Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Brain Deaths and Donors in an Education and Research Hospital.

BACKGROUND: We aimed to define the causes of brain death (BD), criteria, and tests used for diagnosis, rates of family consent, and rates of organ donation in intensive care units (ICUs) of an education and research hospital. METHODS: The data of patients with BD diagnosis in 7 years in our hospital was collected from an electronic database and archives retrospectively consisting of the demographic data, the causes of BD, criteria, and the tests used for diagnosis, family consent, and organ donation rates. RESULTS: A total of 210 patients with BD diagnosis were enrolled in the study. There was a decline in number of patients with BD diagnosis between 2012 (54.76%) and 2018 (17.64%) in the neurology and neurosurgery ICU, while it increased from 35.71% in 2012 to 70.6% in 2018 in the general ICU. The most common cause of hospitalization for BD was spontaneous intracranial hemorrhage (43.8%). A total of 47.6% of brain-dead patients who did not qualify for organ donation were resuscitated unnecessarily after cardiac death. In 2012, diagnosis was always supported by ancillary tests, while in 2018, a total of 35.29% of the patients were diagnosed solely by clinical examination; 23.8% of patients' families had given consent for organ donation, and 19.53% of 210 patients became donors. CONCLUSION: Physicians should be aware that patients with poor neurologic outcome can be candidates of BD donation, and careful examination and rapid diagnosis is crucial. All segments of society and the health care professionals should be informed and updated about organ donation and BD regularly to raise the numbers of organ donation.

Red Cell Distribution Width in Diagnosis of Brain Death.

INTRODUCTION: Red blood cell distribution (RDW) is a hematologic index automatically calculated by blood cell counters. Research about RDW in traumatic brain injury showed positive correlation between high RDW values and mortality, which inspired us to investigate whether RDW could be used as a supportive diagnostic biomarker for diagnosis of brain death. Our hypothesis is that RDW may be useful as a biomarker that supports the diagnosis of brain death. METHODS: After approval of the ethics committee, 209 patients who had been diagnosed with brain death between January 2012 and July 2018 were retrospectively reviewed. The RDW values of patients on the days of admission, brain death, and cardiac arrest were recorded. Data were collected from hospital database and patient charts. RESULTS: Statistical analysis revealed that the RDW values on the days of brain death and cardiac arrest were significantly higher than on the day of admission. In addition, the RDW values for the cardiac arrest day were significantly higher than on the day of brain death (P < .001). CONCLUSIONS: We can say that the increase in RDW, which is reported to be an indicator of mortality for many diseases, can be a supporting biomarker for brain death diagnosis when evaluated concomitantly with clinical diagnostic criteria.

Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery.

STUDY OBJECTIVE: To compare the sedative, anxiolytic, analgesic, hemodynamic, and respiratory effects of buccal dexmedetomidine with intramuscular (IM) dexmedetomidine for premedication in patients undergoing arthroscopic knee surgery during spinal anesthesia. DESIGN: Randomized, placebo-controlled trial. SETTING: University medical center. PATIENTS: 75 ASA physical status I and II patients undergoing arthroscopic knee surgery with spinal anesthesia. INTERVENTIONS: Patients were randomized to one of three groups for premedication: group B, buccal dexmedetomidine 2.5 microg kg(-1); group IM, IM dexmedetomidine 2.5 microg kg(-1); and group P, buccal 0.9% and NaCl 2 mL. MEASUREMENTS: Noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded. Sedation and anxiety levels were consecutively assessed with Ramsay sedation scores and Visual Analog Scale (VAS) scores of anxiety before premedication, before spinal anesthesia, during surgery, and at the end of surgery. Two, 4, and 8 hours after surgery, sedation levels, postoperative VAS pain scores, and consumption of analgesics (diclofenac sodium) were recorded. MAIN RESULTS: Before spinal anesthesia, during surgery, and at the end of surgery, sedation and anxiety scores of the patients receiving buccal or IM dexmedetomidine were, respectively, higher and lower than in group P. Patients receiving buccal dexmedetomidine (group B) had lower requirement of diclofenac sodium than group P and lower pain scores than groups P and IM. Mild hypotension and bradycardia were observed in the buccal and IM dexmedetomidine patients. CONCLUSIONS: Buccal dexmedetomidine for premedication in arthroscopic knee surgery provided equal levels of sedation and anxiolysis, and more evident analgesia compared with IM dexmedetomidine.

Comparison of Intraoperative and Postoperative Effects of Lateral Epidural and Midline Epidural Anaesthesia in Patients Undergoing Unilateral Lower Extremity Operation.

OBJECTIVE: We aimed to compare lateral and midline epidural anaesthesia using a levobupivacaine-fentanyl combination in patients undergoing unilateral lower extremity operation for anaesthetic effects and postoperative complications. METHODS: The study included 40 American Society of Anesthesiologists (ASA) I-II group patients. At the L4-5 space, an epidural catheter was placed in patients in Group 1 by directing the tip of the needle at a 45-degree angle to the operation side and in Group 2 with the needle tip in the cephalad direction. Patients in both groups were administered a combination of 10 mL 0.5% levobupivacaine and 50 µg fentanyl via the epidural catheter. Sensorial and motor block levels during the perioperative and postoperative periods and postoperative complications were recorded. RESULTS: The maximum level of sensory block on the operated side was found to be at the T10 (T8-T10) level in both groups, while the level of sensory block on the non-operated side was at the L2 (L3-T10) level in Group 1, and at the T10 (T8-T10) level in Group 2 (p=0.000). The motor block was more intense on the non-operated side in Group 2 than in Group 1. The postoperative motor block ended earlier in Group 1. The incidence of complication development was similar between the groups. CONCLUSION: With a shorter lasting and lower level sensorial and motor block, lateral epidural anaesthesia may be a more advantageous method than midline epidural anaesthesia.

[Carotico-jugular fistula following a ballistic injury]. / Balistik yaralanmaya bagli karotiko-juguler fistül.

Carotico-jugular fistulae are known complications of gunshot injuries and stab wounds, but they can be iatrogenic. Untreated, these lesions may lead to heart failure, endocarditis, or cerebral embolization. We present the computerized tomography (CT)-angiographic view and its value in the treatment strategy in carotico-jugular fistula. A 35-year-old male was referred in the second hour of a ballistic injury to the right side of the neck. Physical examination revealed hematoma, exit hole and thrill on the right sternocleidomastoid muscle. Diagnosis was confirmed with Doppler ultrasound and CT angiography. Surgical interposition with 6 mm polytetrafluoroethylene for the carotid artery and with 12 mm Dacron for the internal jugular vein was performed. The fistulous tract was ligated. In the postoperative sixth month, Doppler ultrasound was normal and the patient was on antiaggregant therapy and healthy.

External jugular vein catheterization using 'intra-atrial electrocardiogram'.

PURPOSE: To investigate the reliability of intra-atrial electrocardiogram (ECG) use for external jugular vein (EJV) catheterization. MATERIALS AND METHODS: Patients undergoing open heart surgery in Suleyman Demirel University Hospital between February and June 2006 were included in the study. Using a sterile Seldinger technique, a triple lumen polyurethane central venous catheter was introduced (Certofix Trio V 720, length 20 cm, 7 French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. RESULTS: In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. CONCLUSION: Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

Displaced supracondylar humeral fractures in children: open reduction vs. closed reduction and pinning.

INTRODUCTION: In the literature the best results for pediatric supracondylar humerus fractures have been achieved by closed reduction and wire fixation. However, in these reports the patient group of open reduction and pinning contained the patients who had had previous ineffective closed reduction trials. This retrospective study compared open and closed reduction with pinning, in which the first group of patients was all consecutively treated with open reduction. MATERIALS AND METHODS: The study included 99 children with displaced extension-type supracondylar fractures of humerus who had complete follow-up. Open reduction patients had not had a previous attempted closed reduction. Open reduction and pinning were performed through a posteromedial incision in the first 44 patients and closed reduction and pinning in the subsequent 55 patients. Mean duration surgery was 15 h with open reduction and 17 h with closed reduction. Mean follow up was 35 months with the open reduction and 21 months with closed reduction. Humeral-ulnar angle was compared to the contralateral elbow, clinical flexion deficiency and extension lag, and complications were evaluated. RESULTS: At the latest follow-up the open group had an average of 5.1 degrees valgus change and the closed group 3.6 degrees valgus change in humeral-ulnar angle compared to their uninvolved elbow. Average flexion deficiency was 8.61 degrees in the open and 5.25 degrees in the closed group. Average extension lag was 6.23 degrees in the open and 0.6 degrees in the closed group. Functional results were satisfactory in 71% of patients in the open and 93% of those in the closed reduction group. Cosmetic results were satisfactory in 95% of both groups. CONCLUSIONS: Closed reduction and pinning is superior to open reduction and pinning for the treatment of pediatric supracondylar humerus fractures. In the case of technical insufficiencies open reduction and pinning through a posteromedial incision is an alternative treatment for decreasing the surgical time and complications. Complications was not caused in either group by the delayed surgical timing compared to reports in the literature.