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BACKGROUND: We aimed to compare the effects of observation of the physician (POB) or by adhering to the protocol-based (PB) weaning methods on total antioxidant capacity (TAC) and total oxidative stress (TOS) levels and weaning success levels. METHODS: Our study was conducted on patients admitted from the emergency department between January 2015 and January 2018 in the intensive care unit of our hospital. During the spontaneous breathing trial (SBT), when one of the criteria specified in developed, SBT was terminated and the previous mechanical ventilator parameters were returned. The patient was planned to be taken to SBT again the next morning. If the SBT was successful, extubation was decided. The extubation decision based on physician observation was made according to the patient's state of consciousness and adequate chest expansion during the daily visit. RESULTS: The decrease in TAC average value before and after extubation was found to be significant in the POB group patients (p=0.001). The decrease in the average TAC value of the PB group patients before and after extubation was found to be significant (p=0.03). CONCLUSION: In our study, TAC values were found to be higher in the PB group than in the POB group, and in addition, the reintubation rate was found to be lower. We think that the management of weaning as a PB may contribute to maintaining the balance between TAC and TOS and reduce the rate of reintubation.
Assuntos
Antioxidantes , Desmame do Respirador , Extubação/métodos , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Respiração Artificial , Desmame do Respirador/métodosRESUMO
BACKGROUND: The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19. METHODS: Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations. RESULTS: Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025). CONCLUSION: The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.
Assuntos
Anestesia , COVID-19 , Emergências , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of antithrombin III (AT III) and pentoxifylline treatments on the gram negative septic patients with disseminated intravascular coagulation (DIC). METHOD: For six days after plasma AT III activity dropped lower than 80% in Gram-patients who developed DIC were treated with AT III (90-120 IU/kg/day in 6 hours) or pentoxifylline (1.5 mg/kg/h in 6 hours) Fibrinogen, FDP, D-dimer, complete blood count, AT III activity, and DIC scores were calculated and recorded. RESULTS: The coagulation tests, AT III activity and FDP started to improve from the second day of treatment with both treatments (p<0.05). D-Dimer started to decrease on the second day of treatment with pentoxifylline (p<0.001) and fourth day of AT III treatment (p<0.05). Fibrinogen levels decreased on the second day of pentoxifylline treatment (p<0.05) and on the last day of AT III treatment (p<0.001). DIC scores started to decrease on the last day of treatment with AT III treatment (p<0.001) and on the third day of treatment with pentoxifylline (p<0.05). CONCLUSION: Both ATIII and pentoxifylline treatments had positive effects on fibrinogen, FDP, D-Dimer, AT III activity and DIC scores in patients with Gram-negative sepsis who developed DIC.
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OBJECTIVE: The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. METHODS: Sixty Wistar rats weighing 200-350g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. RESULTS: There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). CONCLUSION: In all groups, histopathological damage frequency and severity were more than the motor deficiency.
Assuntos
Anestésicos Locais/efeitos adversos , Bupivacaína/análogos & derivados , Bupivacaína/efeitos adversos , Lidocaína/efeitos adversos , Traumatismos dos Nervos Periféricos/induzido quimicamente , Nervo Isquiático/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Levobupivacaína , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos , Ratos Wistar , Nervo Isquiático/fisiopatologiaRESUMO
OBJECTIVE: The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. METHODS: Sixty Wistar rats weighing 200-350g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. RESULTS: There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). CONCLUSION: In all groups, histopathological damage frequency and severity were more than the motor deficiency.
RESUMO
BACKGROUND: The study aimed to evaluate and compare the effects of a single dose of etomidate and the use of a steroid injection prior to etomidate during rapid sequence intubation on hemodynamics and cortisol levels. METHODS: Sixty patients were divided into three groups (n=20). Before intubation, and at 4 and 24 hours, blood samples were taken for cortisol measurements and hemodynamic parameters (systolic-diastolic-mean arterial pressure, heart rate), and SOFA scores were recorded. Intubation was achieved with 0.3 mg/kg etomidate IV in Group I, 0.3 mg/kg etomidate following 2 mg/kg methylprednisolone IV in Group II, and 0.15 mg/kg IV midazolam in Group III. RESULTS: Mean arterial pressure values were lower in Group I at the 24th hour when compared to Groups II and III. In Group I, heart rate values were higher compared to the other Groups. Cortisol levels were lower in Group I at the 4th and at the 24th hour in Groups II and III. CONCLUSION: Administration of methylprednisolone 2-4 minutes prior to etomidate use in emergency situations can prevent adrenal insufficiency in patients undergoing rapid sequence intubation. Moreover, midazolam can be used in low induction doses as an alternative to etomidate.
Assuntos
Insuficiência Adrenal/prevenção & controle , Anestésicos Intravenosos/administração & dosagem , Tratamento de Emergência/efeitos adversos , Etomidato/administração & dosagem , Intubação Intratraqueal/efeitos adversos , APACHE , Córtex Suprarrenal/efeitos dos fármacos , Insuficiência Adrenal/etiologia , Pressão Sanguínea , Esquema de Medicação , Emergências , Feminino , Escala de Coma de Glasgow , Frequência Cardíaca , Hemodinâmica/efeitos dos fármacos , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes. METHODS: Sixty patients were randomly divided into three groups (n = 20). The PS group received FiO2 = 0.4, PS = 10 cmH2O, and positive end expiratory pressure = 5 cmH2O for 2 hours. The CPAP group was given FiO2 = 0.4 and CPAP 5 = cmH2O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken. RESULTS: Plasma insulin was greater in group T than in the PS and CPAP groups (P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning (P < 0.05) and after extubation (P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001). CONCLUSION: Weaning via the T-piece caused a greater stress response than the PS and CPAP modes.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Sistema Endócrino/fisiopatologia , Desmame do Respirador/efeitos adversos , APACHE , Idoso , Glicemia/análise , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Cuidados Críticos/métodos , Feminino , Humanos , Hidrocortisona/sangue , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Estresse Fisiológico/etiologia , Estresse Fisiológico/fisiopatologia , Ácido Vanilmandélico/urina , Desmame do Respirador/métodosRESUMO
Our aim was to compare the effects of intravenous, enteral, and enteral plus intravenous supplemented glutamine on plasma transferrin, nitrogen balance, and creatinine/height index in septic patients with malnutrition. Blood and urine samples were collected for transferrin, urea and creatinine measurements. Samples, SOFA score and protein-calorie intake values were repeated on days 7 and 15. Patients (n:120) were randomly divided into 4 groups. Group I received 30 g/day IV glutamine, group II received 30 g/day enteral glutamine, group III received 15 g/day IV and 15 g/day enteral glutamine. Group IV received only enteral feeding as a control group. Transferrin levels decreased in group IV (p<0.01 0-7 days, p<0.01 7-15 days, p<0.01 0-15 days). Nitrogen balance levels were highest in group IV when compared with group I (p<0.05, p<0.001), group II (p<0.001), and group III (p<0.05, p<0.001) on days 7-15. Creatinine/height indexes increased in group I (p<0.001), group II (p<0.001), group III (p<0.001), and group IV (p<0.05) on day 15. In group III the creatinine/height index was higher than in groups I and II (p<0.05). In group IV, creatinine/height index was lower than in group I (p<0.01) and group II (p<0.001). Protein-calorie intake in group IV was higher than others on day 7 (p<0.05). SOFA scores of group IV were higher than the other groups on day 15 (p<0.05). This study demonstrated, that combined route of gln supplementation resulted in the most positive outcome to transferrin, creatine/height index and nitrogen balance (on days 7 and 15) during the catabolic phase of septic patients with malnutrition.
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Nutrição Enteral , Glutamina/administração & dosagem , Desnutrição/complicações , Desnutrição/tratamento farmacológico , Nutrição Parenteral , Sepse/complicações , Adulto , Idoso , Creatinina/sangue , Creatinina/urina , Proteínas Alimentares/administração & dosagem , Suplementos Nutricionais , Ingestão de Energia , Feminino , Humanos , Masculino , Desnutrição/metabolismo , Pessoa de Meia-Idade , Nitrogênio/administração & dosagem , Nitrogênio/urina , Sepse/sangue , Sepse/urina , Transferrina/análise , Ureia/sangue , Ureia/urinaRESUMO
ABSTRACT OBJECTIVE: The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. METHODS: Sixty Wistar rats weighing 200-350 g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2 mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. RESULTS: There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). CONCLUSION: In all groups, histopathological damage frequency and severity were more than the motor deficiency.
RESUMO OBJETIVO: Os anestésicos locais podem causar neurotoxicidade. Nosso objetivo foi comparar o potencial neurotóxico de diferentes anestésicos locais, os danos induzidos aos nervos e as alterações patológicas de um nervo periférico. MÉTODOS: Foram estudados 60 ratos Whistler com 200-350 g. Os ratos foram divididos em três grupos, uma agulha de calibre 26 foi inserida no nervo ciático esquerdo, com o uso de ampliação, e 0,2 mL de bupivacaína a 0,5%, levobupivacaína a 5% e lidocaína a 2% foram injetados por via intraneural. Um colaborador, cego para os conteúdos das injeções, monitorou a função neurológica no primeiro dia de pós-operatório e depois diariamente. O exame neurológico incluiu a avaliação da presença e da gravidade da nocicepção e dos reflexos de agarrar. No sétimo dia, uma amostra do nervo ciático foi colhida para avaliar as alterações histopatológicas. RESULTADOS: Não houve diferença estatística entre os grupos em relação ao reflexo de agarrar e à avaliação histopatológica. Dois casos no grupo bupivacaína, um no grupo levobupivacaína e dois no grupo lidocaína apresentaram um leve reflexo de agarrar; também no grupo lidocaína, um caso não apresentou reflexo de agarrar no sétimo dia. Degeneração axonal grave foi observada em todos os grupos: quatro casos no grupo bupivacaína (20%), três no grupo levobupivacaína 3 (15%) e seis no grupo lidocaína (30%). CONCLUSÃO: Em todos os grupos, a frequência de dano histopatológico e de gravidade foi maior do que a deficiência motora.