Doğum analjezisinde sürekli infüzyon ve hasta kontrollü analjezi yönteminin kombine spinal epidural ile epiduralanaljezi tekniklerinde klinik etkinliklerinin karşılastırılması

Çalısmamızda dogum analjezisinde sürekli infüzyon ile hasta kontrollü analjezi yönteminin kombine spinal epidural (KSE) ile epidural (EP) analjezi tekniklerinde klinik etkinliklerini karsılastırmayı amaçladık. Etik kurul onayı ile, vajinal dogum yapması planlanan gebelik haftası 36. ile 42. haftalar arasında, tek fetus, verteks presentasyonu olan 60 primigravid gebe çalısmaya alındı. Olgular rastgele iki gruba ayrıldı (Grup 1: KSE grubu, Grup 2: EP grubu). KSE grubundaki gebelere 2.5 mg hiperbarik bupivakin ile 25 µg fentanil, toplam volüm 1ml olacak sekilde verildi. Her iki grupta da kullanılmak üzere bupivakain (0.5 mg/ml) ile fentanil (1.5 µg/ml) içeren EP infüzyon solüsyonları hazırlandı. Agrının derecesi vizüel analog skala (VAS) kullanılarak degerlendirildi. EP grubundaki gebelere hemen, KSE grubundaki gebelere ise intratekal dozun analjezik etkisinin geçip VAS 4 oldugunda %0.125 bupivakain + 50 µg fentanil 10 ml yükleme dozu ve hemen ardından 10 ml/saat bazal hız olacak sekilde EP infüzyon baslandı. Iki gruptaki gebelerin ihtiyaç duyduklarında 10 ml bolus doz uygulayabilmeleri saglandı. Maternal ve fetal hemodinamik monitorizasyon yapıldı. Gebelere analjezi baslangıç dozu verildikten sonra agrının tamamen kaybolma süresi kaydedildi. Dogumun 1., 2. dönem süreleri, EPinfüzyon süresi, total EPinfüzyon miktarı, tüketilen bupivakain miktarları, ek bolus doz gereksinimi, travayda ve postpartum dönemde gelisen yan etkiler kaydedildi. KSE grubunda analjezinin baslama süresi EP gruba göre çok kısaydı. KSE grubunda özellikle dogumun 1. evresinde servikal dilatasyonda hızlı artma ve dogumun süresinde kısalma gözlendi. KSE grubunda annenin hemodinamisi daha iyi korundugu hipotansiyonun olmadıgı, infüze edilen lokal anestezi (LA) miktarlarının çok düsük oldugu ve anne memnuniyetinin EPgruba oranla daha fazla oldugu gözlendi. Dogum analjezisinde sürekli infüzyon ile birlikte hasta kontrollü analjezi yönteminde KSE analjezinin EPanaljeziye oranla daha güvenilir bir yöntem oldugunu söyleyebiliriz.Our aim was to compare the clinical efficacies of combined spinal-epidural analgesia and epidural analgesia techniques performed with the continuous patient controlled infusion method in labor analgesia. Following approval of the local ethics committee, 60 primigravid singleton pregnant women between 36 and 42 weeks of pregnancy, with vertex presentation and planned to give vaginal birth were included in the study. Patients were randomly divided into two groups. (Group 1: Combined spinal epidural analgesia (CSE) group and Group 2: Epidural analgesia (EP) group). Participants in CSE group were given a total volume of 1 ml, which is composed of 2.5 mg hyperbaric bupivacain and 25 µg fentanyl. EP infusion solutions were prepared with bupivacaine (0.5 mg/ml) and fentanyl (1.5µg/ml) for use in both groups. The degree of pain was assessed by using visual analogue scale (VAS).A10 ml loading dose consisting of 0.125% bupivacaine and 50 µg fentanyl was applied in the EP group. The CSE group received this dose when the VAS score reached 4 after the disapearance of the effect of intrathecal dose. EP infusions with a basal flow rate of 10ml/hr were given immediately after bolus doses. The pregnant women in both groups were able to apply themselves a bolus dose of 10 ml when needed. Maternal and fetal hemodynamic parameters were monitored. The period of time from the first application of analgesia until total dissappearance of the pain was recorded in all subjects. The durations of the first and second stages of labor, durations of EP infusions, total amounts of EP infusions, consumed bupivacaine amounts, any need for further bolus doses, adverse effects in the intrapartum and postpartum periods were recorded. Initiation time of analgesia in subjects of CSE group was much shorter than the EP group. Especially, more rapid dilatation of cervix in the first stage of labor and a shorter labor time were observed in CSE group. Better preserved maternal hemodynamics without hypotension, lower amounts of infused local anesthetics and better patient satisfaction were also observed in theCSEgroup compared with the EPgroup. We can comment that CSE analgesia technique performed with continuous patient controlled infusion method is a more reliable method than EPanalgesia technique in labor analgesia

COVID-19 pandemic and the global perspective of Turkish Thoracic Society

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions