Amaç: Bu fizibiliti çalışmasının amacı pediyatrik hastalarda uygun büyüklükte kaflı endotrakeal tüpün (ETT) öngörülmesinde ultrasonografinin (USG) ilk girişim başarısını araştırmaktır.Yöntemler: Çalışmaya 1-10 yaş arası adenoidektomi veya adenotonsillektomi için endotrakeal entübasyon ile genel anestezi alan 50 çocuk dahil edilmiştir. Bütün katılımcılarda subglottik havayolunun transvers çapı krikoid kartilaj seviyesinden ventilasyon yapılmadan ultrasonografi ile ölçülmüştür. izin verilen maksimum ETT dış çapı (DÇ) ölçülen sublottik havayolu çapına göre seçilmiştir. Tüpün trakeadan geçişi sırasında dirençle karşılaşılması halinde veya havayolu basıncı >25 cm H 2 O'da duyulabilen kaçak varlığında ETT iç çapı (iÇ) 0,5 mm olan bir başkasıyla değişti-rilmiştir. Eğer havayolu basıncı <10 cm H 2 O'da duyulabilen kaçak varsa veya kaf basıncı >25 cm H 2 O'ya ulaşmıyorsa veya tepe havayolu basıncı ventilasyon sırasında >25 cm H 2 O ise tüp bir büyük çapla değiştirilmiştir. En iyi uyan ETT DÇ'ı iÇ'a dönüştü-rülmüştür. En uygun iÇ, ETT değiştirme ihtiyacı, ultrasonografi ile havayolu çapı ölçüm süresi, ve tepe havayolu basınçları kaydedilmiştir. Bulgular:Ultrosonografi ile ilk deneme başarı oranı %86, ETT 5 hastada bir numara büyük olan, 2 hastada bir numara küçükle değiştirilmiştir.Sonuç: Bulgularımız USG ile ölçülen subglottic çapın uygun pediyatrik ETT çapının belirlenmesinde daha güvenilir bir belirleyici olduğunu göstermiştir. Anahtar kelimeler: Pediatrik endotrakeal tüp, subglottik çap, ultrasonografiObjective: The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Methods:Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H 2 O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H 2 O, if a seal could not be achieved with a cuff pressure of >25 cm H 2 O or if a peak airway pressure of >25 cm H 2 O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. Results:The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. Conclusion:Our findings show the subglottic di...

SummaryObjectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks. Methods: After obtaining the ethics committee's approval and informed consent, 50 ASA I-II patients were randomized to either the interscalene (GISB) or supraclavicular (GSCB) group. Preoperatively, patients received an ultrasonography-guided block using 30 ml of 0.5% bupivacaine. In the postoperative period, morphine patient-controlled analgesia was administered as a 0.3-mg/h basal dose and 1-mg bolus dose, with a 20-min lockout time. Postoperative visual analog scale (VAS; 0-10 cm) scores of the patients were evaluated at 4, 8, 12, and 24 h postoperatively; additional analgesic requirements, adverse effects, and complications were recorded. Patient satisfaction (PS) scores were evaluated after 24 h. Results: VAS scores at 4 h were lower in the GSCB group than in the GISB group, and the VAS scores at 8, 12, and 24 h were lower in the GISB group than in the GSCB group, with no statistical significance. Additional analgesic requirements was 28% in the GISB group and 68% in the GSCB group (p < 0.05). Total morphine consumption was lower in the GISB group than in the GSCB group (18.95±9.2 mg vs. 30.6 ± 9.6 mg; p < 0.001). PS scores were higher in the GISB group than in the GSCB group (7.0±1.0 vs. 6.1±0.9; p < 0.01). Adverse effects and complication rates were similar in both the groups. In GISB group, seven patients (28%) had nausea/vomiting, whereas in the GSCB group, 12 patients (48%) had nausea/vomiting. This difference was statistically insignificant. Conclusion: Supraclavicular block can be considered as an alternative to interscalene block for arthroscopic shoulder surgery.Keywords: shoulder surgery, interscalene block, supraclavicular block, postoperative analgesia Özet Amaç: Artroskopik omuz cerrahisi hastalarında postoperatif analjezik olarak opioidler, nonsteroid analjezikler ve lokal anestetikler kullanılabilir. Çalışmamızda tek doz interskalen blokla tek doz supraklavikular bloğun postoperatif analjezik etkinliklerini karşılaştırılması amaçlandı. Gereç ve Yöntem: Etik kurul ve hastalardan izin alındıktan sonra interskalen (GİSB) veya supraklavikular blok (GSKB) uygulanması için kontrendikasyonu bulunmayan ASA I-II 50 hasta randomize olarak ikiye ayrıldı. İki gruba da preoperatif dönemde ultrason eşliğinde blok yapılarak 30 ml %0.5 bupivakain uygulandı. Postoperatif dönemde intravenöz morfin 0.3 mgr/saat infüzyon, 1 mgr bolus doz ve kilitli kalma süresi 20 dakika olacak şekilde hasta kontrollü analjezi uygulandı. Hastaların postoperatif vizuel analog skala (VAS: 0-10 cm) değerleri 4., 8., 12. ve 24. saatlerde sorgulandı, ek analjezik ihtiyaçları ve tekniğe bağlı yan etki ve komplikasyonlar kaydedildi. 24 saat sonunda hasta memnuniyeti (HM) sorgulandı. Bulgular: VAS değerlerine bak...

Should fluid management in thoracic surgery be goal directed?Mert S ¸ent€ urk, Emre Sertac ¸Bing€ ul, and O ¨zlem Turhan Purpose of reviewTo find a reliable answer to the question in the title: Should fluid management in thoracic surgery be goal directed?Recent findings 'Moderate' fluid regimen is the current recommendation of fluid management in thoracic anesthesia, however, especially in more risky patients; 'Goal-Directed Therapy' (GDT) can be a more reliable approach than just 'moderate'. There are numerous studies examining its effects in general anesthesia; albeit mostly retrospective and very heterogenic. There are few studies of GDT in thoracic anesthesia with similar drawbacks.

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Background Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. Methods After random allocation, 74 children aged 1–8 were randomized to receive US-guided TAPB by using 1 mg.kg− 1 bupivacaine as either 0,25% (0,4 ml.kg− 1) (Group 1) or 0,125% (0,8 ml.kg− 1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with a lateral approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy which is assessed by postoperative FLACC behavioral pain assessment score at 15′, 30′, 45′, 1 h, 2 h, 6 h, and 24 h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients’ parents and the surgeons. Results Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6thhour. No local or systemic complication or side effect related to anesthesia or surgery was reported. Conclusion TAPB using 1 mg.kg− 1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. Trial registration This trial was retrospectively registered at Clinicaltrals.gov, NCT04202367.

Background: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. Methods: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg-1 bupivacaine as either 0,25% (0,4 ml.kg-1) (Group 1) or 0,125% (0,8 ml.kg-1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with an intercostoiliac approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy and is assessed by postoperative FLACC behavioral pain assessment score at 15’, 30’, 45’, 1h, 2h, 6h, and 24h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients’ parents and the surgeons. Results: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6thhour. No local or systemic complication or side effect related to anesthesia or surgery was reported. Conclusion: TAPB using 1 mg.kg-1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. TAPB is an effective analgesic technique for children undergoing inguinal hernia repair.