Pankreatik olmayan ağır sepsisli hastalarda belirleyici faktörler olarak yüksek C-reaktif protein ve amilaz değerleri

Amaç: Kritik hastalarda sepsis ilerleyen multi organ yetmezliği ile ilişkilidir. Ağır sepsiste ilave biyogöstergeler, yüksek riskli hastaların etkili tedavi seçiminde ve prognozun belirlenmesi mücadelesinde başarılı olmak için gereklidir. Bu araştırmada ağır sepsisli hastalarda sağkalım için belirleyici faktörler olarak serumda C-reaktif protein (CRP) ve amilaz değerlendirildi. Hastalar ve Yöntemler: Çalışmaya ağır sepsis kriterlerini sağlayan 95 hasta (42 erkek, 53 kadın) dahil edildi. APACHE II skorları, serum CRP ve amilaz düzeyleri hastaların yoğun bakım ünitesine kabul edildiğinde, iki gün sonra ve yoğun bakım ünitesinden taburcu edildiği gün veya kaybedildikleri gün alındı. Bulgular: Amilaz ve ortalama CRP düzeyleri ile APACHE II skorları yaşamını kaybeden hastalarda, sağ kalan hastalardan anlamlı derecede yüksekti. Sonuç: Serum amilaz ve CRP, ağır sepsisli hastalarda sağkalımı belirleyicidir. Yüksek amilaz ve CRP düzeyleri ağır sepsisli hastaların risk değerlendirmesinde ve gelecek çalışmalarda yüksek riskli hastaların sınıflandırılmasında değerli araçlar olarak görülebilir.Objectives: Sepsis in critical illness is associated with the progressive failure of multiple organs. Additional biomarkers in severe sepsis are needed to tackle the challenges of determining a prognosis and optimizing the selection of high-risk patients for therapy. This paper evaluates serum C-reactive protein (CRP) and amylase as prognostic factors for survival in patients with severe sepsis. Patients and Methods: Ninety-five patients (42 males, 53 females) meeting the criteria for severe sepsis were chosen for the study. APACHE II scores, serum levels of CRP and amylase were taken on admission to an intensive care unit, two days later, and on the day of discharge from the intensive care unit or on the day of death. Results: Amylase levels, median CRP levels, and APACHE II scores were significantly higher in the non-survivors than in the surviving patients. Conclusion: Serum amylase and CRP are predictors of survival in patients with severe sepsis. High amylase and CRP levels appear to be a valuable tool for individual risk assessment in severe sepsis patients and for stratification of high-risk patients in future intervention trials

Sugammadex Use in a Patient with Wolff-Parkinson-White (WPW) Syndrome

Background: Wolff-Parkinson-White (WPW) syndrome is a disease associated with episodes of supra- ventricular tachycardia and ventricular pre-excitation or atrial fibrillation. WPW is characterized by an aber- rant electrical conduction pathway between atria and ventricles. Case Report: The major anesthetic problem connected with WPW syndrome is the risk of tachyarrhythmias due to accessory pathway. Therefore, it has been pro- posed that the aim of anesthetic management should be the avoidance of tachyarrhythmia and sympathetic stimulation. Sugammadex was administered as a neu- romuscular reversal agent in this case. To our knowl- edge, this is the first case report of sugammadex use in a patient with WPW. This report presents a case of general anesthesia management in a patient with WPW syndrome. Conclusion: We think that it is appropriate to use su- gammadex to reverse rocuronium for the prevention of sudden hemodynamic changes in patients with WPW who underwent general anesthesia

Fat embolism associated with anesthesia induction with propofol-lidocaine combination: A case report

Yağ embolisi sendromu travmatik, cerrahi ve travma dışı olayları takiben tanımlanmıştır. Uzun kemik kırıkları bu sendromun en olası nedenidir. Yağ embolisine bağlı klinik tablo sıklıkla belirgin olmayabilir. Belirtiler değişiklik gösterdiğinden ve rutin laboratuvar ve radyografik tanı yöntemi olmadığından tanı konması zordur. Propofol, anestezi indüksiyonu ve idamesinde yaygın olarak kullanılmaktadır. Propofole lidokain eklenmesiyle, yağ damlacıkları birleşerek ayrı tabaka meydana getirebilmektedir. Propofol-lidokain karışımının yağ embolisi oluşturma riski, kombinasyonun hazırlanması ve verilmesi arasındaki süreye ve lidokain dozuna bağlıdır. Bu yazıda, trafik kazası sonrası alt ekstremite kırığı nedeniyle uygulanan genel anestezi indüksiyonunda yağ embolisi gelişen bir olgu sunuldu. Yağ embolisinin propofol-lidokain karışımına bağlı olduğu düşünüldü. Yağ embolisi tanısı, klinik değişiklikler, radyolojik ve laboratuvar bulgularının yanı sıra gelişen arteryel hipoksemiye neden olabilecek başka bozuklukların olmaması ile kondu.Fat embolism syndrome has been described following traumatic, surgical, and atraumatic conditions. Long-bone fractures are probably the most common cause of this syndrome. Fat embolic events are often clinically insignificant and difficult to recognize since clinical manifestations vary and there is no routine laboratory or radiographic means of diagnosis. Propofol is widely used for the induction and maintenance of anesthesia. Addition of lidocaine to propofol may result in a coalescence of oil droplets, forming a separate layer. The risk of propofol and lidocaine combination to cause fat embolism depends on the dose of lidocaine and the duration between its preparation and administration. We presented a patient who developed fat embolism following anesthesia induction during surgery for a lower extremity fracture due to a traffic accident. The occurrence of fat embolism was attributed to propofol-lidocaine use. The diagnosis of fat embolism was based on clinical manifestations, radiographic and laboratory findings, and elimination of other causes associated with arterial hypoxemia

A comparison of the effects of different types of laryngoscope on the cervical motions: randomized clinical trial

Background: The rate of cervical injury among all trauma patients is 3.1%. The most important point dur- ing intubation of those patients is not to increase the cervical injury. Aims: In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. Study Design: Prospective, randomized clinical trial. Methods: One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly as- signed the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2® type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying gen- eral anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. Results: One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). Conclusion: A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904). Keywords: Airtraq®, airway management, intratracheal equipment, intubation, Macintosh, Truview EVO2&reg

Horner's syndrome following uncomplicated internal jugular vein catheterization: A case report

Perkütan internal juguler ven kateterizasyonu, santral venöz kateterizasyon uygulamalarında oldukça yaygın kullanılmaktadır. Santral venöz kateterizasyon uygulamaları sırasında nadir bir komplikasyon olarak Horner sendromu gelişebilir. Bu yazıda sağ internal juguler ven kateterizasyonundan bir gün sonra miyozis, pitozis ve anizokorinin eşlik ettiği Horner sendromu gelişen 47 yaşında kadın hasta sunuldu. Bir hafta sonra, hastanın klinik bulguları düzeldi.Percutaneous cannulation of the internal jugular vein is widely used for central venous cannulations. Horner's syndrome may develop as a rare complication of internal jugular vein cannulation. We presented a 47-year-old female patient who developed Horner's syndrome one day after uncomplicated internal jugular venous cannulation, which was accompanied by miosis, ptosis, and anisocoria. The symptoms improved within a week

Tracheal resection after tracheal stenosis: Case report

Hava yolu hasarı, endotrakeal entübasyon veya trakeostomi sonrası görülebilir ve hastada ciddi solunum sıkıntısına neden olabilir. Bu yazıda trakeostomi açılması sonrası ciddi hava yolu darlığı gelişen olguda trakeal rezeksiyon esnasındaki anestezi yönetimi anlatıldı.After endotracheal intubation or tracheostomy, airway damage may be occurred and serious respiratory distress may be seen in the patient. In this case report, we discussed the anesthetic care during tracheal resection in a patient with severe respiratory distress after tracheostomy

The effect of the prebiotic solutions in treatment of severe sepsis

Randomize, ileriye dönük ve çift kör bu çalışmada, enteral yolla verilen oligofrüktoz ve inülin içeren prebiyotik preparatin, ağır sepsisli yoğun bakım olgularında, üst gastrointestinal kolonizasyon ve sistemik enflamasyon üzerine etkileri araştırıldı. Hastalar ve Yöntemler: Yoğun bakım ünitesinde toplam 50 hastaya randomize olarak prebiyotik (grup 1, n=25) [Prebiyotik preparasyonu prebiyotik lif inülinoligofrüktoz içermektedir (0.8 g/100 mL, A, D3, E vitaminleri)] veya plasebo (grup 2, n=25) verildi. Gastrointestinal bariyer fonksiyonu, birinci ve sekizinci günlerdeki nazogastrik aspirat kültürü ile değerlendirildi. Tüm septik komplikasyonlar, akut fizyoloji ve kronik sağlık II skoru (APACHE II), ventilasyon süreleri, gastrointestinal kültür sonuçları, biyokimyasal değerler, C-reaktif protein (CRP) ve mortalite oranları kaydedildi. Bulgular: Gruplar aras›nda yaş, cinsiyet, APACHE II skorları, CRP, ventilasyon süreleri bakımından farklı lık saptanmadı. Gastrointestinal kültür, septik komplikasyonlar veya mortalite açısından gruplar arasında anlamlı farklılık yoktu. Sonuç: Prebiyotik solüsyonunun, ağır sepsisli yoğun bakım hastalarında kullanılmasının, gastrik kolonizasyon, gastrointestinal permeabilite, sistemik enflamatuvar yanıt ve morbidite üzerine etkisi olmadığı saptandı.In this double blind, prospective and randomized study, the effects of the enteral administration of a prebiotic preparation containing oligofructose and inulin on upper gastrointestinal colonization and systemic inflammation in intensive care patients with severe sepsis were investigated. Patients and Methods: A total of 50 patients admitted to an intensive care unit were randomized to receive either prebiotic (group 1, n=25) or placebo preparations (group 2, n=25). The prebiotic preparation consisted of prebiotic fiber inulin-oligofructose (0.8 g/100 mL, A, D3, E vitamins). Gut barrier function was assessed by culture of nasogastric aspirate on the first and eighth days. All septic complications, acute physiology and chronic health evaluation II (APACHE II) scores, ventilation days, gastrointestinal culture results, biochemical parameters, C-reactive protein (CRP) and mortality ratios were recorded. Results: There were no differences between the groups in terms of age, sex, APACHE II scores, CRP, ventilation days. There were no significant differences between the groups in terms of gastrointestinal culture, septic complications or mortality. Conclusion: The administration of prebiotic solution in intensive care patients with severe sepsis had no effect on gastrointestinal permeability, gastric colonisation, the systemic inflammatory response and morbidity

Effect of Preoperative Anxiety on Depth of Anaesthesia and In Vitro Fertilization Success

Objective:Infertility anxiety may have a harmful effect on embryo quality and fertilization during in vitro fertilization (IVF). Monitoring brain function gives real-time information about the depth of anaesthesia of a patient. This study examined the effect of preoperative anxiety on the depth of anaesthesia and IVF success.Methods:One hundred thirty-one patients who had undergone oocyte retrieval were divided into two groups according to the Beck Anxiety Inventory (BAI): the low-anxious Group L (n = 71) and high-anxious Group H (n = 60). Hemodynamic stability, intraoperative total propofol and fentanyl consumption, good quality embryo (GQE) rate, and fertilization rate were recorded.Results:Fertilization and GQE rates were not significant between groups L and H. Total propofol consumption was significantly higher in group H than in group L. Heart rate (HR) preoperatively and postoperatively and systolic arterial pressure (SAP) preoperatively and diastolic arterial pressure (DAP) postoperatively were significantly increased in group H than in group L. The time for the modified Aldrete score to reach 9 (MAS 9) in group H was significantly higher than that in group L. The effect of variables that were found significantly in the univariate analysis (Propofol, HRpreop, HRpostop, SAPpreop, DAPpostop, and MAS 9) on BAI score.Conclusion:Total propofol consumption was higher in patients with high anxiety levels, but it did not have a negative effect on IVF success