Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Comparison of bispectral index values in sevoflurane and sevoflurane-remifentanil administration in children

Objective: This study was designed to compare the effects of remifentanil on anesthesia depth, sevoflurane consumption, hemodynamic parameters on children administered sevoflurane for general anesthesia. Method: 60 children aged 3-10 years were included and allocated to 2 groups. The anesthesia was induced with sevoflurane in nitrousoxide/oxygen in all children. Anesthesia was maintained with sevoflurane (Minimum alveolar concentration (MAC): % 0,5-2) in group I. In group II, 0,5 microgram/kilogram remifentanil was given for one minute, anesthesia was maintained with sevoflurane (MAC: % 0,5-2), 0,25 µg kg-1 h-1 remifentanil infusion. Sevoflurane concentration was titrated to be +/-20% of normal value of systolic, diastolic blood pressure and heart rate. Remifentanil infusion rate was kept constant in group II. Intraoperative bispectral index (BIS) values, heart rate, systolic, diastolic blood pressure, oxygen saturation, end tidal sevoflurane concentration, somatic reflexes (tears, sweating, cough, strain) were recorded every 15 minutes. Results: In all measurement, heart rates were lower in group II than group I (p&lt;0,05). End tidal sevoflurane values were higher in group I than group II (p&lt;0,001). BIS values were higher in group II than group I (p&lt;0,05). Conclusion: Intravenous remifentanil infusion during sevoflurane anesthesia reduced end tidal sevoflurane concentration decreasing heart rate but did not influence BIS values. © 2018 Anestezi Dergisi. All rights reserved

Preliminary experience with dexmedetomidine in neonatal anaesthesia

Background: In paediatric patients dexmedetomidine has been reported to be effective in various clinical settings including provision of sedation during mechanical ventilation, prevention of emergence delirium after general anaesthesia, sedation during non invasive radiological procedures. However very few data of its use in newborn is available. Patients &amp; Methods: Sixteen new born patients of age 2-28 days were studied. Anaesthesia was induced with 1 mgkg-1 ketamine intravenously. Dexmedetomicline 1 µgkg-1 was infused within ten minutres. Maintenance infusion was started as 0.5-0.8 µg kg-1h-1 until the end of surgery ortrcheel intubation was done all patients were mechanical ventelated with O2+H2O safberane 0.1-0.2%. Non invasive systolic &amp; chastake blood pressure, heart rate, SPO2, DETCO2, inhated &amp; end trial sevophrame conc and body temperature were monitored. Results: No significant difference was observed in the measured values of haemodynamic parameter at different intervals and the base line values. No patient had hypotension bradycardia hypertension hypoxia or respiratory depression. Patients had mild hypothermia during post-operative period. Conclusion: Dexmedetomidine 1 µgkg-1 followed by maintenance dose of 0.5 µg kg-1h-1 as an adjacent to sevoflurane anaesthesia in new born undergoing laparatomy provides haemodynamic stability during heightened surgical stimulate

The relationship between preoperative and postoperative anxiety, and patient satisfaction in preparation for elective surgery [Elekti·f cerrahi· hazirliginda preoperati·f ve postoperati·f anksi·yeteni·n hasta memnuni·yeti· i·le i·li·şki·si·]

Background and Objectives: Using the questionnaire investigations for determining the quality of anesthesia is not a new method in anesthesiology investigations. In spite of that, there are a few studies evaluating patient satisfaction related to anesthesia, and most of them are limited with daily studies. In this study, we aimed at reducing the reasons for the anxiety of anesthesia, measuring the preoperative and postoperative anxiety levels and investigating the relationship between patient satisfaction and anxiety of the patients who undergo elective surgery. Material and Methods: In the study, 120 patients of 14-65 years, who applied for elective surgery between April 2007-July 2007 were included. In this study, data was collected by using the state-trait anxiety inventory (STAI), and a questionnaire composed of 12 questions whose purpose was to determine the reasons about anxiety of anesthesia, and QoR-40 questionnaire which quantifies the quality of postoperative recuperation. The patients were seen during the preoperative and postoperative periods and were asked to fill in the questionnaire forms. Results: Preoperative anxiety levels were found to be higher in women compared to men (p< 0.05). The reasons which caused the highest anxiety were not to awake after surgery (42.5%), postoperative pain (26.7%) and staying at intensive care unit (26.7%). It was identified that QoR- 40 satisfaction scores, and STAI-I and STAI-II points had a negative low correlation (r= .-32, p < 0.001 and r= .-27, p< 0.001), whereas QoR- 40 satisfaction scores, and postoperative STAI-I had a negative medium level correlation (r= .-57, p< 0.001), respectively. Conclusions: It was concluded that the preoperative anxiety levels were higher in women than men, and the most frequently reasons of anesthesia anxiety were not to awaken, postoperative pain and staying at intensive care unit. In addition, preoperative anxiety was found to have relationship with postoperative patient satisfaction and pain control

Validity and reliability of the turkish version of the modified yale preoperative anxiety scale

PubMedID: 31091856Background/aim: The modified Yale Preoperative Anxiety Scale (m-YPAS) is widely used to measure children’s anxiety levels. The aim of this study was to translate the m-YPAS into Turkish and test its validity and reliability in Turkish children. Materials and methods: The English version of the m-YPAS was translated into Turkish using the forward-back-forward translation technique. This study enrolled 120 children. The m-YPAS was administered to 120 children who were recorded on video. The StateTrait Anxiety Inventory for Children (STAIC) was used for only 30 of 120 children. The videotapes were evaluated by two experienced observers [an anesthesiologist, ObA(an), and a psychologist, ObB(ps)]. The interrater reliability, concurrent validity, sensitivity, specificity, and positive and negative predictive values were analyzed. Results: The mean age of the children was 7.8 ± 2.2 years. The weighted kappa values of the m-YPAS between observers were in substantial agreement (?w = 0.74–0.80) and almost perfect agreement (?w = 0.84–0.85). The Cronbach alpha values were high [? = 0.85 for ObA(an) and ? = 0.86 for ObB(ps)]. The correlation between m-YPAS and STAIC showed good agreement (P &lt; 0.05). The sensitivity and specificity were high, and the predictive value was 92.86%. Conclusion: The Turkish version of the m-YPAS can be applied as a reliable and valid observational questionnaire for Turkish children. © TÜBİTAK

Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

PubMedID: 21327805Purpose Several studies have reported that sevoflurane was associated with a relatively high incidence of emergence agitation in children even in the absence of any surgical intervention. The aim of this study was to compare early agitation characteristics of oral melatonin, dexmedetomidine, and midazolam premedication in children who were given sevoflurane anesthesia for esophageal dilatation. Methods Following Internal Review Board approval and parental informed consent, 100 ASA physical status I-II children (3-9 years old) who were scheduled to undergo general anesthesia for esophageal dilatation procedures were enrolled. The patients were randomly assigned to four groups (n = 25 in each). The premedications in the groups were saline (group P), dexmedetomidine 2.5 µg/kg (group D), 0.5 mg/kg midazolam (group MD), and melatonin 0.1 mg/kg (group ML), given orally. All premedication drugs were given with paracetamol 2-2.5 mg/kg to be easily drinkable 40-45 min before anesthesia induction. Anesthesia was maintained with sevoflurane 2-4%, N2O 50% in oxygen. No supplemental analgesic agent was given, and an emergence agitation scale (EAS) was measured on admission to the PACU, then every 5 min, and recorded during the postoperative period: 1, awake and calm, cooperative; 2, crying, requires consoling; 3, irritable/ restless, screaming, inconsolable; 4, combative, disoriented, thrashing. Children with an agitation score of 3 or 4 were classified as agitated. Results There were no significant differences among the four groups demographically. The emergence agitation scale was higher in the placebo group than in the others at 5, 10, and 15 min postoperatively (P\0.001). EA was similar among group D, group MD, and group ML. Conclusion We found that oral melatonin, dexmedetomidine, and midazolam reduced the incidence of emergence agitation in children after sevoflurane anesthesia. © 2011 Japanese Society of Anesthesiologists

Management of acute craniotomy pain: The analgesic effect of diclofenac sodium-tramadol or paracetamol-tramadol

BACKGROUND AND OBJECTIVE: There is currently no consensus on pain management after craniotomy in neurosurgical centers in the world. We have investigated either the addition of diclofenac sodium or paracetamol to tramadol for analgesia after craniotomy. METHODS: Fifty patients were allocated randomly to receive an intravenous tramadol with diclofenac sodium (DT) or tramadol plus paracetamol (PT), in a double-blind, randomized study. Then, all patients received bolus doses of tramadol (1.5 mg/kg) every 6 hours during the first 24 hours. Discomfort, sedation, pain scores, and side effects were recorded for up to 24 hours. RESULTS: Although there was no difference in visual analog scale scores between groups 15 and 30 minutes after extubation, and after 1 (t3), 8 (t5), 12 (t6), and 16 hours, the diclofenac-tramadol group had significantly lower scores 4 and 24 hours postoperatively (P<0.05). The number of patients requiring supplementary meperidine was significantly higher in the PT group than in the DT group. Four patients in the DT group (16%) and 10 patients in the PT group (40%) complained of pain during the first 24 hours, despite the tramadol therapy and they were treated with intravenous meperidine (25 mg). CONCLUSIONS: Addition of either diclofenac sodium or paracetamol to tramadol provided effective postoperative analgesia and patient comfort, without causing any sedation or respiratory depression after major intracranial surgery. In addition, diclofenac sodium-tramadol combination provided better postoperative pain relief and less supplementary analgesics than paracetamol-tramadol combination. © 2011 by Lippincott Williams & Wilkins

Comparing the laryngeal mask airway, Cobra perilaryngeal airway and face mask in children airway management [Çocukların havayolu yönetiminde laringeal maske, Cobra perilaringeal airway ve yüz maskesinin karşılaştırılması]

Objective: We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery. Methods: In this study, 90 cases of 1–14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%–50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively. Results: There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p<0.05). Conclusion: We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA. © 2016 by Turkish Anaesthesiology and Intensive Care Society

Postoperative analgesia in children: Comparison of bupivacaine with a mixture of bupivacaine and alfentanil [1]

PubMedID: 11553247[No abstract available

Investigation of the burnout syndrome among the Eastern Mediterranean Region anaesthesiologists [Dogu akdeniz Bölgesindeki anestezi hekimlerinde tükenmişlik Sendromunun araşti{dotless}ri{dotless}lmasi{dotless}]

Objective: The aim of this study was to assess levels of the burnout syndrome among the Eastern Mediterranean Region anaesthesiologists Methods: After obtaining the approval of the Çukurova University Faculty of Medicine ethics committee, anaesthesia and reanimation physicians in the East Mediterranean Region and residents who were working more than one year in the at Cukurova University anaesthesia and reanimation units were included in this study. Emotional exhaustion, depersonalization and personal success were evaluated with Maslach Burnout Inventory (MBI). The personal characteristics, habits and working conditions were evaluated with the socio-demographic data collection form. SPSS 18.0 package program was used for statistical analysis of the data. Results: Sixty (68.2%) physicians and twenty-seven (30.7%) residents were included this study. Burnout scores were not affected by gender, marital status, alcohol abuse, chronic illness. MBI-EE (emotional exhaustion) score (20.09±6.38), MBI-D (depersonalization) score (7.64±3.64) and MBI-NW score (11.50±2.68) were significantly higher in 25-30 age group. In addition, burnout was related to smoking, sleep disturbance, working at a public hospital, not having a hobby, the number of night shifts between 6-10, being a resident. Conclusion: Burnout levels may decrease with reduction of the number of shifts, having a hobby, no smoking, and a regular sleep pattern. Regulation of working conditions, concentrating on education, psychological support and organizational arrangements would effectively contribute to the prevention of burnout