Determining entropy values equivalent to the bispectral index values during sevoflurane anaesthesia

Introduction: We aimed to identify the entropy levels that would be equivalent to the bispectral index (BIS) levels in sevoflurane anaesthesia in patients who are to undergo elective lumbar disc surgery

Impact of leg wrapping in combination with leg elevation on postspinal hypotension in subjects undergoing elective cesarean section under spinal anesthesia

Aim: This study aimed to compare the efficacy of lower extremity wrapping with elastic bandages in conjunction with leg elevation to leg elevation alone in terms of maternal systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 in term mothers undergoing elective cesarean section (CS) with spinal anesthesia. Material and Methods: A series of 62 term mothers aged between 20 and 45 years who were scheduled for elective CS under spinal anesthesia were enrolled in the study. Using sealed envelopes, participants were allocated to one of two study groups: the wrapping group (n=30) or the control group (n=32). All subjects received volume administration of lactated Ringer's solution of 10 mL/kg over the 15 min prior to the administration of the spinal block. Subjects allocated to the wrapping group received lower extremity wrapping with 10-cm Esmarch elastic bandages applied from the ankle to the mid-thigh immediately before the administration of the subarachnoid block. Following intrathecal injection, lower limbs were elevated 20 degrees in subjects allocated to the wrapping group by tilting the foot-end of the operating table. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 were monitored intraoperatively. Results: Systolic, diastolic, and mean blood pressures were significantly higher in the wrapping group compared to the control subjects beginning from the 2nd minute of the intrathecal injection to the 20th-30th minute of the intrathecal injection. The median ephedrine dose was significantly higher in the control group than the wrapping group [15 (0-40) mg vs. 5 (0-30) mg, p=0.007]. Vomiting was also more frequent in control subjects compared to those receiving lower extremity wrapping and leg elevation (18% vs. 0%, p=0.024). Discussion: Lower extremity wrapping in combination with leg elevation provides a better hemodynamic profile than volume administration alone in subjects undergoing elective CS under spinal anesthesia. Subjects receiving lower extremity wrapping and leg elevation require less vasopressors and experience less vomiting compared to subjects receiving only volume administration

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

Purpose: To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects. Methods: After Ethic's Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L3-4 interspace in 90 ASA physical status I-II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 μg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded. Results: Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001). Pain score, respiration rate, and SpO2 values were similar in all study groups. Conclusion: We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration

Comparison of serum corrected and ionized calcium levels in patients with acute kidney injury

Introduction: Acute kidney injury (AKI) is common in hospitalized patients (1.92%). The effect of serum corrected and ionized calcium levels in predicting emergency hemodialysis in patients with AKI is unknown. In this study, we aimed to compare serum corrected and ionized calcium levels in patients who were diagnosed with AKI in the emergency service.Methods: Our study was planned retrospectively. Group 1: Patients with AKI who underwent at least one session of emergency hemodialysis. Group 2: The patients with AKIN stage 1-3 who did not undergo hemodialysis. Serum corrected and ionized calcium, creatinine and albumin values of the patients at the time of admission were analyzed. All data of the study were recorded by SPSS 19.0. For statistical significance, p lt;0.050 was accepted.Results: The mean serum corrected calcium levels were lower in group 1 than in group 2, and the difference was statistically significant (p lt;0.001). The mean ionized calcium levels in blood gas were lower in group 1 than in group 2, and the difference was statistically significant (p = 0.002).Conclusions: Serum corrected, and ionized calcium levels can be useful in predicting emergency hemodialysis in patients with AKI

Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas

PURPOSESimple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants.METHODSIn total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher’s exact test was used to compare independent groups, and Spearman’s correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values.RESULTSThe B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas).CONCLUSIONAs the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas

Postmortem Süreçte COVID-19 Enfeksiyon Etkeninin Pozitif Kalma Süresi

Objective:Studies show that in patients diagnosed with Coronavirus disease-2019 (COVID-19), polymerase chain reaction (PCR) tests can give false negative results depending on sampling techniques/regions. In this study; the positivity of virus RNA was studied consecutive lung tru-cut needle biopsy taken at 6-hour intervals in cases who died during treatment due to COVID-19 infection, it was aimed to determine the postmortem safe working range.Methods:In May 2020-April 2021, 21 patients who died during treatment due to COVID-19 infection diagnosed with clinical and/or RNA detection in Muğla Training Research Hospital, Anesthesia Intensive Care Unit were included. Antemortem, postmortem swabs results, and virus RNA detection by PCR made from postmortem lung tissue samples were compared with their clinics. Statistical analysis was performed.Results:Fifteen (71.4%) of 21 cases were male and 6 (28.6%) were female. The mean age is 71.9 (standard deviation=12.079). All of the toracic CT findings at hospitalization had a ground-glass opacity. The mean hospitalization time was 11.7 days. Antemortem nasopharyngeal virus positivity was shown in 13 cases (61.9%), postmortem nasopharyngeal virus positivity in 5 cases (23.8%), and virus positivity in lung tissue samples in 7 cases (33.3%). No significant correlation was found virus positivity in nasopharyngeal swab and lung tissue sample, the incompatibility rate was 19.1%, which was statistically significant.Conclusion:Although the targeted sample size could not be reached due to study limitations, the inconsistency in virus positivity in nasopharyngeal swabs and lung tissue samples is significant. It is certain that studies with a large comparative sample are needed in terms of postmortem survival time, clinical and organ damage caused by the virus