[Comparison of early and late percutaneous tracheotomies in adult intensive care unit]. / Comparação de traqueotomia percutânea precoce e tardia em unidade de terapia intensiva para adultos.

BACKGROUND AND OBJECTIVES: Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. METHODS: Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0-7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL(-1) were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. RESULTS: There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). CONCLUSION: Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Comparison of early and late percutaneous tracheotomies in adult intensive care unit / Comparação de traqueotomia percutânea precoce e tardia em unidade de terapia intensiva para adultos / Comparación de traqueotomía percutánea precoz y tardía en unidad de cuidados intensivos para adultos

Background and objectives: Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. Methods: Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0–7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10 cmH2O and those with bleeding diathesis or platelet count under 50,000 dL−1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. Results: There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p < 0.05). Conclusion: Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation. .

Justificativa e objetivos: A traqueotomia percutânea tornou-se uma boa alternativa para os pacientes com previsão de intubação prolongada em unidades de terapia intensiva. Os benefícios mais importantes da traqueotomia são alta precoce da unidade de terapia intensiva e menos tempo de permanência no hospital. As complicações da intubação intratraqueal prolongada são: lesão da laringe, paralisia das pregas vocais, estenose glótica e subglótica, infecção e lesão traqueal. O objetivo deste estudo foi avaliar as potenciais vantagens da traqueotomia percutânea precoce versus traqueotomia percutânea tardia em unidade de terapia intensiva. Métodos: Traqueotomias percutâneas foram realizadas em 158 pacientes em unidade de terapia intensiva para adultos e analisadas retrospectivamente. Os pacientes foram alocados em dois grupos para traqueotomia precoce e tardia, de acordo com o tempo de intubação intratraqueal antes da traqueotomia percutânea. As traqueotomias consideradas precoces foram realizadas nos dias 0-7 de intubação intratraqueal e as tardias realizadas após o sétimo dia de intubação intratraqueal. Os pacientes com infecção no local da traqueotomia, intubação difícil ou potencialmente difícil, idade inferior a 18 anos, pressão positiva ao final da expiração acima de 10 cmH2O e aqueles com diátese hemorrágica ou contagem de plaquetas em 50.000 dL−1 foram excluídos do estudo. Os tempos de ventilação mecânica e internação em UTI foram registrados. Resultados: Não houve diferença estatística entre os dados demográficos dos pacientes. Os tempos de ventilação mecânica e de internação em unidade de terapia intensiva do grupo traqueotomia precoce foram ...

Introducción y objetivos: La traqueotomía percutánea se ha convertido en una buena alternativa para los pacientes con previsión de intubación prolongada en unidades de cuidados intensivos (UCI). Los beneficios más importantes de la traqueotomía son el alta precoz de la UCI y menos tiempo de permanencia en el hospital. Las complicaciones de la intubación endotraqueal prolongada son: lesión de la laringe, parálisis de las cuerdas vocales, estenosis glótica y subglótica, infección y lesión traqueal. El objetivo de este estudio fue evaluar las potenciales ventajas de la traqueotomía percutánea precoz versus traqueotomía percutánea tardía en la UCI. Métodos: Se realizaron traqueotomías percutáneas en 158 pacientes en la UCI para adultos, siendo analizadas retrospectivamente. Los pacientes fueron divididos en 2 grupos para traqueotomía precoz y tardía, de acuerdo con el tiempo de intubación endotraqueal antes de la traqueotomía percutánea. Las traqueotomías consideradas precoces fueron realizadas en los días 0-7 de intubación endotraqueal, y las tardías, después del séptimo día de intubación endotraqueal. Los pacientes con infección en la región de la traqueotomía, intubación difícil o potencialmente difícil, con una edad inferior a 18 años, presión positiva al final de la espiración por encima de 10 cmH2O y los que tenían diátesis hemorrágica o conteo de plaquetas en 50.000 dl−1 fueron excluidos del estudio. Se registraron los tiempos de ventilación mecánica y de ingreso en la UCI. Resultados: No hubo diferencia estadística entre los datos demográficos de los pacientes. Los tiempos de ventilación mecánica y de ingreso en la UCI del grupo traqueotomía precoz fueron ...

[A case of combined thoracic epidural anesthesia-interscalene block application in high-risk mastectomy patients: a case report]. / Yüksek riskli mastektomi olgusunda torasik epidural anestezi-interskalen blok kombinasyonunun uygulanmasi: olgu sunumu.

Recent advances in surgical and anesthetic techniques have facilitated general anesthesia and surgical possibilities in the higher-risk patient group. Although general anesthesia is the only preferred approach for breast surgery, there have been many clinical trials about breast surgery that has been achieved with regional anesthesia techniques. It is known that regional anesthesia application decreases the preoperative stress, postoperative morbidity and mortality. Additionally, this application positively affects the early start of feeding and mobilization. Regional anesthesia techniques like high thoracic epidural anesthesia, cervical epidural anesthesia and paravertebral block have been applied successfully in mastectomy operations. Combined thoracic epidural anesthesia-interscalene block technique may also be a good alternative to general or cervical, high thoracic epidural anesthesia. We aimed herein to present a case who underwent successful mastectomy and axillary dissection under combined thoracic epidural anesthesia-interscalene block.

Initial experience with delivery of palliative care toterminal cancer patients.

BACKGROUND/AIM: We investigated the symptoms and needs of terminal cancer patients in a region where formal palliative care is limited. Here we present the demographic features and symptoms of end-stage cancer patients living in a city in northern Turkey. MATERIALS AND METHODS: The study was conducted at Gaziosmanpasa University (Tokat, Turkey), in 2011 and 2012. End-stage cancer patients admitted or referred by various departments to our outpatient pain unit were included. Demographic data, treatment histories, primary tumor sites, patient complaints, and symptom intensities measured using the Edmonton Symptom Assessment System Scale were prospectively entered into a database. RESULTS: A total of 107 patients (36 female and 71 male) were included. Gastrointestinal cancer was the most common form of cancer (43%), followed by genitourinary (25.3%) and lung cancer (15%). The most common symptom was fatigue (98.1%). The other symptoms (in decreasing order) were pain (92.5%), insomnia (92.5%), loss of appetite (76.6%), constipation (71%), dyspnea (63.6%), nausea (60.7%), cough (57.9%), and vomiting (48.6%). Eighty-six percent of the patients (n = 92) had metastases. Most lived in the city (59.8%) and 84 (78.5%) lived with their spouses. CONCLUSION: Patients were referred at the late stages of disease with pain as the principal presenting symptom. Family members were the principal caregivers.

The role of pain catastrophizing score in the prediction of venipuncture pain severity.

BACKGROUND: In addition to the influence of tissue damage, the intensity of pain is also related to individual cognitive factors. The Pain Catastrophizing Scale (PCS) is used to measure individual tendency toward pain by inquiring about a subject's cognitive characteristics. Building on the knowledge that the venipuncture process causes severe pain and anxiety in some patients, the objective of this study was to investigate the relationship between the PCS score and venipuncture pain. METHODS: Patients were asked to complete the PCS questionnaire. Patients' demographic features, presence of chronic pain and American Society of Anesthesiologists (ASA) scores were recorded. Clinical and demographic characteristics of the patients were used for correlation with the PCS scores. Using an 11-point numeric rating scale (NRS), the patients then scored the amount of pain on cannulation. RESULTS: This prospective study was conducted with 196 patients; 31 patients were excluded for various reasons. One hundred sixty-five patients, 74 women and 91 men, were included in the evaluation. The study found that the venipuncture pain score had a significant positive correlation with the PCS score (r = 0.197, P < 0.05). With respect to age, no statistically significant differences in the PCS scores were found (P > 0.05). Female patients had a significantly higher PCS score than the males (P < 0.05). The PCS score of patients with chronic pain was found to be significantly higher in comparison with those without pain complaints (P < 0.05). CONCLUSION: There was a positive correlation between venipuncture pain and PCS score. Consequently, the venipuncture pain score could be useful in informing practitioners about a patient's pain considerations.

Spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery.

OBJECTIVE: In lower extremity orthopedic surgeries, central and peripheral regional anesthesia techniques can be used along with general anesthesia, mainly in elderly patients with accompanying maladies. This study investigates the efficiency of spinal anesthesia and combined sciatic nerve/lumbar plexus block techniques in lower extremity orthopedic surgery in terms of patient-surgeon satisfaction. METHODS: Fifty consecutive patients (age range: 50-90 years), with an ASA score of 2-3 were scheduled for lower extremity orthopedic surgery. The patients were randomly divided into two groups according to anesthesia type. Group 1 (25 patients) received spinal anesthesia (SA) and Group 2 (25 patients) a combined sciatic/lumbar plexus nerve block (CSLPB). Spinal anesthesia was performed with 3 ml of 0.75% ropivacaine, and the combined sciatic/lumbar plexus nerve block was obtained with 10 ml 0.75% of ropivacaine and 10 ml of normal saline (20 ml in total). We recorded the time elapsed during the administration of the anesthesia and the initiation of its effect. Evaluation was made on patient-surgeon satisfaction. RESULTS: Regional anesthesia duration was significantly longer in the CSLPB group (p<0.0001). The time required to prepare the patients for surgery was statistically and significantly shorter in the SA group (p<0.001). Values of patient and surgeon satisfaction did not significantly correlate (p>0.05). CONCLUSION: Both standard anesthesia and combined sciatic/lumbar plexus nerve block were effective in lower extremity orthopedic surgeries. Although surgery preparation time was longer in the CSLPB group, patient-surgeon satisfaction was similar in both groups.

Regional block anesthesia in a patient with factor V Leiden mutation and axillary artery occlusion.

Anesthetic management of patients with coagulation disorders presents safety and technical challenges. This case describes a 58-year-old woman with factor V Leiden mutation who required distal saphenous vein harvest and axillo-brachial bypass to treat axillary artery occlusion. The patient underwent surgery with satisfactory anesthesia using infraclavicular brachial plexus block, thoracic paravertebral block, and unilateral subarachnoid block. These three regional anesthetic interventions were performed in lieu of general anesthesia to minimize risks of thrombotic events, pain, and to decrease recovery time. Despite higher failure rates of regional anesthesia, longer time required for procedures, and added discomforts during surgery, the benefits may outweigh risks for selected high-risk patients, including those with factor V Leiden mutations.