Are Preoperative Routine Laboratory Tests Necessary in Minor and Moderate Surgical Procedures?

Preoperative routine tests are commonly used to evaluate patients who will have planned elective surgical procedure. In this study, we aimed to identify the preoperative tests required for ASA I-II patients, over 40 years old, who will undergo elective minor and moderate surgeries. Totally 140 patients were included in the study. They were separated into 2 groups equally [Group I (40-59 years) and Group II (≥60 years)] according to their ages. The patients’ preoperative tests; including chest radiography, electrocardiography, hemoglobin, white blood cell, platelets, glucose, sodium, potassium, aspartate transaminase, alanine transaminase, ürea and creatinine were evaluated together with history and physical examination. After routine monitoring, balance anaesthesia was performed. The patients were followed during the peroperative and postoperative 24 hours for any problems occurred. In Group I; excluding ürea in both male and female patients and haemoglobin in only female patients; preoperative tests had no effect on the management of the asymptomatic patients. In Group II; electrocardiography, chest radiography, ürea, glucose and hemoglobin tests effected the management of the patients in the preoperative and postoperative period. In conclusion, preoperative tests could be ordered according to history and physical examination of the patients

Prospective evaluation of the recalibrated PRE-DELIRIC model for early detection of intensive care delirium

Deliryum, yoğun bakımda (YB) önemli bir sorundur ve artan mekanik ventilasyon (MV) süresi, daha yüksek mortalite ve daha uzun süreli bilişsel işlev bozukluğu gibi olumsuz hasta sonuçları ile ilişkilidir. Bu nedenle deliryumun erken tespiti önem arz etmektedir. Bu çalışmanın amacı, bir deliryum erken tespit modelinin YB hastalarında öngörü yeteneğini prospektif olarak değerlendirmektir. Araştırma, tek merkezli prospektif olarak Mart 2022-Mayıs 2022 tarihleri arasında yürütüldü. Araştırmanın yürütüldüğü tarih aralığında YB’ne kabulü yapılan ve 24 saatten fazla izlenmesi beklenen, 18 yaş üstü hastalar çalışmaya dâhil edildi. Araştırmanın verileri; “Hasta Tanıtım Formu”, “Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Metodu”, “Richmond Ajitasyon Sedasyon Skalası” ve rekalibre edilmiş “PRE-DELIRIC model” ile toplandı. Araştırmanın örneklemini belirtilen tarih aralığında dâhil edilme kriterlerine uyan 188 hasta oluşturdu. Deliryumlu hastalarda ortalama PRE-DELIRIC skoruna göre (30.32±8.36) ROC eğrisi altındaki alan (AUROC), modelin deliryumu öngörmedeki ayırt edici gücünün 0.937 (%95 güven aralığı: 0.903-0.972) olarak anlamlı olduğunu gösterdi (p=0.001). Modelin %19 kesme değeri ile duyarlılığının %87.5, özgüllüğünün %87.1 olduğu saptandı. Sonuç olarak, rekalibre edilmiş PRE-DELIRIC modelin, YB hastalarında deliryum riskini belirlemede iyi ayırt edicilik özellikler gösterdiği belirlenmiştir. Hesaplaması kolay bu model, hemşirelerin ve hekimlerin YB hastalarında deliryum riskini tahmin etmesine ve erken dönemlerde gerekli önlemleri almalarına yardımcı olacaktır.Delirium is a common problem in intensive care units (ICU) and is associated with adverse patient outcomes such as increased mechanical ventilation (MV) duration, higher mortality, and greater longer-term cognitive dysfunction. Therefore, early detection of delirium is important. The aim of this study was to prospectively evaluate the predictive ability of a delirium early detection model in ICU patients. The study was conducted as a single-center prospective study between March 2022 and May 2022. The study included patients aged over 18 years who were admitted to the intensive care unit during the study period and expected to be followed up for longer than 24 hours. The data of the study were collected with the “Patient Identification Form”, “The Confusion Assessment Method for ICU”, “Richmond Agitation Sedation Scale” and the recalibrated “PRE-DELIRIC model”. The sample of the study consisted of 188 patients who met the inclusion criteria within the specified date range. The area under the ROC curve (AUROC) according to the mean PRE-DELIRIC score (30.32±8.36) in patients with delirium showed that the discriminative power of the model in predicting delirium was significant as 0.937 (95% confidence interval: 0.903-0.972) (p=0.001). In conclusion, it has been determined that the recalibrated PRE-DELIRIC model has good discriminative properties in determining the risk of delirium in ICU patients. This easy-to-calculate model will help nurses and physicians predict the risk of delirium in patients and take the necessary precautions in the early stages

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Effects of perineural morphine and fentanyl on anesthesia and analgesia in brachial plexus blockade

Çalışmamızda, aksiller yaklaşımla yapılmış brakial pleksııs bloğu altında el cerrahisi uygulanacak ASA I-II gruba giren 15'er kişilik 9 gruba ayrılmış toplam 135 olguda perinöral verilen morfin ve fentanilin blok başlama süresi, anestezi ve analjezi süresi üzerine etkilerini araştırdık. Preoperatif dönemde premedikasyon verilmeyen olgular işlem hakkında önceden bilgilendirildi. Tüm gruplara 100 mg %0.5 Bupivakain ve 200 mg % 2 Lidokain solüsyonu standart olarak verildi. Kontrol grubuna biç opioid verilmez iken intramusküler MMı ve MM2, perinöral MAı ve MA2 gruplarına sırasıyla 50 ng/kg ile 100 fig/kg morfin; intramusküler FMı ve FM2, perinöral FAı ve FA2 gruplarına ise sırasıyla 1 jıg/kg ile 2 ng/kg fentanil verildi. Olguların hemodinamik verileri, solunum sayılan, periferik oksijen saturasyonlan, sensorial ve motor blok düzeyleri ile ilk analjezik İhtiyaç zamanlan ve yan etkiler izlendi. Hemodinamik veriler, dakika solunum sayılan, periferik oksijen saturasyonlan açısından grupiçi ve gruplar arası anlamh farklılık bulunmadı. Perinöral fentanil uygulanan FAı ve FA2 gruplarında sensorial bloğun anlamh olarak daha erken başladığı saptanmasına rağmen, perinöral morfin uygulanan MAı ve MA2 gruplarında blok başlama süresinin kontrol grubu ve intramusküler gruplara göre değişmediği görüldü. 43Postoperatif analjezi süresine bakıldığında; ilk analjezik ihtiyaç süresinin kontrol grubuyla karşdaştırıldığında tüm gruplarda klinik olarak daha uzun olduğu saptandı. Ancak bu süre sadece perinöral ve intramusküler 100 pg/kg morfin verilen gruplarda istatistiksel olarak anlamlıydı. Opioidlerin yan etkilerinden bulantı, 100 fig/kg perinöral morfin verilen MA2 grubunda 2 olguda ve 100 ^ıg/kg intramusküler morfin verilen MM2 grubunda 1 olguda görüldü. Kusma, kaşıntı, idrar retansiyonu ve solunum depresyonuna hiçbir olguda rastlanmadı. Sonuç olarak; brakial pleksus bloğunda lokal anestezik solüsyon ile birlikte perinöral uygulanan fentanil ve morfinin postoperatif analjezi süresini etkilemediği ancak fentanilin blok başlangıç süresini anlamlı olarak kısalttığı sonucuna vardık

Axillary Brachial Plexus Blockage in Treatment of Upper Extremity Ischemic Disorder in Critically Ill Patient: A Report of Two Cases

Arterial catheterization, vasoactive agents, autonomic dysfunction and septic embolus may cause ischemia at distal ends of upper extremity in critically ill patients. Axillary brachial plexus blockage is highly reliable intervention when appropriate technique is used. Sympathetic blockage occurs after administration of local anesthetic drug and can resolve the circulatory disorder of extremity. We aimed to present two cases with ischemia of upper distal extremity that resolves after axillary brachial plexus blockage

Amitriptyline Cardiac Toxicity Treated with Hemoperfusion

Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide QRS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period

Application of Rigid Broncoscopy with Heated Serum Physiologic

Rigid bronchoscopy (RB) is a procedure commonly performed thoracic surgery is quite routine. The main application areas of bronchoscopy; foreign body aspiration, atelectasis, control of hemoptysis and diagnostic procedures. In bronchoscopy, cold Serum Physiologic (SP) is used for irrigation. In this article, we present a case used warm SP in order to open an atelectasis during broncoscopy that have never been used in the literature

Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine

Study objective: To evaluate the quality of analgesia and the severity of side effects of intrathecal morphine administered for a dose range of 0.0 to 0.4 mg for postcesarean analgesia with low-dose bupivacaine