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

Evaluation of the relationship between non-contact anterior cruciate ligament rupture and eminential morphometry: a cross-sectional and MRI based study

Abstract Background The literature does not clearly convey the relationship between eminential morphometry and non-contact anterior cruciate ligament (ACL) ruptures. This study attempts to reveal whether there is a relationship between non-contact ACL ruptures and eminential morphometry. Methods Knee magnetic resonance images (MRIs) taken for the various indications between January 2022 and June 2023 were retrospectively scanned. The patients were categorized into 2 groups: those with an ACL rupture and those with an intact ACL. For each patient, eminential angle 1, eminential angle 2, medial eminential height, lateral eminential height, total eminential height, eminential width, and the ratio of tibial plateau width and eminential width to the tibial plateau width were measured by 2 different orthopedists. Patients whose MRIs were used for measurement were evaluated and grouped according to their age, sex, and injury side. Results In total, 400 MRIs of 400 patients were included in the study. While 200 patients had an ACL rupture, 200 had an intact ACL. The total eminential height in the ACL rupture group was measured at 16.1 ± 2.6 mm and 15.5 ± 2.7 mm (p = 0.035) in the ACL intact group. Eminental width in the ACL rupture group was measured at 12.1 ± 1.9 mm and 13.0 ± 2.0 mm in the ACL intact group (p = 0.0001). The tibial plateau width was 75.4 ± 15.7 mm in the ACL rupture group and 73.6 ± 5.8 mm in the ACL intact group (p = 0.002). According to the logistic regression analysis, the p-value for males was 0.0001, and for eminential width, the p-value was 0.0001. Conclusions A significant difference was found between the ACL rupture and the ACL intact groups regarding eminential height, eminential width, and tibial plateau width parameters. Being male and having a low eminential width were identified as independent risk factors for non-contact ACL. Trial registration Not applicable

Low lateral inclination angle, high sulcus angle, high trochlear height and patella alta are risk factors for first lateral patellar dislocation and complete MPFL rupture, comparative study

Abstract Purpose To identify risk factors for complete medial patello‐femoral ligament (MPFL) rupture after first lateral patellar dislocation (LPD) and to develop a model to predict the risk of rupture. Methods Patients who presented with first LPD between February 2019 and June 2024 and were diagnosed with complete MPFL rupture on magnetic resonance imaging (MRI) were retrospectively reviewed. Patients with normal MRI findings in a 1:1 ratio were selected as the control group by computer‐assisted randomisation.All patients in both groups were asked to perform MRI on, tibial tuberosity–trochlear groove (TT–TG) distance, lateral trochlear inclination (LTI) angle, sulcus angle (SA), medial femoral condyle height (MFCH), lateral femoral condyle height (LFCH), trochlear height (TH), patellotrochlear index (PTI), Koshino–Sugimoto Index (KSI), Caton–Deschamps Index (CDI) and Insall–Salvati Index (ISI) were measured and recorded. All measurements were made by two different orthopaedists and intra‐observer reliability was evaluated. The measurements between the groups were compared statistically. Result A total of 98 patients, including 49 patients with complete MPFL rupture (study group) and 49 patients in the control group, were included in the study. Thirty of the patients in both groups were males and 19 were females. Mean age was 23.55 years in the study group and 24.29 years in the control group (p = 0.447). Satisfactory ICC scores were obtained in all measurements. LTI was lower in the study group than in the control group (p = 0.002), while SA was higher in the study group than in the control group. Both CDI and ISI were statistically significantly higher in the study group compared to the control group (p = 0.002, p = 0.003). The probability of predicting the risk of complete MPFL rupture of the risk analysis model created with radiological risk factors for complete MPFL rupture was 70.4%. Conclusion LTI, SA, TH and patella alta are risk factors for complete MPFL rupture after first LPD. Risk analysis of complete MPFL rupture after first dislocation can be successfully performed with MRI findings. This risk analysis can be used to predict the risk of developing complete MPFL after primary LPD, especially in risky patient groups, and can be used in a simple way to decide which patients will receive a preventive programme without the need for additional examination. Level of Evidence Level III, case–control study

Role of Biomarkers in Periprosthetic Joint Infections

Periprosthetic joint infection (PJI) is one of the most serious complications after joint arthroplasty. The incidence rate of PJI after total joint replacement is 1&ndash;3%. Although there are different guidelines and diagnostic criteria used to diagnose PJI, diagnosing PJI is a highly difficult process for orthopedists. The current Musculoskeletal Infection Society (MSIS) criteria are widely used for the diagnosis of PJI. These criteria include results from blood/synovial fluid tests, physical examination, and histological and microbiological analyses of intra-operative samples. However, there is currently no blood or synovial test that can definitively diagnose PJI. To make a more effective diagnosis of PJI, a large number of studies have explored and continue to investigate biomarkers. This review aims to provide general information about serum and synovial markers used for the diagnosis of PJI that may be used to create a database to guide researchers in new studies

The Akcaalan Mortality Score: A Novel Mortality Score to Predict 3-Year Mortality for Elderly Hip Fractures

Backround/Objectives: This study aimed to create a scoring system that can predict the mortality for hip fractures in the elderly, which have high mortality and morbidity rates, by using blood parameters and demographic data at admission. Methods: Patients admitted to the hospital due to a hip fracture between January 2016 and March 2021 were included in the study. A scoring system was created using the patient&rsquo;s age and sex at first admission and hemoglobin, albumin and creatinine levels, neutrophil&ndash;lymphocyte ratio and monocyte&ndash;lymphocyte ratios. The scoring system was created by determining different cut-off values for each of these seven parameters. A total mortality score was determined for each patient using this scoring system. The 3-year follow-up for patients&rsquo; mortality during follow-up was recorded separately for each patient. Following the inclusion and exclusion criteria, the data of 1075 patients were included in the study. Results: All parameters listed in the methodology section were statistically significantly different between the patients who survived and those who died in the three years after hip fracture surgery (p = 0.0001). The total scores obtained using the mortality scoring system created by combining these parameters were also statistically significantly different between the two groups (p = 0.0001). If the mortality score is &gt;11.5, the probability of the patient with a hip fracture dying within the first three years is 63.9%. Conclusion: The Ak&ccedil;aalan Mortality Score can provide predictive data for preoperative prediction to determine the 3-year mortality of elderly patients with hip fractures and may be helpful in terms of surgical timing. The name of this scoring system comes from the lastname of the corresponding author

Do age, gender, and region affect tibial slope? A multi-center study

Introduction Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. Materials and methods A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60-69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. Results The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. Conclusions Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope