Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units.

OBJECTIVES: The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied. DESIGN: We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality. RESULTS: Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively; p = .002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014; p < .001) was higher than those of the MELD-XI (0.726 ± 0.022, p < .001), APACHE III (0.682 ± 0.024, p < .001), and PESI (0.624 ± 0.023, p < .001) scores. CONCLUSIONS: The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.

Nasal care in intensive care unit patients.

PURPOSE: The aim of this study was to investigate nasal hygiene in intensive care patients and improve patient care using isotonic saline nasal spray. MATERIAL AND METHODS: In the study group, over a period of tendays saline nasal spray was administered four times daily. Nasal treatment was not given to the control group. Each patient was examined with a flexible nasopharyngoscope before and after the treatment and a nasal culture was taken. RESULTS: In the study group, the secretion score (1- absent; 2- serosal; 3- seropurulent and 4- purulent) mean value improved from 1.9 to 1.4. In the control group, the secretion score mean value had risen from 1.7 to 3.1. At the beginning of the study, there was no difference in secretion scores between the groups, but on the tenth day a statistically significant difference was found. CONCLUSION: The use of saline nasal spray in this group of intensive care patients was found to be effective in achieving nasal hygiene.

Comparison of EtView™ tracheoscopic ventilation tube and video-assisted fiberoptic bronchoscopy during percutaneous dilatational tracheostomy.

Fiberoptic bronchoscopy (FOB) via endotracheal tube (ETT) is the most frequent utilized technique for monitoring of percutaneous dilatational tracheostomy (PDT) procedure while maintaining mechanical ventilation. Endoscopic guidance has increased the safety of this procedure; nevertheless, the use of a bronchoscope via ETT potentially may deteriorate ventilation and lead to hypercarbia and/or hypoxia. EtView tracheoscopic ventilation tube (EtView TVT) is a standard endotracheal tube with a camera and light source embedded at the tip. The objectives of this study are to introduce EtView TVT as a monitoring tool during PDT and to compare it with video assisted FOB via ETT. We hypothesized that using EtView TVT during PDT may obtain similar visualization; also may have advantages regarding better mechanical ventilation conditions when compared with video-assisted FOB via ETT. Patients, 18-75 years of age requiring mechanical ventilation scheduled for PDT were randomly allocated into two groups for airway monitorization to guide PDT procedure either with FOB via ETT (Group FOB, n = 12) or EtView TVT (Group EtView, n = 12). After standard anesthesia protocol, alveolar recruitment maneuver was applied and all patients were mechanically ventilated at pressure-controlled ventilation mode with same pressure levels. The primary outcome variable was the reduction in arterial oxygen partial pressure (PaO2) values during the procedure. Other respiratory variables and the effectiveness (the visualization and identification of relevant airway structures) of two techniques were the secondary outcome variables. Patients in both groups were comparable with respect to demographic characteristics and initial respiratory variables. Visualization and identification of relevant airway structures in any steps of the PDT procedure were also comparable. The decrease in minute ventilation in Group FOB was higher when compared with Group EtView (51 ± 4 % vs. 12 ± 7.3 %, p < 0.05). The decrease in PaO2 from initial levels during (34 ± 21 % vs. 5 ± 7 % decrease) and after (26 ± 27 % vs. 2.8 ± 16 % decrease) the procedure was higher in Group FOB when compared with Group EtView (p < 0.05). Considering comparable features in monitorization and advantageous features over mechanical ventilation when compared with video bronchoscopy; EtView TVT would be a good alternative for airway monitorization during PDT especially for patients with poor pulmonary reserve.

Use of the gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography cases under sedation/analgesia.

BACKGROUND/AIMS: In this study, we aimed to analyze the effects of Gastro-Laryngeal Tube (GLT) use on intraoperative and postoperative hemodynamic parameters, comfort of the procedure, and patients' satisfaction in endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: A total of 80 patients between the ages of 20 and 75 years who were scheduled for elective ERCP were enrolled. The patients were randomly assigned to two groups: groups N and G. Those in group N underwent the procedure with sedation without any airway instruments and those in group G underwent procedure after sedation and airway management with GLT. Intraoperative and postoperative vital signs as well as the satisfaction of the patients were recorded. RESULTS: The duration to esophageal visualization was found to be significantly higher in group N (16 s) than in group G (7 s) (p=0.001). The mean Visual Analogue Scale for Pain (VAS) was significantly higher in group G (1.85) than in group N (0.45) (p=0.016). Group G had higher endoscopist satisfaction scores than group N. The incidence of desaturation during ERCP was significantly higher in group N (60%) than in group G (0%) (p=0.000). CONCLUSION: In conclusion, ERCP should be performed under optimal conditions to avoid the occurrence of unwanted complications, such as aspiration-related disorders. Therefore, according to the structural properties of GLT, sedation anesthesia application with GLT in ERCP will be safer, more comfortable, and more effective.

Variables determining the development of colistin-associated renal impairment.

AIM: The aim of this study was to identify the predictors of acute renal injury associated with colistin treatment. METHODS: The patients who received treatment with colistin for more than 3 days were included in this retrospective cohort study. Acute renal injury was defined by the RIFLE (Risk Injury Failure Loss End stage renal disease) criteria. Patients whose serum creatinine levels increased at least 1.5-fold compared with baseline value were considered as cases with renal injury. The independent variables determining the development of acute renal injury were investigated by survival analysis. RESULTS: A total of 112 cases [67 (59.8 %) were male, median age 64 (range: 18-93) years] were included in the study. Acute renal injury occurred in 66 (58.9 %) patients. Renal injury developed in first 7 days of the colistin therapy in 52 (78.8 %) cases and at day 8-23 in 14 (21.2 %) cases. On the day with highest levels of creatinine, 25 (22.3 %), 17 (15.2 %), and 33 (29.5 %) cases were in 'Risk', 'Injury', and 'Failure' group, respectively, according to RIFLE criteria. We identified three independent risk factors predicting acute colistin-induced renal injury: advanced age, low serum albumin levels, and high serum total bilirubin levels [odds ratio (confidence interval) = 1.022 (1.006-1.037), 0.643 (0.415-0.994), and 1.129 (1.014-1.257), respectively]. CONCLUSIONS: The advanced age, low serum albumin levels, and high serum total bilirubin levels are independent risk factors for colistin-induced nephrotoxicity.

Comparison of SpO2 values from different fingers of the hands.

Pulse oximetry is a frequently used tool in anesthesia practice. Gives valuable information about arterial oxygen content, tissue perfusion and heart beat rate. In this study we aimed to provide the comparison of peripheral capillary hemoglobin oxygen saturation (SpO2) values among every finger of the two hands. Thirty-seven healthy volunteers from operative room stuffs between the ages of 18-30 years were enrolled in the study. They were monitored after 5 min of rest. After their non invasive blood pressure, heart rate, fasting time and body temperature were measured, SpO2 values were obtained from every finger and each of two hands fingers with the same pulse oximetry. All the SpO2 values were obtained after at least 1 min of measurement period. A total of 370 SpO2 measurements from 37 volunteers were obtained. The highest average SpO2 value was measured from right middle finger (98.2 % ± 1.2) and it was statistically significant when compared with right little finger and left middle finger. The second highest average SpO2 value was measured from right thumb and it was statistically significant only when compared with left middle finger (the finger with the lowest average SpO2 value) (p < 0.05). SpO2 measurement from the fingers of the both hands with the pulse oximetry, the right middle finger and right thumb have statistically significant higher value when compared with left middle finger in right-hand dominant volunteers. We assume that right middle finger and right thumb have the most accurate value that reflects the arterial oxygen saturation.

Medical ozone and radiotherapy in a peritoneal, Erlich-ascites, tumor-cell model.

CONTEXT: Medical ozone therapy is used for treatment of inflammation in alternative and complementary medicine. It has been reported that the beneficial effects of radiotherapy increased with the addition of medical ozone therapy. OBJECTIVES: This study intended to investigate the antitumor and antiedema effects of ozone therapy when applied in different concentrations in mice with peritoneal carcinomatosis (PC) and to evaluate the contribution of medical ozone therapy to the outcomes for radiotherapy in vivo. DESIGN: Ehrlich ascites carcinoma (EAC) cells were inoculated intraperitoneally (IP) to develop peritoneal carcinomatosis in 60 adult male Swiss albino mice. The animals were divided into 5 groups. Groups 1 and 2 were treated IP for a period of 10 d with daily medical ozone therapy. Group 3 received radiotherapy into the abdomen for 5 d. Groups 4 and 5 were treated with medical ozone therapy for 10 d and radiotherapy for 5 d. Groups 1 and 4 received a 20 mg/L concentration of ozone and groups 2 and 5 received a 40 mg/L concentration. A sixth group acted as controls, and serum physiologic was given to them IP. OUTCOME MEASURES: Changes in body weight and abdominal circumference were measured daily for each mouse. Survival rates of the groups of mice were also determined. The results were compared between groups and were statistically analyzed. RESULTS: Changes in body weights and abdominal circumferences in the different groups were statistically different. The longest survival rates were found for groups 3 and 5, and survival rates for the 5 experimental groups were significantly higher than for the control group. CONCLUSIONS: Medical ozone therapy or radiotherapy was found to be effective when administered alone or concurrently to mice with PC, suggesting that medical ozone therapy might serve as a method of obtaining antiedema and antitumor effects, providing a longer survival time.

Total spinal block after lumbar plexus block: a case report.

Lumbar plexus block (LPB) is a suitable method for elder patients for lower extremity surgery. Many complications could be seen during LPB, but not as many as central block. In this case report, we aimed to report a total spinal block, an unusual complication. LPB with sciatic block was planned for a male patient, 76 years old, scheduled for total knee replacement due to gonarthrosis. The patient became unconscious after psoas compartment block with Chayen technique for LPB. The operation ended at 145th minute. The patient was admitted to intensive care unit until postoperative second day and discharged to home on fifth day of surgery. Main concern of patient monitorization should be an anesthesiologist. In this manner, we conclude that contacting to the patient should be ensured during these procedures.

The effects of different oxygen concentrations on recruitment maneuver during general anesthesia for laparoscopic surgery.

INTRODUCTION AND PURPOSE: Recruitment maneuvers (RMs), which aim to ventilate the collaborated alveolus by temporarily increasing the transpulmonary pressure, have positive effects in relation to respiration, mainly oxygenation. Although many studies have defined the pressure values used during RM and the application period, our knowledge of the effects of different oxygen concentrations is limited. In this study, we aimed to determine the effects of different oxygen concentrations during RM on the arterial oxygenation and respiration mechanics in laparoscopic cases. MATERIALS AND METHODS: Thirty-two patients undergoing laparoscopic cholecystectomy were recruited into the study. The patients were randomly divided into 2 groups. RM with a 30% oxygen concentration was performed in patients within the first group (group I, n=16), whereas patients in the second group (group II, n=16) received RM with 100% oxygen. To study respiratory mechanics, dynamic compliance (Cdyn), airway resistance (Raw), and peak inspiratory pressure were measured at 3 different times: 5 minutes after anesthesia induction, 5 minutes after the abdomen was insufflated, and 5 minutes after the abdomen was desufflated. Arterial blood gases were measured during surgery and 30 minutes after surgery (postoperative). RESULTS: The average postoperative partial arterial oxygen pressure values of the patients in groups I and II were 121 and 98 mm Hg, respectively. The difference between the groups was statistically significant. In addition, the decrease in compliance from induction values after desufflation in group II was statistically significant. DISCUSSION: On the basis of our results, maintaining oxygen concentrations below 100% during RM may be more beneficial in terms of respiratory mechanics and gas exchange.

Raquianestesia total após bloqueio do plexo lombar: relato de caso / Total spinal block after lumbar plexus block: a case report / Raquianestesia total posterior al bloqueo del plexo lumbar: relato de caso

O bloqueio do plexo lombar (BPL) é um método adequado para uso em pacientes idosos e cirurgias na extremidade inferior. Muitas complicações podem ser observadas durante o BPL, mas não tanto quanto no bloqueio central. Neste relato de caso, nosso objetivo foi relatar uma raquianestesia total, uma complicação incomum. BPL com bloqueio ciático foi planejado para um paciente do sexo masculino, 76 anos, programado para artroplastia total do joelho por causa de gonartrose. O paciente ficou inconsciente após o bloqueio do compartimento do psoas com a técnica de Chayen para BPL. A operação terminou em 145 minutos. O paciente foi internado em unidade de terapia intensiva até o segundo dia pós-operatório e recebeu alta hospitalar no quinto dia pós-cirúrgico. A principal preocupação da monitoração do paciente deve ser a presença do anestesiologista. Dessa forma, conclui-se que o contato com o paciente deve ser garantido durante esses procedimentos.

Lumbar plexus block (LPB) is a suitable method for elder patients for lower extremity surgery. Many complications could be seen during LPB, but not as many as central block. In this case report, we aimed to report a total spinal block, an unusual complication. LPB with sciatic block was planned for a male patient, 76 years old, scheduled for total knee replacement due to gonarthrosis. The patient became unconscious after psoas compartment block with Chayen technique for LPB. The operation ended at 145th minute. The patient was admitted to intensive care unit until postoperative second day and discharged to home on fifth day of surgery. Main concern of patient monitorization should be an anesthesiologist. In this manner, we conclude that contacting to the patient should be ensured during these procedures.

El bloqueo del plexo lumbar (BPL) es un método adecuado para usarlo en pacientes ancianos sometidos a cirugía de la extremidad inferior. Durante el BPL pueden observarse muchas complicaciones, pero no tantas como en el bloqueo central. En este relato de caso, nuestro objetivo fue exponer una raquianestesia total, una complicación no común. Se planificó un BPL con bloqueo ciático para un paciente del sexo masculino, de 76 años de edad, programado para artroplastia total de la rodilla debida a gonartrosis. El paciente quedó inconsciente después del bloqueo del compartimento del psoas con la técnica de Chayen para BPL. La operación terminó en 145 min. El paciente fue ingresado en la unidad de cuidados intensivos hasta el segundo día del postoperatorio y tuvo alta hospitalaria al quinto día poscirugía. La principal preocupación de la monitorización del paciente debe ser la presencia del anestesiólogo. Así se concluye que el contacto con el paciente debe estar garantizado durante esos procedimientos.

The recovery time of sevoflurane and desflurane and the effects of anesthesia on mental and psychomotor functions and pain.

BACKGROUND: Inhalation anesthetics have many advantages for outpatient general anesthesia, such as minimal postoperative side-effects and rapid and full recovery. The aim of this randomized study was to compare the postoperative recovery time of sevoflurane and desflurane and to observe the effects of anesthesia on mental, psychomotor and cognitive functions and pain in outpatients undergoing arthroscopic surgery. PATIENTS AND METHODS: This study included 40 American Society of Anesthesiologists I-II patients who were divided into two groups via sealed envelopes. For maintenance of anesthesia, a mixture of 66% N2O and 33% O2 and 4-7% desflurane was used in Group D, and a mixture of 66% N2O and 33% O2 and 1-2.5% sevoflurane was used in Group S. The modified Aldrete score (MAS) was evaluated postoperatively at time points determined previously. An MAS of 8 or higher was considered to indicate alertness. Mental and psychomotor functions of the patients were evaluated using the short cognitive examination (SCE), and postoperative pain levels were evaluated using the visual analogue scale (VAS). RESULTS: There was no difference between the groups in terms of demographic data (P > 0.05). The mean time to reach MAS 8, eye-opening, and orientation were higher in Group S as compared to Group D (P < 0.01). The mean MAS initially and at 5 and 10 min was higher in Group D as compared to Group S (P < 0.001). The mean SCE at 5 and 15 min was higher in Group D as compared to Group S (P < 0.01). There was no significant difference between the groups in terms of VAS scores (P > 0.05). CONCLUSION: It has been determined that desflurane provided better quality and more rapid recovery than sevoflurane, and the return of cognitive functions in the early postoperative period was faster. In conclusion, both agents can apparently be used safely in outpatient anesthetic procedures.