Use of a modified surgical APGAR score for prediction of postoperative complications in emergency surgery: An observational retrospective study.

BACKGROUND: The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of post-operative complications and mortality. In this study, we aimed to define a new, modified SAS (mSAS) for predicting the incidence of post-operative complications and mortality in emergency surgery. We also wanted to quantify the effectiveness of this modified scoring system, comprising of the duration of the operation in addition to the three intraoperative parameters of the SAS score. METHODS: Five hundred and seventy-nine patients who underwent emergency surgery were enrolled in this retrospective obser-vational study. At the end of the operation, the SAS was calculated from the data obtained from the examination of the patients and the mSAS was calculated by adding the duration of the operation to data used in the calculation of the SAS (Surgical duration >8 h; -4 points; 7.01-8 h; -3 points; 5.01-7 h; -2 points; 3.01-5 h; -1 points; 0-3 h; 0 points added). RESULTS: There was a statistically significant relationship between the mSAS and the total number of complications (as operative time [OT] increased, the number of complications increased) (r=0.360; p=0.001). The compliance levels of the SAS and mSAS were 98.4% and they have been found as statistically significant (ICC: 0.984; p=0.001; p<0.01). CONCLUSION: We suggest that the OT should be included as a simple, objective and practical indication of the SAS risk score in major operations. The mSAS was an independent predictor of post-operative mortality and complications. With the widespread use of electronic medical record systems and the effective use of pre-operative medical data, the mSAS can be used as an easy and new scoring system to predict prognosis.

Clinical outcomes of in-hospital cardiac arrest in a tertiary hospital and factors related to 28-day survival: A retrospective cohort study.

OBJECTIVES: The primary aim was to define factors related to the return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and the secondary aim was to determine factors related to 28-day mortality in patients admitted to intensive care unit (ICU) after ROSC. METHODS: In this retrospective study, we included the patients who suffered from IHCA in a tertiary hospital between July 2016 and April 2019. Pre- and post-resuscitation characteristics of the patients and event characteristics were defined to reveal the independent factors associated with ROSC and 28-day survival. RESULTS: A total of 254 patients (median age 73 years, 58.3% males) underwent cardiopulmonary resuscitation (CPR). The ROSC rate was 45.7%. Of all, 51 patients (median age, 63 years, 54.9% males) were admitted to in-hospital ICUs. The 28-day survival rate was 31.4%. The independent risk factors were chronic kidney disease (odds ratio [OR], 3.18, 95% confidence interval [CI], 1.37-7.19, P = 0.007), chronic obstructive pulmonary disease (OR, 2.84, 95% CI, 1.23-6.61, P = 0.015), asystole as an initial rhythm (OR, 2.94, 95% CI, 1.27-6.79, P = 0.012), multi-trauma-related complications (OR, 21.11, 95% CI, 4.71-94.69, P < 0.001), and septic shock (OR, 4.10; 95% CI, 1.16-14.54, P = 0.029) for ROSC; and a cerebral performance category score >2 (OR, 20.86, 95% CI, 2.74-158.65, P = 0.003), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 7.58, 95% CI, 1.06-54.23, P = 0.044) for 28-day mortality. CONCLUSIONS: Independent risk factors related to ROSC and 28-day mortality were defined in the study. However, further studies are needed to devise new strategies for increased hospital discharge with preserved neurologic functions.

Echocardiographic features of patients with COVID-19 infection: a cross-sectional study.

COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 63.3 ± 15.7 years, and 54% were male. The mean age of non-severe group (n = 46) was 49.7 ± 21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6 ± 5.9 mm vs. 33.1 ± 4.8 mm, p = 0.003; LV 47.3 ± 5.8 mm vs. 44.9 ± 3.8 mm, p = 0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0 ± 9.8% vs. 61.9 ± 4.8%, p < 0.001; RV-FAC, 41.4 ± 4.1% vs. 45.5 ± 4.5%, p < 0.001), and pericardial effusions were more frequent (23% vs. 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.

Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease.

OBJECTIVE: COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. METHODS: For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between 20 March and 20 April 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. RESULTS: A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5 ± 14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; P < 0.01). The frequency of patients who required ICU (72% vs. 19%), who developed acute kidney injury (14% vs. 1%) and acute respiratory distress syndrome (71%vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury [odds ratio (OR) 10.58, 95% confidence interval (CI) 2.42-46.27; P < 0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR 2.52, 95% CI 1.17-5.45; P = 0.018). CONCLUSION: Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.

Comparison of Different Cuff Pressure Use with the Supreme Laryngeal Mask Airway on Haemodynamic Response, Seal Pressure and Postoperative Adverse Events: A Prospective Randomized Study.

OBJECTIVE: The Supreme™ laryngeal mask airway (SLMA) is a supra glottic airway (SGA) device that is used as an alternative to endotracheal tubes. In the present study, we aimed to compare the use of the SLMA with normal cuff pressure and low cuff pressure, primarily for haemodynamic response. METHODS: In the present study, 120 patients diagnosed with hypertension and scheduled for varicose vein or inguinal hernia operation were enrolled and 99 patients finished. Using randomization, patients were divided into two groups according to cuff pressure as a low-pressure group (Group L, 45 cm H2O) and a normal-pressure group (Group N, 60 cm H2O). Demographics, Mallampati score and the type and duration of surgery, heart rate (HR), mean arterial pressure (MAP), percentage of tidal volume leakage, Ppeak, Pmean, etCO2, seal pressure, fibreoptic scores and postoperative adverse effects of all patients were recorded. RESULTS: MAP and HR values immediately and 2 minutes after SLMA insertion were significantly lower in Group L (p<0.001). In Group L and Group N, the seal pressures were 24.1±3.1 cm H2O and 26.2±3.9 cm H2O, respectively (p=0.003). Also, blood staining and sore throat occurred less frequently in Group L (p<0.05). The fibreoptic average score, insertion features and ventilation parameters were similar between the groups (p>0.05). CONCLUSION: SLMA use with a cuff pressure of 45 cm H2O significantly decreases haemodynamic response and post-operative side effects compared with a normal cuff pressure. Therefore, except for some specific surgeries that require higher seal pressures, we recommend the use of the SLMA with cuff pressures as low as 45 cm H2O.

Burnout Syndrome During Residency.

OBJECTIVE: The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. METHODS: After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. RESULTS: Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. CONCLUSION: BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects.

[The cognitive effects of using transdermal fentanyl in cancer pain]. / Kanser agrisinda transdermal fentanil kullaniminin kognitif fonksiyonlar üzerine etkisi.

OBJECTIVES: In this study, we aimed to investigate the effects of using transdermal fentanyl (TDF) on cognitive functions in cancer pain. METHODS: After approval and informed consent of patients by the Ethical Committee, fifty patients with cancer pain who had no previous opioid treatments were included in the study. Pain was evaluated with Visual Analogue Scale (VAS) while, cognitive functions were assessed using by Addenbrooke's Cognitive Examination final revised version (ACE-R). In addition, performance was evaluated with Eastern Cooperative Oncology Group Performance Status (ECOG) and adverse reactions were noted. Patient algological evaluation was done in the first application and the normal cognitive functions were established using ACE-R. In most cases the treatment began with 25 µg/h TDF and, at certain stages of the treatment, the dose was increased so that VAS ≤2. ACE-R was applied again on day 30 under sufficient analgesia. All patients were compared using ACE-R total scores and subgroups (attention-orientation, memory, fluency, language, visuospatial abilities) at before and after TDF treatment. RESULTS: At the end of the study, attention-orientation, memory, fluency, language, and ACER total scores showed a statistically significant improvement after TDF treatment than before. No significant change was obtained for the visuospatial abilities. No difference was detected in performance status. CONCLUSION: The use of TDF for the treatment of cancer pain is not associated with impairment in cognitive performance. Even some cognitive test scores demonstrated significant improvement. Our data shows that the absence of pain increased the quality of life.

Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit. CASE REPORT: A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service. CONCLUSIONS: Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis.

Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy / Síndrome da secreção inapropriada do hormônio antidiurético relacionada à síndrome de Guillain-Barré após colecistectomia videolaparoscópica / Síndrome de secreción inapropiada de hormona antidiurética relacionado con el síndrome de Guillain-Barré tras colecistectomía laparoscópica

Background and objectives: Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit. Case report: A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service. Conclusions: Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia ...

Justificativa e objetivos: a síndrome de Guillain-Barré é uma das causas mais comuns de polineuropatia aguda em adultos. Recentemente, a ocorrência após grandes e pequenas intervenções cirúrgicas tem sido cada vez mais debatida. Na Guillain-Barré, a síndrome da secreção inapropriada do hormônio antidiurético e a disautonomia são geralmente observadas após déficit motor máximo. Relato de caso: paciente do sexo masculino, 44 anos, submetido a colecistectomia videolaparoscópica para colecistite aguda. Após desenvolver uma forte dor de cabeça, náusea, diplopia e ataques de hipertensão no período pós-operatório imediato, uma tomografia computadorizada do cérebro revelou-se normal. Os exames laboratoriais revelaram hiponatremia associada à síndrome de secreção inadequada de hormônio antidiurético; os líquidos foram restritos e tratamento com furosemida e NaCl a 3% foi iniciado. No segundo dia pós-operatório, o paciente desenvolveu dormência que se propagava a partir das mãos e dos pés, perda de força, dificuldade para engolir e respirar. Suspeitou-se de síndrome de Guillain-Barré e o paciente foi transferido para a unidade de tratamento intensivo. Exame do líquido cefalorraquidiano revelou 320 mg/dL de proteína e neuropatia axonal sensório-motora aguda foi identificada por eletromiografia. Síndrome de Guillain-Barré foi diagnosticada e tratamento intravenoso com imunoglobuliva (0,4 g/kg/dia, cinco dias) foi iniciado. Após 10 dias na unidade de terapia intensiva, durante os quais os parâmetros respiratório, hemodinâmico, neurológicos e laboratoriais voltaram ao normal, o paciente foi transferido para o serviço de neurologia. Conclusões: nosso relato de caso indica que, ...

Justificación y objetivos: el síndrome de Guillain-Barré es una de las causas más comunes de polineuropatía aguda en adultos. Recientemente, la aparición del síndrome de Guillain-Barré después de cirugías mayores o menores se ha convertido en objeto de debate cada vez mayor. En el síndrome de Guillain-Barré, generalmente se observan síndrome de secreción inapropiada de hormona antidiurética y disautonomía después de un déficit motor máximo. Relato de caso: paciente de sexo masculino, 44 años, sometido a colecistectomía laparoscópica por colecistitis aguda. Después de comenzar con un fuerte dolor de cabeza, náuseas, diplopía y ataques de hipertensión en el período postoperatorio inmediato, una tomografía computadorizada del cerebro del paciente se reveló normal. Las pruebas de laboratorio revelaron hiponatremia asociada con el síndrome de secreción inadecuada de hormona antidiurética; los líquidos se restringieron y se inició tratamiento con furosemida y NaCl al 3%. En el segundo día del postoperatorio, el paciente presentó adormecimiento que se propagaba desde las manos y los pies, pérdida de fuerza, dificultad para tragar y para respirar. Se sospechó síndrome de Guillain-Barré y el paciente fue derivado a la unidad de cuidados intensivos. El examen del líquido cefalorraquídeo reveló 320 mg/dL de proteína y mediante electromiografía se identificó neuropatía axonal sensorial y motora aguda. Se diagnosticó síndrome de Guillain-Barré y se inició el tratamiento intravenoso con inmunoglobulina (0,4 g/kg/día, durante 5 días). Después de 10 días en la unidad de cuidados intensivos, durante los cuales los parámetros respiratorio, hemodinámico, neurológico ...

Spinal Anaesthesia and Perioperative Anxiety.

OBJECTIVE: Anxiety is a pathological condition with a feeling of fear accompanied by somatic symptoms due to hyperactivity of the autonomic nervous system. In this study, we aimed to compare perioperative anxiety status and the effects of age, gender, educational status, and The American Society of Anesthesiologists physical status classification (ASA) score on perioperative anxiety in patients undergoing elective surgery under spinal anaesthesia. METHODS: After IRB approval and signed informed consent, 100 healthy patients undergoing elective surgery under spinal anaesthesia were enrolled. The demographic data of patients and ASA scores were recorded. After spinal anaesthesia, State Trait Anxiety Inventory (STAI) and anxiety levels were measured. RESULTS: The mean anxiety score in patients undergoing surgery under spinal anaesthesia indicate the presence of an intermediate level of anxiety (44.58±19.06). A statistically significant positive correlation was found between anxiety scores and age of patients with increased age (p<0.01). Statistically significant differences were found between anxiety scores of patients according to gender, and women's anxiety scores were found to be significantly higher than in men (p<0.05). Anxiety scores did not differ significantly between education levels. A statistically significant difference was found between anxiety scores regarding ASA scores (p<0.05). Evaluation of patients revealed that the anxiety score of patients with ASA score 1 was significantly higher than the anxiety score of patients with ASA score 2. There was no significant difference between anxiety score of patients with ASA scores 2 and 3. CONCLUSION: There is a mid-level anxiety, associated more with advanced age, female gender, and low ASA score, in patients undergoing elective surgery under spinal anaesthesia.

[Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginin akut alevlenmesinde uygulanan noninvaziv mekanik ventilasyonda helmet ile yüz maskesinin karsilastirilmasi

Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the frequent causes of acute respiratory failure. In our study, we aimed to compare helmet with face mask in noninvasive mechanical ventilation (NIMV) on patients who had acute respiratory failure because of exacerbation of COPD in intensive care unit (ICU). Thirty patients, taken into ICU for exacerbation of COPD, were included in the study. Patients were divided into two groups as face mask group (Group Y) and helmet group (Group H). Appropriate mechanical ventilation settings were recorded after the starting period and NIMV was applied to patients continuously for two hours with these settings. Respiratory frequency (f), blood gas (PaO(2), PaCO(2), PH) and PaO(2)/FiO(2) values and hemodynamic data of all patients were recorded periodically. Compliance of patients were evaluated with patient tolerance scale (PTS). Duration of stay of the patients in ICU and complications were also noted. Demographic characteristics of patients, mechanical ventilator settings and hemodynamic data of the patients in the two groups were found to be similar (p>0.05). Frequency values measured during NIMV are also similar at all measurement times (p>0.05). It was determined that there was a remarkable decrease in respiratory frequency, in both groups after the application of NIMV (p< 0.001). There was no difference with respect to PaO(2), PH and PaO(2)/FiO(2) values at all measurement times, between groups (p> 0.05). PaCO(2) values in the beginning were similar in both groups but PaCO(2) measured at other measurement times for group H were statistically higher compared to the other group (p< 0.05). PTC score measured at during NIMV in group H were remarkably higher (p< 0.05). Helmet developed as an alternative to face mask has a better patient tolerance and accordingly in increases success rate in NIMV. But it must be keeping mind that the decrease in PaCO(2) value is slow with helmet.

Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults.

BACKGROUND AND OBJECTIVE: The laryngeal mask airway (LMA) is an important airway device that was developed in 1983. From the first classic LMA models up to now, LMA models have been developed that are easily and quickly inserted, provide ventilation at higher airway pressures, have lower cuff pressure, a reduced risk of gastric aspiration and cause fewer stress responses. We aimed to compare the LMA Classic with the LMA Supreme in assessing the success rate and time for insertion, number of attempts and leak pressure. METHODS: A total of 70 patients of ASA group I or II were included in our study. Regarding the airway device used during surgery, the patients were randomly assigned into two groups: the LMA Supreme group and the LMA Classic group. In order to provide common conditions for inserting the laryngeal mask, insertion was made while the bispectral index was between 50 and 60 and T1 was 0. The success rate of inserting the LMA, the duration of insertion, the number of attempts, the insertion complications, ventilation parameters, haemodynamic parameters and postoperative adverse effects were recorded for each group. RESULTS: In the LMA Classic group and the LMA Supreme group, the LMA was successfully inserted in 27 (88.5%) and 34 (97%) patients, respectively. The duration of insertion in the LMA Supreme group was shorter and the cuff pressure was lower than that in the LMA Classic group (P < 0.001). CONCLUSION: The LMA Supreme is superior to the LMA Classic because of its ease of insertion with low cuff pressure and high oropharyngeal leakage pressure.

Remifentanil-propofol vs dexmedetomidine-propofol--anesthesia for supratentorial craniotomy.

The aim of the present study was to compare the perioperative hemodynamics, propofol consumption and recovery profiles of remifentanil and dexmedetomidine when used with air-oxygen and propofol, in order to evaluate a postoperative analgesia strategy and explore undesirable side-effects (nausea, vomiting, shivering). In a prospective randomized double-blind study 50 ASAI-III patients scheduled for supratentorial craniotomy, were allocated into two equal Groups. Group D patients (n = 25), received i.v. dexmedetomidine 1 microg kg(-1) as preinduction over a 15-min period and 0.2-1 microg kg(-1) hr(-1) by continuous i.v. infusion during the operation period. Group R patients (n = 25), received remifentanil 1 microg kg(-1) as induction i.v. over a 15-min period and 0.05-1 microg kg(-1) min(-1) as maintenance. The propofol infusion was started at a rate of 10 mg kg(-1) h(-1) and titrated to maintain BIS in the range 40-50. Propofol doses for induction and maintenance of anesthesia was lower with dexmedetomidine (respectively p < 0.05, p < 0.01). The time for BIS to reach 50 was significantly shorter in Group D (p < 0.01). Comparison of the parameters of recovery revealed; extubation time (p < 0.01); response to verbal commands (p < 0.05) and time for orientation (p < 0.05) were longer with Group D. With respect to Post Anesthesia Care Unit (PACU) discharge time, dexmedetomidine patients required longer time when compared to remifentanil patients to achieve their first normal neurological score (33 min vs 31 min). The earliest opioid administration was at 38 min. in the dexmedetomidine group and 33 min. in the remifentanil group. Propofol-remifentanil and propofol-dexmedetomidine are both suitable for elective supratentorial craniotomy and provide similar intraoperative hemodynamic responses and postoperative adverse events. Propofol-remifentanil allows earlier cognitive recovery; however, it leads to earlier demand for postoperative analgesics. Undesirable side-effects were similar in two Groups.

Comparison of percutaneous dilatational tracheostomy with surgical tracheostomy.

RATIONALE: 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. OBJECTIVES: 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. RESULTS: 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 ofendotracheal 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. CONCLUSIONS: 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.

Positive end-expiratory pressure reduces pneumocephalus in spinal intradural tumor surgery.

We tested the hypothesis that 5 cm H2O of positive end-expiratory pressure (PEEP) reduces the incidence of pneumocephalus in patients who undergo spinal intradural tumor surgery. Fifty-three ASA I to III patients who underwent thoracolumbar intradural tumor surgery between the years 2003 and 2006 were included in this study. All patients received propofol, fentanyl, and cisatracurium for induction of the anesthesia. Maintenance was provided by propofol infusion and, oxygen (50%) and air (50%). Group I (n=28) did not receive PEEP whereas group II (n=25) received PEEP as 5 cm H2O. Cranial computerized tomography was taken at 8 hours after the surgery and cases were evaluated for pneumocephalus using BAB Bs200ProP Image System software. Pneumocephalus areas between 0.03 and 4.24 cm2 were observed in 9 patients, 8 in group I and 1 patient in group II at the 8th postoperative hour, at various localizations. There were no neurologic findings in other patients except for 2 patients in group I who presented with headache and mental status change. Although the cerebrospinal fluid leakage is minimal, N2O is not used and the patients are well hydrated, pneumocephalus with neurologic deficits may occur in patients undergoing microsurgical spinal intradural tumor surgery in prone position. In our study, we showed that using 5 cm H2O PEEP perioperatively reduced the risk of pneumocephalus. However, more cases must be studied to support this hypothesis.