Is diaphragm ultrasound better than rapid shallow breathing index for predicting weaning in critically ill elderly patients?

Introduction: Prolonged weaning is associated with worse clinical outcomes in elderly patients. Beside traditional rapid shallow breathing index (RSBI), diaphragm ultrasound is a promising technique to evaluate the weaning process. We aimed to perform diaphragm ultrasonography for predicting the weaning process and its relation with frailty in the critically ill elderly population. Materials and Methods: We enrolled thirthy-two patients over 65 years of age who were mechanically ventilated for at least 48 hours. Thickness of diaphragm and excursion were evaluated within 48 h of intubation and during spontaneous breathing trial (SBT). Clinical parameters, frailty, diaphragm ultrasound results were compared according to the weaning status. Results: Mean age (standard deviation) was 79.3 ± 7.9 years, and 18 (56.3%) patients were classified as weaning failure. Diaphragmatic excursion during SBT was the only statistically significant parameter associated with weaning failure [2.37 cm (0.67) vs 1.43 cm (0.15), p= 0.0359]. There was no statistically significant difference regarding RSBI between the groups [70.5 (46) vs 127.5 (80), p= 0.09]. Baseline thickness of diaphragm and excursion at SBT were moderately correlated with frailty. Conclusion: Ultrasound can be used to show diaphragm dysfunction in the elderly frail population, and a multifactorial approach to the extubation process may include ultrasound instead of using traditional RSBI alone.

Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients.

Introduction: Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among critically ill elderly patients. Materials and Methods: Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated. Result: Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ± 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ± 0.9 vs 6.5 ± 1.7, p= 0.035), sepsis (18 vs 7, p<0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p<0.001). Conclusions: Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.

Comparison of clinical and radiological characteristics of COVID-19 patients with and without pneumothorax and/or pneumediastinum.

Introduction: Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease. Materials and Methods: A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study. Result: The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p<0.001). The length of hospital stay was shorter in patients with PTX/PM (p<0.001), but mortality was higher (p= 0.04). Conclusions: PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

COVID-19 Pneumonia and Intensive Care Treatment of a Lung Transplant Recipient.

In the COVID-19 pandemic presently affecting the whole world, solid-organ transplant recipients under immunosuppressive therapy are at higher risk than the general population. COVID-19 infection primarily affects the lungs, and so the risk is further increased in lung transplant recipients. The course of COVID-19 in lung transplant recipients is unclear. Here, we present the intensive care follow-up and treatment process of a bilateral lung transplant recipient who developed acute respiratory failure due to COVID-19, for whom the final outcome was favorable. Antiviral treatment was initiated for the 53-year-old male patient with COVID-19 pneumonia, and in the following hyperinflammatory phase, high-dose pulse steroid therapy was administered. The patient was followed up with high- flow nasal oxygen, and then he was supported by intermittent noninvasive mechanical ventilation as hypoxia became more severe. With these noninvasive ventilation strategies and good intensive care procedures, the patient was successfully discharged.

The predictive power of C-reactive protein- lymphocyte ratio for in-hospital mortality after colorectal cancer surgery.

BACKGROUND: The relation between immunity, inflammation, and tumor development and progression has been emphasized in colorectal cancer widely and the prognosis is linked to the inflammatory reaction of the host as well as the biological behavior of the tumor. AIM: In this study, we aimed to find out the predictive power of C-reactive protein- lymphocyte ratio (CLR) for in-hospital mortality after colorectal surgery. METHODS AND RESULTS: A series of 388 CRC patients were enrolled in the present retrospective study which was conducted in a tertiary state Hospital in Ankara, Turkey. In-hospital mortality was the main outcome to evaluate the predictive power of inflammatory markers, while the other outcomes that would be evaluated as separate variables were LOS in hospital and LOS in ICU. In this study, there were 260 males and 128 females, and the mean age was 60.9. The in-hospital mortality rate was 3.4% (n = 13) and age, APACHE II score and Charlson comorbidity index score were related to in-hospital mortality statistically. The mean LOS in the hospital was 13.9 days and LOS in ICU was 4.5 days. The CRP levels and the CLR levels were higher both in the preoperative and postoperative periods in the mortality (+) group and the difference was significant statistically (P = .008/ .002 and .004/ <.001, respectively). CLR in the postoperative period had the best predictive power with AUC: 0.876. CONCLUSION: In conclusion, within the context of our study there appears to be a relationship between CLR, as measured on day 2 postoperatively, and in-hospital mortality. It is observed to be more effective than NLR, ALC, and CRP.

A Randomized Clinical Trial on the Effect of Hypnosis on Anxiety and Pain in Rigid Cystoscopy Patients.

Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management.

Building a patient blood management program in a large-volume tertiary hospital setting: Problems and solutions.

Successful implementation of a patient blood management program necessitates the collaboration of a strong organization and a multidisciplinary approach. We organized a meeting with broad participation in our center to establish a consensus for implementation of a specific patient blood management program. International and domestic experiences were shared, the importance of coordination and execution of different pillars in patient blood management were discussed, and the problems about the blood transfusion system were also investigated with the proposal for solutions. The data obtained from this meeting are presented to be a guide for similar large-volume tertiary hospitals for integration of a patient blood management protocol.

Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery?

BACKGROUND: In this study, we aimed to investigate the effects of poor blood glucose control on the intraoperative cerebral system in patients undergoing coronary artery bypass grafting using various neuromonitors. METHODS: Between January 2011 and December 2011, a total of 40 adult patients (31 males, 9 females; mean age 58.8±9.2 years; range, 38 to 78 years) who were scheduled for elective coronary artery bypass grafting were included in the study. The patients were divided into four groups according to hemoglobin A1c levels as follows: Group 1 including non-diabetic controls (n=11); Group 2 including those with a hemoglobin A1c value of <7% (n=10); Group 3 including those with a hemoglobin A1c value of 7 to 10% (n=11); and Group 4 including those with a hemoglobin A1c value of ≥10% (n=8). Cerebral monitoring was performed with near-infrared spectroscopy and transcranial Doppler. Measurement periods were defined as follows: Before anesthesia induction (period 1), 10 min after anesthesia induction (period 2), during cannulation (period 3), 10 min after cardiopulmonary bypass (period 4), at 32°C temperature during cardiopulmonary bypass (period 5), at 36°C temperature during cardiopulmonary bypass (period 6), and at the end of the operation (period 7). RESULTS: There was a significant difference in the near-infrared spectroscopy values in the cannulation period for both right (p<0.001) and left (p=0.002) sides and the mean transcranial Doppler flow velocity (p=0.002) in Group 4, compared to Group 1. The heart rate was found to be significantly lower in Group 4 in the cannulation period. The near-infrared spectroscopy values and transcranial Doppler blood flow velocity decreased in Group 4 in all measurement periods. CONCLUSION: The results of our study show that, in patients with severe diabetes undergoing open heart surgery, heart rate decreases in the cannulation period due to possible autonomic neuropathy, and cerebral blood flow and oxygenation decrease. For these patients, particularly in the cannulation period, perfusion of both cerebral and other organs should be closely monitored and necessary interventions should be performed.

Effect of dilutional anemia that can be treated with only one unit of red blood cell transfusion on tissue oxygenation in cardiac surgery patients

Background/aim: Cardiac surgery, especially in the presence of cardiopulmonary bypass (CPB), is associated with an inflammatory reaction that may promote microcirculatory alterations, in addition to the general impact on system hemodynamics. Anemia and transfusion make patients more susceptible to the deleterious effects of CPB. In this study, it was aimed to evaluate the effect of dilutional anemia, which is caused by CPB and can be treated with 1­2 units of red blood cell (RBC) transfusion, on global tissue oxygenation parameters in cardiac surgery patients. Materials and methods: This prospective observational study comprised 127 patients who had a relatively stable operation period without any major anesthetic or surgical complications (e.g., operation duration >5 h, bleeding or hemodilution requiring more than 1­2 units of RBCs, or unstable hemodynamics, requiring inotropic support of more than 5 µg/kg/min dopamine). Patients were observationally divided into two groups: minimally transfused (Group Tr) and nontransfused (Group NTr). Global tissue oxygenation parameters were evaluated after anesthesia induction (T1) and at the end of the operation (T3) and compared between the groups. Results: Group Tr consisted of patients who had significantly lower preoperative hemoglobin values than Group NTr patients. The dilutional anemia of all Group Tr patients could be corrected with 1 unit of RBCs. The lactate levels at T3, increment rates of lactate, and venoarterial carbon dioxide pressure difference (ΔpCO2) levels [(T3 ­ T1) : T1] in Group Tr were significantly higher than those in Group NTr. Conclusion: Dilutional anemia as a result of CPB mostly occurs in patients with borderline preoperative hemoglobin concentrations and its correction with RBC transfusion does not normalize the degree of microcirculatory and oxygenation problems, which the patients are already prone to because of the nature of CPB. Preventing dilutional anemia and transfusion, especially in patients with preoperative borderline hemoglobin levels, may therefore reduce the burden of impaired microcirculation-associated organ failure in on-pump cardiac surgery.

Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study.

BACKGROUND: ECMO support is a final treatment modality for patients in the refractory cardiogenic arrest and postcardiotomy cardiogenic shock with an utmost importance. Eventhough it is linked to high mortality, its usage gains popularity worldwide. We assessed the fluctuation of lactate levels and the clearance of lactate during the ECMO therapy and its prognostic role on mortality. METHODS: Data were gathered on all patients receiving ECMO therapy longer than 48 h between January 2015 and December 2017 retrospectively. Blood lactate had been recorded before ECMO implantation and at specific time points during ECMO support as a routine procedure. In this study, the Lactate clearance at specific time points (Lactate clearance-1) and the duration that lactate cleared more than 10% of the initial lactate level (Lactate clearance-2) was measured. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. RESULTS: Fourty-eight patients underwent ECMO therapy for refractory cardiogenic shock resulting in 70.8% mortality. The lactate levels before and after ECMO therapy as well as the dynamic changes were significantly correlated with mortality variable. With AUC calculation, LC-2 has a strong discrimination (AUC = 0.97) on 30-day survivors and nonsurvivors. LAE-LBE (AUC = 0.785), L48-LBE (AUC = 0.706) showed moderate predictive power on 30-day mortality. CONCLUSIONS: Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate on both effective circulatory support and as prognostic prediction. LC-2 showed a strong discrimination on 30-day mortality.

The Use of Sugammadex in a Patient With Guillain-Barre Syndrome: A Case Report.

Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.

Postperfusion Syndrome in Cadaveric Liver Transplantations: A Retrospective Study.

OBJECTIVE: To evaluate the factors that affects the postperfusion syndrome in cadaveric liver transplantations and the effect of the postperfusion syndrome on discharge from the hospital. METHODS: Patients who underwent cadaveric liver transplantations between 2007 and 2013 were scanned retrospectively. Intraoperative anaesthesia records, intensive care unit follow-up forms and discharge reports were examined from patient files. Overall, 43 patients having complete data were included in the study. The postperfusion syndrome is defined as asystoli or a decrease in mean arterial pressure of more than 30%, which occurred in the first 5 min of reperfusion and continued for 1 min. Patients were divided into two groups: those who had the postperfusion syndrome and those who did not. RESULTS: The number of patients who had the postperfusion syndrome was 25 of 43 (58.1%). The MELD score of patients without the postperfusion syndrome was calculated as 16.9±3.2 and that of patients with the postperfusion syndrome was 19.7±3.6. A statistically significant relationship was detected between the postperfusion syndrome occurrence and a high MELD score (p=0.013). The diastolic blood pressure just before reperfusion was statistically lower in the group with the postperfusion syndrome than in the other group (p=0.023, 50±8 vs. 58±11). According to the logistic regression analysis, the MELD score and the decrease in diastolic blood pressure before reperfusion were defined as independent predictive factors. CONCLUSION: According to the study, the ratio for having the postperfusion syndrome was found to be 58.1%. The independent predictor factors affecting the postperfusion syndrome were detected as the MELD score and the decrease in diastolic blood pressure before reperfusion. The postperfusion syndrome during orthotropic liver transplantation is an important issue for anaesthesiologists. The awareness of the related factors with the postperfusion syndrome may help in the development of various preventive strategies.

Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP.

INTRODUCTION: Using single anesthetic agent in endoscopic retrograde cholangiopancreatography (ERCP) may lead to inadequate analgesia and sedation. To achieve the adequate analgesia and sedation the single anesthetic agent doses must be increased which causes undesirable side effects. For avoiding high doses of single anesthetic agent nowadays combination with sedative agents is mostly a choice for analgesia and sedation for ERCP. AIM: The aim of this study is to investigate the effects of propofol alone, propofol + remifentanil, and propofol + fentanyl combinations on the total dose of propofol to be administered during ERCP and on the pain scores after the process. MATERIALS AND METHOD: This randomized study was performed with 90 patients (ASA I-II-III) ranging between 18 and 70 years of age who underwent sedation/analgesia for elective ERCP. The patients were administered only propofol (1.5 mg/kg) in Group Ι, remifentanil (0.05 µg/kg) + propofol (1.5 mg/kg) combination in Group II, and fentanyl (1 µg/kg) + propofol (1.5 mg/kg) combination in Group III. All the patients' sedation levels were assessed with the Ramsey Sedation Scale (RSS). Their recovery was assessed with the Aldrete and Numerical Rating Scale Score (NRS) at 10 min intervals. RESULTS: The total doses of propofol administered to the patients in the three groups in this study were as follows: 375 mg in Group I, 150 mg in Group II, and 245 mg in Group III. CONCLUSION: It was observed that, in the patients undergoing ERCP, administration of propofol in combination with an opioid provided effective and reliable sedation, reduced the total dose of propofol, increased the practitioner satisfaction, decreased the pain level, and provided hemodynamic stability compared to the administration of propofol alone.

Investigation of the effects of preoperative hydration on the postoperative nausea and vomiting.

INTRODUCTION: Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy operations still continue to be a serious problem. Intravenous fluid administration has been shown to reduce PONV. Some patients have higher risk for PONV described by APFEL score. In this study, our aim was to determine the effects of preoperative intravenous hydration on postoperative nausea and vomiting in high Apfel scored patients undergoing laparoscopic cholecystectomy surgery. PATIENTS AND METHODS: This study is performed with 50 female patients who had APFEL score 3-4 after ethics committee approval and informed consent was taken from patients. The patients were divided into 2 groups: group 1 (P1): propofol + preoperative hydration and group 2 (P2): propofol + no preoperative hydration. RESULTS: When the total nausea VAS scores of groups P1 and P2 to which hydration was given or not given were compared, a statistically significant difference was detected at 8th and 12th hours (P = 0.001 and P = 0.041). It was observed that in group P1, which was given hydration, the nausea VAS score was lower. When the total number of patients who had nausea and vomiting in P1 and P2, more patients suffered nausea in P2 group. DISCUSSION: Preoperative hydration may be effective in high Apfel scored patients to prevent postoperative nausea.

The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during cardiopulmonary bypass--randomized trial.

BACKGROUND: Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac surgery. These complications are thought to be caused by embolisms and cerebral hypoxia. Thus, continuous neuromonitoring is essential during cardiac surgery due to cerebral oxygen desaturation during different periods. Near-infrared spectrophotometry (NIRS), a non-invasive method, appears to offer many advantages for monitoring cerebral oxygenation and hemodynamics. Desaturation of cerebral oxygen may occur at the beginning of cardiopulmonary bypass (CPB) or during the low perfusion and rewarming stages if not corrected. OBJECTIVES: This study was designed to assess the effects of sevoflurane on cerebral protection during CPB. MATERIAL AND METHODS: Eighty patients were divided into two groups. Anesthesia was maintained either with fentanyl and midazolam (total intravenous anesthesia, TIVA) or with one minimum alveolar concentration of sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute decrease in saturation of 20% from baseline cerebral saturation. When desaturation occurred, PaCO2, hematocrit and PaO2 levels were checked and corrected. If desaturation continued, anesthetic depth was increased to reserve saturation with 50-100 mg of propofol. NIRS values and hemodynamics were recorded at predetermined time intervals. RESULTS: Cerebral oxygen saturation values on the right side were higher in the sevoflurane group than in the TIVA group. The values on the left side were higher in the sevoflurane group than in the TIVA group, and meaningful differences were seen at the lowest temperature and at 36°C. CONCLUSIONS: Oxygen saturation was higher in the sevoflurane group than in the TIVA group. Thus, the effect of sevoflurane was useful for maintaining cerebral oxygen saturation during CBP.

Intracranial sewing needles in an adult patient.

A 37-year-old patient is reported with intracranial sewing needles, which were located in the right frontal lobe. Both clinical and radiological findings suggested that these needles must have been introduced in infancy before the closure of anterior fontanelle during an unsuccessful homicide. Usually intracranial foreign objects are placed due to penetrating trauma or surgical procedures. Child abuse has been known for centuries. Many types of physical traumas have been reported, especially in Western countries. In Iran, insertion of sewing needles into the brain aiming to kill the infant have been seen in a lot of cases. This situation takes part in a lot of Persian stories. We reported a 37-year-old man who had 2 intracranial sewing needles with unknown etiology.

Comparison of the effect of mexiletine and methylprednisolone on neural function and histopathological damage after transient spinal cord ischemia in rabbits.

AIM: The purpose of this study was to investigate the effect of mexiletine on the neural function and histopathological changes after ischemic spinal cord injury in rabbits. We also compared the effect of mexiletine to that of methylprednisolone. MATERIAL AND METHODS: Twenty six male New Zealand white rabbits were randomly divided into six groups. Group 1; sham operated group (n=3) underwent only the surgical exposure of infrarenal aorta. Group 2 (n=4) received neither intravenous (iv) nor intraperitoneal medication but the infrarenal aorta was cross-clamped. Group 3 (n=5) received intravenous infusion of 20 ml/kg/h normal saline. Group 4 (n=5) received 30 mg/kg intravenous methylprednisolone. Group 5 (n=3) received intraperitoneal 20mg/kg/h normal saline. Group 6 (n=6) received 50mg/kg mexiletine intraperitoneally. Temporary spinal cord ishemia was induced by infrarenal aortic occlusion for 25 minutes and followed by reperfusion. The neural status was scored using the Tarlov criteria at 24 hours after reperfusion. Immediately after the neurological scoring, the spinal cords of all animals were removed for histopathological study. RESULTS: Histopathological examination scores were significantly higher in group 6 compared to group 2 (p < 0.05). CONCLUSION: Mexiletine can significantly ameloriate the neural function and prevent histopathological damage after transient spinal cord ischemia in rabbits. This is the first research that investigates the neuron=protective effect of mexiletine in a spinal cord ischemia model.

A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG.

The aim of this prospective, randomized, and double-blinded study was to compare the effects of desflurane, sevoflurane, propofol on both atrial and ventricular wall function by measurement of QT dispersion (QTd), corrected QT dispersion (QTcd), and P dispersion (Pd) on electrocardiogram (ECG). Forty-six patients from the American Society of Anesthesiologists class I-II undergoing noncardiac surgery, were enrolled in this study. Patients were randomly allocated to receive desflurane, sevoflurane or propofol anesthesia. ECG recordings were taken before and after 5 minutes of drug administration. Induction with desflurane significantly increased the QTd compared to baseline (38 +/- 2 ms vs. 62 +/- 6 ms, P 0.05). Sevoflurane and propofol anesthesia was not associated with any changes in QTd. QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but this decrease was only significant in the propofol group (67 +/- 5 ms vs. 45 +/- 3 ms, P 0.05). Pd was significantly increased after induction with desflurane (34 +/- 3 vs. 63 +/- 6 ms, P 0.05). There was a significant increase in QTd and Pd in desflurane group, but this increment did not cause any dangerous arrhythmias. QTcd significantly decreased in propofol group. We believe that further investigations are required for using desflurane as safe as sevoflurane and propofol in noncardiac surgery patients who have high cardiac arrhythmia and ischemia risk.

Middle cerebral arterial blood flow velocity and hemodynamics in heart surgery.

The aim of this study was to evaluate the effects of propofol, isoflurane, and sevoflurane on middle cerebral arterial blood flow velocity during open heart surgery, and the relationship between these effects and hemodynamic parameters. Fifty-two patients undergoing coronary artery bypass on cardiopulmonary bypass were divided randomly into 3 groups: the first group received 100 microg x kg(-1) x min(-1) propofol, the other groups received one minimum alveolar concentration of sevoflurane or isoflurane for anesthesia maintenance. Middle cerebral arterial blood flow velocities were measured by transcranial Doppler, and hemodynamics were measured by the thermodilution technique. Middle cerebral arterial blood flow velocities decreased significantly after administration of isoflurane and propofol, but there was no significant difference between the groups. After weaning from cardiopulmonary bypass, cerebral blood flow increased and came close to the value after induction in all groups. The pulsatility index and resistivity index increased significantly only after the propofol infusion, but there was no significant difference between the groups.