Özlem Selvi Can

Has the quality of abstracts for randomised controlled trials improved since the release of Consolidated Standards of Reporting Trial guideline for abstract reporting? A survey of four high-profile anaesthesia journals.

Background and objective Randomised controlled trial (RCT) abstracts published in journal articles have traditionally been deficient of crucial information. To improve the quality of RCT abstracts, in January 2008, the Consolidated Standards of Reporting Trial (CONSORT) group published a checklist of essential information for inclusion. The current study assessed whether there has been an improvement in the quality of RCT abstracts published in main anaesthesia journals since this new guideline was introduced. Methods Articles involving human RCTs published in four high-profile anaesthesia journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology and the European Journal of Anaesthesiology) were reviewed, comparing those published from October 2005 to September 2006 (pre-CONSORT abstracts) with those published from October 2008 to September 2009 (post-CONSORT abstracts). Trials involving healthy volunteers or cadavers, cost-effectiveness studies, meta-analyses and letters were excluded. Abstracts from remaining RCTs were randomly assigned to four reviewers in a blinded fashion and reviewed for content using the new CONSORT checklist. Results In total, 527 RCT abstracts (pre-CONSORT RCTs, n = 275 and post-CONSORT RCTs, n = 252) were analysed. The majority of abstracts in both groups provided an appropriate description of study interventions (73.1 and 73.8%, pre-CONSORT abstracts versus post-CONSORT abstracts, respectively), objective (91.3 and 90.1%) and conclusions (72.4 and 66.3%). From pre-CONSORT to post-CONSORT guidelines for abstract reporting, there were significant improvements in correctly identifying blinding (18.2–29%) and harmful effects (31.6–42.1%). The improvement in reporting the nature of the trial in abstract titles (20.1–29%) and primary outcome measure in the methods section (22.9–30.6%) did not reach significance. There was no clear improvement in the already poor reporting of trial design, participants, randomisation, recruitment, outcomes, trial registration and funding sources. Conclusions Despite some promising improvements and inter-journal differences, the overall quality of RCT abstracts and adherence to the CONSORT checklist for abstracts remains poor.

Therapeutic plasma exchange in an intensive care unit (ICU): A 10-year, single-center experience

Therapeutic plasma exchange (TPE) is a blood purification method that effectively allows for the removal of waste substances by separating out plasma from other components of blood and the removed plasma is replaced with solutions such as albumin and/or plasma, or crystalloid/colloid solutions. Plasma exchange therapies are becoming increasingly essential, being used in daily practice in critical care settings for various indications, either as a first-line therapeutic intervention or as an adjunct to conventional therapies. This retrospective clinical study analyzes 10-year therapeutic plasma exchange activity experience in an 18-bed ICU at a tertiary care university hospital with a large, critically-ill patient population. Medical records of 1188 plasma exchange procedures on 329 patients with different diagnoses admitted from January 2000 to July 2010 were evaluated. The aim of the study was to determine the TPE indications and outcomes of the patients who underwent TPE in the ICU with conventional therapy. The secondary endpoints were to determine the differences between different patient groups (septic vs. non-septic indications) in terms of adverse events and procedural differences.

Percutaneous tracheostomy by Griggs technique under rigid bronchoscopic guidance is safe and feasible in children

OBJECTIVE The aim of this study is to report prospective data of pediatric cases that underwent percutaneous tracheostomy (PT) to show that PT is a safe and feasible procedure in children even in small infants. PATIENTS AND METHODS PT was done in 51 consecutive patients. Demographic data, indications, complications and outcome were recorded prospectively. Initial 6 PT was done by Giaglia technique whereas the Griggs technique was used in the consecutive 45 patients. RESULTS Fifty-one patients with mean age of 38±54months (1month-17years) and, mean weight of 12.4±13kg underwent PT. The only major complication was perforation of esophagus (n=1, 2%) which was recognized early and immediately repaired by cervical approach. This complication occurred in the 6th case done with the Giaglia technique. After conversion to the Griggs technique no major complication was encountered in the consecutive 45 procedures. The mean period of follow up was 21±13.7months. Narrowing of the stoma site requiring simple dilation was developed in 3 (5.8%) patients. CONCLUSION PT is a safe and easy procedure and a less invasive alternative to surgical tracheostomy even in small infants. We strongly recommend PT done by Griggs technique in children. It is important that it should be done in an operating room setting and under rigid bronchoscopic guidance.

Balloon dilatation in esophageal strictures in epidermolysis bullosa and the role of anesthesia.

Esophageal involvement, which causes stricture, is a complication in epidermolysis bullosa. This causes dysphagia and malnutrition and leads to deterioration of skin lesions in these patients. The charts of 11 patients with epidermolysis bullosa and esophageal stricture who were included into dilatation program between 2003 and 2015 were retrospectively reviewed. Seven of the patients were female and four were male. The median age was 14 (2-32) years. The mean body weight of patients was 27.8 (9-51) kg. The location and number of strictured parts of the esophagus were previously evaluated with upper gastrointestinal contrast study and after that flexible endoscopy was used for dilatation. Eight patients had middle esophageal, three patients had proximal esophageal and one of them had both proximal and middle esophageal strictures. The strictures were dilated 56 times in total (mean 5 times). One patient underwent gastrostomy and was medically followed-up after a perforation occurrence during the dilatation procedure. In a 32-year-old female patient, colon interposition was performed after four dilatations since optimal nutritional and developmental status could not be achieved. The dilatation program of nine patients is still in progress. Seven of them can easily swallow solid food but two of them have some difficulties in swallowing between dilatations. One patient rejected the program and quitted, while one patient refused colon interposition and died because of complications related to amyloidosis during the dilatation program. After resolution of the swallowing problem, skin lesions were observed to heal quickly. Epidermolysis bullosa is a rare cause of dysphagia. Esophageal balloon dilatation with flexible endoscopy is a safe and efficient method in patients with this condition.

Anesthetic management of Schimke syndrome

To the Editor: Schimke syndrome is a rare autosomal recessive inherited disorder that is characterized by disproportionately short stature, spondyloepiphyseal dysplasia, hyperlordosis, facial dimorphism resembling mucopolysacchariduria, progressive nephropathy, and defective cellular immunity [1, 2]. We report the anesthetic management of a 10-yearold girl with Schimke syndrome undergoing renal transplantation. It is important to perform a detailed preoperative evaluation in patients with Schimke syndrome. Special attention should be given to airway assessment because of syndrome characteristics such as short neck, microcephaly, lordosis, and facial appearance (ESM Fig. 1). As the patient had a short neck, large tongue, and dimorphic face, we prepared all equipment (different-sized laryngeal mask airways, different-sized laryngoscopes and tracheostomy sets) to be available for the management of a difficult pediatric airway. Although we inserted an appropriate oropharyngeal airway, mask ventilation of the patient was difficult even with two hands, probably because of her large tongue and short neck. After injection of a muscle relaxant, we could perform mask ventilation and tracheal intubation. We believe that we were able to use the muscle relaxant safely because we had sugammadex for rescue events. Neurological symptoms in patients with Schimke dysplasia have been described previously as transient ischemic attacks, probably related to vascular stenosis, and ulceration resulting from atherosclerosis and thrombus formation: such stroke episodes can lead to death [3]. Extra care was taken to maintain stable blood pressure during surgery. In conclusion, difficult airway management and special attention to thrombotic events and epileptic seizures are the important issues involved in anesthetic management of this syndrome.

Stuck tunneled central venous catheters in children: four cases removed by angiography assistance

Ateş U, Taştekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Koloğlu M, Yağmurlu A, Aktuğ T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters. Three children had acute lymphoblastic leukemia and one had an immunodeficiency syndrome. All catheters were made from polyurethane. Indwelling times were 12-24 months. All patients` catheters were removed with great difficulty by trans-femoral access. The angiography-assisted technique is safe and easily-applied for the removal of stuck catheters in pediatric patients. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in children.

Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results

Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short‐term results of a laparoscopic sleeve gastrectomy series in children.