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

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

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

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

Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

ABSTRACT OBJECTIVE: We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. METHODS: The first group (n = 30) received IV lidocaine infusions at a rate of 1.5 mg/kg/min and the second group (n = 30) received IV esmolol infusions at a rate of 1 mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. RESULTS: In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20 min following surgical incision (p < 0.05). Awakening time was shorter in the esmolol group (p < 0.001); Ramsay Sedation Scale scores at 10 min after extubation were lower in the esmolol group (p < 0.05). The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group (p < 0.05). The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group (p < 0.01). Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20 min after extubation (p < 0.05, p < 0.01, respectively). Analgesic supplements were less frequently required in the lidocaine group (p < 0.01). CONCLUSION: In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR) scores and time to reach MAR score of 9 points

Female Sterilization by Tubal Ligation During C-Section in Women with a History of 2 or More C-Section

Objective: The aim of this study is to determine bilateral tubal ligation incidence performed during C-section in women with a history of 2 or more C-section and the factors affecting sterilization demand. Study Design: Patients who were admitted to Zekai Tahir Burak Woman's Health, Education and Research Hospital between February 2017 and June 2017 and who had a history of 2 or more C-section between week 37 and 41 were included in this prospective cross-sectional study. These subjects were separated into 2 groups according to whether they wanted bilateral tubal ligation during C-section. Bilateral tubal ligation was performed by means of modified Pomeroy technique. Both groups were compared in terms of age, gravida, number of children living at home, education level and income status. Patients who did not want bilateral tubal ligation were asked to fill a questionnaire involving reasons for not asking for bilateral tubal ligation. Results: The number of patients who wanted bilateral tubal ligation was 51 (43%) while those who did not want bilateral tubal ligation was 67 (57%). Compared with patients who did not want bilateral tubal ligation, patients who wanted bilateral tubal ligation had more number of children at home and a higher number of previous C-section (p<0.001). Reasons for not wanting bilateral tubal ligation consisted of religious beliefs (26.8%), desire for protection with a reversible contraceptive method (17.9%), partner who does not want bilateral tubal ligation (17.9%), incompletely family size (13.4%), respectively according to their frequency. Conclusion: bilateral tubal ligation for contraception during C-section was performed forty-three percent of women who had had a history of 2 or more C-section. In one fourth of the cases, pregnant women did not want bilateral tubal ligation due to religious beliefs

Effect of Prolonged Fasting Duration on 50 Gram Oral Glucose Challenge Test in the Diagnosis of Gestational Diabetes Mellitus

The aim of this study was to investigate the association between fasting duration before screening with 50g glucose challenge test (GCT) and the test outcome. For this cross-sectional study, we enrolled 508 low-risk pregnant women who underwent 50g GCT between the 24 and 28 weeks of gestation. We excluded women with pregestational diabetes, multiple gestations or a history of gestational diabetes mellitus (GDM), and macrosomia. We evaluated fasting durations, GCT results, and demographic features. A significant positive correlation was found between fasting duration and 50g GCT values (r=0.122; p=0.006), and the best cut-off value was found to be 6.5h, with 85.85% sensitivity and 38.61% specificity (relative risk, 2.73; 95% CI, 1.893-3.936; p6.5h; n=362) groups. Notably, the mean glucose levels, number of patients with GCT>140mg/dl, and rates of unnecessary 100g loadings were significantly higher in the study group. We found no significant differences between the groups in terms of the fasting plasma glucose levels and GDM prevalence. According to our findings, fasting duration of>6.5h resulted in 2.7 times more unnecessary 100g glucose tolerance tests (GTT). We recommend that patients having fasted for>6.5h receive a one-step 75g GTT after completing 8-h fasting