Can chin-nape circumference and the ratio of neck circumference to chin-nape circumference predict difficult mask ventilation or difficult intubation in obese patients?

We aimed to evaluate the success of the ratio of chin-nape circumference (CNC) and neck circumference (NC) to CNC in predicting difficult mask ventilation (DMV) or difficult intubation (DI). Eighty-seven obese patients (body mass index ≥ 30) were evaluated between September 15, 2019 and September 15, 2020. Mallampati score, mouth opening, upper lip bite test, distance between incisors, thyromental distance (TMD), sternomental distance (SMD), and thyromental height were recorded. NC and CNC were measured in a neutral position. The ratio of NC to TMD and the ratio of NC to CNC were calculated. Mask ventilation was graded according to the method described by Han et al (Grade 3 or 4 equals DMV). DI assessment was performed using the intubation difficulty scale (IDS, IDS < 5 equals easy intubation, IDS ≥ 5 equals DI). Logistic regression analysis was performed to identify the variables thought to be effective in DMV and DI. Receiver operating characteristic curves were generated for each parameter considered effective. DMV was found in 17.2% (n = 15) of the patients included in the study, and DI was found in 16.1% (n = 14). The relationship between DMV and age, male gender, obstructive sleep apnea syndrome, NC, ratio of NC to TMD, ratio of NC to SMD, ratio of NC to CNC, and CNC was significant. Male gender and NC >45.5 cm were independent risk factors for DMV. The relationship between DI and distance between incisors, NC, ratio of NC to TMD, ratio of NC to SMD, and CNC was significant. A distance between the incisors < 4.85 cm and a NC > 41.5 cm were found to be independent risk factors for DI. CNC may predict DMV and DI in obese patients. The ratio of NC to CNC may predict DMV in obese patients.

The predictive power of C-reactive protein- lymphocyte ratio for in-hospital mortality after colorectal cancer surgery.

BACKGROUND: The relation between immunity, inflammation, and tumor development and progression has been emphasized in colorectal cancer widely and the prognosis is linked to the inflammatory reaction of the host as well as the biological behavior of the tumor. AIM: In this study, we aimed to find out the predictive power of C-reactive protein- lymphocyte ratio (CLR) for in-hospital mortality after colorectal surgery. METHODS AND RESULTS: A series of 388 CRC patients were enrolled in the present retrospective study which was conducted in a tertiary state Hospital in Ankara, Turkey. In-hospital mortality was the main outcome to evaluate the predictive power of inflammatory markers, while the other outcomes that would be evaluated as separate variables were LOS in hospital and LOS in ICU. In this study, there were 260 males and 128 females, and the mean age was 60.9. The in-hospital mortality rate was 3.4% (n = 13) and age, APACHE II score and Charlson comorbidity index score were related to in-hospital mortality statistically. The mean LOS in the hospital was 13.9 days and LOS in ICU was 4.5 days. The CRP levels and the CLR levels were higher both in the preoperative and postoperative periods in the mortality (+) group and the difference was significant statistically (P = .008/ .002 and .004/ <.001, respectively). CLR in the postoperative period had the best predictive power with AUC: 0.876. CONCLUSION: In conclusion, within the context of our study there appears to be a relationship between CLR, as measured on day 2 postoperatively, and in-hospital mortality. It is observed to be more effective than NLR, ALC, and CRP.

[The effects of preoperative anxiety on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy]. / Efeitos da ansiedade pré­operatória na recuperação anestésica e na dor pós­operatória em pacientes submetidos a nefrectomia para doação.

BACKGROUND AND OBJECTIVES: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. METHODS: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. RESULTS: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p<0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24hours (p<0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. CONCLUSION: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

The effects of preoperative anxiety on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy / Efeitos da ansiedade pré-operatória na recuperação anestésica e na dor pós-operatória em pacientes submetidos a nefrectomia para doação

Abstract Background and objectives: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. Methods: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. Results: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. Conclusion: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

Resumo Justificativa e objetivos: Estima-se que 38-45% dos pacientes apresentem ansiedade pré-operatória. Observamos que doadores vivos submetidos à nefrectomia para doação apresentam ansiedade. A ansiedade pré-operatória pode complicar a recuperação anestésica e controle pós-operatório de dor do paciente. O presente estudo mediu as taxas de ansiedade no pré-operatório e seus efeitos na recuperação anestésica e dor pós-operatória em pacientes doadores submetidos a nefrectomia. Método: Quarenta e oito doadores vivos submetidos a nefrectomia para doação de rim foram incluídos neste estudo de coorte prospectivo observacional. A ansiedade pré-operatória foi medida usando os inventários IDATE-I e IDATE-II. As relações entre os escores de ansiedade e dados relacionados a demografia, recuperação da anestesia e escores de dor no pós-operatório foram estudadas. Resultados: Os achados foram notáveis porque os escores de ansiedade de doadores renais vivos se correlacionaram de maneira significante com as variáveis de recuperação, a saber, tempo para respiração espontânea, tempo para respiração adequada, tempo para extubação e tempo para alta da RPA (p < 0,01). Os escores de ansiedade apresentaram correlação significantemente positiva com os escores de dor do 30o minuto e horas 1, 2, 4, 8, 12 e 24, e a quantidade total de analgésicos administrada nas 24 horas (p < 0,05). Foi observada também correlação significantemente negativa entre os escores de ansiedade e satisfação dos pacientes. Conclusão: Nosso estudo mostrou que doadores vivos submetidos a nefrectomia para doação com altos níveis de ansiedade apresentaram tempos de recuperação tardios e altos escores de dor no pós-operatório. Assim, a identificação dos pacientes com alto nível de ansiedade no pré-operatório é crucial para propiciar recuperação da anestesia e controle da dor no pós-operatório satisfatórios durante a nefrectomia para doação de órgão.

Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery.

BACKGROUND: Fluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications. PATIENTS AND METHODS: In this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively. RESULTS: The mean age of the study population was 56.9±14.4 years and 75% of the patients were male. SVV was used in fluid therapy in 48.9% of the patients. The use of SVV resulted in an increased use of crystalloids and colloids with increased urine output per hour (p<0.05). Of patients in the SVV group and the CVP group, 44.1% and 51.1% developed at least one complication, respectively (p=0.531). The rate of respiratory complications including atelectasis, pneumonia, hypoxemia, and an increased production of secretions was 21% in the SVV group and 37.7% in the CVP group (p=0.104). The rate of complications and the length of hospital stay were comparable between the groups (p>0.05). CONCLUSION: Our study results showed that the use of SVV increased the use of crystalloids and colloids and favorably affected urine output per hour but did not reduce complications in thoracic surgery.