The effects of total intravenous anesthesia and inhalational anesthesia on intra-abdominal pressure in the supine prone positions

Amaç: Sırtüstü ve yüzüstü pozisyonları verilerek ameliyat edilen olgularda, total intravenöz anestezi ve inhalasyonda sevofluran anestezisinin intraabdominal basınç, kardiyovasküler ve solunum sistemlerine etkileri karşılaştırıldı. Çalışma Planı: Çalışmaya, lomber diskektomi ameliyatı geçirecek ASA I-II 30 olgu (17 erkek, 13 kadın; ort. yaş 50; dağılım 35-70) total intravenöz anestezi (grup I, n=15) ve sevofluran anestezisi (grup II, n=15) uygulanmak üzere rastgele iki gruba ayrıldı. Grup I’de, intravenöz olarak uygulanan alfentanil ve propofol ile sağlanan indüksiyondan sonra entübasyon atrakuryum ile gerçekleştirildi. Anestezinin idamesinde ise alfentanil ve 10 dakikalık sürelerle azalan dozlarda propofol infüzyon şeklinde kullanıldı. Grup II’de, intravenöz propofol ile sağlanan indüksiyondan sonra atrakuryum ile entübasyon gerçekleştirildi. Anestezi sürekliliği sevofluran ile sağlandı. Olguların sırtüstü pozisyonda anestezi indüksiyonundan önce ve hemen sonra; yüzüstü pozisyonuna çevrildikten hemen sonra, ameliyat boyunca her 30 dakikada bir ve sırtüstü pozisyonda ekstübasyondan hemen sonra intraabdominal basınç, arter basıncı, kalp atım hızı, periferik oksijen satürasyonu, endtidal CO2 basıncı ölçülerek kaydedildi. Bulgular: İki grup arasında bütün ölçüm zamanlarında, intraabdominal basınç, hemodinamik ve solunum parametre değerleri arasında anlamlı farklılık bulunmadı. Sonuç: Her iki pozisyonda uygulanan total intravenöz anestezi ve sevofluran anestezisinin, intraabdominal basınç ile hemodinamik ve solunum parametrelerinde değişiklik oluşturmadığı belirlendi.Objectives: We compared the effects of total intravenous anesthesia and inhalational anesthesia with sevoflurane on intra-abdominal pressure and cardiovascular and respiratory systems in patients undergoing surgery in the supine and prone positions. Study Design: Thirty ASA I-II patients (17 males, 13 females; mean age 50 years; range 35 to 70 years) undergoing elective lumbar discectomy were randomly assigned to total intravenous anesthesia (group I, n=15) and inhalational anesthesia with sevoflurane (group II, n=15). In group I, after anesthesia induction with intravenous alfentanil and propofol, entubation was performed with atracurium. Anesthesia was maintained with alfentanil and decreasing doses of propofol. In group II, induction was obtained with intravenous propofol, entubation with atracurium, and maintenance with sevoflurane. Intra-abdominal pressure, arterial pressures, heart rate, peripheral oxygen saturation, and endtidal CO2 were monitored and recorded in the supine position before and after anesthesia induction, immediately after turning to the prone position, every 30 minutes throughout the operation, and immediately after extubation in the supine position. Results: At all times of monitoring, no significant differences were found between the two groups with respect to intraabdominal pressure, hemodynamic and respiratory parameters. Conclusion: Total intravenous anesthesia and sevoflurane anesthesia do not appear to affect intra-abdominal pressure, hemodynamic and respiratory parameters in both positions

Optimal interval and duration of CAM-ICU assessments for delirium detection after cardiac surgery

STUDY OBJECTIVE: Our goal was to determine when postoperative delirium first occurs, and to assess evaluation strategies that reliably detect delirium with lowest frequency of testing. DESIGN: This was a retrospective study that used a database from a five-center randomized trial. SETTING: Postoperative cardiothoracic ICU and surgical wards. PARTICIPANT: Adults scheduled for elective coronary artery bypass and/or valve surgery. INTERVENTION AND MEASUREMENTS: Postoperative delirium was assessed using CAM-ICU questionnaires twice daily for 5 days or until hospital discharge. Data were analyzed using frequency tables and Kaplan-Meier time-to-event estimators, the latter being used to summarize time to first positive CAM-ICU over POD1-5 for all patients for various evaluation strategies, including all assessments, only morning assessment, and only afternoon assessments. Sensitivity for various strategies were compared using McNemar\u27s test for paired proportions. MAIN RESULTS: A total of 95 of 788 patients (12% [95% CI, 10% to 15%]) had at least 1 episode of delirium within the first 5 postoperative days. Among all patients with delirium, 65% were identified by the end of the first postoperative day. Delirium was detected more often in the mornings (10% of patients) than evenings (7% of patients). Compared to delirium assessments twice daily for five days, we found that twice daily assessments for 4 days detected an estimated 97% (95% CI 91%, 99%) of delirium. Measurements twice daily for three days detected 90% (82%, 95%) of delirium. CONCLUSIONS: Postoperative delirium is common, and CAM-ICU assessments twice daily for 4 days, versus 5 days, detects nearly all delirium with 20% fewer assessments. Four days of assessment may usually be sufficient for clinical and research purposes

Hypoventilation in the PACU is associated with hypoventilation in the surgical ward: Post-hoc analysis of a randomized clinical trial

Objective: To evaluate the association between early postoperative hypoventilation in the last hour of the post -anesthesia care unit (PACU) stay and hypoventilation during the rest of the first 48 postoperative hours in the surgical ward. Design: Sub-analysis of a clinical trial. Setting: PACU and surgical wards of a single medical center. Patients: Adults having abdominal surgery under general anesthesia. Interventions: Monitoring with a respiratory volume monitor from admission to PACU until the earlier of 48 h after surgery or discharge. Measurements: The exposure was having at least one low minute-ventilation (MV) event during the last hour of PACU stay, defined as MV lower than 40% the predicted value lasting at least 1 min. The primary outcome was low MV events lasting at least 2 min during the rest of the first 48 postoperative hours, while in the surgical ward. The secondary outcome was the rate of low MV events per monitored hour. Main results: Data of 292 patients were analyzed, of which 20 (6.8%) patients had a low MV event in PACU. Low MV events in the surgical ward were found in 81 (28%) patients. All patients who had low MV events in PACU had events again in the ward, while 61/272 (22%) had an event in the ward but not in PACU. The incidence rate of low MV events per hour was 24 (95% CI: 13, 46) among patients having an event in the PACU, and 2 (1, 4) among those who did not. Conclusions: In adults recovering from abdominal surgery, events of hypoventilation during the first post-operative hour are associated with similar events during the rest of the first 48 postoperative hours, with positive predictive value approaching 100%. Sixty-one patients had ward hypoventilation that was not preceded by hypoventilation in PACU

Investigation of Meaning of Leisure Activities and the Satisfaction with Life of Students in the Faculty of Sport Sciences: An Example of Akdeniz University

Aim: It is known that recreational activities have positive effects on people's emotions, thoughts, morale and many other issues. The aim of this study was to measure students’ participation in recreational activities, life satisfaction and the meaning of leisure activities to the students in the Faculty of Sport Sciences at Akdeniz University.Method: A total of 252 students (60.3% male, 39.7% female) participated in the study. As data collection instruments, Turkish version (Köker, 1991) of Life Satisfaction Scale (LSS), which was developed by Diener et al. (1985), and Turkish version (Gürbüz et al., 2007) of Leisure Meanings Inventory (LMI) (Esteve et al., 1999) were used. SPSS Package program was used in the study. ANOVA was used in the data analysis.Findings: According to the findings of Leisure Meanings Inventory by classes, there was a statistically significant difference (p <0.005) among the groups. . This difference appears to be between sophomores and juniors when examined on a class-by-class basis. According to the findings of Leisure Meanings Inventory with regard to departments, it was noted that there was very little difference between them, although there was a difference in the averages. This difference was not statistically significant though. There was no statistically significant difference between groups regarding class and department variables according to the findings of Life Satisfaction Scale.Conclusion: The results of this study showed that there was a significant difference between sophomores and juniors while there was no significant difference between freshmen and seniors according to the LMI averages. There was no significant difference between the mean scores of LSS among the classes

Naloxegol and Postoperative Urinary Retention: A Randomized Trial

BACKGROUND: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. HYPOTHESIS: patients given naloxegol have lower residual bladder urine volume than those given placebo. METHODS: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. RESULTS: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. CONCLUSIONS: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery

The Significance of Hounsfield Unit and Tumor Diameter in the Differentiation of Malignant and Benign Adrenal Masses

Aim: The Hounsfield unit (HU) used in non-contrast computed tomography (CT) imaging can predict adrenal masses. In the literature, a HU measurement of >10 on non-contrast CT has been reported to have a wide range of sensitivity (33-72%) in detecting malignancy in patients with adrenal masses, and the size of malignant masses is >4 cm in approximately 90% of cases. The current study investigated the role of the HU value and tumor diameter measured on preoperative CT imaging in the differentiation of benign and malignant masses. Methods: Data analysis was conducted on patients undergoing adrenalectomy for adrenal masses at two different tertiary care centers between January 1, 2019 and January 1, 2023. Patients who underwent an adrenalectomy non-contrast CT scans were assessed for HU and tumor size. The patients were divided into two groups according to histopathologically confirmed benign or malignant masses. Statistical analysis, including receiver operating characteristic curve assessment, was performed to evaluate the diagnostic accuracy. Results: The study included 108 patients, of whom 66.7% (n=72) were female and 33.3% (n=36) were male. The mean age was 51.01±14.01 years. The laparoscopic technique was used in 72 patients, the robotic technique in 17, and the open technique in 19. The mean length of hospital stay was 4 (2-37) days. The mean tumor size was 55 (10-230) mm. The mean operative time was 80 (50-180) minutes. The mean amount of intraoperative blood loss was 40 (20-300) milliliters. The surgical method, tumor diameter, operative time, amount of intraoperative blood loss, and HU value of the mass statistically significantly differed between the groups (p<0.001). We found that the cut-off values of HU and tumor diameter for distinguishing malignant masses from benign masses were 30.5 and 72.5 mm, respectively. At a cut-off value of 30.5 or above, HU had a sensitivity of 100% and a specificity of 81.6% in identifying malignant masses, whereas a sensitivity of 100% and a specificity of 88.7% were determined for malignant masses with a tumor size of 72.5 mm or above. Conclusion: The HU value and tumor diameter were crucial for distinguishing between benign and malignant adrenal masses, enhancing diagnostic accuracy, and informing treatment decisions

Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial

BACKGROUND: Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. METHODS: Adults having open partial nephrectomies were randomly allocated to epidural or unilateral subcostal anterior quadratus lumborum block. The joint primary outcomes were opioid consumption measured in morphine equivalents and pain measured on a numeric rating scale (0-10) from postanesthesia care unit (PACU) until 72 hours after surgery. The noninferiority deltas were 30% for opioid consumption and 1 point on a 0-10 scale for pain. Secondary outcomes included patient global assessment of pain management on the third postoperative day, the number of antiemetic medication doses through the third postoperative day, duration of PACU stay, and postoperative duration of hospitalization. RESULTS: Twenty-six patients were randomized to anterior quadratus lumborum block and 29 to epidural analgesia. Neither pain scores nor opioid consumption in the quadratus lumborum patients were noninferior to epidural analgesia. At 72 hours, mean ± standard deviation pain scores in subcoastal anterior quadratus lumborum block and epidural group were 4.7 ± 1.8 and 4.1 ± 1.7, with an estimated difference in pain scores of 0.62 (95% confidence interval [CI], 0.74-1.99; noninferiority P = .21). The median [Q1, Q3] opioid consumption was more than doubled in quadratus lumborum patients at 70 mg [43, 125] versus 30 mg [18, 75] in the epidural group with an estimated ratio of geometric means of 1.69 (95% CI, 0.66-4.33; noninferiority P = .80). Patient global assessment and duration of PACU and hospital stays did not differ significantly in the 2 groups. CONCLUSIONS: We were unable to show that subcostal anterior quadratus lumborum block are noninferior to epidural analgesia in terms of pain scores and opioid consumption for open partial nephrectomies. Effectiveness of novel blocks should be rigorously tested in specific surgical setting before widespread adoption

Ethnic Differences in Analgesic Efficacy and Safety of Liposomal Bupivacaine Among Asian and Caucasian Surgical Patients: A Retrospective Matched-Cohort Analysis

BACKGROUND: Extended-release local anesthetics allow for prolonged analgesia after a single administration. Although Asians demonstrate different pain thresholds than Caucasians, whether they have different postoperative local anesthetic analgesic effects has not been elucidated. OBJECTIVE: We aimed to compare the postoperative analgesic efficacy of liposomal bupivacaine on Asian and Caucasian adults, and the incidence of local anesthetic systemic toxicity (LAST) syndrome. METHODS: We conducted a retrospective, assessor-blinded cohort study of adult patients who received liposomal bupivacaine for surgery between 2012 and 2018. Asians and Caucasians were matched in a 1:1 ratio by clinical characteristics and surgery type. The primary outcome was pain management, defined as average pain score and opioid consumption during the initial 72 postoperative hours. The secondary outcome was the incidence of LAST syndrome. Reviewers were blinded to the ethnicity of the patient. RESULTS: After 1:1 propensity score matching, 130 Asians and 129 Caucasians were analyzed. All confounding variables were balanced, except for higher body mass index in the Asian group. Pain scores were lower (adjusted mean difference of -0.50 [97.5% CI, -0.98, -0.01]; superiority p = 0.011) and opioid consumption was not greater (geometric means ratio, 0.61 [97.5% CI, 0.36, 1.04]; non-inferiority p ＜ 0.001) in Asian patients compared to Caucasian patients. Only one Caucasian patient was judged as having a potential case of LAST syndrome. The length of hospital stay and the incidence of additional complications were not different between the groups. CONCLUSION: Asian adults receiving liposomal bupivacaine as part of multimodal perioperative analgesia demonstrated lower pain scores compared to matching Caucasians, despite not having greater opioid consumption