Increased heart rate on first day in Intensive Care Unit is associated with increased mortality

Objective: To investigate the association of maximum HR during the first day of intensive care unit [ICU] and mortality

Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR >/= 100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization [ICU and total], mortality [ICU and total], and CHARLSON and APACHE-II scores

Results: The mean age of patients was 63 +/- 12 years and 86% were after non-cardiac surgery. Maximum HR was 83 +/- 11 in Group-I and 115 +/- 14/min in Group-II [p=0.002]. Group-II patients had more frequent vasopressor and inotropic drugs usage, [p<0.001], anemia, mechanical ventilation [p<0.005], higher CHARLSON and APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I [p<0.05]. APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not

Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit

clinical comparison of etomidate-lipuro, propofol and admixture at induction

The purpose of this study was to compare etomidate-lipuro and propofol and 50%, [1:1] admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus. Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro-propofol admixture. After monitorization with bispectral index [BIS] all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 [BIS 40 time] and total amounts of induction doses were measured. BIS 40 time measurements were P > E > PE [199.4 +/- 40.9, 176.9 +/- 31.6, 163.5 +/- 20.6 s]. The hemodynamic [systolic, diastolic and mean blood pressures, heart rate] changes were minimal in group PE than other two groups [P = 0.017]. The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E [76.3%]. Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were [83.8%] in group P and in [63.2%] group E. Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction

Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery

To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need. Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group group R, and dexmedetomidine group group D received a bolus of 1 ug/kg over 10 minutes, followed by 0.2 ug/kg/minute peroperative infusion of remifentanil, and 0.4 ug/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded. Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D. This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia

Effect of intraarticular injection of lornoxicam on the articular cartilage & synovium in rat.

BACKGROUND & OBJECTIVE: Intraarticular (i.a) drug application is consider to be a new therapeutic approach for the treatment of postoperative pain after arthroscopic knee surgery without any systemic adverse effects. Lornoxicam, a nonsteroid anti-inflammatory drug is a short acting agent, and its anti-inflammatory and analgesic activity may be effective in the postoperative pain management in minor surgery. In this study, the effects of intraarticular administration of lornoxicam on the synovium and articular cartilage in the rat knee joint were investigated. METHODS: Lornoxicam (0.25 ml) was given as an injection into the right knee joint and 0.25 ml of 0.9 per cent saline solution by injection into the left knee joint as a control in 25 rats. Groups of five rats were sacrificed by a lethal injection of ketamine 1st, 2nd, 7th, 14th and 21st days after lornoxicam administration. Knee joints were detached, fixed in 10 per cent buffered formalin and decalcified. Serial sections of 5 microm were stained with haematoxylin-eosin and evaluated for the presence of inflammation in the articular, periarticular regions and synovium. Inflammatory changes in the joints were graded according to a five-point scale, histologically. RESULTS: There were no significant differences in inflammation and cartilage degeneration, between control and lornoxicam applied knees. Grade 3 inflammatory changes occurred only in one knee in lornoxicam group, at 24 h after injection. No pathological changes were observed in both groups at any time point. INTERPRETATION & CONCLUSION: Lornoxicam did not show significant effect on inflammation on rat synovia in knee joint. Further studies including in human need to be done before any recommendations are made for i.a. administration of lornoxicam.

Influence of sevoflurane and desflurane on neurological and adaptive capacity scores in newborns

To evaluate maternal and neonatal effects of desflurane compared with the sevoflurane for general anesthesia for cesarean section. The study was conducted as a prospective randomized blind study between January 2003 to January 2004 at the Hacettepe University, Ankara, Turkey. One hundred and two American Society of Anesthesiologists ASA I patients aged between 20-35 at 37-42 weeks of pregnancy were randomly allocated into 2 groups. All patients received thiopental and succinylcholine for induction. Patients assigned to the first group received desflurane 2.5%, and the second group sevoflurane 1.5% combined with 50% nitrous oxide and oxygen. Maternal blood loss, umbilical arterial blood gas values, delivery intervals, Apgar scores, and neurologic and adaptive capacity score NACS on the fifteenth minute, second hour, and twenty-fourth hour of age were evaluated to assess the neonatal status. One hundred and two 52 sevoflurane group, 50 desflurane group parturients were included in the study. In the desflurane group, NACS were significantly better on the fifteenth minute and second hour evaluations. There were no statistically significant differences in twenty-fourth hour NACS evaluations, Apgar scores, umbilical arterial blood gas values, delivery times, and maternal blood loss between the groups. Desflurane anesthesia offers more favorable results compared to sevoflurane in newborns delivered by elective cesarean section under general anesthesia in the early hours after delivery

Effect of hypotensive anesthesia on cognitive functions. A comparison ofesmolol and remifentanil during tympanoplasty

To compare the effects of esmolol and remifentanil, used as adjuncts for induced hypotension on surgical conditions and short-term cognitive functions, during tympanoplasty. The study was conducted in Hacettepe University, School of Medicine, Ankara, Turkey between January 2005 and December 2006 following Institutional Ethical Committee approval, 40 ASA I-II patients, between 18 and 60 years of age were included in this study. With the induction of anesthesia, for group E, an esmolol infusion of 50-250 microg.kg[-1].min[-1] was titrated, following a bolus of 0.5 mg.kg[-1]; for group R, a remifentanil infusion of 0.2-0.5 microg.kg[-1].min[-1] was titrated; to achieve a mean blood pressure [BP] of 55-65 mm Hg. Arterial BP were recorded continuously throughout the operation. Mini Mental State Test [MMS] was performed at the preoperative 30th minute [MMS[60], postoperative 30th minute [MMS[30]], 60th minute [MMS[60]] and 24th hour [MMS[24]]. Surgical field was evaluated by the blinded surgeon, using a 6 point category scale. Patient demographics were similar in both groups. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Surgical field scores were lower in group R [P<0.05], although the scores were

Intracerebral hemorrhage following enucleation: a result of surgery or anesthesia ? A Case Report

Choroidal melanoma is the most common primary intraocular cancer in adults. A sixty-nine years old, hypertensive male with a choroidal melanoma underwent enucleation. After extubation he woke up confused and unconscious. An emergent computed tomographic [CT] scan demonstrated intracerebral hematoma. The underwent repeat surgery in the postoperative first hour, because of left parietotemporal intracerebral hematoma. His neurological state became worse and he died in the eighth postoperative day. Sympathetic stimulation due to extubation, causing increase in the intracranial pressure or uncontrolled hypertension, may be reasons precipitating intracranial hemorrhage. In patients, who undergo intracranial or intraorbital surgery, had risk factors of intracranial hemorrhage or showed labile blood pressure perioperatively and were confused or unconscious in the postoperatively or had delayed emergence, intracranial hematoma must be suspected

Parental satisfaction with pediatric day case surgery

Children make excellent candidates for day case surgery. Satisfaction is an important measure of the outcome. The aim of this study was to establish the degree of parental satisfaction with day-case surgery for their children. Parents of one hundred children were questioned. They were asked to answer questions on their level of satisfaction in several areas; communication with doctors [surgeon and anesthesiologist], physical conditions, staff's care, patients' problems and 2 open ended questions. Parents were most satisfied with nursing care and most dissatisfied with physical conditions. Ninetyseven per-cent of parents stated that, if given a choice they would opt for day case surgery for their child again. There is a high rate of satisfaction with day case surgery, however, considerable effort is needed to prepare better physical conditions, better time schedule organizations, more anesthesia outpatient clinic consultations

Spinal anesthesia in kartagener's syndrome

Kartageners syndrome, an autosomal recessive disorder is a combination of dextrocardia situs inversus, bronchiectasis and sinusitis. We report a 22-year-old woman with this syndrome scheduled for appendectomy. Spinal anesthesia was preferred for the patient with this rare disorder due to the relative advantages of the regional technique over general anesthesia

Infusion and bolus administration of cisatracurium - effects on histamine release

The purpose of this study is to evaluate the usefulness of Cisatracurium Besilat [CB], and the method of its administration during laparotomies on adult patients, to determine whether CB caused cutaneous, systemic or chemical evidence of histamine release. This study was conducted as a randomized, double-blind clinical trial on 38 patients [ASA I-II]. After a standard anesthetic induction with fentanyl and propofol, patients received an i.v. bolus CB [0.15 mg/kg in Group A [n=20] or Group B [n=18]. In Group B, 0.18 mg/kg/h infusion was started. Following reaching stable muscle relaxations for intraabdominal operation and for recovery, Group A [Bolus group] and Group B [Infusion group] were compared. Train-of-four fade during recovery of block were recorded after administration of CB. The heart rate and arterial blood pressure were monitored noninvasively. There were no significant hemodynamic differences among the groups. 25%-75% spontaneous recoveries were [X +/- s] 12.75 +/- 4.52, 16.11 +/- 9.20 minutes for Group A, Group B. 70% TOF Ratios were [X +/- s] 1.07 +/- 0.13, 1.39 +/- 0.38 hours for the same groups. There was no consistent correlation between hemodynamic changes, cutaneous manifestations and histamine concentrations. - We conclude that CB does not cause systemic or cutaneous histamine release. The infusion method of cisatracurium has a stable level of curarization without side effect and there were no significant recovery time differences between the groups

effect of premedication on preoperative anxiety

The aim of this study was to evaluate the effect of premedication on anxiety, cortisol, residual gastric volume and gastric pH. Following the approval of the institutional Clinical Research Ethics Committee, 100 patients in ASA I-II scheduled for elective gynecologic surgery, were included into a double blind study. Patients were randomly allocated into two groups; the placebo and the premedicated. Oral 10 mg diazepam in the evening before surgery and 1.5 mg midazolam at least 15 min before surgery. The same anesthetic procedure was applied for both groups. Anxiety levels of patients were assessed by using Spiel Berger State- Trait Anxiety Inventory Scale [STAIs]. Blood samples for cortisol measurements were obtained at the preoperative visits, preanesthesia and intraoperative phases. Gastric contents were collected through an orally inserted gastric tube, acidity was measured by using Merck's pH paper. In placebo group, the pre anesthetic STAIs values were increased compared to the values obtained at preoperative visit [p<0.001]. The pre anesthetic STAIs values were decreased in premedicated group [p<0.001]. The changes of preanesthetic and preoperative visit values were statistically different [p<0.001]. The preanesthetic and intraoperative cortisol values were increased in both groups compared to values of preoperative visit. The augmentation was significantly higher in the placebo group [p<0.05]. Positive correlation was observed between basal state anxiety and basal cortisol values and preanesthetic STAIs and cortisol values in the placebo group [r=0.325, p<0.05]. These data support that preoperative sedation suppresses the preoperative anxiety and the cortisol augmentation resulting from surgery and stress

Effects of low and high intra-abdominal pressure on immune response in laparoscopic cholecystectomy

Immunosuppression is directly related to the degree of trauma. The aim of this study is to compare the effects of low and high intra-abdominal pressure on immune response in moderate surgical trauma. Twenty-two patients, scheduled for laparoscopic cholecystectomy, were randomly allocated to one of 2 groups according to intra-abdominal pressure: low and high intra-abdominal pressure. This study was conducted in the Hacettepe University Faculty of Medicine, Operation Room, Ankara, Turkey. Serum interleukin [IL]-2 and IL-6 levels were measured. Serum IL-2 showed a significant decrease before the incision in high intra-abdominal pressure group. The increase in serum IL-6 at the end of surgery and postoperatively was lower in low intra-abdominal pressure group. These results, can be interpreted as the immune system, are less depressed when there is lower intra-abdominal pressure. This may have clinical implications in immunocompromised patients