Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section

Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women

Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents

Introduction. Dynamic tests for predicting fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion index and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in determining fluid responsiveness. Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and reanimation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontaneous breathing, cardiac arrhythmia, and impaired peripheral circulation. We measured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45° semi-recumbent position (SP) and then 15° Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 ± 10.57 to 12.66 ± 9.64; p > 0.05), while we did observe significant decreases in PVI (from 21.91 ± 13.99 to 20.46 ± 14.12; p < 0.05). The PPV fluid responsiveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specificity) and 18% (76.67% sensitivity, 72.46% specificity), respectively. The PVI fluid responsiveness cut-off value in the SP and TP was 20% (80.49% sensitivity, 81.03% specificity) and 16% (81.25% sensitivity, 62.69% specificity), respectively. The area under the ROC of the PPV and PVI was 0.843 and 0.858 in the SP, respectively, and 0.760 and 0.747 in the TP, respectively. The PPV and PVI were correlated in the SP (r = 0.578; p = 0.001) and the TP (r = 0.517; p = 0.001). Conclusions. Our results showed that the PPV and PVI were correlated independent of position change in sepsis patients. Both tests appear to be equivalently reliable. However, the ability of the PPV and PVI to predict fluid responsiveness decreased in the TP in our study

The Effects of Different Insufflation Pressures on Liver Functions Assessed with LiMON on Patients Undergoing Laparoscopic Cholecystectomy

Purpose. Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy, but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion. We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests (ICG-PDR). Methods. We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy. The patients were randomly allocated to two groups. In Group I, the operation was performed using 10 mmHg pressure pneumoperitoneum. In Group II, 14 mmHg pressure pneumoperitoneum was used. The ICG-PDR measurements were made after induction (ICG-PDR 1) and after the end of the operation (ICG-PDR 2). Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels were all recorded preoperatively, 1 hour, and postoperative 24 hours after surgery. Results. The ICG-PDR 1 values for Groups I and II were as follows: 26.78 ± 4.2% per min versus 26.01 ± 2.4% per min (P > 0.05). ICG-PDR 2 values were found to be 25.63 ± 2.1% per min in Group I versus 19.06 ± 2.2% per min in Group II (P < 0.05). There was a statistically significant decrease between baseline and postoperative ICG-PDR values in Group II compared to Group I (P < 0.05). Statistically, there was an increase between baseline and postoperative 1st-hour serum AST and ALT level in Group II (P < 0.05) compared to Group I. No statistical differences were detected on postoperative 24st-hour serum AST and ALT levels and all the time bilirubin between groups (P > 0.05). Conclusion. In conclusion, the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels. We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy

Tracheal resection after tracheal stenosis: Case report

Hava yolu hasarı, endotrakeal entübasyon veya trakeostomi sonrası görülebilir ve hastada ciddi solunum sıkıntısına neden olabilir. Bu yazıda trakeostomi açılması sonrası ciddi hava yolu darlığı gelişen olguda trakeal rezeksiyon esnasındaki anestezi yönetimi anlatıldı.After endotracheal intubation or tracheostomy, airway damage may be occurred and serious respiratory distress may be seen in the patient. In this case report, we discussed the anesthetic care during tracheal resection in a patient with severe respiratory distress after tracheostomy

Allergic reaction during hydatid cyst operation: Case report

Kist hidatik, echinococcus granulosus ve echinococcus alveolaris tarafından oluşturulan paraziter bir enfeksiyondur. Bu enfeksiyon kist oluşumu ile karakterize olup, kistler en sık olarak karaciğerde yerleşmektedirler. Kistlere yönelik cerrahi tedavi sırasında kistler rüptüre olabilir ve alerjik reaksiyonlar gelişebilir. Bu olgu sunumunda karaciğerde kist hidatik nedeniyle ameliyat edilen hastada gelişen ürtikerle karakterize alerjik reaksiyon gelişmesi sunulmuştur.Hydatid disease is a parasitic infection caused by echinococcus granulosus and echinococcus alveolaris. This infection is characterized by cyst formation and the liver is the most commonly involved organ. Hydatid cysts can rupture during surgical operation and allergic reaction may occur. In this case report, we presented a patient who developed an allergic reaction characterized by urticaria during the operation of a hidatic cyst in the liver

Continuous spinal anesthesia application in a patient with high cardiac risk: Case report

Alt ekstremite cerrahisi anestezisinde, genel anesteziden çok rejyonel yöntemler tercih edilmektedir. Özellikle yaşlı ve yüksek kardiyak riskli hastalarda hemodinamik stabiliteyi koruyarak yeterli anestezi sağlanması temel amaçtır. Acil sağ diz üstü amputasyon planlanan 63 yaşındaki kadın hasta, altı gün önce ST yükselmesiz miyokard infarktüsü (Mİ) tanısı konularak tedavi edilmişti. Olgunun 15 yıldır tip 2 diabetes mellitusu, 10 yıldır hipertansiyonu vardı. İki yıl önce iki damar baypas ile mitral annuloplasti ve iki ay önce sağ diz altı amputasyon uygulanmıştı. Sağ lateral pozisyonda, L3-4 intervertebral aralıktan kateter içinden iğne tekniği ile intratekal kateter yerleştirildi. Serbest BOS akışı görüldükten sonra 2.5 mg %0.5'lik bupivakain uygulandı. Yeterli duyusal blok seviyesi sağlanana kadar her beş dakikada bir tekrarlanan 2.5 mg'lık dozlarla toplam 7.5 mg %0.5 bupivakain uygulanarak anestezi sağlandı. Duyusal blok T10 seviyesine ulaştıktan sonra sırtüstü pozisyon verildi. Ameliyat süresince hemodinamik olarak stabil seyreden olguya kateterden ek ilaç uygulanmadı ve bir saatlik ameliyat sonunda spinal kateteri çıkarılarak servise gönderildi. Sonuç olarak, özellikle yaşlı ve kardiyak riski yüksek olgularda alt ekstremite ameliyatları için sürekli spinal anestezi tekniğinin uygun bir anestezi seçeneği olarak kullanılması gerektiğini düşünmekteyizRegional techniques are preferred to general anesthesia in lowerextremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T10 level. The patient was hemodynamically stable during the operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery

Farklı iki lipid solüsyonunun kan trigliserid ve kolesterol düzeylerine etkileri

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.7.0ZET Çalışmamızda %60 poliunsatüre yağ asidi içeren soya yağı bazlı bir lipid solüsyonu ile (Lipofundin % 20) monounsatüre yağ asitlerinden zengin olan (%63) ve %20 oranında poliunsatüre yağ asidi içeren zeytinyağı bazlı bir lipid solüsyonunun septik olmayan yoğun bakım hastalarında kan trigliserid ve kolesterol düzeylerine etkilerinin karşılaştırılması amaçlandı. Etik kurul izni alınarak başlanan çalışma TPN uygulanan ve rastgele iki gruba ayrılan 20 yoğun bakım hastası üstünde gerçekleştirildi.Hastaların enerji tüketimleri Schofıeld eşitliği kullanılarak belirlendi.Günlük protein ihtiyacı 1,2-1,6 g/kg/gün olarak saptanırken, non protein kalori ihtiyacının % 60' karbonhidratlardan, % 40'ı ise lipid solüsyonlarından karşılandı. Malignite, sepsis, septik şok, hemodinamik instabilizasyon, akut travma(ilk 24 saat), böbrek fonksiyon bozukluğu, karaciğer fonksiyon bozukluğu, bilinen diabetes mellitus, endokrin sistem hastalığı, lipid metabolizma bozukluğu, hemorajik diatez ve gebelik dışlama kriteri olarak kabul edildi. 48 saat boyunca Grup 1 'e Clinoleic % 20 ve, Grup 2'ye ise Lipofundin % 20 verildi. İnfüzyon öncesinde, başlangıcında ve infüzyon bitimini takip eden 2,4 ve 8. saatlerde alınan kan örneklerinden kolesterol ve trigliserid düzeyi belirlendi. Çalışmamızda soya yağı kökenli ve PUFA'dan zengin lipid solüsyonları ile zeytinyağı kökenli ve MUFA'dan zengin lipid solüsyonlarının plasma total kolesterol düzeylerinde değişikliğe yol açmadığı görülmüştür. Çalışmamızda soya yağı kökenli ve PUFA'dan zengin lipid emülsiyonu kullanılan grupta trigliserid düzeyinin yükselmiş olmasına rağmen zeytinyağı kökenli ve MUFA'dan zengin lipid solüsyonu kullanılan grupta trigliserid seviyesinin değişmediği görüldü. 5

Infraclavicular brachial plexus blockade in a case with ulnar shaft fracture

The brachial plexus is a peripheral nerve system that is responsible for motor, sympathetic and sensorial innervations of upper extremity. Brachial plexus lies between neck and shoulder next to great vessels and lungs. The anesthesia of upper extremities and shoulder can be achieved by blockade of brachial plexus in different places. Brachial plexus can be blocked using interscalene, supraclavicular, infraclavicular and axillary methods. In this case report, we presented an infraclavicular brachial plexus blockade for a patient with ulnar shaft fracture