A Study of Cerebral Performance Categories Based on Initial Rhythm and Resuscitation Time Following In-Hospital Cardiac Arrest in a State Hospital in Turkey

Background: The cerebral performance category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the results of the CPC in Turkey. Objective: This study aimed to determine whether the CPC is associated with the initial rhythm and resuscitation time following resuscitation from in-hospital cardiac arrest. Methods: This study compared the CPCs (CPC 1-2 and CPC 3-4-5) of patients discharged from the hospital after surviving cardiopulmonary arrest (CPA) during a 2-year period between June 2013 and June 2015 (at discharge, and at 6th, 12th, 18th, and 24th months) based on the initial rhythm (asystole/pulseless electrical activity and ventricular fibrillation/pulseless ventricular tachycardia) and resuscitation time (0–14 min and 15–30 min) at the time of arrest. Results: No difference was found between CPC 1-2 and CPC 3-4-5 scores at discharge or at 6th, 12th, 18th, and 24th months in terms of the first rhythm and resuscitation time (P > 0.05). Conclusion: Patients discharged from the hospital following in-hospital cardiopulmonary resuscitation (CPR) were found to have no difference in 2-year CPC scores with respect to cardiac rhythms and resuscitation durations at the onset of resuscitation

Opinions of Physicians and Nurses on the Postoperative Pain of Pediatric Patients Undergoing General Anesthesia: A Qualitative Study

ABSTRACT Aim: It is aimed to determine the opinions of physicians and nurses on the evaluation of pain in the postoperative period of pediatric patients undergoing general anesthesia. Materials and Methods: Qualitative research method was used in the study. The study was carried out with a total of 13 physicians and nurses working voluntarily in the anesthesia and pediatric surgery clinic of Selçuk University Medical Faculty Hospital. Data were collected through individual in-depth interviews through a semi-structured questionnaire in October 2022. Individual interviews were held in a suitable meeting room within the hospital with the participation of two researchers. Note-taking technique was used in the interviews and a voice recorder was used. The qualitative data obtained were analyzed by the researchers with the content analysis method. Results: Qualitative findings were determined as four main themes: thoughts about pain, beliefs about pain management, the role of health professionals in pain management, and the role of family/parent in pain management. Conclusion: As a result of the study, it was determined that pain was followed, pharmacological methods were used, non-pharmacological methods were not in the clinical routine, teamwork was important in pain management, and the family/parent were with the child

Radial sinir duyusal dalının iki taraflı izole kesisi

Bilateral injuries of the sensory branch of the radial nerve (SBRN) usually occur as a result of tight-handcuff neuropathy. In this case we aimed to present bilateral isolated cut of SBRN resulting an injury mechanism that has not been reported in the literature previously. A male twentyfour years old, a worker in a glass factory, presented to our clinic. The dorsolateral skin of his wrists were cut by breaking of the glass as a result of occupational accident and was primarily sutured in a healthcare center. The patient sought additional care after a month because of lingering numbness and pain, and surgery was planned. During surgery, scar tissue and neuroma at the cut ends of SBRN were excised, and bilateral SBRN cuts were repaired. Four weeks after operation, mild sensory deficit on the dorsal side of bilateral thumbs, and left first web space and flexion limitation on the right wrist were detected. At the 3rd month postoperative, right wrist joint range of motion was full, and sensory deficits, and hyperesthesia were decreased. The SBRN elicits the sensory innervation of the thumb dorsum and its injury does not cause important functional deficit. However because of susceptibility of SBRN to develop painful neuroma, diagnosis, treatment and follow up of isolated SBRN injury would be worthwhile for prevention of possible painful neuropathy disturbing quality of life

Assessment of the Opinions of Anesthesiology and Reanimation Research Assistants Regarding Clinical Anatomy Education: A University Example

Introduction: Anatomy is considered one of the cornerstones of medical education. In-depth understanding of anatomy is essential, especially for safe clinical practice in surgical disciplines. This study aimed to evaluate the feedback of research assistants in the department of anesthesiology and reanimation, who received clinical anatomy education. Methods: Clinical anatomy education was provided for research assistants at different levels in the department of anesthesiology and reanimation, with two hours per week, and the education was completed within one month. The 5-point Likert scale questionnaire consisting of 18 questions was administered to research assistants to gather their opinions about education. Participants were asked to rate the questions on a scale from 1 to 5. Additionally, data such as age, gender, duration of clinical experience, experience with neuroaxial or peripheral nerve blocks, and participation in regional anesthesia courses were recorded. Results: A total of 40 participants, including 15 (37.5%) males and 25 (62.5%) females, with an average age of 29.67 ± 3.94 years, were included in the study. Nearly all participants in our study reported that integrated clinical anatomy education is necessary. The majority mentioned that anatomy education would contribute to airway management and regional anesthesia applications. The participation rate in regional anesthesia courses before education was 17.5%. There was no significant difference in average questionnaire scores between those who participated in regional anesthesia courses and those who did not (p=0.06). Conclusion: In the process of anesthesiology and reanimation specialization training, we believe that incorporating clinical anatomy education would enhance the quality of specialization education, thereby improving safety and effectiveness in clinical applications

Farklı deksmedetomidin infüzyon hızlarının desfluran anestezisi altında BIS monitorizasyonu rehberliğinde karşılaştırılması

Bu çalışmamızda, sedatif ve analjezik etkinliği sebebiyle dexmedetomidinin, bispektral indeks (BIS) rehberliğinde optimum hemodinamik ve humoral stabilitenin sağlanmasında en uygun infüzyon hızım araştırmayı amaçladık. Bu çalışmaya ASA I-II grubu, Total Abdominal Histerektomi-Bilateral Salpingo Ooferektomi planlanan ve yaşlan 18-65 arasında değişen 71 hasta alındı. Hastalar rastgele üç gruba ayrılarak operasyondan önceki gece premedikasyon uygulandı. BIS, ortalama arter basıncı (O AB), kalp atım hızı (KAH) ve Sp02 kontrol değerleri kaydedildi. Sedasyon skorları Ramsay sedasyon skorlaması ile değerlendirildi. Stres hormon (glikoz, kortizol, insulin, ACTH) analizi için üç ayrı zamanda kan örnekleri alındı. Anestezi indüksiyonundan önce her üç gruba deksmetedomidin lugr/kg dozunda 10 dakika içinde uygulandı. İndüksiyonla birlikte her bir grup için farklı konsantrasyonda dexmedetomidin infüzyonu uygulanmaya başlandı ve tüm cerrahi süresince devam edildi. Anestezi indüksiyonunda lugr/kg, fentanilin uygulanmasını müteakip BIS rehberliğinde yeterli anestezi derinliği oluşuncaya kadar propofol ve kas gevşemesi için atrakuryum uygulandı. İdamede desfluran kullanıldı. Hemodinamik parametrelere ait ölçümler dexmedetomidin yüklemesi sırasında, entübasyon ve cerrahi insizyondan birer dakika sonra,cerrahi süre boyunca onar dakika ara ile ve ekstübasyon döneminde tekrarlandı, Extubasyonun 1. ve 15. dakikalarında hastalar Aldrete derlenme skoruyla değerlendirildi. Hasta kontrollü analjezi tekniği ve visüel analog skoru (VAS) kullanılarak ameliyat sonrası analjezik gereksinimi ve yan etkileri açısından değerlendirildi. Verilerin istatistiksel analizi varyans analizi, kikare ve pearson korelasyon testi ile yapıldı. Anlamlılık seviyesi p0.05). Gaz kesme, göz açma, ad söyleme ve komutlara uyma zamanı değerleri ortalaması benzerdi (P>0.05). Olguların hemodinamik ve solunumsal parametrelerinin indüksiyona kadarki ölçüm değerleri gruplar arasında anlamlı bir farklılık göstermedi (P>0.05). İndüksiyondan itibaren operasyon sonuna kadarki dönem değerlendirildiğinde; OAB 40, 60, 80, 90, 100 ve 110. dakikalarda gruplar arasında anlamlı farklılık tespit edildi (P0.05). Glikozun zaman içindeki değişimleri grupların tamamında anlamlı artış gösterdi (PO.05). Kortizolde ekstübasyon değeri kontrol değerine göre anlamlı farklılık gösterdi (PO.05). İnsülin değerleri ise önce düşüş gösterip daha sonra ekstübasyonda en üst ortalama değerleri aldı. Grup II ve III de anlamlı değişiklik tespit edildi (PO.05). ACTH ortalama değerlerinin üç grupta da zaman içinde arttığı tespit edildi (PO.05). Operasyon sonrası yan etki oranlan benzerdi. Sedasyon 30. dakika ve 1. saat ölçümlerinde farklılık gösterdi. Çalışma gruplarının derlenme skorlarında benzerdi (P>0.05). Deksmedetomidinin aynı yükleme dozlarında laringoskopi, endotrekeal entübasyon, cilt insizyonu ve ekstübasyon periyodlannda gelişen hemodinamik yanıtı etkili bir şekilde baskılamada idame infüzyon hızlan arasında bir fark tespit edilememiştir. Bu anlamda anestezi idamesi için BIS rehberliği eşliğinde kullanıldığı takdirde seçilecek infüzyon hızının düşük ve orta miktarda olması önerilebilir.This research determined efficacy of three different dose infusions of dexmedetomidine by evaluating sedation, cardiorespiratory function and neuroendocrin stress response on surgery in 71 vomen (ASA fhysical status I-II) sheduled for total abdominal hysterectomy and bilateral salphingooferectomy. The study design included three sessions in which subject received, in random order lugr/kg dexmedetomidine load followed by infusions of either 0.2, 0.4 or 0.7 ugr/kgh"1 dexmedetomidine. After institution review board approval, the subject provided writen informed consent, inclusion criteria were women between the ages of 18 and 65 yr. who were free of uncontrolled sytemic disease. Exclucion criteria included story of serious adverse reaction or allergy to any drug, body weigth greater than 100 kg, an abnormal electrocardiogram; or use of alfa 2 agonists and antagonists. After premedication with atropine 0.5 mg intramusculary 30 minutes before surgery heart rate, blood pressure, respiratory rate, 02 saturation and bispectral analysis were monitored. Baseline measuraments were acquierd and measuraments were repeated at the 1., 3, 6. and 10. minutes of dexmedetomidine loading dose and 1 minute after induction, intubation skin incision and every 10 minutes per operatively and 1 minute after extubation. After the loading dose of dexmedetomidine anesthesia was induced with fentanyl lug/kg and propofol BIS quided until the lash reflex disappeared and maintaince with desflurane in 50% air and 02. desflurane was administered according to predetermined hemodynamic critaria. Dexmedetomidine maintaince dose continued until closure of the abdominal fascia and desflurane was discontinued with the last skin suture. Residual neuromuscular block was antagonized by 1 mg neostigmine and 0.5 mg atropine IV. Aldrete recovery score was applied at the first and fifteenth minutes after extubation, and those patients who had score 8 and over, and whose hemodynamic status was stable were admidded to their clinics. The statistical analysis was performed using analysis of variance (ANOVA), chi- squared test and Pearson corelation test. A P value of <0.05 was considered statistically significant. The two groups were similar in weight, age and duration of surgery. There was no difference between the means of BIS values and hemodynamic parameters before the surgery. Dexmedetomidine was well tolerated and no serious hemodynamic or other 51 possibly drug-related adverse events were observed. With the induction the difference between the MAP values of three groups in 40.,60.,80., 90., 100., 110. minutes, was obtained. The differences between the heart rate of the groups from the baseline until the end of the operation values, was not statisticaly significant. The ventilatory parameters, from the baseline to the induction period values, were different statisticaly. All the neuroendocrin humoral response to the surgery were statisticaly significant. Postoperative adverse event ratios were similar. Sedation scores were different in 30. and 60. minutes of recovery period. The Aldrete scores were similar between the groups. As a result dexmedetomidine infusion did not completely abolish the need for desflurane but diminished its requirement. The hemodinamic response to endotracheal intubation and skin incision was signifiantly blunted but was not able to attenued the stress response on surgery. The optimal dose of dexmedetomidine for maintaince of anaesthesia with desflurane appears to be in the range of 0.2-0.4 ij.gr/kgh"1