Sevoflurane/remifentanil versus propofol/remifentanil for electroconvulsive therapy: comparison of seizure duration and haemodynamic responses

PubMed: 24398757Objective: To compare the anaesthetic and convulsive effects of sevoflurane/remifentanil versus propofol/remifentanil combination in electroconvulsive therapy (ECT). Methods: In this prospective, randomized double-blind study, patients diagnosed with treatment-resistant depression were included for ECT. Prior to treatment, 1 ?g/kg remifentanil was intravenously administered to all patients, followed by anaesthetic induction with either 0.5 mg/kg propofol or 8% sevoflurane. Following muscular paralysis with succinylcholine and hypnosis, bitemporal ECT was applied. Vital signs, depth of sedation, recovery parameters, motor and electroencephalography (EEG) convulsion activity and postictal suppression index scores were recorded. Results: A total of 120 sessions of ECT were administered to 12 patients. Heart rate was higher in the sevoflurane group than the propofol group. Compared with the sevoflurane group, bispectral index level was lower in the propofol group during the induction period and higher during the recovery period. Anaesthetic induction and recovery times were lower, and average motor and EEG convulsion activity was longer, in the propofol group than in the sevoflurane group. Conclusion: Propofol/remifentanil is more successful compared with sevoflurane/remifentanil in anaesthesia management during ECT since it provides quick induction and recovery, longer seizure activity and stable haemodynamics. © The Author(s) 2014

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Comparison of postoperative effects of phentanyl with combination of phentanyl and levobupivacaine in children with thoracotomy

Amaç: Retrospektif çalışmamızda torakotomi geçiren çocuklarda epidural fentanil ile fentanil-levobupivakain infüzyonlarının postoperatif analjezik etkinliği, hemodinamik ve yan etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Karadeniz Teknik Üniversitesi Tıp Fakültesi Çocuk Cerrahisi kliniğinde elektif torakal cerrahi girişim sonrası postoperatif analjezi amacıyla torakal epidural analjezi uygulanan 5-12 yaş arası, Amerikan Anestezi Cemiyeti ( ASA) I-III grubu, toplam 31 hasta retrospektif olarak incelendi. Bilgiler hasta dosyalarından, anestezi ve postoperatif hasta kontrollu analjezi (HKA) kayıt formlarından elde edildi. Hastalar, kullanılan analjezik ajana göre; Fentanil (F) ve Fentanil+Levobupivakain (FL) şeklinde iki gruba ayrıldı. Fentanil grubundaki tüm hastalara 0,5 µg/kg/sa fentanil infüzyonu kullanıldığı görüldü. Fentanil+levobupivakain grubundaki tüm hastalara ise 0,2 µg/kg/sa fentanil + 0,15 mg/kg/sa levobupivakain kullanıldığı görüldü. Torakal epidural HKA uygulamasının 0., 4., 12., 24., 36. (sırasıyla; T1, T2, T3, T4, T5) saatlerdeki visüel analog skala (VAS), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), kalp atım hızı (KAH), solunum sayısı (SS) ve yan etkilere ait veriler kayıt edildi. Bulgular: Gruplar arasında yaş, cinsiyet, boy, kilo ve ASA sınıflaması açısından istatistiksel olarak anlamlı fark görülmedi. Hemodinamik parametreler(SKB, DKB, KAH, SS), VAS skoru ve yan etkiler açısından da istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Çocuklarda torakotomi sonrası postoperatif epidural fentanil infüzyonunun, fentanil–levobupivakain kombinasyonu uygulanmasına eşdeğer analjezi sağlayabileceği görü- şündeyiz.Aim: We aimed to compare the postoperative analgesic efficacy, hemodynamic and side effects of epidural phentanyl and phentanyl-levobupivacaine administration in children undergoing torocotomy. Material and Method: 31 children with American Society of Anesthesiologists (ASA) I-III group and age between 5-12 years who were applied thoracic epidural with the purpose of postoperative analgesia after elective thoracic surgery in Karadeniz Technical University Faculty of Medicine, Clinics of Paediatric Surgery were examined retrospectively. Information was obtained from patients’ files, anaesthesia and postoperative patient controlled analgesia (PCA) recording form. Patients were separated into two groups according to analgesic agents used as phentanyl (F) and phentanyl+Levobupivacain (FL). It was found that 0,5 (µg/kg/h) phentanyl infusion was used for all patients in Group F. It was also found that, µg/kg/h phentanyl + 0,15 mg/kg/h levobupivacaine were used for all patients in Group FL. Visual analogue scale (VAS), systolic artery pressure (SAP), diastolic artery pressure (DAP), heart rate (HR), respiratory rate (RR), and side effects were recorded in 0., 4., 12., 24., 36. hours of thoracic epidural PCA application (T1,T2,T3,T4, T5 respectively). Results: There were no significant difference in age, sex, height, weight and ASA status between the groups. There were also no difeference in hemodynamic parameters (SAP, DAP, HR and RR), VAS score and side effects between the groups. Conclusion: We conclude that postoperative epidural phentanyl infusion provides equipotent analgesia to administration of phentanyl and levobupivacaine combination following thoracotomy in children

Comparison of postoperative effects of phentanyl with combination of phentanyl and levobupivacaine in children with thoracotomy

Amaç: Retrospektif çalışmamızda torakotomi geçiren çocuklarda epidural fentanil ile fentanil-levobupivakain infüzyonlarının postoperatif analjezik etkinliği, hemodinamik ve yan etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Karadeniz Teknik Üniversitesi Tıp Fakültesi Çocuk Cerrahisi kliniğinde elektif torakal cerrahi girişim sonrası postoperatif analjezi amacıyla torakal epidural analjezi uygulanan 5-12 yaş arası, Amerikan Anestezi Cemiyeti ( ASA) I-III grubu, toplam 31 hasta retrospektif olarak incelendi. Bilgiler hasta dosyalarından, anestezi ve postoperatif hasta kontrollu analjezi (HKA) kayıt formlarından elde edildi. Hastalar, kullanılan analjezik ajana göre; Fentanil (F) ve Fentanil+Levobupivakain (FL) şeklinde iki gruba ayrıldı. Fentanil grubundaki tüm hastalara 0,5 µg/kg/sa fentanil infüzyonu kullanıldığı görüldü. Fentanil+levobupivakain grubundaki tüm hastalara ise 0,2 µg/kg/sa fentanil + 0,15 mg/kg/sa levobupivakain kullanıldığı görüldü. Torakal epidural HKA uygulamasının 0., 4., 12., 24., 36. (sırasıyla; T1, T2, T3, T4, T5) saatlerdeki visüel analog skala (VAS), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), kalp atım hızı (KAH), solunum sayısı (SS) ve yan etkilere ait veriler kayıt edildi. Bulgular: Gruplar arasında yaş, cinsiyet, boy, kilo ve ASA sınıflaması açısından istatistiksel olarak anlamlı fark görülmedi. Hemodinamik parametreler(SKB, DKB, KAH, SS), VAS skoru ve yan etkiler açısından da istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Çocuklarda torakotomi sonrası postoperatif epidural fentanil infüzyonunun, fentanil–levobupivakain kombinasyonu uygulanmasına eşdeğer analjezi sağlayabileceği görü- şündeyiz.Aim: We aimed to compare the postoperative analgesic efficacy, hemodynamic and side effects of epidural phentanyl and phentanyl-levobupivacaine administration in children undergoing torocotomy. Material and Method: 31 children with American Society of Anesthesiologists (ASA) I-III group and age between 5-12 years who were applied thoracic epidural with the purpose of postoperative analgesia after elective thoracic surgery in Karadeniz Technical University Faculty of Medicine, Clinics of Paediatric Surgery were examined retrospectively. Information was obtained from patients’ files, anaesthesia and postoperative patient controlled analgesia (PCA) recording form. Patients were separated into two groups according to analgesic agents used as phentanyl (F) and phentanyl+Levobupivacain (FL). It was found that 0,5 (µg/kg/h) phentanyl infusion was used for all patients in Group F. It was also found that, µg/kg/h phentanyl + 0,15 mg/kg/h levobupivacaine were used for all patients in Group FL. Visual analogue scale (VAS), systolic artery pressure (SAP), diastolic artery pressure (DAP), heart rate (HR), respiratory rate (RR), and side effects were recorded in 0., 4., 12., 24., 36. hours of thoracic epidural PCA application (T1,T2,T3,T4, T5 respectively). Results: There were no significant difference in age, sex, height, weight and ASA status between the groups. There were also no difeference in hemodynamic parameters (SAP, DAP, HR and RR), VAS score and side effects between the groups. Conclusion: We conclude that postoperative epidural phentanyl infusion provides equipotent analgesia to administration of phentanyl and levobupivacaine combination following thoracotomy in children

Difficulties in the differential diagnosis of neuroleptic malignant syndrome with quetiapine poisoning

Ketiapin depresyon, bipolar bozukluk ve şizofreni tedavisi için yaygın olarak kullanılan atipik antipsikotik bir ajandır. Nöroleptik malign sendrom (NMS) hipertermi, kas rijiditesi, otonomik disfonksiyon, mental durum değişikliği, lökositoz ve creatinin fosfokinaz yüksekliği ile karakterizedir. NMS antipsikotik tedavinin nadir ama hayati tehdit eden bir komplikasyonudur. Bu olgu sunumunda biz ketiapin zehirlenmesi ile NMS’nin ayırıcı tanısında yaşanan güçlükleri vurgulamak istedik.Quetiapine is atypical antipsychotic agent that is widely used for the treatment of depression, bipolar disorder and schizophrenia. Neuroleptic malignant syndrome is characterized by hyperthermia, muscle rigidity, altered mental status, autonomic dysfunction, leukocytosis and elevation of creatinine phosphokinase. NMS is rare but lifethreatening complication of antipsychotic treatment. In this report we emphasized the difficulties in the differential diagnosis of NMS with quetiapine poisoning

Difficulties in the differential diagnosis of neuroleptic malignant syndrome with quetiapine poisoning

Ketiapin depresyon, bipolar bozukluk ve şizofreni tedavisi için yaygın olarak kullanılan atipik antipsikotik bir ajandır. Nöroleptik malign sendrom (NMS) hipertermi, kas rijiditesi, otonomik disfonksiyon, mental durum değişikliği, lökositoz ve creatinin fosfokinaz yüksekliği ile karakterizedir. NMS antipsikotik tedavinin nadir ama hayati tehdit eden bir komplikasyonudur. Bu olgu sunumunda biz ketiapin zehirlenmesi ile NMS’nin ayırıcı tanısında yaşanan güçlükleri vurgulamak istedik.Quetiapine is atypical antipsychotic agent that is widely used for the treatment of depression, bipolar disorder and schizophrenia. Neuroleptic malignant syndrome is characterized by hyperthermia, muscle rigidity, altered mental status, autonomic dysfunction, leukocytosis and elevation of creatinine phosphokinase. NMS is rare but lifethreatening complication of antipsychotic treatment. In this report we emphasized the difficulties in the differential diagnosis of NMS with quetiapine poisoning