Sedation with Propofol and Propofol-Ketamine (Ketofol) in Flexible Bronchoscopy: A Randomized, Double-Blind, Prospective Study.

BACKGROUND: The flexible bronchoscopy procedure, which is performed in awake conditions or under local anesthesia, is a difficult and complicated procedure for patients and physicians. Propofol is a fast-acting sedative-hypnotic anesthetic with a rapid return. Ketamine hydrochloride is a fast-acting general anesthetic producing an anesthetic state characterized by deep analgesia, normal pharyngeal, and laryngeal reflexes. MATERIALS AND METHOD: The study was planned in a randomized, prospective, and double-blind design. The drug(s) administered by the anesthesiologist was not known to the bronchoscopist and the patient. A total of 64 cases were included in the study (34/propofol, 30/ketamine-propofol (ketofol) group). Group propofol received 0.1 mL/kg propofol, and group ketofol received 0.1 mL/kg ketofol intravenously over approximately 30 seconds. Vital signs, non-invasive blood pressure, peripheral oxygen saturation, and pulse values of all cases were measured three times and were recorded just before the start of the procedure, after entering the trachea, and after the procedure was terminated. The Visual Analogue Scale (VAS) and The Ramsay scoring were additionally used in the present study. RESULTS: Statistically significant differences were detected between the groups in terms of blood pressure and heart rates. Statistically significant differences were detected between the two groups according to The VAS scoring and additional dose requirement. CONCLUSION: It must be noted that flexible bronchoscopy procedures, which are performed with local anesthesia by both the patient and the physician with a high degree of difficulty, especially combined drugs to be applied with anesthesia support, are more effective/comfortable/reliable, and have fewer complications and higher tolerability if there are no contraindications.

Pulmonary pseudocyst secondary to blunt or penetrating chest trauma: clinical course and diagnostic issues.

PURPOSE: Traumatic pulmonary pseudocysts (TPPs) are rare complications of chest trauma. The aim of this retrospective study was to report the clinical presentations, diagnosis, complications and treatment for a series of TPPs at a hospital in Turkey. METHODS: The charts of 996 patients who were admitted for thoracic trauma between 1999 and 2012 were retrospectively reviewed. Fifty-two patients had TPPs, and the data collected for these individuals were sex, age, and type of trauma (blunt and/or penetrating). Univariate analysis of categorical data was performed using Pearson's Chi square test. Results for continuous variables were statistically compared using the Mann-Whitney U test. RESULTS: The patients were 42 males and 10 females aged 12-72 years (mean age 33.1 years). Forty-one had blunt trauma and 11 had penetrating trauma. There was no significant difference between the proportion of blunt trauma patients who developed TPP (41/761, 5.3%) and the proportion of penetrating trauma patients who developed TPP (11/235, 4.6%) (p > 0.05). All 42 patients had pulmonary contusion. Only 10 patients (19.2%) had TPP identified on their chest X-ray, and thoracic computed tomography revealed TPP clearly in all these cases. Forty-two patients (80.7%) were diagnosed with TPP on day 1 post-trauma. The hospital stays ranged from 2 to 35 days for the patients with blunt-trauma, and from 4 to 15 days for those with penetrating trauma (means 8.8 and 8.0 days, respectively; p > 0.05). Only one patient required thoracotomy for a pseudocyst that did not resolve and became progressively enlarged. This TPP was resected at 6 months post-trauma. One patient died on day 9 post-trauma due to multiple organ failure. The other 40 pseudocysts resolved spontaneously within 1-5 months. CONCLUSIONS: Traumatic pulmonary pseudocysts are pulmonary lesions that occur after either blunt or penetrating trauma and tend to be overlooked. Most of these lesions are self-limiting, benign lesion.

The evaluation of MDCT and quantitative first-pass perfusion in lung cancers.

OBJECTIVES: The aim of this study was the in vivo evaluation of tumor angiogenesis in lung cancers grouped according to their histopathological diagnosis, localization and necrosis characteristics determined using CT first-pass parameters. MATERIALS AND METHODS: The study was performed between January and April 2012 on 44 patients consisting of 38 males and 6 females who were diagnosed with lung cancer as a result of cytological and/or histopathological evaluations. Patients who had not received radiotherapy and/or chemotherapy previously were included in the study. Images were obtained for each patient by using the 64-detector MDCT scanner. Colored perfusion maps were created from the obtained images. Perfusion parameter measurements were performed by placing ROI at 3 different locations in the solid sections, avoiding the necrotic cystic areas of the masses. Obtained BV, BF, TTP, and MTT perfusion parameters were recorded. RESULTS: The BF values of central and peripherally located lung cancers that showed normal distribution were found to be statistically significantly different. No statistically significant difference was found between TTP values. The BV values of central and peripherally located lung cancers that did not show normal distribution showed a statistically significant difference. There was a statistically significant difference between the BV and BF values of lung cancer with and without necrosis that did not show a normal distribution and the BV and BF values of lung cancers with and without necrosis. CONCLUSIONS: Non-invasive evaluation of tumor perfusion of first-pass perfusion CT in lung cancers provides valuable information about tumor angiogenesis. However, we believe that peripheral and solid lung cancers will benefit more from treatments such as anti-angiogenetic drugs, radiotherapy and chemotherapy more than the centrally located and necrotic lung cancers and that perfusion CT will play a greater role in the evaluation of the efficiency of these treatments in the future.