The effects of adjuvant immunoglobulin M-enriched immunoglobulin therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome: retrospective analysis of intensive care unit patients.

OBJECTIVE: To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS: Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS: A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS: Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.

High estradiol levels and depth of anaesthesia.

Estradiol is a steroid-structured hormone that has a periodic rhythm in the menstrual cycle. We aimed to evaluate the interference of high estradiol levels and the depth of anaesthesia. The study was performed on 44 females undergoing gynaelocologic surgery. Blood samples were performed for estradiol level before the procedures. BIS scores were recorded at 5-min intervals after induction and during the operation. Cases were assigned to three groups: Group 1 (n: 17) estradiol levels at or under 100 microg/dl, Group 2 (n: 14) levels were between 100 and 200 microg/dl and Group 3 (n: 13) levels were above 200 microg/dl. Estradiol levels were found to be 59.94 +/- 23.59 microg/dl in Group 1, 138.60 +/- 23.49 microg/dl in Group 2 and 239.30 +/- 41.08 microg/dl in Group 3. Significant differences were found between initial control and 10 and 80 min BIS levels. Anaesthetic consumption showed a decreased tendency in high estradiol cases. We concluded that an advanced clinical series should be performed to fully define the relationship between estradiol levels and anaesthesia depth.

Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients.

PURPOSE: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. MATERIAL AND METHODS: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n=40) were compared with those of the anatomical landmark method (n=40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. RESULTS: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. CONCLUSION: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

Resuscitation with modified gelatin causes higher bacterial translocation in experimental sublethal hemorrhagic shock.

The effect of colloidal solutions on bacterial translocation was studied. Sublethal hemorrhagic shock was established by blood withdrawal until the mean arterial pressure fell to 40 mmHg within 15 min on 36 adult Wistar Albino rats. Resuscitation was performed using four different solutions with the same amount of blood. Group I (n = 9) 0.9% NaCl, Group II (n = 9) 10% dextran 40, Group III (n = 9) 6% hydroxyethyl starch, Group IV (n = 9) 4% modified fluid gelatin. Before resuscitation and after anesthesia blood samples were drawn to analyze pH, PCO2, PO2, SaO2, HCO3 and ABE values. Twenty-four hours after anesthesia laparotomy was performed to obtain tissue samples of the liver, spleen and mesenteric lymph nodes. Samples were cultured on EMB and blood agar media. Results were analyzed with the one-way ANOVA and Post-hoc test (Tukey's HSD). The translocated bacteria were mainly Eschericia coli and three grew in Group I, two in Group II, three in Group III and six in Group IV. Although there was a trend in difference in bacterial translocation rates among groups, statistical analyses revealed no difference among groups (p < 0.05). It can be concluded that resuscitation with modified gelatin causes higher bacterial translocation in an experimental sublethal hemorrhagic shock model.

The efficacy of intravenous versus epidural tramadol with patient-controlled analgesia (PCA) in gynecologic cancer pain.

We attempted to compare the analgesic effects of tramadol infusion intravenously and epidurally administered through a patient-controlled analgesia (PCA) method for postoperative analgesia following gynaecological cancer surgery. Forty patients undergoing elective cancer surgery, included in the American Society of Anesthesiologists (ASA) class II and III, were randomly placed into two groups. The patients in the intravenous (IVA) group were administered a 20 mg bolus of tramadol intravenously and the patients in the epideral analgesia (EA) group epidurally five minutes before induction. The PCA equipment was programmed to deliver 20 mg of tramadol as a bolus dose, with a lock-out time of 15 minutes, at a 10 mg/hour infusion rate in both groups. A visual analogue scale (VAS) and patient satisfaction as well as haemodynamic and respiratory parameters were determined at given times postoperatively. Total tramadol consumption at 24 hours and side-effects were recorded. There was no difference between groups based on haemodynamic and respiratory parameters whereas there was a significant difference based on tramadol consumption, VAS and side-effects of tramadol and patient satisfaction between groups. VAS values of patients, 6.85 +/- 1.34 and 3.00 +/- 1.58, respectively, for the IVA group (group 1) and the EA group (group 2) were found to be significantly different. Postoperative patient satisfaction was higher was in group 2 than in group 1 (3.45 and 2.7, respectively). In conclusion, epidural administration of tramadol through the PCA method following gynecologic cancer surgery was found to be a more effective analgesia in lower doses when compared to the intravenous administration.

Transient locked-in syndrome resulting from stellate ganglion block in the treatment of patients with sudden hearing loss.

Stellate ganglion blockage (SGB) is a local anesthetic procedure intended to block the lower cervical and upper thoracic sympathetic chain and is one of the treatment modalities for a wide range of disorders such as sudden hearing loss, Menier's disease, stroke, sudden blindness, shoulder/hand syndrome and vascular headache. The complications of SGB are recurrent laryngeal or phrenic nerve block, pneumothorax, unconsciousness, respiratory paralysis, convulsions and sometimes severe arterial hypotension. We present a case with transient locked-in syndrome following SGB for the management of sudden hearing loss. The risk of an intra-arterial injection can be eliminated by rotating the needle, as is described in this report.

Comparison of granisetron with granisetron plus droperidol combination prophylaxis in post-operative nausea and vomiting after laparoscopic cholecystectomy.

The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 micrograms/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2-2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.