Is tranexamic acid safe for the hip joint?

To show the effects of tranexamic acid, which is a drug frequently used to control bleeding, on the hip joint and sciatic nerve in animal experiments. There were 15 rats in each of the 3 groups, with a total of 45 rats. Topical saline injections were applied to the first group, topical TXA injections to the second group, and intravenous (IV) TXA injections to the third group. In the samples taken from the hip joint 3 weeks later, femoral head cartilage, sciatic nerve, and joint capsule thicknesses were analyzed histologically. Statistically significantly more cartilage degradation was detected in the femoral head cartilage in both the IV and intraarticular TXA group when compared to the control group. The groups were also compared in terms of acetabular cartilage; however, no histological difference was found between the groups. It was seen that when the femoral head cartilage thickness (the average of the measurements made from 3 different points were used) was examined, the cartilage thickness in the topical TXA group was less when compared to the other 2 groups. However, this difference was determined to not be statistically significant. The data of the hip joint capsule thickness measurement, it was found that the capsule thickness in the topical TXA applied group was less when compared to the other 2 groups. However, this difference was not statistically significant. When the sciatic nerves in all 3 groups were compared, no different staining characteristics were found in the immunofluorescence examination. TXA, which is frequently used in orthopedic practice, shows negative effects on hip joint cartilage in both topical and intravenous application.

Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study

Background & objective: Corona pandemic has had profound effects on the practice of healthcare delivery across the globe. The institutional practices and protocols had to be rewritten to cope up with the surge of corona patients and to save the staff and the non-corona patients. We evaluated the emergency surgery cases during the first wave of COVID-19 after the decision to stop elective surgeries, in regard to differences in terms of case distribution, patient profile, anesthesia methods used and the management, and compared with an equivalent period before the pandemic. Methodology: Patient files related to emergency surgery from October-November 2019 and April-May 2020, were retrospectively evaluated. Assessment parameters included age, gender, surgical discipline, ASA score, type of anesthesia, time to discharge, reoperation, laparoscopic or open surgery. Results: The most common surgical cases in both periods belonged to general surgery. While the number of patients in ASA-I decreased during the COVID period, those in ASA-II increased. We found that while general anesthesia was preferred in majority of the surgeries during the non-COVID period, spinal anesthesia gained popularity in the COVID period (p < 0.05). Conclusion: The decrease in the number of patients with ASA-I indicates a change in the surgeons’ priorities in emergency surgery cases. Although there is a worldwide approach to the use of laparoscopic surgery, the use of open surgical techniques increased in our hospital. Key words: Covid-19; Pandemic, Emergency surgery Citation: Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth. pain intensive care 2022;26(3):469-473; DOI: 10.35975/apic.v26i4.1949 Received: Sep 29, 2021; Reviewed: Jan 10, 2022; Accepted: Mar 26, 2022

Does the preoperative fasting period affect the liver in a distant organ model of renal ischaemia reperfusion?

OBJECTIVES

To experimentally evaluate the effects of preoperative fasting duration on distant organ liver in renal ischaemia-reperfusion (IR) injury.

METHODS

This is an experimental study. In the study, 3 groups were formed. In Group A, abdominal laparotomy was carried out after 12 hours of preoperative fasting without any IR damage. In Group B, IR injury was carried out after 12 hours of preoperative fasting, and abdominal laparotomy was carried out, in Group C after 2 hours of fasting after IR injury. Apoptosis, congestion, balloon degeneration, nuclear pleomorphism, and leukocyte infiltration were examined histopathologically and tumor necrosis factor-alpha (TNF-α), interleukin (IL) -1 beta, IL-6, and IL-10 were evaluated biochemically.

RESULTS

A statistically significant difference was determined between the groups in respect of postoperative IL-10 levels (p=0.020) with significantly lower levels determined in Group C than in Groups A and B (p=0.021). Similar rates of mild nuclear polymorphism were seen with no statistically significant difference determined between the groups (p>0.167). A statistically significant difference was determined between the groups in respect of the congestion scores (p<0.001), with a lower score in Group C than in Groups A and B, where the scores were similar (p<0.001, p=0.017).

CONCLUSION

With this result, it would be correct to say that the short preoperative fasting period has protective effects on the liver tissue.

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. 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. 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 < 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 < 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 < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05). 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. Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation 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. DOI: 10.35975/apic.v26i1.1775 Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021