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OBJECTIVE: To evaluate the efficiency of use of rocuronium and vecuronium in different dose regimens in neuroanaesthesia practice in terms of intubation time and first additional dose requirement. METHODS: Sixty-eight neurosurgery patients with intracranial mass that were operated on were included in our study. Patients were randomly divided into 4 groups according to the induction dose of neuromuscular blocker (NMB) as: Group 1: Vecuronium 0.1 mg kg(-1), Group 2: Priming, 20% of total vecuronium (0.1 mg kg(-1)) needed for induction injected 5 minutes before induction and then the rest used for induction, Group 3: Rocuronium group: 0.6 mg kg(-1), Group 4: Rocuronium with rapid-sequence induction dose (RSID) (1.2 mg kg(-1)). TOF (Train of four) test was used to decide on intubation and an additional NMB dose during surgery. Intubation quality, time from induction to intubation, time until the first additional NMB dose and subsequent NMB dose intervals were recorded. RESULTS: The RSID of rocuronium provided a significantly shorter time period for intubation against the other groups. Also, the time period from induction to first additional NMB requirement was significantly longer in the RSID group than the others. There were no statistically significant differences between the groups' in terms of time period for monitorisation, positioning and start of surgery. CONCLUSION: With the use of RSID of rocuronium, it was seen that excellent intubation quality is provided at around 1 minute and, with its longer duration of action until a first additional dose, it covers the time period for monitorisation, positioning and start of surgery. Because of these effects, we think that RSID of rocuronium may be a better choice of dose regimen for neuroanaesthesia practice.
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OBJECTIVE: Automatic Tube Compensation (ATC) is a newly developed mechanical ventilatory support method. The aim of this study was to compare the ATC and the T-piece as a weaning method. METHODS: Patients who were treated in ICU with mechanical ventilation for longer than 24 hours were included in this prospective clinical study. Fifty patients were divided into two groups for weaning, ATC or T-piece group. Patients tolerating 30 minutes spontaneous breathing trial underwent immediate extubation. The following parameters were recorded just before the spontaneous breathing trial and every 5 minutes during the 30 minute period; PEEP, Pplt, Pmean, FiO2, heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SaO2, ETCO2. The primary outcome of the study was successful extubation defined as the ability to maintain spontaneous breathing for 48 hours after extubation. RESULTS: The mean duration of weaning were 4.96 days and 7.42 days in the ATC and T-piece groups, respectively (p value 0.022). There were no significant differences between the groups with respect to the hemodynamic parameters, mechanical ventilation and gas exchange parameters. CONCLUSION: In terms of success for weaning, there was no superiority between the ATC and the T-Piece methods for spontaneous breathing and it was concluded that each of the methods can be used for weaning. The ATC group were compared in terms of successful weaning period but have shown no significant periods of time were found to be lower.
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OBJECTIVE: The purpose of our study is to compare two different ventilation modes-pressure support ventilation (PSV) and volume support ventilation (VSV)-as the means of weaning. METHODS: Sixty patients were enrolled in our study. Patients were randomized in to two groups. For the PSV group, FiO2 and airway pressure values were adjusted in order to sustain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV (tidal volume), and saturation >92%. For the VSV group, FiO2, TV, respiration frequency (f), and peak pressure were adjusted to obtain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV, saturation >92%, and PO2>60 mm Hg. Every morning, spontaneous breathing was tried in those patients. The patients were extubated after 2 hours of T-piece breathing. The patients who failed spontaneous respiration with the T-piece were returned to mechanical ventilation. Assisted ventilation time (ART), mechanical ventilation time (MRT), total T-piece time (TTT), total weaning time (TWT), and sedation need (SN) values were recorded. "T-test" and "Chi-square" methods were used for statistical analysis. RESULTS: In our study, the mean ART was 82.60 hours for the PSV group and 56.03 hours for the VSV group (p<0.041). TWT was 93.30 hours for the PSV group and 56.03 hours for the VSV group (p<0.035). The mean TTT was 7.67 hours for the PSV group and 3.83 hours for the VSV group (p<0.007). Nineteen patients in the PSV group and 9 patients in the VSV group required sedation during the weaning process (p<0.01). CONCLUSION: In the weaning period, VSV seems to be more advantageous than PSV.