Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Preparation, Characterization and Catalytic Properties of SBA-15-SO₃H Supported Tungstophosphoric Acid for Esterification Reaction

SBA-15-SO₃H supported tungstophosphoric acid (TPA, H₃PW₁₂O₄₀) mesoporous materials were synthesized by impregnation of TPA into the hydrothermally synthesized SBA-15-SO₃H and the catalytic performances were compared for the esterification reaction. The physical and chemical properties of the catalysts were characterized by XRD, SEM/EDX, FT-IR and N₂ adsorption/desorption techniques. The characterization results show that TPA/SBA-15-SO₃H retained the typical mesoporous structure of SBA-15-SO₃H. The experimental results indicated that TPA/SBA-15-SO₃H is a more efficient catalyst than SBA-15-SO₃H for the esterification reaction. The higher activity of TPA/SBA-15-SO₃H compared with that of SBA-15-SO₃H was consistent with the material having the low pKa value, confirming that the esterification rate was mostly dependent on the acid strength of the additional functional groups of solid acid catalyst. Accordingly, the reason for the catalytic activity difference was simply explicated by the effect of TPA, having low pKa value, affecting the pore structure and the total acidity

Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy

Background The use of neuromuscular blocking agents is still controversial in myasthenic patients but rocuronium could be useful after the introduction of sugammadex as a selective antagonist. The aim of the study was to evaluate the use of rocuronium-sugammadex in myasthenic patients undergoing thoracoscopic thymectomy. Methods After ethical approval, 10 myasthenic patients undergoing videothoracoscopic-assisted thymectomy were enrolled in the study. Neuromuscular block was achieved with 0.3mg/kg rocuronium and additional doses were given according to train-of-four (TOF) monitoring or movement of the diaphragm. Sugammadex 2mg/kg was given after surgery. Recovery time (time to obtain a TOF value >0.9) was recorded for all subjects. Result All patients were extubated in the operating room after administration of sugammadex. Mean rocuronium dose was 48mg and the average operation time was 62min. Recovery time after sugammadex administration was 111s (min 35; max 240). Conclusions A rapid recovery of neuromuscular function was found in myasthenic patients receiving rocuronium when sugammadex was used for reversal. This combination could be a rational alternative for myasthenic patients for whom neuromuscular blockade is mandatory during surgery

An investigation of equine infectious anaemia infection in the Central Anatolia region of Turkey

In this study, 162 horses, 80 donkeys and 51 mule serum samples were collected in Konya city. Additionally, 64 horse serum samples from Ankara and 49 samples from Kayseri city were included in the study. A total of 406 serum samples were examined by agar gel immunodiffusion (AGID) and enzyme-linked immunosorbent assay (ELISA) for antibody to equine infectious anaemia virus (EIAV) and no positive result was detected

Termal Buharlaştırma Yöntemiyle Hazırlanan Ga Katkılı CuInSe2 İnce Filmlerin Yapısal Özelliklerinin İncelenmesi

Özet: Bu çalışmada, güneş hücrelerinde soğurucu malzeme olarak kullanılan CuInSe2 ince filmler 10-4 Pa vakum altında, yapıyı oluşturan malzemelerin aynı anda termal buharlaştırılma yöntemi ile 400 °C sabit alttaş sıcaklığında cam altlıklar üzerine biriktirilmiştir. Tavlama sıcaklığı ve tavlama yönteminin, filmler üzerine etkisini belirlemek için 3 grup ince film üretilmiş ve bunlardan bir grup referans olarak ayrılmıştır. İkinci grup ince filmler vakum altında 400 °C – 700 °C arasındaki sıcaklıklarda tavlanmıştır. Üçüncü grup ince filmler yapısal değişimlerini incelemek için 500 °C’de azot gazı ortamında selenyum parçacıklarıyla beraber tavlanmıştır (selenizasyon). Vakum altında tavlama işleminde sıcaklık ile kristalleşme arasında doğrudan bir ilişki olmadığı görülmüştür. Azot ortamında yapılan selenizasyon işlemi ise CIS ’in kristalleşmesini iyileştirmiş fakat azot gazının safsızlığından kaynaklanan In2O3 pikleri de oluşmuştur. Yapısal karakterizasyon için SEM, EDS, AFM, XRD sistemleri kullanılmıştır. Farklı ortamlarda tavlamanın etkileri araştırılmış ve Ga katkılı CIS ince filmler için üretim parametreleri belirlenmeye çalışılmıştır. Abstract: In this study, the CuInSe2 thin films, which are used as an absorbing material in solar cells was deposited on glass substrate at a constant substrate temperature of 400 °C by means of thermal co-evaporation method, under 10-4 Pa vacuum pressure. Three groups of thin films were produced to determine the effect of annealing temperature and annealing method on the films, and a group of them were separated as reference. Second group thin films were annealed between 400 °C and 700 °C temperature under vacuum. Third group of thin films were annealed at 500 °C together with the selenium particles in nitrogen gas atmosphere (selenization) to investigate the structural change of the films. It has been found that there is no direct relationship between temperature and crystallization during vacuum annealing. The selenization process in the nitrogen environment improved the crystallization of CIS but the formation of In2O3 peaks originating from the impurity of the nitrogen gas has been seen. SEM, EDS, AFM, XRD systems were used for structural characterization. The effects of annealing in different environments have been investigated and production parameters have been tried to be determined for the Ga doped CIS thin films

Implantable cardioverter-defibrillator placement in patients with mild-to-moderate left ventricular dysfunction: Hemodynamics and recovery profile with two different anesthetics used during deep sedation

Objective: To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement

Predictive Factors Involved in Development of Postoperative Pulmonary Complications

Objective: In the present study, we applied the method of the multi-center Prospective Evaluation of a Risk Score for postoperative pulmonary Complications in Europe (PERISCOPE) study, which was designed to predict postoperative complications and funded by the European Society of Anaesthesiology, to patients in our institution with the aim of prospectively analyzing the postoperative risk factors of pulmonary complications

Comparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 73 mg respectively), both with fentanyl 20 mu g, for spinal anaesthesia in lower abdominal surger