No abstract

During the month of Ramadan, practicing Muslims abstain from eating and drinking from sunrise to sunset. We aimed to investigate the effect of Ramadan fasting on arousal and continuous attention. The electrodermal activity and cancellation test of students were measured in fasting and non-fasting conditions after the conclusion of the Ramadan fast period. The skin conductance level of the fasting group was no different from the non-fasting group. In non-fasting group, the skin conductance response amplitude to an auditory stimulus was higher and the skin conductance response onset latency was lower than in the fasting group. Cancellation test results: the fasting group had a lower total number of marked targets (TNTM) but a higher total number of missed targets (TNMT) and length of time for the subject to complete the test (LTCT) than the non-fasting group. Ramadan fasting did not change arousal, but the reaction time to an auditory stimulus increased during the Ramadan intermittent fasting. Both reaction amplitude and continuous attention also decreased in the fasting condition.

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

The utility of the pleth variability index in predicting anesthesia-induced hypotension in geriatric patients Abstract Background/aim: Anesthesia induced hypotension may have negative consequences in geriatric patients. Therefore, predicting hypotension remains an important topic for anesthesiologists. Pleth Variability Index (PVI) measurement provides information about the fluid status and vascular tonus of the patients. In our study, the ability of Pleth Variability Index to predict hypotension after general anesthesia induction was evaluated. Materials and methods: PVI values obtained from pulse oximetry were recorded in addition to preoperative standard anesthesia monitoring. The correlation between the PVI value and mean arterial pressure (MAP), systolic arterial blood pressure (SAP) changes and the power of PVI values to predict the incidence of hypotension after anesthesia induction (>20% MAP decrease) was tested. Results: Eighty patients over 65 years of age who were operated under general anesthesia were included in the study. Hypotension was observed in 20 patients (25%). PVI values were mild and positively correlated with MAP changes (r = 0.195 and p=0.041). According to the ROC analysis, the incidence of hypotension increased in patients with PVI values above 15.45%. We also found the following diagnostic results for PVI value for predicting hypotension: p=0.044 and Area Under ROC Curve 0.651 ± 0.073 (95%, Confidence Interval: CI 0.507-0.794), Sensitivity of 40%, specificity of 80%, PPV of 40%, NPV of 80%, cutoff value of 15.45, positive likehood ratio of 2, negative likehood ratio of 0.75, Youden Index of 0.2. 2 Conclusion: Predicting hypotension in geriatric patients is an important issue for anesthesiologists. As an easily applicable test, The Pleth Variability Index is useful in predicting MAP reduction in patients. This practical technique can be used routinely in all geriatric patient groups.

Introduction: Spinal anesthesia (SA) is one of the most frequently applied anesthesia procedures today. However, SA failure rate varies between 1 and 17%. The age of the patient, the position at which the procedure is performed, or the characteristics of the technical operation can affect success. In this study, we aimed to compare the most frequent SA failures according to the types of surgery and causes of failure. The results of SA procedures performed in a university hospital were compare to those published in the current literature. Materials and Methods: After obtaining ethics committee approval for our study, the hospital archives were examined retrospectively for 1 year with respect to SA procedures. SA application and failure rates were examined. Three or more SA attempts, failed dural puncture, or unsuccessful injection, and anesthesia applications that did not provide sufficient sensory block for surgery despite successful drug treatment were defined as failure. Results: Of all anesthesia procedures, SA was applied at a rate of 23.5%. Our SA failure rate was calculated as 16.6%. Considering a single surgical procedure, obstetric anesthesia was the most common surgery with failed SA (28.7%). The most common cause of failure was insufficient analgesia (32.9%). Discussion: SA failure rates were observed to be in a variable distribution range in the literature, and in some studies, SA failure was defined as a block that did not occur despite a full dose and successful injection, and this rate was found to be 3.9%. The high rate in our study group may be explained by differences in the definition of SA: blocks performed with several trials and any block that could not be applied were also recorded as SA failure. The reasons for failing to apply this procedure is an issue that is worth examining also in terms of patient satisfaction and safety, which is an important issue. Conclusion: Although the definition of unsuccessful SA is confusing, SA failure rates are worth examining and improving for each hospital.