Can Ultrasound-Guided Femoral Vein Measurements Predict Spinal Anesthesia-Induced Hypotension in Non-Obstetric Surgery? A Prospective Observational Study

Background and objectives: To investigate whether ultrasound (US)-guided femoral vein (FV) and inferior vena cava (IVC) measurements obtained before spinal anesthesia (SA) can be utilized to predict SA-induced hypotension (SAIH) and to identify risk factors associated with SAIH in patients undergoing non-obstetric surgery under SA. Methods: This was a prospective observational study conducted between November 2021 and April 2022. The study included 95 patients over the age of 18 with an American Society of Anesthesiologists (ASA) physical status score of 1 or 2. The maximum and minimum diameters of FV and IVC were measured under US guidance before SA initiation, and the collapsibility index values of FV and IVC were calculated. Patients with and without SAIH were compared. Results: SAIH was observed in 12 patients (12.6%). Patients with and without SAIH were similar in terms of age [58 (IQR: 19–70) vs. 48 (IQR: 21–71; p = 0.081) and sex (males comprised 63.9% of the SAIH and 75.0% of the non-SAIH groups) (p = 0.533). According to univariate analysis, no significant relationship was found between SAIH and any of the FV or IVC measurements. Multiple logistic regression analysis revealed that having an ASA class of 2 was the only independent risk factor for SAIH development (p = 0.014), after adjusting for age, sex, and all other relevant parameters. Conclusions: There is not enough evidence to accept the feasibility of utilizing US-guided FV or IVC measurements to screen for SAIH development in patients undergoing non-obstetric surgery under SA. For this, multicenter studies with more participants are needed

Fibrin Glue's Intraabdominal Adhesion Creation Potential:Experimental Study

AMAÇ: Çalışmamızda abdominal operasyon yapılan sıçanlarda, hemostatik ajan olarak kullanılan Fibrin Glue(Tisseel)'nin operasyon sonrası intraabdominal adezyon oluşturma potansiyelini değerlendirdik.GEREÇ VE YÖNTEMLER: SB Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği'nde planlanan çalışmada, 30 (otuz) adet Wistar Albino cinsi dişi rat kullanıldı. Ratlar randomize olarak, 10'ar ratdan oluşan 3 gruba ayrıldı. Sham grubuna; laparotomi çekumun dışarı alınması ve yeniden batına gönderilmesi işlemi uygulandı.Kontrol grubuna; çekal abrazyon karşı peritondan 1x1 cm eksizyon işlemi, Fibrin Glue grubuna ise; çekal abrazyon karşı peritondan 1x1 cm eksizyon ve çekum üzerine Figrin Glue uygulaması yapıldı. Postoperatif 21. Günde ratlar yüksek doz anestezik verilerek sakrifiye edildi. Laparotomi esnasında adezyon skorlaması; yaygınlık, görünüm ve uygulanan kuvvete karşı direncin temel alındığı adezyon skorlaması; gruplar hakkında bilgisi olmayan bir cerrahi ekip tarafından; yaygınlığın, görünümün ve uygulanan kuvvete karşı direncin temel olarak alındığı bir yöntemle yapıldı. Periton ve çekumdan alınan doku örnekleri histopatolojik incelemeye gönderildi.BULGULAR: Adezyon skoru değerlendirmesinde, tüm gruplar Kruskal -Wallis Testi ile genel karşılaştırıldığında; Sham, Kontrol ve Fibrin Glue grupları arasında istatistiksel anlamlı fark bulundu (p 0.003). Mann-Whitney Testi ile yapılan ikili karşılaştırmalarda; Sham ve Kontrol grupları arasında istatistiksel anlamlı fark olduğu (p 0.013), Sham ve Fibrin Glue grupları arasında da anlamlı fark olduğu görüldü (p 0.001). Ancak Kontrol ve Fibrin Glue grupları arasında anlamlı istatistiksel fark bulunmadı (p0.05). Fibrin Glue grubunun adezyon skor ortalaması, Kontrol grubundan daha yüksek idi. Histopatolojik değerlendirme sonuçları için tüm gruplar Kruskal-Wallis Testi ile genel karşılaştırıldığında; Sham, Kontrol ve Fibrin Glue grupları arasında inflamasyon ve fibrozis açısından anlamlı fark olduğu (Fibrozis için p0.001, inflamasyon için p0.014) tespit edildi. Mann-Whitney Testi ile ikili grup karşılaştırılmalarında; Sham ve Kontrol grubu arasında anlamlı fark görüldü (inflamasyon için p0.022, fibrozis için p0.001), Sham ve Fibrin Glue grupları arasında da anlamlı fark görüldü( inflamasyon için p0.006, fibrozis için p0.002). Kontrol ve Fibrin Glue grupları arasında anlamlı fark yoktu (p0.05). Ancak, Fibrin Glue grubundaki inflamasyon ve fibrozis skor ortalamaları Kontrol grubundaki değerlerden daha yüksek idi. SONUÇ: Fibrin Glue (Tisseel)'nun intraabdominal yapışıklık oluşturma potansiyeli deneysel olarak değerlendirilmiş, makroskobik ve mikroskobik olarak yapılan karşılaştırmalarda; Sham, Kontrol grubu ve Fibrin Glue (Tisseel) grupları arasında istatistiksel olarak anlamlı fark bulunmuştur. Ancak, insanlardaki abdominal cerrahilerde olası adezyon potansiyelinin değerlendirilebilmesi için denek sayısının fazla olduğu daha kapsamlı çalışmalara ihtiyaç olduğu kanaatindeyiz.OBJECTIVE: In our study, we evaluated the potential of intraabdominal adhesion of fibrin glue (Tisseel), which is used as a hemostatic agent in rats undergoing abdominal surgery.MATERIAL AND METHODS: Thirty (30) female Wistar Albino rats were used in the study which was planned at the General Surgery Clinic of the Ankara Training and Research Hospital. The rats were randomly divided into 3 groups, each consisting of 10 rats. Sham group: Laparotomy withdrawal of the graft and resuscitation was performed. Control group: 1x1 cm excision process from cecal abrasion counterperiton. Fibrin Glue group; cecal abrasion 1x1 cm excision from the peritoneum and Fibrin Glue were applied on the cecum. On postoperative day 21, the rats were sacrificed by high dose anesthetic. Adhesion scoring during laparotomy; the prevalence, appearance, and resistance to applied force are based on adhesion scoring; by a surgical team without information about the groups; the appearance, and the resistance against the applied perspiration were used as a basis. Tissue specimens taken from the peritoneum and cecum were sent to a histopathological examination.RESULTS: When all groups were compared with the Kruskal-Wallis test in evaluating the adhesion score. There was statistically significant difference between sham, control and fibrin glue groups (p 0.003). In the binary comparisons made with the Mann-Whitney Test; There was a statistically significant difference between sham and control groups (p 0.013), and there was also a significant difference between sham and fibrin glue groups (p 0.001). However, there was no statistically significant difference between Control and Fibrin Glue groups (p> 0.05). The adhesion score average of the fibrin glue group was higher than the control group. When all groups were compared with Kruskal-Wallis test for histopathological evaluation results; There was a significant difference between the sham, control and fibrin glue groups in terms of inflammation and fibrosis (p 0.001 for fibrosis, p 0.014 for inflammation). Mann-Whitney test was used to compare the two groups; There was a significant difference between sham and control group (p 0.022 for inflammation, p 0.001 for fibrosis) and a significant difference between sham and fibrin glue groups (p 0.006 for inflammation and p 0.002 for fibrosis). There was no significant difference between control and fibrin glue groups (p> 0.05). However, the mean scores of inflammation and fibrosis in the fibrin glue group were higher than those in the Control group.CONCLUSION: Fibrin glue (Tisseel) has been experimentally evaluated in terms of the potential for intraabdominal adhesion formation, macroscopically and microscopically, There was a statistically significant difference between sham, control group and fibrin glue (Tisseel) groups. However, we believe that there is a need for more extensive studies to assess the potential adhesion of abdominal surgeons in humans