Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Bel ağrısında pulse ve konvansiyonel radyofrekans termokoagulasyon uygulamaları

TEZ7152Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2009.Kaynakça (s.41-52) var.vii, 56 s. ; 29 cm.Purpose: While treating chronic low back pain several procedures are applied according to the algorithm. Radiofrequency thermocoagulation is one of these procedures. The basis of this procedure is producing damage with heat of the electrodes terminal.Amaç: Kronik bel agrısı tedavisinde algoritmaya uygun olarak çesitli yöntemler uygulanmaktadır. Radyofrekans termokoagulasyon yöntemi bunlardan biridir. Bu yöntemin temeli, elektod ucundaki ısı ile hasar olusturmaktır. Bu çalısmamızda pulse ve konvansiyonel radyofrekans termokoagulasyon uygulamalarının, tedavi açısından bel agrılarındaki etkinligini karsılastırmayı amaçladık. Gereç ve Yöntem: Fakültemiz Etik Kurul onayı ve olguların yazılı onayları alındıktan sonra radyofrekans uygulanacak toplam 30 hasta çalısma kapsamına alındı. Randomize çift kör olarak planlanan çalısmamız, her biri 15 hastadan olusan 2 gruba ayrıldı. Grup I'e 4 dk. 420C pulse radyofrekans, Grup II'e 2dk. 650C konvansiyonel radyofrekans uygulandı. Her iki gruptaki hastalara islem bitiminde toplam 3ml volum içinde Metilprednisolon ve Levobupivakain uygulandı. Her iki grupta da islem öncesi ile islem sonrası 1. ve 3. aylarda Vizuel Analog Skala degerleri (VAS), Modifiye OswestryBu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No

Can Point Shear Wave Elastography be Used as an Indicator of Metabolic Complications in Overweight Children and Adolescents? Evaluation of Subcutaneous Adipose Tissue

This study aims to search the association of obesity, metabolic parameters, and abdominal subcutaneous white adipose tissue (scWAT) stiffness in children and adolescents using ultrasound point shear wave elastography (p-SWE). One hundred and forty overweight or obese children referred to as overweight were included in the study group. Thirty-two lean children, referred to as leans, were included in the control group. In all individuals, scWAT shear wave speed (SWS) was measured with p-SWE. ScWAT stiffness was compared between the two groups. The association of anthropometric, metabolic factors and scWAT stiffness is determined. Weight, body mass index, body mass index-standard deviation score, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, fasting insulin were significantly higher in the overweight group (p<0.05). ScWAT SWS was significantly different between the groups (p=0.006) The median value of scWAT SWS was 1,5 m/s (range; 0.9-3.8), 1.23 m/s (range; 0.7-3.1) for leans and overweight, respectively. In leans, no significant difference was found between boys and girls for scWAT SWS (p=0.094). In overweight, a significant difference was found for scWAT SWS between boys and girls (p=0.022). The scWAT stiffness is lower in overweight than leans. Gender has a pivotal role in scWAT stiffness. If supported with future long-time follow-up studies, p-SWE may be compatible with assessing subcutaneous adipose tissue changes related to obesity and metabolic complications in childhood and adolescenc

Sugammadex in a Patient with Brugada Syndrome

Brugada Sendromu ilk kez 1992 yılında Pedro Brugada tarafından tanımlanan, ani kalp durması ile sonuçlanabilen ventrikül aritmi- leri ile karakterize genetik bir sendromdur. Bu sendromda özel- likle sağ dal bloğu ve sağ prekordiyal derivasyonlarda ST segment elevasyonu gözlenmektedir. Perioperatif birçok farmakolojik ve fizyolojik faktör bu malign aritmileri tetikleyebilir. Nadir görülen bir durum olmasına rağmen ölümcül komplikasyonlarla seyrede- bildiğinden Brugada Sendromunda anestezi uygulaması önem arz etmektedir. Brugada sendromlu hastaların ameliyatlarında birçok anestezi ilacı uygulanmıştır. Bu makalede sugammadeks kullanı- mının genel anestezi uygulanan Brugada sendromlu hastadaki yeri tartışıldı.Brugada Syndrome was first described in1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhyth- mias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right pre- cordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complica- tions. Many anaesthetics have been administered during the oper- ation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study

PERFORMANCES OF SESAME GENOTYPES (SESAMUM INDICUM L.) WITH DIFFERENT SEED SHELL COLORS IN SEMI-ARID CLIMATE CONDITIONS

This research was conducted to determine the adaptability of some sesame (Sesamum indicum L.) varieties as a second crop under semi-arid climatic conditions during 2014 and 2015. The experiment was conducted on the research area of Agricultural Faculty, Kezer Campus, Siirt University, Turkey. Thirteen registered sesame species were used as material in the experiment. The experiment was carried out in a randomized block design with four replications. Planting of sesame seeds was performed by hand following the harvest of wheat planted as the first crop. The plant height, number of side branches in the plant, the first branch height in the plant, the number of capsules per plant, the number of seeds per capsule, the weight of 1000 seeds, seed yield, fat content, fat yield and protein content were determined in the study. The results of two-year study revealed that 10 out of 13 varieties were not suitable to semi-arid climatic conditions (Siirt province ecological conditions). The varieties which were not adopted to semi-arid climatic conditions (Tan 99, 6DUÕVX 7DQDV g]EHUN .HSVXW 0XJDQOÕ 57, Baydar 2001, Ottoman 99, Orhangazi 99 and Cumhuriyet 99) are widely cultivated sesame cultivars in the Aegean and Mediterranean regions. The other WKUHH YDULHWLHV $UVODQEH\ +DWLSR÷OX DQG %R\GDN are mostly recommended for the Southeastern Anatolia Region. The study clearly revealed the importance of genotype x climate interaction in adaptation of sesame species to a region

Anesthesia for rigid bronchoscopy in children: single center experience

Amaç: Rijit bronkoskopi, çocuklarda başta yabancı cisim çıkarılması olmak üzere havayolunun incelenmesi ve örnek alınması için genel anestezi ile uygulanan cerrahi bir girişimdir. Retrospektif yapılan bu çalışmada rijit bronkoskopi uygulanan çocuklarda anestezi yönetimi ve perioperatif komplikasyonlar değerlendirildi. Gereç ve Yöntem: Ocak 2015 - Mart 2017 tarihleri arasında rijit bronkoskopi için alınan 74 olgu değerlendirmeye alındı. Olgulara ait bilgiler, Nükleus Medikal Bilgi Sistemi ve anestezi kayıt formlarından elde edildi. Bu kayıtlardan, hastaneye başvuru nedenleri, preoperatif özellikleri, anestezi yönetimi, komplikasyonlar ve yatış süreleri değerlendirildi. Bulgular: Olguların yaş ortancası 24 (3-156) ay, 41’i (%55.4) erkek, 33’ü (%44.6) kız olarak tespit edildi. Olgular yabancı cisim şüphesi (%40.5) ve öksürük (%31.1) şikayetleri nedeniyle hastaneye getirilmişlerdi. Olguların %52.7’sinin akciğer dinleme bulgusunda ve %67.6’sının akciğer grafisinde bir özellik olmadığı belirlendi. Anestezi indüksiyonunda intravenöz ajanlar (%91.8) ve non-depolarizan kas gevşeticilerin (%100) kullanıldığı ve manuel kontrollü ventilasyonun uygulandığı saptandı. Olguların %58.1’inden yabancı cisim çıkarıldığı belirlendi. Nöromusküler blok antagonizması için olguların %46’sında sugammadeks kullanılmıştı. Bir olguda pnömotoraks gelişirken, 5 olgu entübe olarak yoğun bakıma çıkarılmış ve mekanik ventilasyon uygulanmıştır. Sonuç: Rijit bronkoskopi, çocuklarda iyi planlanmış anestezi yöntemi ile güvenle uygulanabilir. Preoperatif değerlendirmenin iyi yapılması, intra- ve postoperatif dönemlerdeki yakın takip, olası komplikasyonların önlenmesinde etkilidir.Purpose: Rigid bronchoscopy is performed by general anesthesia because of inspection, taking sample and extraction of foreign body in airway. In this study, anesthesia methods, perioperative complication and hospitalization time of children performed rigid bronchoscopy was retrospectively noted. Materials and Methods: Seventy-four children performed rigid bronchoscopy were included to the study in between Jan/2015- Mar/2017. The data of patients were acquired from Nucleus Medical Information System and anesthesia registration forms. Major complaint, perioperative features, anesthesia managements, and hospitalization time were evaluated. Results: Median age was 24 (3-156) months. Forty-one (55.4%) were male and 33 (44.6%) were female. The patients were received for complaint of foreign body aspiration suspicion (40.5%) and cough (31.1%). 52.7% of patients’ lung auscultation and 67.6% of their lung x-ray were found to be normal. Intravenous agents (91.8%) and non-depolarizing neuromuscular blockers (100%) for anesthesia induction and manual controlled ventilation were used. Foreign bodies were found and extracted in 58.1% of the patients. Sugammadex was used for neuromuscular block antagonism in 46% of the patients. There was one pneumothorax, and 5 patients were received to intensive care unit by intubated and supported by mechanical ventilation. Conclusion: Rigid bronchoscopy is safely performed by good managed anesthesia. Meticulous evaluation of patients preoperatively and intense follow up of patients intra- and postoperatively are very important for the prevention of potential complications

Comparing the Laryngeal Mask Airway, Cobra Perilaryngeal Airway and Face Mask in Children Airway Management

OBJECTIVE: We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery. METHODS: In this study, 90 cases of 1–14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%–50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively. RESULTS: There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p<0.05). CONCLUSION: We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA

Comparing the Laryngeal Mask Airway, Cobra Perilaryngeal Airway and Face Mask in Children Airway Management

Amaç: Çalışmamız elektif inguinal bölge cerrahisi uygulanan pediyatrik olgularda havayolu açıklığı sağlamak için kullanılan laringeal maske, Cobra perilaringeal airway ve yüz maskesinin spontan ventilasyon sırasında etkilerinin karşılaştırılması amacıyla planlandı. Yöntemler: Elektif inguinal bölge cerrahisi uygulanacak 1-14 yaş arası 90 olgu çalışma kapsamına alındı. Üç gruba ayrılan hastalara anestezi indüksiyonunda sevofluran ve %50-50 azot protoksit-oksijen uygulandı. Yeterli anestezi derinliği sağlanarak Grup I ve II'ye supraglottik havayolu gereçleri yerleştirildi. Grup III'e ise yüz maskesi ile devam edildi. Güvenli havayolu sağlamak için geçirilen süre, kaçıncı denemede başarılı olduğu, olguların hemodinamik parametreleri, plato basıncı, pik inspirasyon basıncı, ekspirasyon sonu pozitif basınç indüksiyon sonrası, enstrümantasyon sonrası, peroperatif 5, 10, 15. ve 30. dakikada kaydedildi. Bulgular: Hemodinamik parametreler açısından gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Grup II'de enstrümantasyon süresinin daha kısa ve enstrümantasyon başarısının daha yüksek olduğu saptandı. ekspirasyonu sonu, plato ve pik inspirasyon basınçları Grup II'de istatistiksel olarak daha düşük saptandı (p0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (<0.05). Conclusion: We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA

Ultrasound guided rectus sheath block vs intravenous tramadol on postoperative analgesia in children undergoing inguinal hernia repair

Amaç: Rektus kılıf bloğu postoperatif ağrı kontrolünde kullanılan bir rejyonal anestezi tekniğidir. Açık inguinal herni tamiri cerrahisi geçiren çocuklarda ultrason kılavuzluğunda rektus kılıf bloğu ve intravenöz tramadol'ün postoperatif ağrı üzerindeki etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Genel anestezi altında inguinal herni cerrahisi geçirecek olan 2-7 yaşları arasındaki 40 hasta prospektif randomize çalışmaya dahil edildi. Hastalar iki gruba ayrıldı. Grup UR' deki (n=20) hastalara cerrahi öncesi 0,2 mg/kg dozunda %0,25 levobupivakain ile ultrason kılavuzluğunda rektus kılıf bloğu uygulandı. Grup T' deki (n=20) hastalara ise intravenöz 1 mg/kg tramadol uygulandı. Çalışmanın birincil sonucu postoperatif ağrı derecesidir. Postoperatif ağrı skorları, sedasyon seviyesi, ek analjezik gereksinimi ve yan etkiler kaydedildi. Bulgular: Ağrı skorları 5. dakika (UR 1.90 [95% confidence interval [CI], 1.05-2.74] ; T 5.50 [95% CI, 4.31-6.68; P < 0.001]), 15. dakika (UR 1.00 [95% CI, 0.27-1.72] ; T 4.65 [95% CI, 3.56-5.73; P < 0.001]), 30. dakika (UR 0.85 [95% CI, 0.08-1.61] vs T 3.05 [95% CI, 2.14-3.95; P < 0.001]) ve 60. dakikada (UR 0.20 [95% CI, -0.12-0.52] vs T 0.95 [95% CI, 0.41-1.48; P=0.008]) Grup T'ye göre Grup UR'de daha düşüktü. Ek analjezik ihtiyacını Grup T'de 15 hasta gösterirken Grup UR'de hiçbir göstermedi. Sonuç: İnguinal herni tamiri geçiren çocuklarda ultrason kılavuzluğunda rektus kılıf bloğu etkili postoperatif analjezi sağlar. Bu etki tramadol ile karşılaştırıldığında özellikle postoperatif ilk 1 saat boyunca daha belirgin ortaya çıkmaktadır.Purpose: Rectus sheath block is a regional anesthesia technique for postoperative pain control. We aimed to evaluate the effects of ultrasound-guided rectus sheath block on postoperative pain relief comparing with intravenous tramadol in children undergoing open inguinal hernia repair. Material and Methods: Forty children, aged between 2-7 years, scheduled for inguinal hernia repair were enrolled into this prospective assessor blinded randomized study. Patients were allocated into one of two groups to receive ultrasound-guided rectus sheath block with a dose of 0.2 ml/kg, levobupivacaine 0.25% (group UR, n=20) or tramadol IV of 1 mg/kg (group T, n=20) under general anesthesia. The primary endpoint was the postoperative pain degree. Postoperative pain scores, sedation levels, supplemental analgesic requirements, and side effects were recorded. Results: Pain scores were lower in group UR compared to group T at postoperative 5 min (UR 1.90 [95% confidence interval [CI], 1.05-2.74] vs T 5.50 [95% CI, 4.31-6.68; P < 0.001]), 15 min (UR 1.00 [95% CI, 0.27-1.72] vs T 4.65 [95% CI, 3.56-5.73; P < 0.001]), 30 min (UR 0.85 [95% CI, 0.08-1.61] vs T 3.05 [95% CI, 2.14-3.95; P < 0.001]) and 60 min (UR 0.20 [95% CI, -0.12-0.52] vs T 0.95 [95% CI, 0.41-1.48; P=0.008]). Fifteen patients required supplemental analgesic in group T whereas group UR patients did not require it. Conclusion: Ultrasound-guided rectus sheath block produces an effective postoperative pain relief in children undergoing inguinal hernia repair surgery, noticeably for the first postoperative hour, compared with tramadol