Anesthetic management of two patients with alkaptonuric ochronosis for total knee arthroplasty

The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. However respiratory, airway, cardiovascular and genitourinary systems complications can occur with age progressing. Restricted range of motion of cervical spine may lead to difficulty with airway management. In addition, degenerative changes and stiffness of lumbar spine due to ochronosis would make neuraxial blockade challenging. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for management of potential challenging problems. This report highlights special care and precautions that need to be taken during anesthetic management. Resumo: Este relato descreve o manejo anestésico em dois casos de ocronose alcaptonúrica. Alcaptonúria é uma doença genética rara do metabolismo de tirosina caracterizada por acúmulo de ácido homogentísico em cartilagem e tecidos conjuntivos. Os pacientes geralmente recorrem à cirurgia ortopédica devido à artropatia progressiva que, muitas vezes, pode ser diagnosticada incorretamente. No entanto, complicações das vias respiratórias, cardiovasculares e geniturinárias podem ocorrer com o avanço da idade. A restrição de mobilidade da coluna cervical pode levar ao manejo difícil das vias aéreas. Além disso, as alterações degenerativas e a rigidez da coluna lombar devido à ocronose podem tornar o bloqueio neuroaxial um desafio. Embora essa condição hereditária seja extremamente rara, os anestesiologistas devem estar cientes de sua existência e se prepararem para o manejo de potenciais problemas desafiadores. Este relato destaca os cuidados e precauções especiais que devem ser tomadas durante o manejo anestésico. Keywords: Alkaptonuria, Ochronosis, Anesthesia, Palavras-chave: Alcaptonúria, Ocronose, Anestesi

Anesthetic management of two patients with alkaptonuric ochronosis for total knee arthroplasty

Abstract The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. However respiratory, airway, cardiovascular and genitourinary systems complications can occur with age progressing. Restricted range of motion of cervical spine may lead to difficulty with airway management. In addition, degenerative changes and stiffness of lumbar spine due to ochronosis would make neuraxial blockade challenging. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for management of potential challenging problems. This report highlights special care and precautions that need to be taken during anesthetic management

Case Report Paravertebral Block Combined with Sedation for a Myasthenic Patient Undergoing Breast Augmentation

Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period

Paravertebral Block Combined with Sedation for a Myasthenic Patient Undergoing Breast Augmentation

Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period

Communication difficulties in perioperative anesthesia management for immigrant and refugee patients

Healthcare providers who encounter different ethnic groups have been faced with serious communication problems with immigrant and refugee (I/R) patients. The perioperative period is very important for both anesthesiologists and patients. In this study, it was aimed to reveal anesthesiologists problems related to I/R patients and to propose solutions for determined problems. An online survey questionnaire about the quantity and quality of communication problems that anesthesiologists come across in the perioperative period was developed. 120 of the anesthesiologists (49.0%) were trying to communicate by using body language or dictionary. 65 (26.5%) of the anesthesiologists could not communicate with these patients at all. During the process of taking Informed Consent Form before the anesthesia practice, 125 of the anesthesiologists (51.2%) stated that used a form written in physicians own language which was not understood by I/R patients. 76 anesthesiologists (31%) stated that they preferred general anesthesia instead of regional anesthesia because of language barriers. As a conclusion, the present study reveals that there are serious problems in the providing health care services regarding anesthesia to I/R patients especially due to the language barriers. [Med-Science 2019; 8(2.000): 375-80

Assessment of readability level of informed consent forms used in intensive care units

Informed consent forms are printed forms prepared to assist patients in the treatment process by explaining the indications, benefits and possible risks of medical practices. Readability describes understanding difficulty and is calculated by mathematical formulas. The study aimed to assess the readability level of Informed Consent Forms used in intensive care units. The informed consent forms from 45 hospitals in our country have been gathered. In each average form number of words, the average number of syllables and the average number of words with 4 or more syllables were manually calculated using the Microsoft Office Excel 2016® program. Their readability levels have been assessed with Atesman and Bezirci-Yilmaz readability formulas. The readability level of forms was difficult according to the Atesman readability formula and at undergraduate level according to the Bezirci-Yilmaz readability formula. The readability level of forms used in private hospitals was found to be significantly lower than that used in state and university hospitals (p=0.019, p=0.012). The average number of words and the average number of words with 4 or more syllables in forms were found to be significantly higher in private hospitals compared to state and university hospitals (p=0.004, p=0.01). It has been determined that the readability level of informed consent forms was at academic literacy level. To protect patient rights and to regulate patient-physician relationships by taking into account individuals rights, informed consent forms should be reviewed and that their readability levels should be adjusted to cover the overall educational level of individuals in the general population. [Med-Science 2019; 8(2.000): 277-81

Effect of alveolar recruitment maneuver on ischemia-modified albumin and oxidative stress in laparoscopic cholecystectomy

The effect of intraoperative recruitment maneuver on ischemia-modified albumin (IMA) and oxidative stress in performed laparoscopic cholecystectomy with intra-abdominal 12 mmHg pressure was investigated. Fifty patients undergoing laparoscopic cholecystectomy were included in the study by separating the two groups. Basal ventilator settings in both groups were set as tidal volume: 6-8 ml / kg, respiratory rate: 12 breaths / min, I: E = 1: 2, flow: 4 l / min. In group R, after intubation, 5 cm H2O PEEP was adjusted in addition to basal ventilator settings. Five minutes after CO2 insufflation and exsufflation, PEEP was step by step raised to 10-15-20 cm H2O, and patients were ventilated for 10 breaths. Venous blood samples were taken from the patients for three times in perioperative periods to measure IMA and oxidative stress.There was no difference between the groups in terms of demographic data, surgery and insufflation times. Significant differences in IMA,TOS,TAS and OSI levels within the group were observed but no difference was between groups. The recruitment maneuver that we used in laparoscopic cholecystectomies was found to have no effect reducing tissue ischemia and oxidative stress response in the intraoperative period. [Med-Science 2019; 8(2.000): 325-9

Are body roundness index and a body shape index in the first trimester related to foetal macrosomia?

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126–1.917, p = .005; OR = 4.289, % CI: 0.178–1.030, p = .012, OR = 6.277, %Cl: 1.233–31.948, p = .027, and OR = 1.393, %Cl: 1.060–1.832, p = .017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women.Impact statement What is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution. What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women. What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women

Assessment of the readability of patient education materials regarding breast cancer on websites

Introduction: The Google search engine is a widely used resource for accessing health-related patient education texts. Therefore accessible information in the texts should be accurate, up-to-date and appropriate to the general public health literacy level. In this research, we aimed to analyze the readability of patient education texts prepared for breast cancer presented on internet and to evaluate the content of texts.Methods:A total of 200 web sites at Google search engine were evaluated using the terms  “breast cancer and breast mass”. The average readability level was analyzed using Ateşman and Bezirci-Yilmaz readability formulas. The texts were also evaluated in terms of the risk factors identified in the development of breast cancer, the presence of examination and screening methods that could be used in early diagnosis.Results:A total 64 internet sites that are in compliance with the research criteria were evaluated. The overall mean reading level of the texts was found moderate, using the Ateşman formula and college level according to Bezirci. 18 Web sites had both the risk factors identified in the development of breast cancer and the methods of screenings.Conclusions: A total 64 internet sites that are in compliance with the research criteria were evaluated. The overall mean reading level of the texts was found moderate, using the Ateşman formula and college level according to Bezirci. 18 Web sites had both the risk factors identified in the development of breast cancer and the methods of screenings