with SIRS clinic, causative factor may be aspergillus located in an old tuberculosis cavity, and this may have a fatal course in an old patient having previous pulmonary and systemic diseases

Do the Patients Read the Informed Consent?

Background: Informed consent is a process which consists of informing the patient about the medical interventions planned to be applied to the patient’s body and making the patient active in the decision making process. Aims: The aim of this study was to evaluate whether the patients read the informed consent document or not and if not, to determine why they did not read it. This was achieved via a questionnaire administered at the pre-anaesthetic visit to assess the perception of patients to the informed consent process. Study Design: Survey study. Methods: The patients were given a questionnaire after signing the informed consent document at the pre-anaesthetic visit. We studied whether the patients read the informed consent document or not and asked for their reasons if they did not. Results: A total of 522 patients were included during the two month study (mean age: 38.1 years; 63.8% male, 36.2% female). Overall, 54.8% of patients reported that they did not read the informed consent. Among them, 50.3% did not care about it because they thought they would have the operation anyway, 13.4% did not have enough time to read it, 11.9% found it difficult to understand, 5.9% could not read because they had no glasses with them, and 5.2% found it frightening and gave up reading. Inpatients, older patients and patients with co-morbidities were less likely to read the informed consent document than outpatients, and younger and healthy patients (p<0.05). Also, 57.9% of parents whose children would be operated on had read the document. Conclusion: This study shows that the majority of our patients did not understand the importance of the informed consent. It is therefore concluded that informed consent documents should be rearranged to be easily read and should be supported with visual elements such as illustrations or video presentations, as informed consent is a process rather than just simply signing a form