Correlation of integrated pulmonary index with clinical observation in unilateral and bilateral spinal anaesthesia in geriatric patients

Background: In present study, we aimed to determine the role of integrated pulmonary index (IPI) in monitorising geriatric cases that have spontaneous ventilation under unilateral and spinal block during partial hip prosthesis and total knee arthroplasty.Methods: 24 patients who were over 65 years of age and with ASA I-IV, femoral neck fracture, intertrochanteric fracture and in whom gonarthros had developed were simply randomised into two groups. Values of blood pressure, pulse rate (PR), SPO2, EtCO2, respiratory rate (RR), IPI were recorded. Unilateral spinal block was administered with 7.5 mg, 0.5% bupivacaine and 25 mcg fentanyl in Group I and with 12.5 mg 0.5% bupivacaine and 25 mcg fentanyl in Group II. Values were recorded in intervals of 5 and 15 minutes and continued to be recorded from the moment of cement application. Preoperative mask ventilation or intubation need was recorded.Results: For EtCO2, bilateral spinal block scores at post-cement 15 minutes; postop 5 minutes were found to be high providing that they were within the clinically normal limits compared to the unilateral scores. A correlation between IPI and SpO2, EtCO2, respiratory rate, pulse rate was identified. In both groups, IPI was found to be in normal range and a correlation was identified through clinical observation.Conclusions: IPI might be the sole numerical value in early identification of clinical correlation and respiratory failure. For the IPI monitor is small and easy to be handled along with its screen that shows many parameters together makes the device be easily used

Correlation of integrated pulmonary index with clinical observation in unilateral and bilateral spinal anaesthesia in geriatric patients

Background: In present study, we aimed to determine the role of integrated pulmonary index (IPI) in monitorising geriatric cases that have spontaneous ventilation under unilateral and spinal block during partial hip prosthesis and total knee arthroplasty.Methods: 24 patients who were over 65 years of age and with ASA I-IV, femoral neck fracture, intertrochanteric fracture and in whom gonarthros had developed were simply randomised into two groups. Values of blood pressure, pulse rate (PR), SPO2, EtCO2, respiratory rate (RR), IPI were recorded. Unilateral spinal block was administered with 7.5 mg, 0.5% bupivacaine and 25 mcg fentanyl in Group I and with 12.5 mg 0.5% bupivacaine and 25 mcg fentanyl in Group II. Values were recorded in intervals of 5 and 15 minutes and continued to be recorded from the moment of cement application. Preoperative mask ventilation or intubation need was recorded.Results: For EtCO2, bilateral spinal block scores at post-cement 15 minutes; postop 5 minutes were found to be high providing that they were within the clinically normal limits compared to the unilateral scores. A correlation between IPI and SpO2, EtCO2, respiratory rate, pulse rate was identified. In both groups, IPI was found to be in normal range and a correlation was identified through clinical observation.Conclusions: IPI might be the sole numerical value in early identification of clinical correlation and respiratory failure. For the IPI monitor is small and easy to be handled along with its screen that shows many parameters together makes the device be easily used

Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure

Investigation for the Effects of Omega Fatty Acid and Glutamine-L-Alanine on Morbidity and Mortality in the Critically ILL Patients after Major Abdominal Surgery

Background & Objectives: This study investigated the effects for the addition of omega 3 fatty acids and glutamine-L-alanine to the standard enteral and/or parenteral nutrition regimen on infection and mortality in the critically ill patients after major abdominal surgery. Methods: This is a prospective, randomized, single center study. A total of 43 patients (age range: 18-85 years), who were in the critical care unit after major abdominal surgery, were included. Patients were divided into two groups according to simple randomized selection [Control group, n=20; Study Group, n=23 (omega3 fatty acids and glutamine-L-alanine)] and were monitored for 21 days. Patients were examined for the assessment of APACHE II Score and existence of ALI (acute lung injury)/ARDS (acute respiratory distress syndrome) requiring mechanical ventilation. In addition to standard enteral or parenteral nutrition, patients in the study group were given parenteral pharmaconutrition products for 10 days postoperatively. Groups were compared for the duration of mechanical ventilation, duration of stay in the intensive care unit and hospitalization, and mortality. Laboratory parameters including CRP, TNF, IL6, IL8, nitrogen balance, albumin, and total lymphocyte count were recorded. Results:Although the mean APACHE score was higher in study group in which patients received omega-3 fatty acids and glutamine-L-alanine support, the clinical infection rate seemed to decrease insignificantly. Conclusions: A clinically decreased rate of infection was observed in patients with a high APACHE II score, or who received omega-3 fatty acids, glutamine-L-alanine, are required to be administered more selectively and in larger patient groups in different doses and in combination protocols in accordance with the current pharmaconutritional support and in different timing combinations, including preoperative perio

Investigation for the Effects of Omega 3 Fatty Acid and Glutamine- L-Alanine on Morbidity and Mortality in the Critically ILL Patients after Major Abdominal Surgery

Background & Objectives: This study investigated the effects for the addition of omega 3 fatty acids and glutamine-L-alanine to the standard enteral and/or parenteral nutrition regimen on infection and mortality in the critically ill patients after major abdominal surgery. Methods: This is a prospective, randomized, single center study. A total of 43 patients (age range: 18-85 years), who were in the critical care unit after major abdominal surgery, were included. Patients were divided into two groups according to simple randomized selection [Control group, n=20; Study Group, n=23 (omega3 fatty acids and glutamine-L-alanine)] and were monitored for 21 days. Patients were examined for the assessment of APACHE II Score and existence of ALI (acute lung injury)/ARDS (acute respiratory distress syndrome) requiring mechanical ventilation. In addition to standard enteral or parenteral nutrition, patients in the study group were given parenteral pharmaconutrition products for 10 days postoperatively. Groups were compared for the duration of mechanical ventilation, duration of stay in the intensive care unit and hospitalization, and mortality. Laboratory parameters including CRP, TNF, IL6, IL8, nitrogen balance, albumin, and total lymphocyte count were recorded. Results:Although the mean APACHE score was higher in study group in which patients received omega-3 fatty acids and glutamine-L-alanine support, the clinical infection rate seemed to decrease insignificantly. Conclusions: A clinically decreased rate of infection was observed in patients with a high APACHE II score, or who received omega-3 fatty acids, glutamine-L-alanine, are required to be administered more selectively and in larger patient groups in different doses and in combination protocols in accordance with the current pharmaconutritional support and in different timing combinations, including preoperative perio

Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery

Background and objectives: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol–remifentanil (Total Intravenous Anesthesia) and sevoflurane–remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. Methods: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2 μg.kg−1, propofol 2.5 mg.kg−1 and rocuronium 0.6 mg.kg−1 were administered. During maintenance, 1.0 MAC sevoflurane + remifentanil 0.05–0.3 μg.kg−1.min−1 and propofol 50–150 μg.kg−1.min−1 + remifentanil 0.05–0.3 μg.kg−1.min−1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30 min postoperatively. Postoperative visual analog scale (VAS) values at 30 minutes were recorded. Results: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. Conclusion: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort. Resumo: Justificativa e objetivos: O Índice de analgesia/nocicepção (ANI) é usado para medir os níveis de dor, a atividade do sistema simpático e a variabilidade da frequência cardíaca durante a anestesia geral. Em nosso estudo, a monitoração do ANI em dois grupos que foram submetidos à cirurgia de estabilização da coluna vertebral e receberam propofol-remifentanil (Total Intravenous Anesthesia - TIVA) e sevoflurano-remifentanil foram comparados para identificar sua importância na previsão precoce de dor no pós-operatório. Métodos: Os pacientes foram monitorados com o uso de BIS e ANI juntamente com a monitoração padrão. Durante a indução, fentanil (2 μg.kg−1), propofol (2,5 mg.kg−1) e rocurônio (0,6 mg.kg−1) foram administrados. Durante a manutenção, 1 CAM de sevoflurano + remifentanil (0,05–0,3 μg.kg−1.min−1) e propofol (50–150 μg.kg−1.min−1) + remifentanil (0,05–0,3 μg.kg−1.min−1) foram administrados aos grupos S e T, respectivamente. Parâmetros hemodinâmicos, valores de BIS e ANI foram registrados durante a cirurgia e aos 30 minutos de pós-operatório. Os valores Visual Analogue Scale (VAS) aos 30 minutos de pós-operatório foram registrados. Resultados: Enquanto não observamos diferença entre as médias do ANI em todos os tempos de mensuração de ambos os grupos, as mensurações do ANI após a administração do analgésico no perioperatório foram significativamente maiores que os valores basais de ambos os grupos. Houve correlação entre as médias dos valores de ANI e VAS após a anestesia. Conclusão: ANI é um parâmetro importante para o monitorização de analgesia nos períodos perioperatório e pós-operatório. Na cirurgia da coluna vertebral, analgesia semelhante pode ser obtida com anestesia intravenosa total com remifentanil e com a administração de sevoflurano. O ANI é eficiente para prever a necessidade de analgesia durante o período pós-operatório imediato e, portanto, para proporcionar conforto ao paciente. Keywords: Analgesia Nociceptive Index, Sevoflurane, TIVA, Spinal surgery, Palavras-chave: Índice de analgesia/nocicepção, Sevoflurano, TIVA, Cirurgia de coluna vertebra

Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure

Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery

Abstract Background and objectives: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. Methods: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2 µg.kg-1, propofol 2.5 mg.kg-1 and rocuronium 0.6 mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane + remifentanil 0.05-0.3 µg.kg-1.min-1 and propofol 50-150 µg.kg-1.min-1 + remifentanil 0.05-0.3 µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30 min postoperatively. Postoperative visual analog scale (VAS) values at 30 minutes were recorded. Results: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. Conclusion: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort