Comparison of Conscious and Deep Sedation Methods in Terms of Pulmonary Complications in ERCP Procedures of Patients with Billroth II Gastrectomy: A Retrospective Study

Background/Objective: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study was to compare conscious sedation and deep sedation in terms of pulmonary complications in this selected cohort. Methods: Patients who had previously undergone Billroth II surgery and underwent ERCP procedure with sedation for gallstones or biliary tract strictures in a tertiary hospital between January 2020 and September 2023 were studied. Patient records were retrospectively obtained from the hospital information system. All the patients were divided into two groups as conscious sedation (Group CS) and deep sedation (Group DS). The groups were compared statistically in terms of pulmonary complications. Results: A total of 63 ERCP procedures were performed on 28 patients who had undergone Billroth II gastrectomy. There were 37 procedures involving conscious sedation (Group CS) and 26 involving deep sedation (Group DS). No statistically significant difference was found regarding pulmonary aspiration (p = 0.297) and other respiratory complications such as laryngospasm or desaturation between the two groups. In Group DS, it was observed that vomiting incidence was higher (p = 0.012), and airway maneuver requirements were increased (p = 0.007). Conclusions: In patients who have undergone Billroth II gastrectomy, both conscious sedation and deep sedation techniques can be used effectively during ERCP procedures. The complication rates and patient outcomes of the two techniques are comparable. The occurrence of respiratory complications leading to adverse post-procedural outcomes requires careful monitoring and meticulous follow-up for these patients

Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities

The higher incidence of comorbidities in advanced age causes difficulties in anesthesia management. When choosing the anesthesia technique in old aged patients, our target must be to avoid aggravating the existing systemic diseases and avoid disturbing the hemodynamics to ensure their rapid return to routine life.  In this case report, we present our choice of infraclavicular nerve block accompanied with spinal anesthesia in a patient with advanced age and several comorbidities, who sustained multiple trauma. The surgery of the patient was successfully performed with minimal effects on the hemodynamics, and he was transferred to the clinic. We stress careful selection of the most appropriate anesthesia technique according to the existing state of the patient, and opting for appropriate nerve blocks even to the patients with respiratory problems.&#x0D; Key words: Advanced age; Trauma; Spinal anesthesia; Infraclavicular block&#x0D; Citation: Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. Anaesth. pain intensive care 2021;25(2):222-224. DOI: 10.35975/apic.v25i2.1475&#x0D; Received: 1 December 2020, Reviewed: 7 February 2021, Accepted: 23 February 2021</jats:p

Femoral venous catheter: intraperitoneal placement

Central venous cannulation through femoral veins is known to be associated with various complications. Early complications include extravasation and collection of blood, fluid, and/or contrast material in the retroperitoneal spaces or the peritoneal cavity, whereas late complications include abdominal compartment syndrome (ACS).&#x0D; A 30-year-old patient was admitted to the emergency department and brought into the operating room with a preliminary diagnosis of pelvic fracture and acute abdomen. An intravenous catheter was placed into the peripheral vein and a central venous catheter in the femoral vein, in the emergency room through which blood was transfused. At the start of the operation, it was found that intraperitoneal bleeding was caused by a perforation associated with the femoral catheter.&#x0D; We conclude that in the case of acute abdomen, if the femoral venous catheter was already placed in the emergency room, proper placement should be confirmed with ultrasound imaging.&#x0D; Key words: Central venous catheterization; Femoral vein; Complications; Acute abdomen; Ultrasound imaging; Emergency care&#x0D; Citation: Piskinel Y, Sahap M, Balci CA, Gulec H, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. Anaesth. pain intensive care 2021;25(2):203-205. DOI: 10.35975/apic.v25i2.1466&#x0D; Received: 23 November 2020. Reviewed: 10 February 2021, Accepted: 1 February 2021</jats:p

Efeito da infusão de esmolol sobre a necessidade de anestesia no intraoperatório e analgesia, náusea e vômito no pós‐operatório em um grupo de pacientes submetidos à colecistectomia laparoscópica

ResumoObjetivoA dor e a incidência de náusea e vômito no período pós‐operatório (NVP) são comuns em pacientes submetidos à colecistectomia laparoscópica. Os agentes simpatolíticos podem diminuir a necessidade de opiáceos ou anestésicos inalatórios ou intravenosos. Neste estudo, nosso objetivo foi analisar os efeitos de esmolol sobre a necessidade de anestésico no período intraoperatório e de analgésico no pós‐operatório e a incidência de dor e NVP.MétodosSessenta pacientes foram incluídos. Propofol, remifentanil e vecurônio foram usados para a indução. Os grupos de estudo foram os seguintes: grupo I, a infusão de esmolol foi adicionada aos anestésicos (propofol e remifentanil) para manutenção; grupo II, apenas propofol e remifentanil foram usados durante a manutenção; grupo III, a infusão de esmolol foi adicionada aos anestésicos (desflurano e remifentanil) para manutenção; grupo IV, apenas desflurano e remifentanil foram usados durante a manutenção. O período de acompanhamento foi de 24 horas para avaliar a incidência de NVP e a necessidade de analgésicos. Os escores de dor também foram avaliados por meio da escala visual analógica (EVA).ResultadosOs escores EVA foram significativamente menores no grupo I (p=0,001‐0,028). A incidência de NVP foi significativamente menor no grupo I (p=0,026). NVP também foi menor no grupo III em relação ao grupo IV (p=0,032). A necessidade de analgésicos foi significativamente menor no grupo I e menor no grupo III em relação ao grupo IV (p=0,005). A frequência cardíaca foi significativamente menor nos grupos esmolol (grupos I e III) comparados com os controles (p=0,001), mas a pressão arterial foi semelhante em todos os grupos (p=0,594). A comparação entre os grupos esmolol e controles revelou que houve uma diminuição.ConclusãoO uso de esmolol durante a manutenção da anestesia reduz significativamente a necessidade de anestésico‐analgésico, dor e incidência de NVP.AbstractPurposePostoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic‐postoperative analgesic requirements, postoperative pain and PNV.MethodsSixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II – Only propofol and remifentanil was used during maintenance, III – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated.ResultsVAS scores were significantly lowest in group I (p=0.001–0.028). PNV incidence was significantly lowest in group I (p=0.026). PNV incidence was also lower in group III compared to group IV (p=0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p=0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p=0.001) however blood pressures were similar in all groups (p=0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p=0.024–0.03).ConclusionUsing esmolol during anesthetic maintenance significantly decreases anesthetic‐analgesic requirements, postoperative pain and PNV

Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks

Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset.&#x0D; Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service.&#x0D; Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p &lt; 0.05). Significant higher mean values of hemodynamic findings in the ketofol  group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p &lt; 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p &lt; 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p &lt; 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p &gt; 0.05).&#x0D; Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation.&#x0D; Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation&#x0D; Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109.&#x0D; DOI: 10.35975/apic.v26i1.1775&#x0D; Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021</jats:p

What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

Objectives: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture. Patients and methods: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons. Results: The canal-to-diaphysis ratio was significantly increased in patients with hip fracture compared with the intact side of same patient (p<0.001) and control subjects (p<0.001). According to the results of the receiver operating characteristic analysis, canal-to-diaphysis ratio had a diagnostic value in predicting hip fracture in osteoporosis patients, and the limit value was approximately 0.53 (sensitivity: 81\%, specificity: 86\%). An index of 0.53 represents a risk of intertrochanteric hip fracture of 89\%. Conclusion: This method can be easily applied by all physicians as X-ray device is readily accessible with low cost. The risk of hip fracture should be determined, osteoporosis should be evaluated, and treatment should be started in patients with high risk to take the necessary precautions before the fracture develops

One patient, one bone, and two different tumoral lesions

In this article, we report a 67-year-old female patient who has two different tumoral lesions located in left humerus with clinical and radiological findings. Previously, the patient was diagnosed as impingement syndrome in shoulder, but, tumoral lesions were detected on the radiograms incidentally during evaluation