Anaesthetic Method Preference of Obstetricians for Caesarean Section

WOS: 000370842000009PubMed ID: 27366463Objective: Anaesthesiologists are applying regional anaesthesia for caesarean section at an increasing rate compared to previous years. In our study, we tried to evaluate the perspective of obstetricians towards this trend. Methods: Questionnaires were sent to e-mail addresses of obstetricians via the internet; 195 obstetricians replied. Sex, age, work place, employer, working durations as consultant, preference of anaesthesia for caesarean section and their bias towards regional anaesthesia were asked with these questionnaires. A 5-point Likert scale was used to evaluate their bias towards regional anaesthesia. Results: While 82.1% of obstetricians (n: 160) preferred regional anaesthesia, 17.9% of obstetricians (n: 35) favoured general anaesthesia for caesarean section for both themselves and their primary relatives. However, 80% of the participants opted for regional anaesthesia for their patients; only 20% of the participants still preferred general anaesthesia for caesarean section. Chi-square tests that were used to evaluate the relationship between demographic data and anaesthesia choices of obstetricians for both themselves, their primary relatives and their patients did not reveal any statistically significant differences (p<0.05). Conclusion: A large portion of Turkish obstetricians consider regional anaesthesia a safe procedure and prefer it highly for both themselves and their patients

Comparison of endotracheal intubation and a new-generation supraglottic airway device in training of difficult airway: a manikin study

WOS: 000437459200058Objective: To compare the performance times and success rates of the classic Macintosh laryngoscope (CML) or video laryngoscope (VL) with endotracheal intubation (ETI) and second-generation supraglottic airway devices (SAD) in difficult airway management during cardiopulmonary resuscitation (CPR). Materials and methods: Classic Macintosh Laryngoscope (D1), C-Mac (R) videolaryngoscope (D2), Laryngeal Tube LTS-D (R) (D3), LMA Supreme (R) (D4), i-gel (R) (D5) and air-Q (R) (D6) were used to achieve a secure airway in the study. In the first week, 60 trainee paramedics made ten attempts with each device using a manikin that was immobilized with a collar. Eight weeks later, the trainees made ten more attempts with each device. Application times, success rates, and the device preferences of the trainees were compared. Results: When we analyzed total application times, the shortest times were identified in the D5 and D6 groups. The success rate was low in the D1 group in the first ten attempts. There was no statistically significant difference in the last ten attempts. When we evaluated application skills after eight weeks, application times were improved significantly in all groups. The trainees stated that they would prefer D2, D5, and D3 devices during CPR. Conclusions: Practitioners with sufficient experience had high success rates with both ETI and SAD even though application times were different during CPR. SADs without a cuff seem advantageous compared with the others regarding total application times. However, no success rate difference was observed with the other devices

The spread of spinal anesthesia in term parturient: effect of hip/shoulder width ratio and vertebral column length

WOS: 000391260800118Objective: This study aims to determine the effect of age, height, weight, BMI, hip/shoulder width ratio, and vertebral column length on the spread of spinal anesthesia in term parturient. In pregnant patients with a larger hip width and a relative narrow shoulder width, more cephalad spread of spinal anesthesia is observed with a fixed dose of hyperbaric bupivacaine. We hypothesized that the increase in cephalad spread of spinal anesthesia may be correlated with the increased hip/shoulder width ratio. Methods: Age, weight, height, body mass index, hip width, shoulder width, hip/shoulder width ratio, and vertebral column length were recorded for 75 term parturient. The L4-L5 interspace was introduced and 2 ml 0.5% hyperbaric bupivacaine was injected subarachnoid in 10 seconds without barbotage. Pearson and Sperman's Rho Correlation Tests were used for the analysis of correlation between patient characteristics and the cephalad spread of spinal anesthesia. Results: Hip/shoulder width ratio had a positive correlation with the cephalad spread of spinal anesthesia (P=0.037). Other patient variables in the present study did not have correlation with the cephalad spread of spinal anesthesia (P>0.05). Vertebral column length had correlation with patient height (P=0.01). Conclusions: The cephalad spread of spinal anesthesia is correlated with hip/shoulder width ratio in term parturient patients. Vertebral column length has no correlation with the spinal anesthesia spread but correlates with the height of the parturient. The hip/ shoulder width ratio may be more important than either patient height or vertebral column length in predicting the cephalad spread of spinal anesthesia for each parturient

The effects of aromatherapy using rose oil (Rosa damascena Mill.) on preoperative anxiety: A prospective randomized clinical trial

WOS: 000462046300006Introduction: Preoperative anxiety is a common problem before anesthesia. Pharmacologic agents or non-pharmacologic methods are widely used to reduce preoperative anxiety. The aim of our study was to investigate the effect of aromatherapy with rose oil on preoperative anxiety. Methods: This study was a prospective, randomized, controlled trial. The patients (n = 99) were randomized as the control group (group C), the sham group (group S) and the rose oil group (group R). The State-Trait Anxiety Inventory-State Questionnaire of Spielberger (STAI-S) was used to determine anxiety levels. The first STAI-S (Q_1) was administered in the otorhinolaryngology clinic in the morning on the day of the operation. Group C received no intervention. In group S, a mixture (distilled water/ethyl alcohol) and in group R, a mixture (distilled water/ethyl alcohol/0.2 mL rose oil (Rosa damascena Mill.)) was used with the ultrasonic aroma diffuser. Aromatherapy was applied by an ultrasonic nebulizer for 15 min before patients went to the operating room for surgery in group S and group R.In the operating room, the second STAI-S (Q_2) were recorded. Results: There was no statistical significant difference between the groups at baseline in terms of Q_1 scores, but when the second STAI-S was administered after the intervention, there was a significant difference in Q_2 scores (43.15 +/- 7.55, 36.03 +/- 9.60, respectively, 95% CI, 38.39-43.12, P = .004) between group C and R. Conclusions: The application of rose oil aromatherapy by inhalation reduced the scores of preoperative anxiety of patients undergoing septorhinoplasty/rhinoplasty

Comparison of Classic and Inguinal Obturator Nerve Blocks Applied for Preventing Adductor Muscle Contractions in Bladder Tumor Surgeries: A Prospective Randomized Trial

WOS: 000460995500012PubMed ID: 30345498Purpose: Obturator nerve block (ONB) has been performed in surgeries of transurethral resection of bladder tumors (TUR-BT) for the prevention of the development of obturator muscle contraction. Currently, classic and inguinal approaches are frequently being used. In the present study, we aimed to compare the success rate, performance speed, and complication risks of both approaches. Materials and Methods: Sixty-six patients who underwent TUR-BT under spinal anesthesia were randomly selected, and ONB was performed on the tumor location side using classic (n = 33) or inguinal (n = 33) approaches. Ten milliliters of 0.25% bupivacaine were administered using a peripheral nerve stimulator in both approaches. Two endpoints were defined in the study: Primary endpoint; the duration of the determination of the obturator nerve and number of interventions when each participant is assessed in at the end of the ONB procedure. Secondary endpoint; development of contractions, and complications each participant is assessed during the TUR-BT and 24 hours after ONB. (Clinical Trial Registration Number: ACTRN12617001050347) Result: General anesthesia was applied to the five patients in the classic ONB group who detected diffuse or bilateral tumors. These patients were excluded from the study. Contractions developed in 4 patients in each group, no statistically significant difference was detected between the groups (14.3%, n = 4 versus 12.1%, n = 4) (P = 1.00). No complications were detected in both groups during the TUR-BT and 24 hours after ONB. We found that the inguinal approach provided a statistically significant advantage regarding the number of punctures (1.9 +/- 0.9 versus 1.5 +/- 0.7) (P =.036), and duration of the procedure (99.1 +/- 48.4 seconds versus 76.0 +/- 31.9 seconds) (P=.029) compared with the classic approach. Conclusion: Although complications and success rates were similar in both groups, the inguinal method may be a better approach because it is faster and requires fewer punctures

The role of videolaryngoscope in endotracheal intubation training programs

WOS: 000441502600004PubMed ID: 30025947Background: Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods: Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC (R) videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. Results: Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group-VM (p = 0.008). Conclusions: The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes tater. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs. (C) 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda

The role of videolaryngoscope in endotracheal intubation training programs

Background: Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods: Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. Results: Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group-VM (p = 0.008). Conclusions: The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs. Resumo: Justificativa: Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos: A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo-MM e Grupo-MV utilizaram laringoscópios Macintosh e o Grupo-VV e Grupo-VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo-MM e Grupo-VM e videolaringoscópios pelo Grupo VV e Grupo-MV. Resultados: As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV (p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo-VM (p = 0,008). Conclusões: A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal. Keywords: Macintosh laryngoscopes, Videolaryngoscopes, Endotracheal intubation, Education, Cardiopulmonary resuscitation, Anesthesiologists, Paramedic, Emergency staff, Palavras-chave: Laringoscópios Macintosh, Videolaringoscópios, Intubação endotraqueal, Educação, Reanimação cardiopulmonar, Anestesiologistas, Paramédico, Equipe de emergênci

Achalasia case detected during endoscopy application accompanied by anaesthesia

WOS: 000390680400014PubMed ID: 28053688

Evaluation of medical drug and herbal product use before anesthesia

WOS: 000374655200518We aimed to determine the prevalence of herbal product and medical drug use among preoperative patients. Patients over the age of 18 applied for preanesthetic evaluation were directly asked by anesthesiologists if they were using any drug. Patients were also asked whether they use any herbal product. We also asked patients whether they know the side effects of herbal product or any drug they have used. 898 surgical patients were evaluated in the anesthesia assessment unit before surgery for a 3-month period. 43.4% patients were taking medical drugs. 9.5% patients reported taking herbal products and 21 of those patients were consuming more than one. 33 of all patients were using both medical drug and herbal product. The most commonly consumed herbal products, in descending order of frequency, were green tea (n=29), lime (n=20), garlic (n=8), ginger (n=7) nettle (n=7) ye daisy (n=5). 375 patients reported using medical drug in the initial assesment. Whereas only 4 patients reported consuming herbal product in the initial assesment. 38 (9.7%) of patients using medical drug and 3 (3.5%) of patients using herbal product said that they know the side effects of drugs. Usage of herbal product is common among patients undergoing surgery. Anesthesiologists should be aware of the herbal use because the patients may not give information about herbal consumption. Most commonly used herbal products may vary according to regions. Most of the patients do not know the side effects of both medical drug and herbal products

Role of Ultrasonography in Detecting the Localisation of the Nasoenteric Tube

WOS: 000399412700011PubMed ID: 28439443Objective: In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area using ultrasonography (USG) and compare with the commonly used method direct abdominal graphy. Methods: A single anaesthesiologist placed all the NETs. The NET was visualised by two radiologists simultaneously using USG. The localisation of the tube was confirmed using an abdominal graph in all patients. Results: The blind bedside method was used for NET insertion into 34 patients. Eleven of the tubes were detected passing through the postpyloric area using USG. In one case, the NET could not be visualised in the postpyloric area using USG; however, it was detected in the postpyloric area through control abdominal radiography. In 22 patients, NETs were detected in the stomach using control abdominal radiography. The rate of imaging post pyloric using USG was 91.6%. When all cases were considered, catheter localisation was detected accurately using USG by 97% (33 in 34 patients). Conclusion: USG is a reliable and practical alternative to radiography, which can be used to detect localisation of the nasogastric tube and NET