Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery

Background and aim General anesthesia (GA) is the most commonly used anesthetic technique for spinal surgery. This study aimed to compare spinal anesthesia (SA) and GA in patients undergoing spinal surgery, in terms of perioperative outcome and cost effectiveness. Materials and methods The study included 80 patients with ASA (American Society of Anesthesiologists) physical status I–II. The patients were randomized to receive SA (n=40) or GA (n=40). Heart rate (HR), mean arterial blood pressure (MABP), blood loss, duration of surgery, duration of anesthesia, surgeon satisfaction, and duration in the post-anesthesia care unit (PACU) were recorded. Postoperative analgesic requirement, nausea and vomiting (PONV), perioperative hemodynamic variables, and anesthetic costs were determined. Results HR and MABP were significantly higher in the GA group than in the SA group at the end of surgery and at PACU admission. Duration of anesthesia, surgeon satisfaction, postoperative analgesic requirement, and anesthetic costs were significantly higher in the GA group. Mean blood loss was lower in the SA group than in the GA group, but the difference was not significant. Duration of surgery, duration in the PACU, perioperative hemodynamic variables, and complications were similar in both groups. Conclusions SA could be considered a reliable alternative to GA in patients undergoing lumber spine surgery, as it is clinically as effective as GA, but more cost effective

Palliative care and intensive care integration

With developments in technology and in healthcare policies in Turkey, both the quality and number of applications of care have increased in recent years in intensive care units. At the same time, rates of hospital mortality have increased due to the rise in the elderly population, changes in family structure, increased urban population and easier access to health facilities. Intensive care units are the places where deaths and functional and cognitive disorders are most frequently seen. Current models where intensive care and palliative care are integrated are seen as an important component of comprehensive care for patients with critical disease and who are receiving aggressive intensive care treatment. The goal in intensive care and palliative care integration is to promote better quality, lower cost, patient and family satisfaction. The aim of this review was to highlight the importance and necessity of palliative care applications in intensive care units. It can be concluded that an increase in palliative care training, legal regulations made related to end-of-life patient care and the implementation of palliative care in intensive care unit would provide more effective use of intensive care units. [Med-Science 2017; 6(3.000): 603-9

An examination of factors affecting the length of stay in long-term intensive care

With increased life expectancy, developments in intensive care (IC) and applications, there has been an increase in the length of stay of patients in IC Unit (ICU) in recent years. The aim of this study was to examine factors affecting the Length of Stay (LOS) in long-term ICU (LTICU)A total of 503 patients were included and the effects of variables were evaluated such as age, gender, comorbidities, tracheostomy, nutrition, mechanical ventilator (MV) support, and bacteria produced in cultures, which were predicted to have a clinical effect on the LOS in LTICU. The mean LOS in LTICU was 47.6±52.9 days. The LOS was determined to be increased 0.408-fold in patients with tracheostomy, 0.678-fold with Proteus spp production in cultures and 0.400-fold with E. coli production (p [Med-Science 2018; 7(1.000): 214-217

Traumatic brain injury and palliative care: a retrospective analysis of 49 patients receiving palliative care during 2013–2016 in Turkey

Traumatic brain injury (TBI), which is seen more in young adults, affects both patients and their families. The need for palliative care in TBI and the limits of the care requirement are not clear. The aim of this study was to investigate the length of stay in the palliative care center (PCC), Turkey, the status of patients at discharge, and the need for palliative care in patients with TBI. The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected, including age and gender of patients, the length of stay in PCC, the cause of TBI, diagnosis, Glasgow Coma Scale score, Glasgow Outcome Scale score, Karnofsky Performance Status score, mobilization status, nutrition route (oral, percutaneous endoscopic gastrostomy), pressure ulcers, and discharge status. These patients were aged 45.4 ± 20.2 years. The median length of stay in the PCC was 34.0 days. These included TBI patients had a Glasgow Coma Scale score ≤ 8, were not mobilized, received tracheostomy and percutaneous endoscopic gastrostomy nutrition, and had pressure ulcers. No difference was found between those who were discharged to their home or other places (rehabilitation centre, intensive care unit and death) in respect of mobilization, percutaneous endoscopic gastrostomy, tracheostomy and pressure ulcers. TBI patients who were followed up in PCC were determined to be relatively young patients (45.4 ± 20.2 years) with mobilization and nutrition problems and pressure ulcer formation. As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit, provision of palliative care services should be integrated with clinical applications

Snake Bite: Case Report

We present a case of a fourty-year-old man who was bitten by a snake on his left leg. It was a severe envenomation with ensuing marked edema and severe pain with complicated coagulation defects. After medical treatment with antivenom and fresh frozen plasma the patient discharged without any complication. (Journal of the Turkish Society of Intensive Care 2010; 8: 73-6

FACTORS AFFECTING THE DURATION OF ADMISSION AND DISCHARGE IN A PALLIATIVE CARE CENTER FOR GERIATRIC PATIENTS

WOS: 000391285300003Introduction: The factors that have an impact on the stay and discharge of geriatric patients who were admitted to palliative care center (PCC) were investigated. Materials and Method: 111 were included in the study. Age, gender, marital status, primary diagnoses, nutritional status, decubitus ulcer, pain issues, palliative performance scale ( PPS) scores, duration of PCC and "wanting to be discharged" status of patients were recorded. Results: Distribution of patients were as follows: neurological disease 47 (42.3%), cancer 26 (23.4%), chronic systemic conditions 46 (41.4%), infections 12 (10.8%), nutritional problems 58 (52.2%), decubitus ulcers 45 (40.5%) and pain 14 (12.6%). The median duration of PC was 24 days. Duration of hospitalization in patients with nutrition and decubitus ulcers were detected longer (p<0.05). "Wanting to be discharged" rate was lower in patients with neurological disease, poor PPS scores, decubitus ulcer and nutritional problems whereas higher in patients with cancer. According to the binary logit model, a diagnosis of cancer and PPS score were increased whereas nutritional problems and decubitus ulcers were decreased the probability of wanting to be discharged. Conclusions: A coordinated effort between palliative care and home health care may shorten the duration of in-patient palliative care and hasten the process of discharge

Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n=30) and low-flow sevoflurane anesthesia group (Group L, n=30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy