ABSTRACT
Malposition of a catheter is found in approximately 7% of cases after central venous catheterisation. This may result in haemorrhage, venous thrombosis and functional impairment, depending on the injury to the vessel wall. Uncomplicated catheterisation, easy aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the catheter. In our rare case series, we share our experience of four cases of malposition into the left internal mammary vein (LIMV) that we experienced in a three-year period. The thinness and fragility of the vessel wall, particularly, increases the probability of complications in malposition into the LIMV. Administration of a catheter through the right jugular vein is associated with the lowest incidence of malposition. Performing the procedure under the guidance of ultrasonography (USG) and confirmation of the catheter position after puncture using one of the USG techniques will minimise the probability of malposition. In addition, a lung X-ray should immediately be taken, and venography and fluoroscopy should be considered in the presence of suspicion.
ABSTRACT
Background/aim: The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study, we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels. Materials and methods: The ANI and NRS values, heartbeat rate (HR), systolic and diastolic arterial pressure (SAP/DAP), and oxygen saturation (SpO2) values of the patients were recorded into three groups based on the initial NRS values recorded in the postanesthesia care unit (group I: NRS ≤ 3, group II: NRS 46, group III: NRS ≥ 7). Patients whose ANI values were lower than 47, considered as the pain threshold, and the groups to which these patients belonged were also recorded. Results: Statistically significant increases were noted in HR, SAP, and DAP after extubation, while there was no significant change in ANI values. A weak correlation was identified between the ANI and NRS values of all patient groups. Conclusion: We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction of potential postoperative pain.
Subject(s)
Nociception/physiology , Pain Measurement/methods , Pain, Postoperative/diagnosis , Adult , Analgesia , Cholecystectomy, Laparoscopic , Female , Humans , Male , Middle AgedABSTRACT
AIM: Two different ventilation protocols during general anesthesia have been compared regarding their effects on amount of epidural bleeding during lumbar microdiscectomy in the prone position. Previous studies have not not revealed a relationship between ventilation mode and epidural bleeding in the prone position while measuring the intra-abdominal pressure (IAP) level. MATERIAL AND METHODS: This study was conducted on 40 American Society of Anesthesiologists (ASA) I and II patients that underwent a single level, unilateral lumbar microdiscectomy in the prone position. The anesthetic protocol was the same except the ventilation modes that were used in the study: (1) high volume-low frequency technique in group A, and (2) low volume-high frequency technique in group B. Pulmonary and hemodynamic parameters were noted. The patients also had urinary bladder catheter to measure the intra-abdominal pressure during surgery. Epidural bleeding was measured in every patient after microdiscectomy by using the aspiration volume. A convenience scale was used to assess the surgeon's satisfaction. RESULTS: Although intra-abdominal pressure remained within normal ranges in both groups, peak and plateau pressures were slightly higher in group A. Mean epidural bleeding after ligamentum flavum resection was 43.9 ± 11.82 ml in group A, and 26.35 ± 6.59 ml in group B. The difference was statistically significant. Also the surgeon's satisfaction according to convenience scale was better in group B. CONCLUSION: Decreasing epidural venous engorgement depends on the ventilation technique and may lead to surgical convenience. It may be suggested that high frequency-low tidal volume ventilation during general anesthesia for lumbar microdiscectomy can be useful in minimizing epidural bleeding by using low peak and plateau pressure during surgery.
