Valor predictivo de los test preoperatorios para estimar la intubación difícil en pacientes sometidos a la laringoscopia directa para la cirugía de oído, nariz y garganta

ResumenJustificación y objetivosEl valor predictivo de los test preoperatorios para estimar la intubación difícil puede ser diferente en afecciones laríngeas. Se hizo una revisión de las historias clínicas de los pacientes sometidos a laringoscopia directa y una investigación del valor predictivo de los exámenes preoperatorios para estimar la intubación difícil.MétodosSelección de historias clínicas de los períodos preoperatorio e intraoperatorio y del sistema informatizado del hospital.ResultadosSe evaluaron 2.611 pacientes. En un 7,4% se detectaron intubaciones difíciles. Las intubaciones difíciles fueron constatadas en pacientes con una puntuación de Mallampati (escala de Mallampati [EM]) clase 4 (50%); clasificación de Cormack-Lehane grado 4 (95,7%); conocimiento previo de la vía aérea difícil (86,2%); restricción de la amplitud de movimientos del cuello (amplitud de movimientos cervical) (75,8%); distancia tiromentoniana corta (81,6%); y masa en las cuerdas vocales (849,5%) (p<0,0001). La EM tuvo una sensibilidad baja, mientras que la amplitud de movimientos cervical, tuvo la presencia de masa en las cuerdas vocales, distancia tiromentoniana corta y EM con un valor predictivo positivo relativamente mayor. La incidencia de intubaciones difíciles se incrementó 6.159 y 1.736 veces en cada nivel de aumento de los grados de la clasificación de Cormack-Lehane y de la clase de la EM, respectivamente. Cuando todos los test fueron considerados en su conjunto, la intubación difícil pudo ser clasificada con exactitud en un 96,3% de los casos.ConclusiónLos resultados de los test que prevén intubaciones difíciles en casos con laringoscopia directa coincidieron claramente con los resultados previstos en la literatura para las poblaciones de pacientes en general. Las diferencias en algunos resultados de los test, cuando se les comparó con los de la población en general, pueden ser debidas a las condiciones patológicas subyacentes de la laringe en las poblaciones de pacientes con intubación difícil.AbstractBackground and objectivesPredictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated.MethodsPreoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened.ResultsA total of 2.611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system class 4 (50%), Cormack–Lehane classification grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical range of motion) (75.8%), short thyromental distance (81.6%), vocal cord mass (849.5%) as indicated in parentheses (P<.0001). MS had a low sensitivity, while restricted cervical range of motion, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in Cormack–Lehane classification grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases.ConclusionTest results predicting difficult intubations in cases with direct laryngoscopy had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation

A Single Clone Acinetobacter baumannii Outbreak in a State Hospital in Turkey

ERTURK, AYSE/0000-0001-6413-9165WOS: 000320094900014PubMed: 23698489Acinetobacter baumannii is an important pathogen in hospitalized patients, particularly those in the intensive care unit (ICU). A total of 21 A. baumannii (6 from 5 patients and 15 from environmental samples) were isolated in the ICU and the isolation room of a state hospital in June 2011. The possible source of the outbreak was investigated. A. baumannii isolates were identified using conventional biochemical tests, BBL Crystal Identification Systems, OXA-51 specific PCR, and 16S rDNA sequencing. All the isolates were multidrug-resistant, showing resistance to cephalosporins, carbapenems, fluoroquinolones, and the aminoglycoside group of antibiotics. Pulsed-field gel electrophoresis suggested that all A. baumannii isolates were derived from a common source

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydra­tion times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge. Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we al­lowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the pa­tients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The par­ents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospi­tal admission. Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported. Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental

Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p < 0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation

The effects of anaesthesia induction with propofol or ketofol on cerebral oxygenation in patients above 60 years of age

Side effects such as hypotension and cerebral perfusion disorder may be encountered after anaesthesia induction, especially in elderly patients. Some studies have attempted to determine whether hypotension during induction and associated organ perfusion disorders can be prevented when propofol is used in combination with ketamine. However, no study has come to light investigating the effects of ketamine added to propofol on cerebral oximetry. The present study aimed to compare the effects of anaesthesia induction with propofol or propofol+ketamine (ketofol) on haemodynamic changes and cerebral oximetry in elderly patients undergoing anaesthesia induction. A total of 40 patients were randomly divided into two groups. Cerebral oximetry sensors were placed in the right and left of the frontal region. Patients in Group P were treated with 1.5 mg/kg propofol IV induction and patients in Group K were treated with the 0.2 ml/kg ketofol IV. The patients in both groups received 0.5 mg/kg lidocaine, 0.6 mg/kg rocuronium and a 0.1 mcg/kg/min infusion of remifentanil. Heart rate (HR), systolic, diastolic and mean arterial pressure (SBP, DBP, MAP) and cerebral oxygen saturation (RSO2) values before and 1, 3, 5, 10, 30 and 60 minutes after induction were recorded.SBP, DBP and MAP values were significantly lower in the propofol group at 1, 3 and 5 minutes after induction (p &lt; 0.05). The right-side RSO2 values were significantly lower at 3 and 5 minutes after induction in the propofol group compared to the ketofol group and the left-side RSO2 values were similarly significantly lower after 1, 3 and 5 minutes (p &lt; 0.05). Ketofol used in anaesthesia induction has less effect than propofol on mean arterial pressure and cerebral oxygen saturation values. Therefore, ketofol appears to be a good choice for use in anaesthesia induction in elderly patients. [Med-Science 2020; 9(1.000): 21-5

Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study

Summary: Background: Harmonic focus (HF) was introduced in thyroid surgery in an effort to reduce operation time and complications. Objective: The present study aimed to compare function of superior laryngeal nerve and incidence of other postoperative complications in total thyroidectomies using HF and conventional ligation (CL). Methods: The trial is a randomized single-center, single-blinded study. Patients aged ≥ 18 years scheduled for total thyroidectomy were considered for participation. An ultrasonic dissector was used for coagulation and cutting in the HF group, while the standard technique was used in the CL group. Demographic, surgical data, and complications were recorded. Data were analyzed using SPSS for Windows. Results: Of 244 eligible patients, data of 206 patients who completed the study were analyzed. The groups were similar in terms of age, sex, and indication for operation. The mean operative time in the HF group was significantly shorter than that in CL group (p = 0.01). Drain necessity, duration of drainage, duration of postoperative hospitalization, and the incidence of postoperative complications was similar in the groups (p > 0.05). The external branch of the superior laryngeal nerve and recurrent laryngeal nerve palsy were noted in three and two patients in the HF group and in two and one patients in the CL group at 6 months. Conclusion: To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique. Keywords: harmonic focus, superior laryngeal nerve, thyroidectom

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

Abstract Background Cesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study. Methods We analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18–45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h. Results There was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2–3] vs. TFPB group, 2 [0–2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2–4] vs. TFPB group 2 [0–3], p = 0.001). Conclusions In patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9–24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant

Effect of ultrasound-guided pericapsular nerve group (PENG) block on pain during patient positioning for central nervous blockade in hip surgery: a randomized controlled trial

Abstract Background Most patients with hip fractures are elderly patients with comorbidities, and well-managed pain management is associated with positive postoperative outcomes. In recent years, new indications for regional anesthesia techniques have been defined, and they have found more place in clinical practice. Herein we investigate the effect of US-guided PENG block on positioning pain and compare that effect to intravenous opioid in patients undergoing surgery under spinal anesthesia for hip fractures. Additionally, we sought to investigate the effect of PENG block on pain scores, opioid intake, time to first analgesic requirement, and quality of recovery within the first 24 h following surgery. Methods In this study, patients were divided into the PENG (n = 42) and control group (n = 42) one hour prior to surgery. A team who was blinded to the assigned groups, collected and evaluated all data such as spinal anesthesia positioning pain, postoperative pain, opioid requirement. Results Patients that underwent PENG had statistically significantly lower NRS scores after interventions, immediately before positioning, at positioning and at end of spinal anesthesia. Pain scores during positioning for spinal anesthesia were statistically significantly lower in the PENG group than in the control group (p < 0.001). Total morphine use over the first 24 h was extremely statistically significantly lower in the PENG group (p < 0.001). Conclusions Positive outcomes of PENG block in patient positioning pain before spinal anesthesia, postoperative pain scores, and morphine consumption are consistent with similar studies. High patient satisfaction in patients who underwent PENG block contributes to the literature. Trial Registration ClinicalTrials.gov Identifier: NCT0487106