A comparison of the effects of desflurane and total intravenous anaesthesia on the motor evoked responses in scoliosis surgery

Background: In the present study, we compared the effects of total intravenous anaesthesia (TIVA) and desflurane anaesthesia on tcMEPs in scoliosis surgery.Methods: The study included 45 patients between the ages of 18 to 50 years, and classified as ASAI-II; which were planned to undergo posterior fusion/instrumentation operations for elective scoliosis.  Anaesthesia was maintained using 50-150 mcg/kg/min propofol in Group T(TIVA), and desflurane (0.5 MAC) in Group D, and with infusions of 0.05-0.3 mcg/kg/min remifentanil at 50 % O2 + air in both groups, by applying drugs at doses so that bispectral index (BIS) would be maintained between 40 and 60 throughout the course of anaesthesia. The tcMEP responses were measured four times during the operation, and BIS, train-of-four (TOF), mean arterial pressure (MAP), heart rate(HR), and end tidal CO2(ETCO2) values were recorded simultaneously. In both group the anaesthesia was ended at the final surgical suture.  The recovery parameters were recorded.Results: The groups were found not to differ regarding the demographic characteristics, duration of the anaesthesia and the surgery, remifentanil dosage, tcMEP, the simultaneously recorded TOF, MAP, HR and ETCO2 values, and the amount of perioperative bleeding. The cooperation time and the orientation time were shorter in group D. The tcMEP responses were recorded in the appropriate times and amplitudes in both groups. Conclusions: TIVA is primarily used in routine applications in spinal surgery; however our study results revealed that 0.5 MAC desflurane may also be safely used in association with remifentanil, with the resultant correct tcMEP responses. 

Comparison of the remifentanil and remifentanil+propofol combination for sedoanalgesia in functional endoscopic sinus surgery

AMAÇ: Lokal anestezi altında uygulanan fonksiyonel endoskopik sinüs cerrahisi operasyonlarında sedoanaljezi amacıyla verilen remifentanil ve remifentanil + propofol kombinasyonu karşılaştırıldı. YÖNTEMLER: 18-70 yaş arasındaki ASAI-II grubundan 40 hasta rastgele olarak iki gruba ayrıldı. I. gruba (n=20) 1 mcg/kg remifentanil bolus, 0.1 mcg/kg/dk remifentanil infüzyonu; ikinci gruba (n=20) 0.5 mcg/kg remifentanil bolus, 0.05 mcg/kg/dk remifentanil infüzyonu ve 50 mcg/kg/dk propofol uygulandı. Belirlenen aralıklarla sistolik, diyastolik ve ortalama arter basınçları ile kalp atım hızı, solunum sayısı ve SpO2 değerleri, “discomfort” skoru, ağrıya verilen sözel yanıt, OAA/S (Observer’s Assessment Alertness/Sedation) skalası, Aldrete derlenme skoru ve yan etkiler kaydedildi. BULGULAR: Her iki grupta hemodinamik açıdan fark bulunamadı. Kullanılan dozlarda her iki grupta da sedasyon düzeyinin yeterli olduğu saptandı. 0.1 mcg/kg/dk remifentanil grubunda daha iyi analjezi sağlanmasına rağmen solunum sayısında diğer gruba göre daha fazla azalma ve daha fazla bulantı kusma görüldü. SONUÇ: Fonksiyonel endoskopik sinüs cerrahisi operasyonlarında, gerek remifentanilin gerekse remifentanil + propofol kombinasyonunun, belirlenen doz aralıklarında, monitörize anestezik bakımda sedoanaljezi amacıyla güvenle kullanılabileceği kanaatindeyiz.OBJECTIVE: We aimed to compare the remifentanil and remifentanil + propofol combination for sedoanalgesia in functional endoscopic sinus surgery performed under local anesthesia. METHODS: Forty patients from American Society of Anesthesiologists (ASA) I-II patients between the ages of 18-70 years were divided randomly into two groups. The 1st group (n=20) received 1 mcg/kg remifentanil bolus and 0.1 mcg/kg/min infusion and the 2nd group (n=20) received 0.5 mcg/kg remifentanil bolus, 0.05 mcg/kg/min infusion and 50 mcg/kg/min propofol. Systolic, diastolic, mean arterial pressure, heart rate, respiratory rate, and SpO2 values, discomfort scores, verbal response to pain, OAA/S (Observer’s Assessment Alertness/Sedation) scale, Aldrete recovery scores, and side effects were recorded at particular intervals. RESULTS: There was no difference between groups hemodynamically. The doses used in each group showed adequate levels of sedation. 0.1 mcg/kg/min remifentanil provided better analgesia; however, the respiratory rate was reduced and nausea and vomiting were increased. CONCLUSION: We believe that either remifentanil or remifentanil + propofol combination can be used safely during functional endoscopic sinus surgery operations for sedoanalgesia in monitored anesthetic care at determined dose intervals

Comparison of the Maternal and Neonatal Effects of Intratechal Bupivacaine Plus Fentanyl or Morphine During Cesarean Delivery

Aim: To evaluate the effects of morphine and fentanyl added to bupivacaine and intrathecal bupivacaine to combine spinal-epidural anaesthesia during caesarean. Methods: Forty subjects with American Society of Anesthesiologists I-II status who would have caesarean were included in the study. The subjects were divided into two groups. Group bupivacaine-fentanyl (BF) were given 0.5% bupivacaine 7.5 mg + 25 µg fentanyl and group bupivacaine-morphine (BM) received 0.5% bupivacaine 7.5 mg + 0.1 mg morphine intrathecal total 2 mL. Periods for access to T4 block, two dermatome regression of sensory block, time elapsed between the administration of the local anaesthetic and reaching Bromage scale 1, reaching the highest level of motor block, first analgesic necessity, umbilical cord clamping time, and when the operation ends were recorded. One-minute and five-minute Apgar scores, umbilical blood gas values of the newborns and the adverse effects were recorded. Results: Comparisons between the two groups show that group BM has longer periods for motor block start time, two dermatome regression time, and first anaesthetic necessity time and group BF had higher levels for motor block level at the 1st minute and visual analog scale scores at postop 60th minute. There was no significant difference between the groups for the adverse effects. Conclusion: Fentanyl and morphine added to intrathecal bupivacaine show similar effects in intraoperative analgesia. We have deduced that although low doses of hyperbaric bupivacaine is effective during caesarean section, fentanyl and morphine added to bupivacaine can also be used safely and effectively

Incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical hospital in Istanbul, intensive care unit of a teaching Turkey (2004-2006)

The identification of microorganisms causing ventilator-associated pneumonia (VAP) is important for formulating appropriate therapies. In this study, we report the incidence, etiology, and antibiotic resistance patterns of Gram-negative microorganisms isolated from patients diagnosed with VAP in our medical-surgical intensive care unit (ICU) during the years 2004-2006. VAP was diagnosed by using the clinical criteria of the Centers for Disease Control and Prevention. Antibiotic resistance patterns of isolated microorganisms were defined by standard methods. The VAP incidence rate was 22.6/1,000 ventilator days. The most frequently isolated pathogens were Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Ninety percent of Acinetobacter spp. isolates were resistant to ceftazidime, 64% to imipenem, and 80% to ciprofloxacin. Fifty-nine percent of P. aeruginosa isolates were resistant to ceftazidime, 32% to imipenem, and 62% to ciprofloxacin. Cefoperazone-sulbactam was the most active agent against Acinetobacter spp. In conclusion, the incidence of VAP and the prevalence of multidrug-resistant microorganisms are quite high in our ICU. Comparison of the resistance rates of isolates demonstrates that certain antibiotic agents are more effective than others

Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010)

The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum beta-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed