The success rate and safety of internal jugular vein catheterization under ultrasound guidance in infants undergoing congenital heart surgery.

BACKGROUND: In this study, we aimed to investigate the effect of central venous catheterization under ultrasound guidance on the success and complication rates in low-weight infants (under 5 kg) undergoing surgery due to congenital heart disease. METHODS: A total of 70 infants (38 boys, 32 girls; mean age of patients <1 month was 16.4±9.5 days [n=20; 28.6%]; 1-7.5 months was 126.3±47.8 [n=50; 71.4%]) who underwent ultrasound-guided internal jugular venous catheterization between October 2014 and October 2015 were retrospectively analyzed. All catheterizations were done under the guidance of ultrasound by two skilled anesthesiologists. Data including demographic characteristics of the patients, procedural success rate, catheter access time, number of attempts, and complications were recorded. RESULTS: The overall success rate of the procedure was 92.8% (n=65). In 82% of the patients (n=53), the insertion was successful at the first attempt. The mean catheter access time (time from the first puncture to the catheter insertion) was 214±0.48 sec. Complications were seen in five patients (7.14%), and the body weight of these patients was less than 2,500 g. There was no arterial puncture in any patients. One patient (1.42%) developed pneumothorax and four patients (5.7%) developed hematoma due to repeated attempts. CONCLUSION: Our study results suggest that ultrasound-guided central venous cannulation is a safe and effective technique in pediatric population weighing less than 5 kg undergoing congenital heart surgery.

The effect of cardiopulmonary bypass on the expression of inducible nitric oxide synthase, endothelial nitric oxide synthase, and vascular endothelial growth factor in the internal mammary artery.

OBJECTIVE: Endothelial function of a vessel may be impaired by local or systemic inflammation initiated by cardiopulmonary bypass (CPB) during coronary artery bypass graft (CABG) surgery. The present study was designed to investigate the early effects of CPB on nitric oxide production and vascular endothelial growth factor (VEGF) expression in internal mammary artery (IMA). DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Twenty patients who were scheduled for elective CABG with CPB. INTERVENTIONS: IMA sections were studied immunohistochemically from these patients. The samples were taken from the distal end of the IMA before the institution of CPB and just before the construction of the IMA-left anterior descending artery anastomosis. MEASUREMENT AND MAIN RESULTS: After CPB, VEGF and endothelial nitric oxide synthase immunoreactivity increased significantly when compared with baseline values in the endothelium (p = 0.0156, p = 0.0313) and adventitia (p = 0.0313, p = 0.0001), respectively. No significant change was observed in inducible nitric oxide synthase immunoreactivity. CONCLUSIONS: The increase in eNOS expression may have been induced by the inflammation caused by CPB.

Basic life support skills of doctors in a hospital resuscitation team.

The aim of the present study was to evaluate the basic life support skills of doctors in a hospital resuscitation team and to identify potential factors affecting those skills. Twelve anesthesiology residents were induced in this study. Each doctor was asked to perform mouth-to-mouth ventilation for 10 minutes and then chest compression for another 10 minutes on a Laerdal Skillmeter Resusci-Anne manikin during the day (10 am) and at night (10 pm). The rates of correct ventilation, correct chest compression, ventilation errors (i.e., excessive inflation, stomach insufflation, insufficient ventilation), and compression errors (i.e., insufficient chest compression/decompression, excessive chest compression, incorrect hand placement) were determined for each 2-min interval up to 10 min. In addition, effects of sex, seniority, CPR duration, and time of day (day vs night) on those skills were assessed. The mean rates of correct ventilation were 53.3+/-23.9% (day) and 60.4+/-16% (night); the mean rates of correct chest compression, 76.9+/-15% (day) and 76.5+/-14.7% (night). During the first 2-minutes period of testing at night, men doctors more frequently achieved correct ventilation than did women doctors (p<0.05). Overall, the practical CPR skills of the study participants were not influenced by sex, seniority, CPR duration, or time of day; however, the participants' skills were poor. This suggests that all medical staff, especially members of in-hospital resuscitation teams, should undergo regular, periodic CPR training.

Assessment of in-hospital cardiopulmonary resuscitation using Utstein template in a university hospital.

The aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of inhospital CPR strategies.

A histological analysis of the protective effect of ischemic preconditioning in the rat retina.

PURPOSE: Ischemic preconditioning (IP) protects the retina from the damaging effect of subsequent ischemia in vivo. We aimed to investigate the histological alterations induced by the protective effect of IP to the retina. METHODS: The eyes of the rats were rendered ischemic by intra-ocular pressure (IOP) elevation. IP procedure consisted of producing ischemia for 5 minutes. Sham operation was similar to IP procedure except the pressure elevation. The operational eyes of sham and IP group underwent 60 minutes of ischemia 24 hours after the first procedure. The eyes contralateral to the experimental eyes made up the control group. The eyes were histologically analysed one week after the ischemia. RESULTS: The total retinal thickness of the sham group was significantly less than total retinal thickness of the control group (p < 0.001). There was not a significant difference between control and IP group regarding the total retinal thickness (p > 0.05). The thickness of the inner retinal layers of the sham group were significantly less than corresponding retinal layers of the control group (p < 0.001). The inner plexiform layer (IPL) and inner nuclear layer (INL) thickness values of the sham group were significantly less than same layers of the IP group (p < 0.001). Ganglion cell layer (GCL) thickness of the IP group was significantly less than GCL thickness of the control group (p < 0.001). IPL thickness of the IP group was significantly less than that of control group's (p < 0.05). The GCL and total retinal thickness of the IP group were significantly more than thickness of the corresponding layers of the sham group (p < 0.05). CONCLUSION: IP considerably protects inner retinal layers from subsequent ischemic damage in a high IOP ischemic model. This endogenous process could further be utilized to tailor specific neuroprotective strategies for retinal cells.