Sedation/Anestehesia Experiences During Magnetic Resonance Imaging Procedure in the Pediatric Patients

Introduction: Sedation is often needed for magnetic resonance imaging (MRI) in pediatric patients for diagnostic purposes. In this study, we aimed to present anesthesia techniques and complications that occurred during sedation in pediatric patients. Methods: A total of 337 pediatric patients, in whom MRI was performed with sedation between January 1, 2016 and December 31, 2016, were retrospectively reviewed. The procedure, anesthetic drugs used, complications, and the need for additional medications were recorded. The patients were divided into 3 groups. Group 1: MRI procedure lasted 15 minutes, group 2: MRI procedure lasted 15-30 minutes and group 3: MRI procedure lasted more than 30 minutes. Within the groups, subgroup evaluations were made according to the type of anesthetic drug used. Results: There was no statistically significant effect of drug types used on complication development (bradicardia, hypoxia) and additional drug requirements in binary comparisons among subgroups (p=0.655, p=0.655 and p=0.317). In comparison of the groups according to the duration of the MRI procedure, complication development and need for additional medication were found to increase with prolonged imaging time (p=0.008, p=0.012 and p=0.02). Conclusion: Combinations of anesthetic and sedative drugs used during MRI in the pediatric patient group have no effect on complication development (bradicardia, hypoxia) and additional drug need. However, as the duration of the imaging procedure increases, complications and need for additional medication increase

Mean Platelet Volume, Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio to Predict Complications During Postoperative Recovery of High Risk Surgical Patients

Objective:This study sought to define the correlation between the occurrence of the complications and certain blood parameters in high risk surgical patients who were monitored for 24 hours in the intensive care unit postoperatively.Method:Two hundred-fifty seven cases (126 females 131 males; mean age 42.18±8.54 years; range 19-73 years) who were operated on in our hospital and followed up in the intensive care unit for 24 hours were included in this study. The files of all cases included demographic characteristics, erythrocyte count (RBC), leukocyte count (WBC), platelet count (PLT), mean platelet volume (MPV), neutrophil, lymphocyte, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), serum blood urea nitrogen (BUN) and creatinine values. Group A consisted of cases that did not develop complications in the first 24 hours, and group B consisted of cases that developed complications in the first 24 hours postoperatively. The blood hemogram parameters RBC, WBC, PLT, MPV, NLO, PLO, and the biochemistry parameters BUN and creatinine were compared between the groups.Results:Preoperative MPV value and postoperative MPV value were significantly higher in group B than group A (p-values 0.038 and 0.045, respectively). In groups A and B, the postoperative MPV value increased significantly compared to the preoperative period (p=0.032, p=0.000, respectively). Preoperative PLR and postoperative PLR values did not differ significantly in groups A and B (p=0.101 and p=0.458, respectively). The postoperative PLR value increased significantly in groups A and B compared to the preoperative period (p=0.000 and p=0.047, respectively) Preoperative and postoperative NLR values in group B were significantly higher than group A (p=0.006 and p=0.025 respectively). In groups A and B, the postoperative NLR value increased significantly compared to the preoperative period (p=0.000 and p=0.006, respectively).Conclusion:In this study, the cases that developed complications had more significant increases in their MPV, NLR, and PLR values during the postoperative period than their counterparts who experienced no complications

The Effect of Early Rehabilitation on COVID-19: A Prospective, Observational Study

Objective:The aim of this study was to investigate the effect of early pulmonary rehabilitation (PR) on the course of the disease, respiratory functions, physical activity, fatigue, and discharge time in Coronavirus disease-2019 (COVID-19) patients in the intensive care unit (ICU) setting.Method:A total of 31 patients (20 females, 11 males) with COVID-19 confirmed by real-time polymerase chain reaction who were admitted to the ICU were included. Demographic, clinical, and laboratory data of the patients were recorded. Physical activity, dyspnea, and fatigue of all patients were evaluated before and after PR program. All patients were evaluated on the day of PR in the ICU, the day of discharge from ICU to the ward, and on the day of discharge from hospital. Functional status was evaluated using the functional disability questionnaire (FDQ), the ambulation status using the functional ambulation classification (FAC), dyspnea using the modified Borg scale (MBS), and fatigue using the fatigue severity scale.Results:The mean length of ICU and hospital stay was 17.93±11.54 days and 18.29±8.41 days, respectively. The mean number of sessions was 8.87±7.66. The mean time from hospitalization to recovery was 13.00±9.62 days. Median FDQ and MBS scores were significantly higher during the ICU stay than the ward stay and at the time of discharge (p<0.05). Median FAC scores were significantly higher at the time of discharge than the ward and ICU scores (p<0.05). There was a positive and statistically significant correlation between the FDQ scores during the ward stay and C-reactive protein (CRP) values during the ICU stay (r=0.382, p=0.034) and CRP values during the ward stay (r=0.379, p=0.035). There was a negative and statistically significant correlation between the FDQ scores at the time of discharge and ferritin levels during the ICU stay (r=-0.421, p=0.018). A positive and statistically significant correlation was observed between MBS scores at the time of discharge and CRP values during the ward stay (p=0.418, p=0.019).Conclusion:Our study suggests that PR is an effective and safe approach with improved physical and functional results and COVID-19 survivors should undergo a PR program in an individualized manner using a multidisciplinary approach to improve short- and long-term outcomes

Yoğun bakim ünitesindeki hastalarda yelken göğüs nedeniyle göğüs duvarı stabilizasyonunun sonuçları

Objectives: In this study, the effect of multi-trauma on treatment results in flail chest patients who underwent chest wall stabilization was investigated. Methods: The data of thirty-six flail chest cases between the ages of 18-79 who were consulted for thoracic surgery were retrospectively analyzed in the study. The presence of flail chest in the patients was confirmed by thoracic surgeons, and the multi-traumas were confirmed through the diagnoses made by specialist physicians reexamining clinical methods. Results: It was found that 27 (75%) of flail chest cases evaluated had multi-trauma, and 3 (8.3%) of the cases had mortality in the study. It was found that the duration of the intensive care unit stay and the number of days on invasive mechanical ventilation of the cases were positively correlated with the number of surgical areas exposed to trauma (p<0.05). According to the univariate binary logistic regression analysis, it was found that the total number of rib fractures (OR = 1.44, p=0.055), the number of fixed ribs (OR = 0.76, p=0.558), the number of plates placed for fixation (OR = 0.70, p=0.368), and the number of additional trauma areas outside the thorax (OR = 6.76, p=0.076) were not statistically significant in increasing the mortality risk. Conclusion: Considering that multi-trauma is an effective factor in the prolongation of the duration of treatment, the management of traumas with different specialties can positively affect the treatment results and reduce the risk of mortality.Araç: Bu araştırmada göğüs duvarı stabilizasyonu yapılan yelken göğüs hastalarında multitravma varlığının tedavi sonuçlarına ve mortaliteye etkisi incelenmiştir. Yöntem: Araştırmada gögüs cerrahisine konsülte edilen 18-79 yaş aralığındaki 36 yelken göğüs vakasının verisi geriye dönük olarak incelendi. Hastalardaki yelken göğüs varlığı göğüs cerrahi uzmanlarınca konulan, multitravmaları ise alanında uzman hekimler tarafından konulan tanılar aracılığıyla (rutin kan tahlili, direkt X-ray radyografi bulguları, ultrason sonuçları, bilgisayarlı tomografi ve MR) doğrulandı. Bulgular: Araştırmada değerlendirilen yelken göğüs vakalarının 27’sinde (%75) mutitravma ve vakaların 3'ünde (%8,3) mortalite olduğu bulundu. Moratlite olan vakaların tamamında erkek cinsiyet, oral trakeal entübasyon ve invaziv mekanik ventilasyon ihtiyacı, pulmoner kontüzyon, hemopnönomotoraks, kafa travması ve omurilik travması olduğu bulundu. Vakaların yoğun bakımda kalma ve invasive invaziv mekanik ventilasyonda kalma sürelerinin travmaya maruz kalan cerrahi bölge sayılarıyla pozitif ilişkili olduğu (p<0,05) bulundu. Tek Değişkenli Binary Lojistik Regresyon Analizine göre toplam kaburga kırığı sayısının (OR=1,44 %95 CI: 0,99-2,09, p=0,055), fikse edilen kaburga sayısının (OR=0,76; %95 CI: 0,35-1,77, p=0,558), fiksasyon için konulan plak sayısının (OR=0,70; %95 CI: 0,32 1,52, p=0,368) ve toraks dışı ek travma sayısının (OR=6,76; %95 CI: 0,82-55,93, p=0,076) mortalite riskini artırmada istatistiksel açıdan anlamlı derecede etkili olmadığı bulundu. Sonuç: Yelken göğüs vakalarında multitravmalar göreceli olarak mortalite riskini artırsa da bu risk artışının istatistiksel açıdan anlamlı değildir. Multitravmaların tedavi sürelerinin uzamasında etkili bir faktör olduğu düşünüldüğünde farklı uzmanlık alanlarıyla travmaların yönetilmesi mortalite riskini azaltabilir