Comparison of the effects of general and regional anesthesia on mortality and hospital length of stay in geriatric hip fractures

OBJECTIVE

In this study, we sought to compare the effects of general and regional anesthesia techniques on the length of hospital stay and morbidity-mortality in geriatric patients who have had hip fractures and underwent surgical treatment.

PATIENTS AND METHODS

A total of 331 patients who were 65 or older and had had surgical treatment for elective or urgent hip fractures were classified into two groups; regional and general anesthesia. Recorded variables were: age, sex, American Society of Anesthesiologists (ASA) score, comorbid disease, length of stay at the clinic, mortality, morbidity, intraoperative loss of blood, the necessity of blood transfusion, and type of fracture. These variables were compared in the control groups and evaluated retrospectively.

RESULTS

For the regional anesthesia group, length of stay in the clinic, loss of blood, and necessity of blood transfusion were significantly lower compared to the general anesthesia group (p<0.05). Additionally, we found general anesthesia mortality and morbidity rates were significantly higher than regional anesthesia (p<0.05). Finally, we determined that increased age and number of comorbid diseases increased the morbidity and mortality rates significantly (p<0.05).

CONCLUSIONS

This study evaluated regional anesthesia's advantages over general anesthesia when treating geriatric hip fractures. This includes reduced morbidity-mortality rates, bleeding, and shorter length of hospital stay.

Evaluation of the association between the optic nerve sheath diameter and extracorporeal life support time during cardiac surgery in newborns

OBJECTIVE

Congenital heart disease (CHD), a birth defect, is a major cause of neonatal mortality; however, improvements in surgical procedures and medical treatments have resulted in decreased mortality rates. Nonetheless, postoperative morbidity, particularly cerebral dysfunction, remains an issue in patients receiving extracorporeal life support (ECLS) for cardiac surgeries. Herein, we aimed to assess the association between optic nerve sheath diameter (ONSD) and ECLS time in newborns receiving ECLS for cardiac surgery.

PATIENTS AND METHODS

We enrolled 25 newborn patients who received ECLS for cardiac surgery at our hospital. ONSD was measured at four different time points during the surgery: baseline (T1), 15 min after cross-clamping (T2), after displacement of cross-clamping (T3) and at the end of the surgery (T4). Furthermore, the ECLS time, aortic cross-clamp time, and surgery time were recorded.

RESULTS

The regression analysis revealed a significant association between ONSD and ECLS time, cross-clamp time and surgery time. The correlation analysis showed strong associations between baseline ONSD and ONSD at T2, T3, and T4. Moreover, ONSDs significantly increased at T2 compared with those at baseline during cardiac surgery.

CONCLUSIONS

Our findings suggest an association between ONSD and ECLS time in newborns receiving ECLS for cardiac surgery. Monitoring ONSD may provide valuable information about intracranial pressure changes in these patients.

Comparison of extraperitoneal and intraperitoneal laparoscopic procedures for intracranial pressure increase: a prospective clinical study

OBJECTIVE

According to the literature, higher levels of both intracranial pressure (ICP) and intraabdominal pressure (IAP) are related in a way that suggests a causal relationship. An increase in ICP can cause major neurological problems both during and after laparoscopic surgery. In this study, we aimed to examine the increase in ICP between totally extraperitoneal (TEP) inguinal hernia repair and laparoscopic cholecystectomy.

PATIENTS AND METHODS

We investigated 52 individuals who underwent laparoscopic surgery for the treatment of inguinal hernia (n = 26) or had a laparoscopic cholecystectomy (n = 26). The optic nerve sheath diameter (ONSD) was assessed before the procedure (T0), 10 minutes after carbon dioxide insufflation (T1), and immediately before extubation (T2).

RESULTS

There were significant differences in the ONSD values between the two groups as a function of time (p = 0.001). In terms of ONSD, the laparoscopic cholecystectomy value (LV) group showed a greater shift from T0 to T1 and T2 than the inguinal hernia value (HV) group. At T1, the ONSD values of both groups were considerably higher than those of T0 and T2. The impact of the extraperitoneal and transperitoneal laparoscopic methods on ICP was investigated. The ONSD value reached its maximum at T1 in both groups. At all measurement periods, the ONSD values of the LV group were noticeably higher than those of the HV group.

CONCLUSIONS

The diagnostic accuracy of ONSD ultrasonography is an important approach for determining the ICP level. During the decision-making process of TEP inguinal hernia repair, this study can guide medical professionals in the evaluation of elevated ICP.

Effect of Remote Ischemic Preconditioning in Total Knee Arthroplasty on Thiol-Disulfi de Balance: a Randomized Controlled Study

PURPOSE OF THE STUDY The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thioldisulfi de homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes. MATERIAL AND METHODS Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS). RESULTS This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfi de levels, disulfi de/native thiol, disulfi de/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfi de values at T0 and T4 periods, however, was not statistically signifi cant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002). DISCUSSION This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfi de levels at each postoperative time point were signifi cant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort. CONCLUSIONS Our fi ndings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes. Key words: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfi de balance, oxidative stress, total knee arthroplasty.

The effect of intrathecal sufentanil preconditioning against myocardial ischemia-reperfusion injury

OBJECTIVES

We aimed to investigate the cardioprotective effect and hemodynamic response of intrathecally administered sufentanil on myocardial IR injury.

BACKGROUND

Sufentanil, mu opioid receptor agonist, intravenously administered during clinical and experimental studies, has been shown to have a cardioprotective effect on myocardial ischemia-reperfusion injury.

METHODS

Thirty-two New Zealand type rabbits, which were anesthetized, were divided into four equal groups: sham, ischemia-reperfusion, sufentanil and ischemia-reperfusion+sufentanil. Sufentanil was administered intrathecally prior to ischemia. Hemodynamic parameters were monitored by electrocardiography and invasive arterial blood pressure measurements. In the ischemia-reperfusion groups, the degree of myocardial infarct was determined as the ratio of ischemic region to the risk area by a 1 % 2,3,5-triphenyl tetrazolium chloride staining.

RESULTS

The mean infarct size in the ischemia-reperfusion group was 47.5 ± 7.0 %, whereas that of the ischemia-reperfusion+sufentanil group was found to be 34.2 ± 4.7 %, indicating a statistically significant difference (p = 0.002). The heart rate was different between the ischemia-reperfusion and the sufentanil groups for baseline measurement and between the ischemia-reperfusion and the ischemia-reperfusion+sufentanil groups at the 120th minutes measurement (p < 0.05).

CONCLUSION

Intrathecal sufentanil appears to have a cardioprotective effect against myocardial ischemia--reperfusion injury in the experimental rabbit model (Tab. 1, Fig. 2, Ref. 19).