Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section.

BACKGROUND: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. AIMS: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. STUDY DESIGN: Cross-sectional study. METHODS: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. RESULTS: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. CONCLUSION: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women.

[The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation]. / O valor da medida da saturação cerebral de oxigênio para avaliar o prognóstico após ressuscitação cardiopulmonar.

BACKGROUND: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. OBJECTIVE: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. DESIGN: Retrospective analysis. MEASUREMENTS AND RESULTS: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34°C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36°C. RESULTS: In survivors, the baseline rSO2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p=0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. CONCLUSION: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR.

Postarthroscopy analgesia using intraarticular levobupivacaine and intravenous dexketoprofen trometamol.

PURPOSE: The aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia. METHODS: Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively. RESULTS: The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p < 0.05). The average VAS score during the first 24 h post-operatively was significantly lower in group III than in group I and group II (p < 0.001). Total meperidine consumption was significantly lower in group III than in groups I and II (p < 0.001). CONCLUSION: Intraarticular levobupivacaine with adjuvant intravenous dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone. LEVEL OF EVIDENCE: II.

[Comparison of different tests to determine difficult intubation in pediatric patients]. / Comparação de diferentes testes para determinar intubação difícil em pacientes pediátricos.

BACKGROUND: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. OBJECTIVE: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. DESIGN: Prospective analysis. MEASUREMENTS AND RESULTS: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. RESULTS: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. CONCLUSION: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

The effects of different insufflation pressures on liver functions assessed with LiMON on patients undergoing laparoscopic cholecystectomy.

PURPOSE: Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy, but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion. We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests (ICG-PDR). METHODS: We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy. The patients were randomly allocated to two groups. In Group I, the operation was performed using 10 mmHg pressure pneumoperitoneum. In Group II, 14 mmHg pressure pneumoperitoneum was used. The ICG-PDR measurements were made after induction (ICG-PDR 1) and after the end of the operation (ICG-PDR 2). Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels were all recorded preoperatively, 1 hour, and postoperative 24 hours after surgery. RESULTS: The ICG-PDR 1 values for Groups I and II were as follows: 26.78 ± 4.2% per min versus 26.01 ± 2.4% per min (P > 0.05). ICG-PDR 2 values were found to be 25.63 ± 2.1% per min in Group I versus 19.06 ± 2.2% per min in Group II (P < 0.05). There was a statistically significant decrease between baseline and postoperative ICG-PDR values in Group II compared to Group I (P < 0.05). Statistically, there was an increase between baseline and postoperative 1st-hour serum AST and ALT level in Group II (P < 0.05) compared to Group I. No statistical differences were detected on postoperative 24st-hour serum AST and ALT levels and all the time bilirubin between groups (P > 0.05). CONCLUSION: In conclusion, the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels. We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.

The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock.

BACKGROUND: Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown. OBJECTIVE: The aim of this study was to assess the effects of levosimendan vs dobutamine added to dopamine on liver functions assessed using noninvasive liver function monitoring (LiMON) in patients with septic shock. DESIGN: Prospective analysis. MEASUREMENTS AND RESULTS: We analyzed 30 patients with septic shock who were treated in an intensive care unit. Indocyanine green plasma disappearance rate (ICG-PDR) was conducted concurrently using the LiMON system. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. RESULTS: Statistical analysis showed that the variation of hemodynamic variables was different between groups. In our results, the increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was significantly higher in levosimendan group than in dobutamine group (P < .05). There was a decrease in before- and after-infusion ICG-PDR values in dobutamine group (20.38 ± 4.83 vs 20.34 ± 5.30), and no statistical difference was detected (P = .649). There was an increase in before- and after-infusion ICG-PDR values in levosimendan group (18.70 ± 2.59 vs 21.65 ± 3.20), and a statistical difference was detected (P = .001). There was statistical difference between groups (P = .000). CONCLUSION: These results suggest that levosimendan added to dopamine improves systemic hemodynamics and increases splanchnic perfusion assessed using the user-friendly noninvasive bedside system LiMON in patients with septic shock compared with dobutamine.

Investigation of the availability of tongue movements in Mallampati classification.

OBJECTIVE: To investigate the relation of Mallampati classification with a new alternative method suggested for use in the estimation of tongue movements. METHODS: This study was conducted in the Department of Anesthesiology, Faculty of Medicine, Trakya University, Edirne, Turkey from April to October 2009. Two hundred and thirty patients were enrolled in this study. The modified Mallampati score (MMS) was devised by an anesthetist. To define tongue movements, horizontal and vertical lines were utilized. Horizontal lines passing through the mid points of the upper lip and mandible, and vertical lines passing through the right and left infraorbital points were constituted on each subject. Subjects were asked to elevate, depress, and abduct (right-left) the tip of the tongue. The scores corresponding with the movements of the tongue were determined. RESULTS: Depression of the tip of the tongue (DTT) and elevation of the tip of the tongue (ETT) levels were significantly different between MMS 1, MMS 2, and MMS 3, MMS 4 groups (p=0.001). The risk of being MMS 3 or MMS 4 for the groups that cannot reach the borderline for the DTT or ETT are 5.5 times and 5.4 times higher consequently than the groups that can reach the borderline. CONCLUSION: This new method can be combined with MMS classification, which requires clinical experience and knowledge in predicting difficult intubation.

Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients.

BACKGROUND: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. METHODS: We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. RESULTS: We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p < 0.001). The baseline ICG-PDR values were significantly lower among nonsurvivors than survivors (10.86 [SD 3.35] v. 24.51 [SD 6.78]), and the twelfth-hour ICGPDR values were decreased in all groups; the difference between groups was significant (p < 0.001). CONCLUSION: Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients.

Comparison of TruView EVO2 with Miller laryngoscope in paediatric patients.

BACKGROUND: Except for neonates and specific malformations in children, management of the paediatric airway is not a major problem for the anaesthetist. Miller laryngoscope was traditionally used for paediatric intubation. The TruView EVO2 system is a recently introduced device with a unique blade that provides a wide and magnified laryngeal view. OBJECTIVE: To assess the value of the TruView EVO2 laryngoscope with that of Miller laryngoscope in paediatric patients. DESIGN: Prospective analysis. MEASUREMENTS AND RESULTS: Fifty 2-8-year paediatric patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Miller (Group M, n = 25) and TruView EVO2 laryngoscope (Group T, n = 25). Preoperative airway evaluation was performed by using the Mallampati scores. The Intubation Difficulty Scale (IDS), the duration of the tracheal intubation procedure, the rate of successful placement of the endotracheal tube in the trachea, the view of the glottis according to the Cormack and Lehane grading criteria, number of intubation attempts, mean arterial pressure (MAP) and heart rate (HR) before and after intubation, lowest peripheric oxygen saturation during intubation attempts and all complications (minor laseration, dental or other airway trauma) were all recorded. RESULTS: Preoperative Mallampati scores and the IDS scores were similar between the Miller and TruView EVO2 laryngoscope. The average time for laryngoscopy was 6.36 ± 0.99 s in group M and 13.8 ± 7.99 s in group T (P < 0.001). The TruView EVO2 laryngoscope improved the Cormack and Lehane glottic view compared with the Miller laryngoscope. The HR change (difference before and after) in group M was significantly lower than that in group T (P < 0.001). However, the MAP change was similar between groups. The lowest peripheric oxygen saturation during intubation attempts was different between groups, 99.4 ± 0.57% in group M and 97.6 ± 2.41% in group T (P < 0.001). CONCLUSION: The results suggest that when compared with the Miller laryngoscope, the TruView EVO2 laryngoscope appears to improve the view of the larynx but requires a longer time for tracheal intubation. The IDS scores were similar; thus, the TruView EVO2 laryngoscope can be a good alternative to traditionally used Miller laryngoscope.

The effect of dexmedetomidine on liver histopathology in a rat sepsis model: an experimental pilot study.

BACKGROUND: In this pilot study, we aimed to investigate the effect of dexmedetomidine on liver tissues during experimental sepsis by histopathological examination. METHODS: The animals were allocated randomly to four groups, two of which received endotoxin. In the Sepsis Group (n:10) and Dexmedetomidine/Sepsis Group (n:10), endotoxemia was induced by E. coli lipopolysaccharide derived from E. coli 0111: B4. Animals in the Control Group (n:10) received an infusion of 0.9% saline (1.0 mL x kg(-1) x hr(-1)) intravenously. The Dexmedetomidine Group (n:10) and Dexmedetomidine/Sepsis Group received a bolus injection of 0.9% saline (1.0 mL/kg), followed by dexmedetomidine administration (infusion at 5 microg x kg(-1) x hr(-1)). All rats were euthanized at the 8th hour of endotoxin infusion. Histopathological examinations were performed on liver tissues. RESULTS: In the liver, central venous congestion, congestion and dilation of the hepatic sinusoids and inflammation of the portal tracts were noted in the Sepsis Group. These parameters were seen slightly in the Sepsis/Dexmedetomidine group. There was a statistically significant difference between the Sepsis and Sepsis/Dexmedetomidine Groups (p<0.001). CONCLUSION: Dexmedetomidine has a protective effect on liver tissues during experimental sepsis in the rat. We propose that dexmedetomidine sedation may be useful in the therapy of the liver dysfunction associated with sepsis and in other diseases related to local or systemic inflammation.

Intensive care cost and survival analyses of traumatic brain injury.

BACKGROUND: Intensive care of Traumatic Brain Injury (TBI) is associated with substantial morbidity, mortality and cost; however, there is very little published work on this topic. The purpose of this study was to examine direct costs and survival outcomes of patients with TBI admitted to an intensive care unit (ICU). METHODS: A retrospective review of the records of Trakya University Hospital's ICU from 2002-2006 was undertaken. Patients with TBI were determined and assessed regarding costs and survival. RESULTS: The study group consisted of 126 patients, and 27.8% of them had been operated. Male gender (80.2%) was dominant, mean length of stay was 9.8+/-8.7 days, and motor vehicle injury (59.5%) was the major reason for ICU admission. Mortality rate was 50% and the Glasgow Coma Score (GCS) of the patients was 6.1+/-1.9. The average cost per ICU stay was US$ 4846+/-5084. Cost per life saved and per life-year saved were US$ 9533 and US$ 313.60, respectively. Survival rates were significantly different among injury types (p=0.010). GCS appeared to be a prognostic parameter in patient survival (Hazard Ratio: 0.643; 95%CI: 0.529-0.781; p<0.001). CONCLUSION: Intensive care of TBI cases is characterized by high mortality and high cost.

Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit.

BACKGROUND: This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU). MATERIAL: Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, 1 mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted. RESULTS: Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P < .05). In group MP, postoperative meperidine consumption (76.75 ± 18.2 mg vs. 198 ± 66.4 mg) and extubation time (64.3 ± 40.6 min vs. 204.5 ± 112.7 min) were lower than in group M (P < .01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P < .05). CONCLUSION: We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery.

The effect of celiac plexus block in critically ill patients intolerant of enteral nutrition: a randomized, placebo-controlled study.

BACKGROUND: In this study, we evaluated the efficacy of celiac plexus block for the treatment of feeding intolerance in critically ill patients. METHODS: Nineteen mechanically ventilated medical patients intolerant of enteral nutrition and receiving metoclopramide underwent bilateral celiac plexus block. The anterior procedure was accomplished under sonographic guidance with the injection of either 25 mL bupivacaine 0.25% (celiac group, n = 10) or saline (control group, n = 9) bilaterally. Gastric emptying was assessed by the acetaminophen absorption method. After the block, nasogastric feeding was commenced, and nasogastric aspirates were collected once every 24 hours. Successful feeding was defined as 24-hourly gastric residual volume <250 mL with a feeding rate > or = 40 mL/h. RESULTS: Demographic data were similar for the 2 groups. The area under the plasma paracetamol absorption curve (383.8 +/- 248.1 mg . min . L(-1)) and the peak plasma paracetamol concentration (C(max); 3.28 +/- 2.15 mg/L) in the celiac group were significantly lower than the area under the curve value (1233.5 +/- 771.2) and C(max) value (10.14 +/- 6.04) in controls (P < 0.001 for all). After treatment, celiac plexus block reduced the mean gastric residual volume (celiac group: 430 +/- 32 mL to 205 +/- 30 mL, P < 0.001; control group: 450 +/- 33 mL to 461 +/- 19 mL, P > 0.05) and improved the proportion of patients with successful feeding (celiac block 80% vs controls 0%, P < 0.001). CONCLUSION: In critical illness, celiac plexus block is effective for treating feeding intolerance when IV drug therapy has failed to improve gastrointestinal dysfunction.

Late-onset pulmonary edema and disseminated intravascular coagulation due to latex anaphylaxis.

BACKGROUND: Anaphylaxis after the administration of tissue expanders has been reported. Late onset hypotension, thrombocytopenia, disseminated intravascular coagulation (DIC) and pulmonary edema due to the tissue expanders have not been reported. METHODS: In this case report, late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema due to the administration of tissue expanders were described. RESULTS: The authors report a 16-year-old girl with burn scar deformities scheduled for reconstruction of the scar contractures with insertion of tissue expanders in which the administration of latex tissue expanders was associated with late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema. Skin tests performed for latex demonstrated strong positive weal and flare reactions. CONCLUSION: Late onset anaphylactic reactions due to latex tissue expanders, an unusual unpredictable adverse reaction, must be kept in mind. Early recognition and proper emergent treatment are essential to reversing this complication.

Effects of polygeline and hydroxyethyl starch solutions on liver functions assessed with LIMON in hypovolemic patients.

BACKGROUND: Hypovolemia is a common clinical entity in critical patients, and adequate volume replacement therapy seems to be essential for maintaining tissue perfusion. However, it is still uncertain which solution is most appropriate for fluid resuscitation. OBJECTIVE: The aim of this study was to investigate the effects of fluid resuscitation with 3.5% polygeline versus 6% hydroxyethyl starch solutions on hemodynamic functions and liver functions assessed with a noninvasive liver function monitoring system (LIMON) in hypovolemic patients. DESIGN: This study is a prospective randomized clinical trial. MEASUREMENTS AND RESULTS: Thirty hypovolemic patients (intrathoracic blood volume index, <850 mL/m(2)) were randomized into hydroxyethyl starch (mean molecular weight, 130,000 Da) and polygeline (mean molecular weight, 30,000 Da) groups (15 patients each). Indocyanine green plasma disappearance elimination (ICG-PDR) were conducted concurrently using LIMON. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. For fluid resuscitation, 500 mL of colloid was given to the patients. Repeated hemodynamic and ICG-PDR measurements were done at baseline, after infusion, and then at 30 minutes after infusion. RESULTS: Intrathoracic blood volume index and systolic, diastolic, and mean blood pressures increased significantly after infusion and remained elevated for 30 minutes after infusion, but there was no significant difference between the 2 groups. Indocyanine green plasma disappearance elimination values were similar in both groups with no significant difference between the two. CONCLUSION: Increasing intrathoracic blood volume index and hemodynamic variables by fluid loading is not associated with a significant change in ICG-PDR.

Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.

BACKGROUND: We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients. METHODS: Forty early septic shock patients were included in the study and administered either the loading dose infusion of propofol (n = 20, group P) of 1 mg/kg over 15 minutes followed by a maintenance dose of 1 to 3 mg/kg per hour (n = 20, group P), or a loading dose of dexmedetomidine 1 microg/kg over 10 minutes followed by a maintenance of 0.2 to 2.5 microgg/kg per hour (n = 20, group D) (24-hour infusion). Indocyanine green (ICG) elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON; Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg of ICG was given through a cubital fossa vein as a bolus and immediately flushed with 10 mL of normal saline. We calculated ICG-PDR. Indocyanine green plasma disappearance rate measurements were obtained at baseline (before start of the propofol or dexmedetomidine infusion) and were repeated at the 24th hour. Biochemical and hemodynamic parameters and ICG-PDR were recorded before start of the study and at 24th hour. RESULTS: Biochemical and hemodynamic parameters did not differ significantly between the groups (P < .05). Baseline ICG-PDR levels of group P compared to group D were 24.7 +/- 14.4 vs 22.2 +/- 10.7, respectively, and after the study, ICG-PDR levels (26.5 +/- 13.7 vs 23.7 +/- 12.4) did not differ in groups (P > .05). When we examined ICG-PDR changes between groups before and after administration, there was no significant difference (P > .05). CONCLUSION: In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.

The assessment of QT intervals in acute carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning is known to cause myocardial toxicity and life threatening arrhythmias. QT interval measured from electrocardiogram is an indirect measure of the heterogeneity of ventricular repolarization, which may contribute to ventricular arrhythmias. The purpose of the study was to investigate whether the carboxyhemoglobin (COHb) level may be related to the changes of QT, corrected QT (QTc), QT dispersion (QTd), corrected Qtd (QTdc) and cardiac enzymes during carbon monoxide poisoning. METHODS: We conducted an observational study; 104 patients who had been diagnosed with CO intoxication were included in the study. Measurement of QT, QTc, QTd and QTdc intervals were performed form electrocardiogram on admission, 24 and 48 hours after admission. Cardiac enzymes were measured at each time-point. The myocardial perfusion scan was determined in all patients 1 week after admission. RESULTS: The QT interval level in 24 h was significantly higher than admission level (p<0.001), additionally QTc interval levels in 24 h and 48 h were significantly lower than admission levels (p<0.001 and p<0.001, respectively). Carboxyhemoglobin level only significantly correlated with QT intervals (r=-0.288 ; p=0.019), troponin T (r=-0.297; p=0.007), and creatine kinase MB levels (r=0.262; p=0.020). As a result of ROC analysis the QT interval level was significantly powerful parameter to predict COHb (p=0.022). CONCLUSION: Our data indicate COHb level correlated with QT intervals and cardiac enzymes. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the QT, QTc, QTdc intervals in patients at high risk of cardiac disability due to high levels of COHb after CO poisoning.

Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis.

STUDY OBJECTIVE: To compare the effects of an intravenous infusion of propofol and the alpha-2 adrenoceptor, dexmedetomidine, on inflammatory responses and intraabdominal pressure (IAP) in severe sepsis after abdominal surgery, specifically, serum cytokine levels (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-alpha) and IAP. DESIGN: Prospective, single-center study. SETTING: University hospital. PATIENTS: 40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation. INTERVENTIONS: Patients received either a loading dose infusion of propofol (Group P; n = 20) one mg/kg over 15 minutes followed by a maintenance dose of one to three mg/kg/hr (n = 20, Group P) or a loading dose of dexmedetomidine of one microg/kg over 10 minutes followed by a maintenance dose of 0.2-2.5 microg/kg/h (n = 20, Group D) at the 24th hour. MEASUREMENTS: Biochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours. MAIN RESULTS: TNF-alpha levels were significantly lower at the 24th hour (14.66 +/- 4.40 pg/mL vs. 21.21 +/- 11.37 pg/mL, respectively) and at the 48th hour (21.25 +/- 15.85 pg/mL vs. 46.55 +/- 35.99 pg/mL, respectively) in Group D. IL-1 levels were significantly lower at the 24th hour (5.03 +/- 0.15 pg/mL vs. 6.23 +/- 2.09 pg/mL, respectively) and the 48th hour (5.01 +/- 0.37 pg/mL vs. 6.42 +/- 2.76 pg/mL, respectively) in Group D. IL-6 levels were significantly lower at the 24th hour (253.1 +/- 303.6 pg/mL and 511.3 +/- 374.8 pg/mL, respectively) and at the 48th hour (343.5 +/- 393.4 pg/mL and 503.7 +/- 306.4 pg/mL, respectively) in Group D. Intraabdominal pressure also was significantly lower at the 24th hour (12.35 +/- 5.84 mmHg vs. 18.1 +/- 2.84 mmHg, respectively) and the 48th hour (13.9 +/- 6.15 mmHg vs. 18.7 +/- 3.46 mmHg, respectively) in Group D. CONCLUSION: Dexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.