Comparison of the applicability and safety of the cobra perilaryngeal airway and the laryngeal mask airway classic in anesthetized and paralyzed patients

To compare two supraglottic airway devices [SAD], laryngeal mask airway classic [LMA- Classic] and cobra perilaryngeal airway [Cobra-PLA], in terms of insetion characteristics, sealing pressure, hemodynamic effects and post-operative complications. Prospective study. Okmeydani Teaching and Research Hospital, Istanbul, Turkey. A total of sixty patients were included in our study. Patients were randomly divided into two groups as Group Cobra-PLA and Group LMA-Classic.upon successful insertion, the cuff was inflated with air to a pressure of 60 cm H[2]O by using manometer. A maximum of two attempts were made to insert the SAD. In case of failure, orotracheal intubation was the SAD devices, the duration of insertion, the number of attempts, the insertion complications, ventilation parameters, hemodynamic parameters and postoperative adverse effects were recorded for each group. In Group Cobra-PLA and Group LMA-Classic, the SAD were successfully inserted respectively in 26 [86.7%] and 28 [93.3%] patients. The duration of insertion was shorter in group LMA-Classic [p < 0.05]. The seal pressure was significantly higher in group Cobra-PLA [p < 0.001]. Bleeding was less frequently observed in patients with LMA-Classic group [p < 0.05]. Both SAD can safely be used as an alternative to endotracheal intubation. According to the results of our study, LAM-Classic seems to be a more practical device regarding the insertion characteristics and the postoperative complications; however, it should be noted that sealing pressure is higher in Cobra-PLA

Effects of enteral and parenteral glutamine on intestinal mucosa and on levels of blood glutamine, tumor necrosis factor-alpha, and interleukin-10 in an experimental sepsis model

To investigate the effects of enteral and parenteral glutamine [Gln] usage on rats in sepsis. This study was conducted in Istanbul University Experimental Medical Research Institution [DETAE] laboratory, Istanbul University, Istanbul, Turkey between June and September 2009. The levels of blood Gln, tumor necrosis-alpha [TNF-alpha and interleukin [IL]-10 was measured. Samples of tissue were obtained from the mesenteric lymph nodes, liver, and lower lobe of the right lung to evaluate the reproduction of bacteria, and samples of tissue were also obtained from the small intestine to evaluate blood and villus atrophy. Bacteremia of Group EP [combined group] were found lower than Group C [control] [p=0.007]. Villous atrophy rates of all groups were lower than Group C: between Group E [enteral] and C [p=0.003]; between Group P [parenteral alanine] and C [p=0.019]; and between Group EP and C [p=0.001]. The values of serum TNF-alpha and IL-10 of Group EP and P were lower than the other groups at the 24th and 96th hours [p=0.000]. In this study we found that the most efficient Gln administration technique in sepsis was enteral administration together with parenteral administration due to trophic effect on the intestinal mucosa, decrease of reproduction in tissue and blood cultures, immunomodulator effect, and approximately the same cost as parenteral application

Comparison of percutaneous dilatational tracheostomy with surgical tracheostomy

Tracheostomy is done mostly in critically ill patients, many of whom may not survive. We still do not know the long term complications of tracheostomy itself; tracheal and subglottic stenosis, and tracheomalacia. To compare the complications of surgical tracheostomy [ST] versus percutaneous dilatational tracheostomy [PDT] by means of MRI control up to 1 month after closed tracheostomy. There was no death related to tracheostomy. In both groups there were two preoperative complications: one minor hemorrhage and one subcutaneous empysema in the ST group, and one minor bleeding and one puncture of endotracheal tube cuff in the PDT group. When the early and the late postoperative complications of the two groups were compared, it was observed that in the ST group, five early [one minor bleeding, three stomal infections and one accidental decannulation], and two late [one peristomal granuloma and one persistent stoma] postoperative complications had occurred. In the PDT group, four early [minor bleeding] and two late postoperative complications [two minor bleeding] were observed. MRI of two patients in the PDT group demonstrated tracheal stenosis. PDT is as safe and as effective as ST. Although the early and late postoperative complication rates were not significant in the PDT group, we believe that further investigations with larger groups are necessary to find long-term outcome following PDT. MRI scanning provides an excellent non-invasive method of assessing the tracheal lumen