The gender composition of the members of the editorial board of toxicology journals: Assessment of gender equality

In many areas of medicine, gender equality has not yet been fully adopted despite recent developments. The inequality of gender in various areas of medicine is still debated. In this study, we analysed the gender composition of the editorial boards of toxicology journals in the Science Citation Index-Expanded (SCI-E) databases and the factors affecting this composition. The genders of the participants were determined by the data obtained from the official websites of the journals in September 2023. We analysed the journal metrics and publisher properties using Mann-Whitney U, Fisher's exact, Chi-square tests and Spearman's correlation coefficient. We used logistic regression analysis to reveal the independent factors related to gender parity. The representation rates of women were 28.62% on all editorial boards and 23.33% in editor-in-chief positions. The 'Neuroscience' (OR, 2.46 95%CI, 1.68-3.60, p < 0.001), 'Reproductive Biology'(OR, 2.05 95%CI, 1.22-3.42, p = 0.006) and 'Public, Environmental & Occupational Health'(OR, 1.49 95%CI, 1.18-1.88, p = 0.001) as a coverage category, the United States as a journal country (OR, 1.21, 95%CI, 1.04-1.40, p = 0.001), 5-year-IF≥3.6(OR, 1.54, 95%CI, 1.27-1.86, p < 0.001), 5-year H index≥29 (OR, 1.23, 95%CI, 1.01-1.49, p = 0.037) were the independent factors for gender parity. However, 'Oncology' (OR, 0.08 95%CI, 0.01-0.55, p = 0.011), 'Biochemistry, Molecular Biology' (OR, 0.62 95%CI, 0.44-0.86, p = 0.005) and 'Pharmacology & Pharmacy' (OR, 0.69 95%CI, 0.59-0.82, p < 0.001) as a coverage category, Japan as a publisher country (OR, 0.52 95%CI, 0.35-0.77, p = 0.001), and Switzerland as a journal country (OR, 0.61, 95%CI, 0.46-0.81, p = 0.001) were related to gender disparity. Greater endeavours are needed to reduce gender discrimination in toxicology. Toxicology authorities should continuously improve existing policies by optimising the analysis of objective information to eliminate barriers for toxicologists in terms of gender equality.

Clinical Significance of Pleural Lactate Measurement in Critically Ill Patients with Parapneumonic Pleural Effusion

OBJECTIVE

Pleural fluid pH measurement is recommended for tube thoracostomy decisions in complicated parapneumonic pleural effusions. However, pleural fluid pH may be affected by blood pH in critically ill patients with common systemic acid-base disorders. We aimed to investigate the use of pleural fluid lactate to distinguish culture-positive parapneumonic effusions from other pleural effusions.

MATERIAL AND METHODS

This prospective observational study included 121 eligible patients (51 female and 70 male). All patients with pleural effusion who underwent thoracentesis were assessed. Pleural fluid lactate was measured by a blood gas analyzer.

RESULTS

Of the 121 patients, 30 (24.8%) were transudate and 91 (75.2%) were exudate. Of the 91 patients with exudative pleural effusion, 61 were diagnosed as culture-negative parapneumonic, 13 as culture-positive parapneumonic, 9 as malignant, and 8 as other exudative effusion. There was a strong positive linear association between serum pH and pleural fluid pH (R = 0.77, P < .001). The post hoc tests for pleural fluid lactate revealed there was a significant difference between culture-positive parapneumonic versus culture-negative parapneumonic groups (P = .004), culture-positive parapneumonic versus transudative effusion groups (P < .001), culture-negative parapneumonic versus transudative effusion groups (P = .008) and lastly; malignant effusion versus transudative effusion groups (P = .001). Receiver operating characteristics curve analysis for culture-positive parapneumonic indicated a cutoff of 4.55 mmol/L for pleural fluid lactate to have a sensitivity of 76.9% and a specificity of 84.3% (positive predictive value: 37%, negative predictive value: 96.8%).

CONCLUSION

A cutoff of 4.55 mmol/L of pleural fluid lactate can be used as a useful tool to distinguish culture-positive parapneumonic effusions from other effusions in critically ill patients.

Gender distribution of editorial board members in critical care journals: Assessment of gender parity

PURPOSE

To reveal factors related to gender parity on editorial boards of critical care journals indexing in SCI-E.

METHODS

The genders were defined according to data obtained from journals' websites between 01-30 September 2022. Publisher properties and journal metrics were analyzed by using Chi-square, Fisher exact, Mann-Whitney U tests, and Spearman's correlation coefficient. Logistic regression analysis was used to reveal independent factors.

RESULTS

Women's representation on editorial boards was 23.6%. The USA (OR, 0.04, 95% CI, 0.01-0.15, p < 0.001) and Netherlands (OR, 0.04, 95% CI, 0.01-0.16, p < 0.001) as publisher's countries, an IF >5 (OR, 0.25, 95% CI, 0.17-0.38, p < 0.001), publication duration <30 years (OR, 0.09, 95% CI, 0.06-0.12, p < 0.001), multidisciplinary perspective of editorial policy (OR, 0.46, 95% CI, 0.32-0.65, p < 0.001), journals categorized also in nursing (OR, 0.38, 95% CI, 0.22-0.66, p < 0.001), and being a section editor (OR, 0.49, 95% CI, 0.32-0.74, p = 0.001) were associated with gender parity. Europe as a journal continent (OR, 36.71, 95% CI, 8.39-160.53, p < 0.001) was related to gender disparity.

CONCLUSIONS

Further efforts are needed to expand diversity policies in critical care medicine.

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors

Objective:

This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU).

Methods:

Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded.

Results:

The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P  < 0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P  < 0.05).

Conclusion:

There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality.

Level of Evidence:

Level IV, Therapeutic Study

Thesis Studies of Universities in Anaesthesiology and Reanimation between 1970 and 2016: Retrospective Evaluation of Work Areas, Publishing Rates and Evidence Levels

AIM

The aim of this study was to investigate the publication status, research design, subjects and levels of evidence of theses written in the field of anaesthesiology and reanimation between 1970 and 2016 in Turkey.

METHODS

After the theses included in our study were accessed through the Higher Education Institution National Thesis Center, theses were searched using Google, Google Scholar, PubMed, and TR Directory TU¨ B_ITAK ULAKB_IM search engines. The publication status, research design, evidence levels, date of the published theses, journals and citation numbers for the theses were determined.

RESULTS

A total of 2,803 theses were included in our study. When the evidence levels of the theses are evaluated, it was determined that B evidence level was present in 1,603 (57.2%), C in 597 (21.3%), F in 256 (12.3%) and D in 257 (9.2%). It was also determined that 719 (25.7%) of the theses were published later. The time difference between the thesis and the publication year was 3.14 6 2.26 years. Of these publications, 367 (51.0%) were appeared in national journals, with 293 in SCI-E (40.8%), 25 in SCI (3.5%) and 34 in other foreign journals (4.7%). While the rate of thesis studies with a prospective design decreased over the years, it was determined that experimental and retrospective thesis studies increased (P < .05). In the correlation analysis, there were weak correlations among the publication year, the number of citations and the impact of the journal. There was a positive correlation between the publication year and the number of cases.

CONCLUSION

Although the number of prospectively designed theses and clinical theses in the field of anaesthesiology and reanimation has decreased over the years, there is an increase in the number of theses converted to publications. Although the rate of publication of theses abroad and in SCI-E journals has increased, decreases in the thesis rate published in SCI journals over the years and in the impact factors of the journals are notable. In the future, studies in anaesthesiology and reanimation should be performed to increase the number of theses that can be published in journals with higher impact.

Knowledge and Attitudes about Helsinki Declaration on Patient Safety among Anaesthesiologists in Turkey: A Questionnaire Study

Objective

The Helsinki Declaration on Patient Safety in Anaesthesiology is an important document for anaesthesiologists. This study aimed to evaluate the knowledge and experiences of anaesthesiologists in Turkey on the "Helsinki Declaration on Patient Safety."

Methods

After the ethics committee approval and participants' consent, electronic questionnaires were sent to anesthetists working in Turkey. The questionnaire included 48 questions.

Results

The mean age of the participants was 44.28±8.01 years, and 52.1% were women (n=142). The mean time spent in the field of anesthesiology was 12.83±7.76 years. The percentage of participants working in private hospitals was 13.4%. A total of 58.5% of the participants were educated on patient safety out of whom 57% said that their knowledge was sufficient, 37.3% said that it was limited, and 5.6% felt that it was insufficient. The knowledge of participants about the Helsinki Declaration was sufficient in 31.7%, limited in 39.4%, insufficient in 9.2%, and 19.7% had no knowledge. A total of 27% of participants believed that implementation of the Helsinki Declaration improved patient safety. It has been stated that the minimum patient monitoring standards recommended by the European Board of Anaesthesiology has been complied in operating rooms and recovery units (90.8% and 78.2%, respectively).

Conclusion

The findings of this survey might guide not only the individual anesthetists but also hospital administrators to develop strategies to improve patient safety and thus quality of care in the light of the recommendations listed in the Helsinki Declaration.

Anaesthesiology and Reanimation Education in Turkey: Residents' Views

Objective

This study aimed to determine opinions of medical residents undergoing anaesthesia and reanimation training about equipment, programmes, applications, study conditions and shift systems at training institutions in Turkey.

Methods

A web-based survey was sent by e-mail to residents in anaesthesiology and reanimation training programmes. The survey comprised 73 questions about demographic characteristics, satisfaction, basic specialisation knowledge, anxiety and motivation.

Results

The study included 270 individuals. Of the residents, 82.2% willingly chose their field, whereas 66.7% stated that specialisation was necessary because of incorrect application of first-stage and GP medical services. The mean of the weekly working hours was 91.69±36.69 hours; the mean number of monthly on-call shifts was 7.49±1.99. Of the participants, 61.9% found the predicted five-year training duration long. The intensive care training duration was sufficient for 71.1% and only 26.3% found the pain management training duration sufficient.

Conclusion

According to the results, the number of residents is insufficient, workload is heavy, working hours are long and large numbers of shifts are worked without leave afterwards. In spite of negatives and high dissatisfaction, most residents willingly chose their departments and would choose the same branches again. Participants stated that their institutions emphasised service rather than education and research, and educators were less accessible to residents due to increasing service loads.

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers

OBJECTIVES

We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study.

MATERIAL AND METHODS

This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00.

RESULTS

Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation.

CONCLUSION

In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

BACKGROUND

The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.

METHODS

A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.

RESULTS

Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.

CONCLUSIONS

A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.

Gabapentin pretreatment for propofol and rocuronium injection pain: A randomized, double-blind, placebo-controlled study

AIM

This prospectively-planned, randomized, double-blind and placebo-controlled study aims to evaluate the effect of 1200 mg gabapentin premedication on the incidence and severity of propofol and rocuronium injection pain.

METHOD

One hundred patients, between 18-60 years of age and ASA I-II for elective surgery planned under general anaesthetic, were randomized and divided into two groups. Two hours before the operation, the patients were given either a placebo tablet (Group P, n = 50) or 1200 mg gabapentin tablet (Group G, n = 50). On the back of the non-dominant hand, a vein was opened using a 20 G cannula , 0.9% NaCl was begun and preoxygenation was provided. For anaesthesia induction, 1% propofol at 800 ml/hr infusion rate was administered for 20 s. Propofol injection pain was evaluated up to the 20th second and recorded using a scale between 0 and 3 developed by McCrirrick and HunteR The remaining propofol dose (2.5 mg/kg), 5 ml saline and 0.6 mg/kg rocuronium were injected in that order over 10 seconds and rocuronium injection pain response was evaluated with a four point scale.

RESULTS

Pain after propofol infusion average score (degree ≥ 1) (Group G = 0.5; Group P = 1.0) and incidence (Group G = 46%; Group P = 68%); and average withdrawal movements response score linked to rocuronium injection pain (≥ 1 response) (Group G = 0.3; Group P = 1.2) and incidence (Group G = 20%; Group P = 80%) were detected to be significantly lower in the gabapentin group compared to the placebo group (p < 0.001).

CONCLUSION

Premedication with 1200 mg gabapentin 2 hours before propofol and rocuronium injection reduced the incidence and severity of injection pain.

Pseudocholinesterase levels in patients under electroconvulsive therapy

Objectives:

In this study, we aimed to retrospectively assess the correlation of pseudocholinesterase (PChE) levels with age, gender, body weight and diagnosed psychiatric diseases in electroconvulsive therapy (ECT) cases.

Methods:

This retrospective study was conducted at Bülent Ecevit University Hospital, Zonguldak, Turkey, between 2007 and 2011. In the study, 193 ECT case files were retrospectively scanned to evaluate PChE values before ECT and other file information.

Results:

There was no difference between gender in terms of PChE levels. Correlation analysis determined a weakly positive correlation between age (p=0.013; correlation coefficient [cc]: 0.178) and body weight (p<0.001; cc: 0.273) and PChE levels. No correlation was found between age, gender, weight or psychiatric diagnosis, and PChE levels.

Conclusion:

Neuromuscular blockage is a significant factor that increases patient safety, while increasing the efficacy of ECT. In choosing muscle relaxant agents, both patient factors and the pharmacological properties of the neuromuscular blocker should be considered. We think that in situations with delayed recovery of ECT cases without identified PChE levels, low PChE levels must be considered.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block on postoperative pain and morphine consumption in varicocelectomy

Objectives:

To evaluate the analgesic effect of transversus abdominis plane (TAP) block administered before varicocele surgery.

Methods:

This study was completed at the Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey, between January 2011 and April 2013. In a prospective, double blind, randomized, placebo controlled clinical study, 40 male patients scheduled for elective varicocele operations were randomized to group T (treatment group) or group C (controls). After receiving general anesthesia, group T received a TAP block using 20 mL 0.25% bupivacaine on the operation side, whereas group C received a control block using 20 mL 0.9% Sodium chloride. During the first 24 hours after surgery, the patient pain was evaluated using the visual analogue scale (VAS) at rest and while coughing. Postoperative patient controlled analgesia morphine consumption, VAS scores, and side effects were recorded.

Results:

Of 34 patients, Group T (n=18) had significantly lower VAS pain scores than Group C (n=16) both at rest and while coughing. The total morphine consumed was lower (7.7 ± 4.0) versus 21.6 ± 12.4 mg, p<0.001) in the 24 hours after surgery.

Conclusion:

As part of a multimodal analgesic regime after varicocelectomy surgery, morphine consumption and VAS pain scores were significantly lower among those receiving 20 mL 0.25% bupivacaine administered for a TAP block than among controls.

The Most Frequently Cited 100 Articles in Liver Transplantation Literature

INTRODUCTION

We investigated the liver transplantation literature since 1975 and found the most frequently cited 100 articles and assessed the distribution of authors and journals of these articles.

METHOD

Using the advanced mode of the Institute for Scientific Information (ISI) Web of Science (WOS) search engine, the words "SU = transplantation AND TI = liver OR SU = transplantation AND TS = liver" were used to scan articles and determine the most-cited 100 articles on July 18, 2016.

RESULTS

From 1975 to date, it appears a total of 43,369 articles were published in the field of liver transplantation in the WOS. Although the most cited article had 677 citations, the least cited article had 180 citations. The mean citation number for the 100 articles was 252.31 ± 96.75. The mean annual citation number for the articles varied from 61.55 to 5 and the mean was 15.31 ± 8.63. The most cited article was by Feng et al "Characteristics Associated With Liver Graft Failure: The Concept of a Donor Risk Index" published in the American Journal of Transplantation (677 citations).

CONCLUSION

Bibliometric analysis highlights the key topics and publications that have shaped the understanding and management of liver transplantation. According to our research, this is the first study to investigate articles with most citations in the field of liver transplantation. In our study the article with the most citations was cited 677 times, whereas the 100th article was cited 180 times with a mean citation number for the 100 articles of 252.31 ± 96.75.

Turkish Publications in Science Citation Index and Citation Index-Expanded Indexed Journals in the Field of Anaesthesiology: A Bibliographic Analysis

OBJECTIVE

Our study aimed to assess Turkish publications in Science Citation Index (SCI) and Science Citation Index Expanded (SCI-E) indexed journals in the field of 'anaesthesiology'.

METHODS

Journals related to 'anaesthesiology' in the Science Citation Index-Expanded database of 'Thomson Reuter Web of Science' were searched. The search engine of Institute for Scientific Information (ISI) Web of Science (WoS) was used in the advanced mode by typing 'IS=ISSN number' to identify publications in the journal. By typing 'IS=ISSN number AND CU=Turkey', Turkish papers on anaesthesiology were found. If Turkish and non-Turkish authors had collaborated, the article was included in the search when the corresponding author had provided a Turkey-based address. The catalogue information and statistics were used to determine Turkish publications as the percentage of total publications and the annual mean number of Turkish publications. In WoS, 'SU=anesthesiology' was used to determine the number, country, year and topic distributions of publications from 1975 to date and within the last 10 years. The citation numbers and h-indices were determined based on the country for publications within the last 10 years.

RESULTS

From 1975 to the early 2000s Turkey was 20^th in the list of countries with highest number of publications on anaesthesiology, however in the last 10 years Turkey moved up to 18^th place. Its mean citation number has been 4.64, and it remains the 2^nd lowest country pertaining to citations among the 22 countries with the most number of publications. According to the percentage of publications in the field of anaesthesiology, the journals with highest rate of Turkish publications were Revista Brasileira de Anestesiologia, European Journal of Anaesthesiology and Journal of Anesthesia.

CONCLUSION

In the field of anaesthesiology, the highest number of articles from Turkey was published in Revista Brasileira de Anestesiologia, European Journal of Anaesthesiology and Journal of Anesthesia. The mean citation number from these publications was 4.64.

Anesthesia methods used by anesthetic specialists for circumcision cases. National survey study for Turkey

Objectives:

To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey.

Methods:

This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods.

Results:

The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%).

Conclusion:

Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit

The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study

BACKGROUND

Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially.

METHODS

Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1μg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated.

RESULTS

There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores.

CONCLUSION

Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

Use of Succinylcholine by Anaesthetists in Turkey: A National Survey

OBJECTIVE

Although succinylcholine (SCh) has side effects, it is among the most commonly used muscle relaxants for rapid induction because of the faster onset of its effects and short effect duration. However, there is no information regarding the frequency of use of SCh by anaesthetists in Turkey. This study aims to investigate the use of SCh by anaesthetists working in Turkey.

METHODS

A web-based survey form was sent by e-mail to anaesthetists working in Turkey. The form comprised a total of 24 questions.

RESULTS

E-mails were sent to a total of 1882 addresses at two separate times. E-mail replies were received from 433 (23%) anaesthetists. Based on those who responded to the survey, 54.27% anaesthetists routinely used SCh for adult elective cases, 29.33% for paediatric elective cases and 74.13% for emergency cases. In adult elective cases, SCh was most frequently chosen for caesarean section (20.5%), and in paediatric elective and emergency cases, SCh was chosen most frequently because difficult intubation was expected (31.3 and 21.4%, respectively).

CONCLUSION

Our study reveals that SCh is still widely used by anaesthetists in Turkey. Majority of physicians who participated our survey were aware of the side effects; however, they reported using SCh in certain special situations. It is evident that creation of a standard care guide for departments is essential. The first stage of creating a standard care guide is to analyse and document the current application. With this aim, more wide-ranging advanced studies should be completed.

Effects of peroperative intravenous paracetamol and lornoxicam for lumbar disc surgery on postoperative pain and opioid consumption: A randomized, prospective, placebo-controlled study

OBJECTIVES

The aim of the present randomized, placebo-controlled study was to compare postoperative analgesic effects of peroperative paracetamol and lornoxicam administration.

METHODS

Sixty adult patients with American Society of Anesthesiologists (ASA) risk classification I-II, who would undergo single-level lumbar discectomy under general anesthesia, were enrolled. Patients were administered either 1000 mg paracetamol (Group P), 8 mg lornoxicam (Group L), or saline (Group C) prior to induction of anesthesia (n=20 for all groups). All patients were administered the same anesthesia induction and maintainance. Postoperative analgesia was maintained with the same analgesic drug in each group. Rescue analgesia was supplied with intravenous meperidine delivered by a patient-controlled analgesia device. Numeric rating score (NRS) results, first analgesic demand time, and cumulative meperidine consumption were recorded postoperatively. Primary outcome was NRS at first postoperative hour. Secondary outcome was measure of opioid consumption during first 24 postoperative hours.

RESULTS

At first postoperative hour, NRS of Group L [4 (0-8)] was lower than NRSs of Groups P and C [6(0-7); 6(0-9), respectively; p<0.016]. Time to first analgesic demand of Group L was longer, compared with those of the other groups (p<0.016). Cumulative postoperative meperidine consumption in Group L was less than those of Groups P and C at 2-, 12-, and 24-hour time intervals (p<0.016), while Groups P and C had similar findings for the same time intervals.

CONCLUSION

Preoperative lornoxicam administration decreased early postoperative pain scores more effectively than paracetamol.

Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting

BACKGROUND AND OBJECTIVES

The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV).

METHODS

Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2mgkg^-1 sugammadex (Group S) or 50μgkg^-1 neostigmine plus 0.2mgkg^-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded.

RESULTS

In the first hour postoperative 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011).

CONCLUSIONS

At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia

BACKGROUND AND OBJECTIVES

The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery.

METHODS

This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60mg dextrose was added to 7.5mg of 0.5% levobupivacaine, in Group II, 80mg and in Group III, 100mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10min.

RESULTS

The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p<0.05, p<0.00). The time to full recovery of the sensorial block was 136min in Group I, 154min in Group II and 170min in Group III. The differences were statistically significant (p<0.05). The mean duration of the motor block was 88min in Group I, 105min in Group II, and 139min in Group III and the differences were statistically significant (p<0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p<0.00).

CONCLUSIONS

The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30mg mL(-1) concentration of dextrose added to 7.5mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

Cost-Conscious of Anesthesia Physicians: An awareness survey

Objective:

Increasing competitive pressure and health performance system in the hospitals result in pressure to reduce the resources allocated. The aim of this study was to evaluate the anesthesiology and intensive care physicians awareness of the cost of the materials used and to determine the factors that influence it.

Methods:

This survey was conducted between September 2012 and September 2013 after the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units.

Results:

One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation.

Conclusion:

Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively,

Evaluation of Public Awareness, Knowledge and Attitudes about Cardiopulmonary Resuscitation: Report of İzmir

OBJECTIVE

Early initiation of cardiopulmonary resuscitation (CPR) by witnesses increases survival after cardiac arrest. In Turkey, our country, it is rare that basic life support (BLS) is initiated by a layperson. In our study, we aimed to use a survey to research awareness, level of knowledge and attitudes of the public to CPR and BLS.

METHODS

A 21-question survey was administered to individuals aged ≥18 years on a busy street in a city of a western region of Turkey. Topics such as knowledge about cardiac arrest findings, previous experience of CPR, knowledge of BLS and concerns related to CPR were questioned.

RESULTS

The fully completed forms of 533 people were evaluated. There were 40.7% who stated that they had received training in CPR. For signs of cardiac arrest, 40.7% answered loss of consciousness, 49.3% answered cessation of breathing and 60.7% answered cessation of circulation. It was found that 35.5% could perform only chest compressions, 27.6% could perform mouth-to-mouth ventilation and 28.7% able to perform both. While 52.0% knew the location for performing chest compressions, 34.3% knew the correct depth and 15.6% knew the correct compression-ventilation rate. Bystander CPR was performed by 3.6%.

CONCLUSION

In conclusion, 40.7% of people living in a highly educated region in the western part of Turkey had received CPR training and 3.6% performed bystander CPR. A majority of participants stated that they were willing to correct and develop their knowledge and skills related to CPR. Effective public CPR training programmes may increase the knowledge and awareness of CPR in the adult population.

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction

Introduction: The aim of this study was to measure the haemodynamic responses to a etomidate-propofol combination used for anaesthesia induction and to compare the haemodynamic responses with the separate use of each drug.

Methods: The patients were randomly divided into three groups as group P (n = 30, propofol 2.5 mg kg^-1), group E (n = 30, etomidate 0.3 mg kg^-1) and group PE (n = 30, propofol 1.25 mg kg^-1 + etomidate 0.15 mg kg^-1). For each patient, the times of measurement of the heart rate (HR) and mean arterial pressure values were defined as baseline, after the induction, before the intubation, immediately after the intubation and 1, 2, 3, 4, 5 and 10 minutes after the intubation.

Results: In all 3 groups, a significant decrease in MAP values were seen at T2 and T3 compared to the baseline values, and this decrease was greater in group P compared to that in group E and PE (P < 0.001, P < 0.01). A significant increase was seen in all 3 groups in the mean arterial pressure (MAP) value at T4 after the intubation. When the groups were compared with each other, this increase was greater in group E than in the other two groups (with group P, P < 0.001; with group PE, P < 0.01).

Conclusion: Etomidate-propofol combination may be a valuable alternative when extremes of hypotensive and hypertensive responses due to propofol and etomidate are best to be avoided.

Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

AIM

To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection.

METHOD

One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2μgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation.

RESULTS

Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient.

CONCLUSION

Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

Continuous Spinal Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm in High-Risk Patient

Endovascular aneurysm repair (EVAR) is increasingly being used in abdominal aortic aneurysm (AAA) treatment, as it is less invasive than open surgery. A wide range of anaesthetic types, such as general anaesthesia, neuroaxial blocks and local anaesthesia, have been shown to be appropriate for the EVAR procedure. In the continuous spinal anaesthesia (CSA) method, the local anaesthetic may be titrated through a catheter placed in the subarachnoid space, allowing better control of the anaesthetic level and a reduction in potential haemodynamic side effects. Our aim is to present CSA as a successful anaesthetic technique for EVAR in an AAA patient with severe co-existing diseases.

Turkish Anaesthesiologist's Experiences of Anaesthetic Management of Patients with Obstructive Sleep Apnea (OSA)

OBJECTIVE

Obstructive sleep apnea (OSA) is an important health problem that is increasing with the increase in the incidence of obesity. For patients with OSA, it is reported that preoperative OSA diagnosis is made in only 10%-20% of the patients. Therefore, it gains importance that these patients are diagnosed in the preoperative period. The aim of this study is to analyze with a survey the experiences of anaesthesia experts working in Turkey about the diagnosis of patients with OSA, anaesthetic methods and postoperative care.

METHODS

The study was completed with an online survey form distributed via email. Survey participants were sent an email, and those experts who wished to participate clicked on the link, answered the questions and returned the survey via email.

RESULTS

A total of 134 anaesthesia experts participated in this study. While 97% of the participating anaesthetists considered diagnosis of patients with OSA to be important, only 53% trusted themselves to recognize this patient group. Of the total number of participants. 43% did not know the STOP-BANG test used in the preoperative period to diagnose patients with OSA. The percentage who thought that patients with OSA would increase the incidence of difficult intubation was 84%. In the intraoperative period, the percentage who chose inhalation anaesthetics was 35%, whereas the rate of those who chose total intravenous anesthesia (TIVA) was 48%.

CONCLUSION

This study indicates that the medical knowledge of Turkish anaesthetists on the topic of OSA requires updating. In addition, we believe a practical guide to standardize the diagnosis and preoperative/perioperative management of patients with OSA should be prepared for Turkish anaesthetists.

A Retrospective Analysis of Comparison of General Versus Regional Anaesthesia for Endovascular Repair of Abdominal Aortic Aneurysm

OBJECTIVE

The aim of this study is to compare general anaesthesia (GA) versus regional anaesthesia (RA) for endovascular aneurysm repair (EVAR).

METHODS

We analysed the files of 89 patients between August 2010-August 2012 who underwent elective EVAR retrospectively.

RESULTS

We performed RA for 32 patients (36%) and GA for 57 patients (64%). The operations were completed successfully in both groups and did not require conventional surgery. The mean age of the patients was 71.5±7 (range 50-88 years). RA was preferred more than GA in the presence of advanced-stage chronic obstructive pulmonary disease statistically (p=0.032). The usage of vasodilator drug and atropine was found to be higher in the GA group than the RA group in the intraoperative period (p=0.001 and p=0.01, respectively). The intensive care unit (ICU) was necessary for 5 patients in the RA group (16%) and 13 patients for the GA group (23%) postoperatively (p=0.301). The median ICU stay in the RA group was 2 hours and 4.4 hours in the GA group (p=0.114). The median hospital stay was 2.63±1.91 days in the RA group and 2.04±1.16 days in the GA group, with no statistically significant difference between groups (p=0.120). There was no mortality of patients in either group for the peroperative period and the 30-day follow-up period.

CONCLUSION

Our present study suggests that patient characteristics are more important than the anaesthetic method on the outcomes of EVAR.

[Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy]

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

[Effects of various anesthesia maintenance on serum levels of selenium, copper, zinc, iron and antioxidant capacity]

BACKGROUND AND OBJECTIVES

In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity.

METHODS

60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mgkg(-1) propofol, 1mgkg(-1) lidocaine and 0.6mgkg(-1) rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4Lmin(-1), 1 MAC sevoflorane was administered to Group S and 1 MAC desflurane to Group D; and under carrier gas of 50:50% O2:air 4Lmin(-1) 6mgkgh(-1) propofol and 1μgkgh(-1) fentanyl infusion were administered to Group P. At postoperative blood specimens were collected again.

RESULTS

It was observed that only in Group S and P, levels of MDA decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in Group S and Group P, zinc levels decreased in Group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period.

CONCLUSION

According to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study

OBJECTIVE

We aimed to investigate the attitudes and behaviors of anaesthesiologists in "non-operating room anaesthesia" applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey.

METHODS

Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program.

RESULTS

A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants' institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05).

CONCLUSION

Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed.

The protective effect of quercetin on IMA levels and apoptosis in experimental ovarian ischemia-reperfusion injury

OBJECTIVE

To investigate the protective effect of quercetin (QE), an anti-inflammatory and anti-oxidant agent, on torsion-detorsion induced histopathological changes and blood IMA levels in experimental ovarian ischemia-reperfusion (IR) injury.

STUDY DESIGN

Twenty-four female Wistar rats were randomly divided into four groups in this study (n=6). Group I, (sham operation); Group II, torsion-detorsion plus saline (IR); Group III, torsion-detorsion plus solvent (dimethylsulfoxide: DMSO, IR+DMSO); Group IV, torsion-detorsion plus 15 mg/kg/bw quercetin (IR+QE) injected intraperitoneally 30 min prior to detorsion. After 3h of reperfusion, the right ovaries were removed surgically. The ovary tissue samples were fixed in 10% formalin solution for histopathological and immunohistochemical examination. Blood samples were obtained at the end of the procedures for each group of animals.

RESULTS

Ovarian sections in Groups II and III showed higher follicular cell degeneration, hemorrhage, vascular congestion and edema when compared with Group I. Administration of quercetin in rats significantly prevented degenerative changes in the ovary. Significantly less histopathological changes were found in Group IV compared with Groups II and III. Caspase-3 and TUNEL positive cells were detected in the ovarian surface, follicle epithelium, and stromal cells in all experimental groups, and there was a significant increase in Groups II and III compared with Group I (P<0.05). Treatment with quercetin decreased the number of caspase-3 and TUNEL positive cells. IR increased the ischemia modified albumin (IMA) levels in comparison to the sham group (1.06 ± 0.10 ABSU and 0.92 ± 0.08 ABSU, P<0.05). Quercetin administration before IR reduced the levels of IMA (0.93 ± 0.08 ABSU, P<0.05).

CONCLUSION

Administration of quercetin is effective in preventing tissue damage induced by IR injury in ovaries.

Evaluating the Readibility of Informed Consent Forms Available Before Anaesthesia: A Comparative Study

OBJECTIVE

Informed consent forms that are used prior to administering anaesthesia inform patients before any proposed surgical procedure or treatment. They should provide patients with sufficient information about the operation and treatment. Readibility refers to whether it is easy or hard for a reader to read and understand an available text, and this is evaluated via various formulas. The aim of this study was to evaluate the readability of different informed consent forms commonly used in the anaesthesiology departments of different hospitals in our country using different readability formulas.

METHODS

After obtaining ethics committee approval, the readability of different consent forms used in the anaesthesiology departments of university hospitals (n=15), Ministry of Health (MOH) education and research hospitals (n=15), and public hospitals (n=15) was analysed. Each consent form was displayed electronically in "Microsoft Word" and the number of words contained was counted automatically. The first 100 words on the first page of the forms were evaluated using the Gunning Fog, Flesch-Kincaid and Ateşman readability formulations. The rate of medical terms detected within these 100 words was determined as a percentage (%).

RESULTS

Different consent forms obtained from 45 anaesthesia departments were assessed using various readability formulas. According to the Gunning Fog index, the readability of the consent forms obtained from MOH education and research and public hospitals was relatively low. The Flesch-Kincaid index measured very low levels of readability in all institutions. The Ateşman index displayed very low readability levels for the consent forms used in university hospitals, and low levels in other institutions.

CONCLUSION

We conclude that the readability of the anaesthesia informed consent forms is low. The level of education in our country should be considered in the preparation of anaesthesia consent forms. We believe that physicians should pay more attention to this medical and legal issue.

Passive smoking increases pain perception in children undergoing venous catheterization

AIM

To establish whether there is any association between passive smoking and pain perception in children, in the absence of existing studies into possible links.

METHODS

This single-centre study focused on 100 children - 50 who had been exposed to passive smoking and 50 who had not - who were admitted to general polyclinics from September 2012 to December 2012 and needed venous catheterization. Patients with chronic diseases, neurologic and psychiatric illnesses, communication problems and analgesic use in the last 24 h were excluded. The passive smoking group had a mean age of 7.3 years (56% male) and the nonpassive smoking group had a mean age of 7.7 years (44% male). The main study parameter was the Wong-Baker faces pain rating scale (WBFPS) score during catheterization.

RESULTS

There was a statistically significant difference between the pain perceptions of the 100 children studied and smoke exposure. The WBFPS scores of the 50 children who were passive smokers were significantly higher than the scores of the 50 who were not passive smokers (p = 0.00).

CONCLUSION

Passive smoking increases pain perception in children during invasive medical procedures.

Relationship of QT dispersion with sex hormones and insulin in young women with polycystic ovary syndrome: an observational study

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a common endocrinopathy in reproductive women. Cardiovascular disease risk factors are more frequent in this population. We aimed in this study to investigate presence of QT dispersion and effects of sex hormones and insulin on QT duration in young PCOS patients.

METHODS

This present study was cross-sectional observational study. A total of 47 women, 25 patients with PCOS and 22 healthy, were included. Serum testosterone, estradiol and insulin levels were studied and electrocardiography was performed at 2nd or 3th days of menstrual cycle. The study population was divided into groups according to serum testosterone and estradiol levels. Sub-groups and pairwise groups were compared by Mann-Whitney U or student t-test. The associations of QTc durations with hormone levels were calculated using Spearman rank correlation analysis. The results were evaluated at the p<0.05 significance level.

RESULTS

No differences found between groups regarding to demographic parameters. Estradiol and testosterone levels were higher in patients with PCOS (41.12 ± 13.59 vs. 35.57 ± 19.29 pg/mL, p=0.09 and 105 ± 58.5 vs. 17.6 ± 10.9 ng/dL, p=0.01, respectively). QT dispersion was significantly longer in PCOS patients (47.1 vs. 32.7 ms, p=0.01). A positive correlation was found between the serum insulin level and QTc min, QTc max, and QTc mean (r=0.402, p=0.011; r=0.341, p=0.033; r=0.337, p=0.036; respectively). QT dispersion with serum testosterone and estradiol levels were positively correlated (r=0.525, p=0.001 and r=0.326, p=0.046; respectively).

CONCLUSION

Our results suggest that QT dispersion is prolonged and testosterone, estradiol and insulin are associated with QT duration in young PCOS patients.

Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy

BACKGROUND AND OBJECTIVES

Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit.

CASE REPORT

A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service.

CONCLUSIONS

Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis.

The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: A randomized controlled study

Objective

Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia.

Methods

Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30 min into the procedure, as well as from serum taken from cord blood after double clamping.

Results

At total of 51 healthy pregnant women underwent either general anaesthesia ( n = 28) or combined spinal epidural anaesthesia ( n = 23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30 min of surgery compared with the immediate preoperative period.

Conclusions

Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.