Our Unpredicted Difficult Airway Experience in Tracheobronchopathia Osteochondroplastica Patient: A Case Report

Difficult airway is a serious condition that can be fatal and is frequently encountered during general anesthesia applications. Tracheobronkopathy osteochondroplasty (TBO) is a rare benign disease that is one of the causes of unpredictable difficult airway. A 45-year-old male patient with no comorbidities was transferred to the operating room for elective cholecystectomy. He couldn’t be intubated after standard monitoring and induction of anesthesia. The patient, who had papillomatous lesions in the trachea detected by bronchoscopy, was awakened to be scheduled for rigid bronchoscopy. TBO was detected in pathological examination of the samples taken in rigid bronchoscopy. TBO is a rare benign disease. Its etiology is unknown. It may be asymptomatic or may present with persistent dry cough, hemoptysis, dyspnea, recurrent lower respiratory tract infection, atelectasis and difficult intubation. Some patients may be diagnosed for the first time in the operating room due to difficult intubation.In cases with advanced tracheal stenosis, invasive airway intervention may be required or it may have a fatal course. The use of a laryngeal mask in the perioperative period may be an ideal option in a patient known to have TBO before. Unexpected difficult airway management in the operating room is important for anesthesiologists. According to the difficult airway society algorithm, waking the patient from a planned operation is the safest way until the problem is detected. We did not need invasive intervention because our patient also had elective surgery and ventilation was not difficult. In addition, we think that it is an important decision to make a diagnosis using fiberobtic bronchoscopy in operating room conditions and to wake up our patient with sugammadex without repeated attemps of tracheal intubation and delay elective surgery. In coclusion, it should be kept in mind that TBO may be one of the unpredictable causes of difficult intubation in the operating room

Investigation of the Prognostic Values of the Shock Index and Modified Shock Index in Predicting the Clinical Outcomes in Elderly Hospitalized Patients with Coronavirus Disease-2019

Introduction:Advanced age is an independent risk factor for increased mortality in coronavirus disease-2019 (COVID-19). However, the best method for estimating mortality in elderly patients with COVID-19 is still under debate. We performed this study to assess the shock index (SI) and the modified shock index (MSI) for the abovementioned problem.Methods:A retrospective study was conducted including elderly cases (≥65 years) confirmed with COVID-19 who admitted to a tertiary university hospital between March-December 2020. The SI and MSI at the time of the emergency department visits were used to evaluate the intensive care unit admission, ventilator support, septic shock, and 30-day mortality in all patients. The receiver operating characteristic and area under the curve (AUC) were used to measure the overall ability of SI and MSI to predict clinical outcomes.Results:We recruited 334 consecutive COVID-19 patients with a mean age of 75.2±7.3 and an almost equal gender distribution [170 males (50.9%)]. In deceased and surviving patients, the SI was 0.66±0.16 and 0.6±0.1 (p=0.014), while the MSI was 0.95±0.22 and 1.09±0.34 (p=0.003), respectively. In predicting mortality, the AUC of the SI and MSI were 0.590 [95% confidence interval (CI): 0.535 to 0.643] and 0.608 (95% CI: 0.553 to 0.660), respectively.Conclusion:Increased SIs and MSIs are associated with 30-day mortality. SI and MSI can benefit the triage of elderly patients hospitalized for COVID-19. However, it was found that there is no single cut-off value of SI or MSI with optimum accuracy for predicting COVID-19-related clinical outcomes

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi amaçlanmaktadır.Gereç-yöntem: Sedo-analjezi ile endoskopik ultrasonografi işlemi planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve 0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5 mg.kg-1 Propofol, 1 mg.kg-1 Ketamin, Propofol+fentanil grubuna (Grup F) da 1,5 mg.kg-1 Propofol, 1 mcg. kg-1 Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı, periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.Bulgular: Her iki grupta demografik veriler ve total operasyon süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha düşüktü (p<0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa gözlendi (p<0.001). Endoskopist memnuniyetinde herhangi bir fark gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.Sonuç: Endoskopik girişim yapılan hastaların büyük çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz