Effect of ultrasound-guided erector spinae plane block on post-surgical pain in patients undergoing nephrectomy: a single-center, randomized, double-blind, controlled trial

Objective Erector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group. Methods In a single-center, double-blind randomized comparative trial, patients undergoing nephrectomy with a subcostal flank incision under general anesthesia were divided into the following two groups: ESP block group (ESP block before anesthesia) and non-ESP (control) group (no intervention). The primary outcome measure was pain score (Numeric Rating Scale [NRS] 0 to 10). Secondary outcomes were postoperative opiate use, anesthetic and surgical complications, length of hospital stay, and patient-reported outcomes. Results Postoperatively (0 to 24 hours), the ESP block group experienced less pain and had lower NRS pain scores 0 to 24 hours postoperatively than the non-ESP group. Opioid consumption and the number of rescue analgesic doses decreased significantly in the ESP group compared with the non-ESP group. Patient-Reported Outcomes Information System (Quality of Recovery-15) scores significantly improved in the ESP group compared with the non-ESP block group. Conclusions Patients receiving an ESP block for intraoperative and postoperative analgesia during radical nephrectomies experienced less postoperative pain 0 to 24 hours compared with the non-ESP group

Evaluation of surgical nurses’ attitudes concerning patient safety

The present study was designed as a descriptive study to evaluate the attitudes of surgical nurses concerning patient safety. The study included 123 nurses, who have been working in the operating rooms of the hospitals in Karaman, Konya for at least one year and were voluntary to participate in the study. Data collection tools included a questionnaire to inquire demographic characteristics of surgical nurses, and “Safety Attitudes Questionnaire (SAQ) -Operating Room Version” to evaluate their attitudes concerning patient safety. The mean scores obtained from SAQ sub-dimensions were between 42.12 ±16.82 and 69.07±24.44, whereas the mean score of SAQ total was 59.11 ±13.29. Statistically significant difference was determined between the mean SAQ total score and age, weekly working hours, duration of working in the operating room, resting status, receiving in service training, and training about patient safety. The present study will enhance patient safety in operating rooms by providing an improvement in communication among health workers and in team collaboration, regulating working hours, and scheduling training programs to establish an opinion about worker safety and patient safety

Dedikodu Hemşirelerin İş Performansı Algıları ile İlişkili midir?

This study seeks to reveal the relationship between nurse_x000D_ job performance and gossip level. The data were collected from 211 nurses working in training and research_x000D_ hospitals and public hospitals affiliated with the Provincial Directorate of Health in Sakarya province of Turkey_x000D_ between April and June 2018. The data collection tool_x000D_ was a scale consisting of three sections that are Nurse_x000D_ Performance Scale, Gossip Questionnaire, and Introductory Information Form. For analysis, independent sample_x000D_ t test, one-way variance analysis, and correlation and regression analyses were employed. The study showed that_x000D_ there is a negative, insignificant relationship between_x000D_ nurses’ gossip perceptions and performance perceptions_x000D_ (r= -0.134; p>0.05). It is possible to say that despite the_x000D_ negative relationship between influences, one of the subdimensions of gossip, and nurse performance, informal_x000D_ communication among nurses does not create a negative_x000D_ effect on nurse performance.Bu çalışma hemşirelerin iş performansı ile dedikodu düzeyleri arasındaki ilişkiyi belirlemek amacıyla gerçekleştirilmiştir. Çalışmanın verileri Nisan-Haziran 2018 tarihleri arasında Sakarya ilinde faaliyet gösteren İl Sağlık Müdürlüğüne bağlı eğitim ve araştırma hastanesi ve kamu hastanesinde çalışan 211 hemşireden toplanmıştır. Veri toplama_x000D_ aracı olarak; hemşire performansı ölçeği, dedikodu ölçeği_x000D_ ve tanıtıcı bilgi formu olmak üzere üç bölümden oluşan anket formu kullanılmıştır. Verilerin analizinde bağımsız örneklem testi ve tek yönlü varyans analizi; korelasyon, regresyon analizleri kullanılmıştır. Çalışmada, hemşirelerin dedikodu işlev algıları ile performans algıları arasında negatif_x000D_ yönlü olmasına rağmen anlamlı ilişkinin olmadığı tespit_x000D_ edilmiştir (r= -0,134; p>0,05). Dedikodu alt boyutundan etkileme boyutu ile hemşirelerin performansları arasında_x000D_ olumsuz yönde etkileşim olsa bile hemşireler arasındaki informal iletişim ağının performansları üzerinde olumsuzluk_x000D_ oluşturmadığını söyleyebiliriz

ATYPICAL CT FINDINGS AND CLINICAL CORRELATION OF COVID-19 PNEUMONIA

Aim: Our study aimed to evaluate the atypical CT findings and concomitant pathologies of COVID-19 pneumonia and clinical and laboratory findings and compare them with typical CT findings.Materials and Methods: A total of 69 patients were diagnosed with COVID-19, 14 of which were atypical (20.2%), and 55 of which were typical (79%) chest computed tomography (CT) findings. CT images and clinical and laboratory data of patients with atypical findings were retrospectively analyzed. Lesions of the typical and atypical group and CT severity scores were compared.Results: Atypical CT findings were centrilobular nodule, tree in bud, pleural effusion, lobar/segmental consolidation, bronchiectasis, pulmonary embolism, and mosaic attenuation by typical lesions with ground-glass opacity with/without consolidation. CT severity score was significantly higher in the atypical group (p <0.001). CRP, procalcitonin, the neutrophil rate increased, and the lymphocyte count decreased in patients with a high CT severity score. Comorbidity was common in the atypical group (50%).Conclusion: High CT severity score and widespread lung involvement of the patient group with atypical CT findings may be due to disease progression or other concomitant diseases. Atypical lesions accompanying typical lesions may cause false negativity in reporting. As radiologists' experience with COVID-19 pneumonia increases, it may improve that they categorize these images as typical or atypical

COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

An assessment of the preoperative information given to patients in the province of Karaman

The purpose of this research was to determine the status of information provision for patients in the preoperative period. Two hundred fifty patients undergoing surgery in the Karaman Public Hospital. A questionnaire prepared by the authors based on information in the literature and consisting of questions intended to determine patients’ sociodemographic characteristics and the preoperative provision of information was used as a data collection tool. Data were expressed as number, percentage, mean and standard deviation. Mean age of patients was 45±21.08 years. We determined that 47.2% had been given information concerning preoperative procedures and preoperative preparations, and that 7.6% had been given this information by nurses. In the light of the study findings, we conclude that physicians and nurses need to be more proactive in providing patients with preoperative information and that, considering the forgetfulness factor, such information should also be provided in written form

Lornoxicam use to reduce the pain associated with propofol injection

Aim: To investigate the efficacy of lornoxicam in the prevention of the pain associated with propofol injection.Material and method: Approval for this study was granted by the ethics committee of our hospital. Using a computer randomisation software, 120 patients undergoing elective surgery were assigned to four equal groups. In Group I (control group), immediately before anaesthesia induction, 10 ml of isotonic 0.9% NaCl solution (placebo) was administered intravenously (IV). In Groups II, III and IV, the same injection contained 2 mg, 4 mg and 8 mg of lornoxicam respectively. A tourniquet was then applied to the forearm for two minutes. Pain evaluation was made using a verbal pain score.Results: Differences in pain severity scores were statistically significant between Groups I and II, Groups I and III, Groups I and IV and between Groups II and III (p &lt; 0.05). However, no significant difference was determined between Groups III and IV (p = 0.401).Conclusion: In all groups administered with lornoxicam, there was a significant reduction in the severity of pain associated with propofol injection, in comparison with the control group. Maximum effect is obtained with a dose of 4 mg

Ultrasound-guided serratus plane block combined with intercostal block for a high-risk patient with pericardial tamponade: A case report

Anesthetic management of patients with pericardial tamponade is challenging. A 65-year-old man diagnosed with small-cell lung carcinoma and bilateral malignant pleural effusion in the lungs and pericardial effusion was scheduled for pericardial-window-opening surgery. The severely compromised lung function of the patient led to an anesthetic plan of ultrasound-guided serratus anterior plane block combined with an intercostal block. Although serratus plane block was initially developed for postoperative analgesia, we have shown here that it can be used under deep sedation in combination with an intercostal block for anesthesia for surgeries involving the hemithorax; the block may be promising in high-risk cases

Dişeti çekilmelerinin tedavisinde farklı cerrahi teknikler ile birlikte mine matriks türevlerinin kullanımı: Bir olgu sunumu

Dişeti çekilmelerinin tedavisinde, uzun birleşim epiteli ile sonuçlanan konvansiyonel cerrahi teknikler dışında, çıplak kök yüzeylerinde periodontal rejenerasyonu sağlamak amacıyla son yıllarda mine matriks türevleri (MMT) kullanımı gündeme gelmiştir. Yapılan çalışmalarda MMT’nin yeni periodontal ligament, kemik, sement oluşumunu uyardığı gösterilmiştir. Bu olgu raporunun amacı: kök yüzeyi kapatılmasında, koronale pozisyone flep (KPF) ile birlikte MMT, epitel bant içeren subepitelyal bağ dokusu grefti (EBDG) ve epitel bant içermeyen supepitelyal bağ dokusu grefti (BDG) ile birlikte MMT uygulamalarının etkinliğinin klinik olarak değerlendirilmesidir. Yüzüncü Yıl Üniversitesi Diş Hekimliği Fakültesi’ne dişeti çekilmesi şikayeti ile başvuran 33 yaşında, sistemik olarak sağlıklı erkek hastaya ait alt, üst çene kanin dişlerde bulunan dişeti çekilmeleri periodontal plastik cerrahi yöntemler ile tedavi edilmiştir. Başlangıç periodontal tedaviyi takiben hasta yeniden değerlendirilmiş ve cerrahi operasyonlar gerçekleştirilmiştir. 13, 23 nolu dişlerde bulunan Miller sınıf 1 dişeti çekilmeleri, KPF+MMT ile tedavi edilirken, 43 nolu dişteki Miller sınıf I dişeti çekilmesi BDG+MMT ile, 33 nolu dişte bulunan Miller sınıf II dişeti çekilmesi EBDG+MMT ile tedavi edilmiştir. Klinik parametreler; sondalama derinliği, klinik ataşman seviyesi, keratinize doku yüksekliği, çekilme derinliği, çekilme genişliği, yapışık dişeti genişliği operasyon öncesinde, operasyon sonrası 6. ayda ve operasyon sonrası 3. yılda değerlendirilmiştir. Operasyon sahasının yara iyileşme indeksi cerrahi sonrası 1. ve 4. haftada kaydedilmiştir. Kullanılan üç teknikte de yapışık dişeti genişliğinde ve keratinize doku yüksekliğinde artış, dişeti çekilme genişliği ve derinliğinde azalma, sondalama derinliğinde azalma, klinik ataşman seviyesinde kazanç görülmüştür. Bu olgu raporundan elde edilen klinik veriler KPF+MMT, EBDG+MMT, BDG+MMT tekniklerinin açık kök yüzeyinin kapatılmasında başarılı olduklarını göstermektedir

The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud’s disease

Stellate ganglion blockage (SGB) is a method used for treating Raynaud’s phenomenon (RP). This study primarily aimed to determine whether the perfusion index (PI) can be used an alternative to Horner’s signs in evaluating the efficacy of SGB in patients diagnosed with RP. In a total of 40 patients, aged 18–65 years and diagnosed with primary RP, SGB was applied for 5 days on the same side with the 2-finger method, using 6 mL of 5% levobupivacaine at the 7th cervical vertebra level. The PI values were recorded from the distal end of the 2nd finger of the upper extremity on the side applied with the block at baseline and at 5, 15, 30, 60 and 120 min. The onset time of Horner findings was recorded. The PI values and visual analogue scale (VAS) pain scores were recorded pre-treatment and after 2 weeks.When the PI values of the 40 patients were examined, a 62.7% increase was observed from baseline to the first session at 5 min (p &lt; 0.05). When all sessions were evaluated, a statistically significant increase was determined in the PI values measured at 5, 15, 30, 60 and 120 min compared with the baseline PI values. There was a statistically significant decrease in the post-treatment VAS pain scores and a statistically significant increase in the post-treatment PI values (p &lt; 0.05). By eliminating peripheral vasospasm with the application of SGB in patients with RP, the distal artery blood flow and PI are increased. PI measurement is a more objective method and therefore could be used as an alternative to Horner findings in evaluating the success of SGB. PI is a non-invasive and simple measurement and also an earlier indicator in evaluating the success of SGB than Horner’s signs.Keywords: Raynaud’s phenomenon; perfusion index; stellate ganglion blockage; pain; Horner's sig