Case Report: Anaesthetic Approach For Emergency Surgery In A Patient With Acute Myocardial Infarction

In this case report, we examined anaesthetic approach for emergency surgery in a patient with acute myocardial infarction and stomach perforation at the same time.Anaesthesia was induced with midazolam, propofol, fentanyl and vecuronium, and maintained with sevoflurane 1-2% in 100% oxygen, fentanyl and vecuronium. Patient controlled analgesia with morphine was used for postoperative analgesia. At postoperative 17th day, the patient was discharged from the hospital as health

Prognostic value of the lactate-albumin difference for predicting in-hospital mortality in critically ill patients with sepsis

Objective: To evaluate the prognostic performance of the lactate–albumin difference (LAD), maximum lactate levels, and the Sequential Organ Failure Assessment (SOFA) score taken on the first day in critically ill patients with sepsis, on in-hospital mortality and 90-day survival. Patients and Methods: Data from the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4 were evaluated retrospectively. The first day data of adult patients with sepsis diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria were recorded. The effectiveness of all diagnostic modalities on admission was analyzed to predict in-hospital mortality and 90-day survival. Results: In-hospital mortality was 20.3% among the 2270 patients included in this study. The area below the receiver operating characteristic curve (AUC) value of the LAD was higher than lactate for predicting mortality (AUC, 0.691; 95% confidence interval [CI], 0.663–0.718; p< 0.01, and AUC, 0.675; 95% CI, 0.646–0.703; p< 0.01, respectively), and the AUC of SOFA score was the highest (AUC, 0.716; 95% CI, 0.663–0.718). The optimal cutoff of LAD was 0.7. Conclusion: In addition to its easy and simple calculability relative to the SOFA, the prognostic performance of LAD was superior to maximum lactate levels for predicting in-hospital mortality and 90-day survival in adult patients with sepsis

The value of internal jugular vein collapsibility index in sepsis

BACKGROUND: Rapid, accurate, and reproducible assessment of intravascular volume status is crucial in order to predict the efficacy of volume expansion in septic patients. The aim of this study was to verify the feasibility and usefulness of the internal jugular vein collapsibility index (IJV-CI) as an adjunct to the inferior vena cava collapsibility index (IVC-CI) to predict fluid responsiveness in spontaneously-breathing patients with sepsis. METHODS: Three stages of sonographic scanning were performed. Hemodynamic data were collected using the Ultrasonic Cardiac Output Monitor IA system (Uscom, Ltd., Sydney, NSW, Australia) coupled with paired assessments of IVC-CI and IJV-CI at baseline, after passive leg raise (PLR), and again in semi-recumbent position. Fluid responsiveness was assessed according to changes in the cardiac index (CI) induced by PLR. Patients were retrospectively divided into 2 groups: fluid responder if an increase in CI (Delta CI) >= I5% was obtained after PLR maneuver, and non-responder if Delta CI was <15%. RESULTS: Total of 132 paired scans of IJV and IVC were completed in 44 patients who presented with sepsis and who were not receiving mechanical ventilation (mean age: 54.6 +/- 16.1 years). Of these, 23 (52.2%) were considered to be responders. Responders had higher UV-CI and IVC-CI before PLR maneuver than non-responders (p<0.001). IN-CI of more than 36% before PLR maneuver had 78% sensitivity and 85% specificity to predict responder. Furthermore, less time was needed to measure venous diameters for IN-CI (30 seconds) compared with IVC-CI (77.5 seconds; p<0.001). CONCLUSION: UV-CI is a precise, easily acquired, non-invasive parameter of fluid responsiveness in patients with sepsis who are not mechanically ventilated, and it appears to be a reasonable adjunct to IVC-Cl

Renal Resistive Index Measurement by Transesophageal Echocardiography: Comparison With Trans lumbar Ultrasonography and Relation to Acute Kidney Injury

Objectives: The aim of this study was to evaluate the relationship between transesophageal ultrasonography-derived renal resistive index values (RRITEE) and a standard translumbar renal ultrasound-derived RRI (RRITLUSG). The effectiveness of each method to predict acute kidney injury (AKI) after cardiac surgery also was compared. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Sixty patients undergoing cardiac surgery. Interventions: First, RRI was measured with both methods after anesthesia induction. Second, another measurement was performed with TEE after cardiopulmonary bypass and immediately following the surgery with translumbar ultrasound. To test the correlation between the 2 methods and to plot a Bland-Altman graph, preoperative RRI values measured by both techniques were used. Receiver operating characteristic curves also were plotted to compare the diagnostic values of RRI measured intraoperatively by TEE after cardiopulmonary bypass and by RRITLUSG after surgery. Measurements and Main Results: There was a statistically significant correlation between the 2 RRI measurement approaches (r = 0.86, p < 0.0001). The Bland-Altman plot indicated good agreement between the methods. The area under the curve (AUC) of RRITEE in predicting AKI was 0.82 (95% confidence interval (Cl] = 0.64-0.9, p = 0.001), and the AUC of RRITLUSG after surgery was 0.85 (95% Cl = 0.7-0.98, p < 0.0001). In predicting AKI, an uncertainty zone for RRITEE values between 0.68 and 0.71 was computed by the gray-zone approach. Conclusions: RRITEE showed clinically acceptable agreement with RRITLUSG. Indeed, RRI measured intraoperatively with TEE was comparable to RRITLUSG in terms of detecting postoperative AKI. (C) 2015 Elsevier Inc. All rights reserved

Preemptive Analgesic Effects Of Caudal Block In Paediatrıc Patients Undergoing Orthopaedic Surgey

We examined preemptive analgesic effect of caudal block in patients undergoing orthopaedic hip or lower extremities surgery.Forty children between ages of 1-12 years whom orthopaedics hip and or lower extremities surgery would be applied to were included into study. Fifteen minutes before surgical incision, in Group I, 0.125% bupivacaine 0.5 ml/kg was given for caudal anaesthesia. In Group II, caudal block was postoperatively applied with the same dose of drug. During postoperative period, patients were followed for 48 hours, and OPS “objective pain scale”, time to demand of first analgesic, and total analgesic consumption were recorded. In Group II, OPS score and total analgesic consumption were higher in initial 8 hours (P<0.05, P<0.001). Duration of first analgesic application was longer in Group I (P<0.001).We concluded that preoperative caudal block has preemptive analgesic effect in children undergoing orthopaedic surgery

Intraoperative venous air embolism in semi-sitting position

Venöz hava embolisi, nöroşirurji operasyonlarında özellikle oturur, yarı oturur ve hatta supin pozisyonlarda oluşabilen sonucunda morbidite ve mortalitesi yüksek olan bir komplikasyondur. Parietal bölgede glial tümör nedeniyle yarı oturur pozisyonda operasyona alınan hastada aniden end tidal CO2, oksijen saturasyonu ve kan basıncının düştüğü görüldü. Hastada sol akciğerinde havalanma azlığı ve kalbin oskültasyonunda pansistolik üfürüm saptandı. Venöz hava embolisi geliştiği düşünülen hastanın santral venöz kateterinden hava aspire edildi ve hemodinamik stabilite tekrar sağlandı. Operasyonun sonunda hasta uyandırılarak ekstübe edildi. Bu olguda hastanın iyi monitorize edilmesi ve erken müdahale edilmesi sayesinde oluşabilecek komplikasyonlar engellenebilmiştir. Nöroşirurjinin oturur pozisyonlarındaki operasyonlarının yanısıra yarı oturur ve supin pozisyonlardaki operasyonlarında da standart monitorizasyonun yanında mutlaka santral venöz kateterizasyon ve arterial monitorizasyonun yapılarak yakın takip edilmesinin olası komplikasyonların erken tanı ve tedavisi açısından önemli olduğunun bir kez daha vurgulanmasında yarar olduğunu düşünüyoruz.Venous air embolism is a complication with high mortality and morbidity which may occur in neurosurgical operations especially in patients with semi-sitting, sitting and even supine position. In a patient who underwent surgery because of a glial tumour located in the parietal lobe end tidal CO2, O2 saturation and systemic blood pressure decreased suddenly during the operation. The aeration of the left lung was restricted and a pansystolic cardiac murmur was auscultated. Air was aspirated from the central catheter of the patient who was thought to have developed venous air embolism and hemodynamic stability was reassured. At the end of the operation the patient was awaken and extubated. In this case the potential complications were prevented by standard optimum monitoring and early intervention. The aim of this case report is to remind the close follow up of the patients undergoing neurosurgical operations in semi-sitting, sitting or supine positions by central venous catheterization and arterial monitoring additionally to the standard monitoring, carries importance in early diagnose and therapy of possible complications