A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval

OBJECTIVE: To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval. METHODS: Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effectsite concentration of 1.5 μg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded. RESULTS: Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea. CONCLUSION: Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL

Myocardial infarction after an electric shock: A rare complication

Myocardial infarction is one potential outcome after an electric shock though it is seen relatively rarely. Nonetheless, an increased death rate because of cardiopulmonary arrest is of concern and merits careful scrutiny. Here, we report a man with myocardial infarction following electrical shock. Although he had frankly normal coronary arteries by coronary angiography, myocardial infarction was objectively evident by cardiac enzymes, electrocardiography and echocardiography. Oral medication with a beta-blocker and angiotensin converting enzyme inhibitor was started. He was discharged in good health after stabilization for a co-existing pelvic fracture and retroperitoneal hematoma. The patient had an uneventful follow-up one year later, with persisting non-specific electrocardiographic changes

Current cardiac imaging techniques for detection of left ventricular mass

Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test

Therapeutic effects of intralipid and medialipid emulsions in a rat model of verapamil toxicity

Background/aim: Lipid emulsions are promising as a potential new therapy for severe verapamil overdose. Our purpose is to draw attention to the choice of solution by investigating the efficacy of intralipid 20\% or medialipid 20\% in verapamil overdose. Materials and methods: Eighteen adult Sprague Dawley rats were randomly divided into three groups: control (saline; Group C), intralipid 20\% (Group I), and medialipid 20\% (Group M). Rats were anesthetized with ketamine. Blood gas analysis, baseline heart rate (HRb), and mean arterial pressure (MAP(b)) were evaluated. Verapamil at 2.5 mg kg(-1) min(-1) was infused until the HRb and MAP(b) decreased by 50\% and the times to HR0 and MAP(0) were recorded. Treatment solutions of the groups were administered as 12.4 mL kg(-1) in 5 min. Results: While HR did not show a difference, MAP showed statistically significant differences among the groups. Intralipid 20\% was more efficient than the other two treatments at an early stage; however, as the administration time progressed, medialipid 20\% also turned out to be more efficient than the control treatment. Conclusion: Our findings indicate that in a toxicity model of rats produced with verapamil, intralipid 20\% and medialipid 20\% solutions partially eliminate cardiac- depressant effects and increase the survival rate

Picturing asthma in Turkey: results from the Turkish adult asthma registry

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery