1,720,988 research outputs found
Renal Resistive Index Measurement by Transesophageal Echocardiography: Comparison With Trans lumbar Ultrasonography and Relation to Acute Kidney Injury
No full textObjectives: The aim of this study was to evaluate the relationship between transesophageal ultrasonography-derived renal resistive index values (RRITEE) and a standard translumbar renal ultrasound-derived RRI (RRITLUSG). The effectiveness of each method to predict acute kidney injury (AKI) after cardiac surgery also was compared. Design: A prospective observational study. Setting: A teaching university hospital. Participants: Sixty patients undergoing cardiac surgery. Interventions: First, RRI was measured with both methods after anesthesia induction. Second, another measurement was performed with TEE after cardiopulmonary bypass and immediately following the surgery with translumbar ultrasound. To test the correlation between the 2 methods and to plot a Bland-Altman graph, preoperative RRI values measured by both techniques were used. Receiver operating characteristic curves also were plotted to compare the diagnostic values of RRI measured intraoperatively by TEE after cardiopulmonary bypass and by RRITLUSG after surgery. Measurements and Main Results: There was a statistically significant correlation between the 2 RRI measurement approaches (r = 0.86, p < 0.0001). The Bland-Altman plot indicated good agreement between the methods. The area under the curve (AUC) of RRITEE in predicting AKI was 0.82 (95% confidence interval (Cl] = 0.64-0.9, p = 0.001), and the AUC of RRITLUSG after surgery was 0.85 (95% Cl = 0.7-0.98, p < 0.0001). In predicting AKI, an uncertainty zone for RRITEE values between 0.68 and 0.71 was computed by the gray-zone approach. Conclusions: RRITEE showed clinically acceptable agreement with RRITLUSG. Indeed, RRI measured intraoperatively with TEE was comparable to RRITLUSG in terms of detecting postoperative AKI. (C) 2015 Elsevier Inc. All rights reserved
Direct transaortic transcatheter aortic valve implantation
No full textTranscatheter aortic valve implantation (TAVI), has emerged as a new treatment option in patients with severe aortic stenosis who are considered to be high-risk for conventional surgery. In recent years, TAVI has been widely used in Turkey as in all the world. Transaortic approach for TAVI is a new approach in patients with poor peripheral vessels. In this article, we report a 82-year-old female case with severe aortic stenosis and coronary artery disease presenting with several comorbidities who was treated with direct transaortic TAVI and off-pump coronary artery bypass grafting for the first time in Turkey
The value of internal jugular vein collapsibility index in sepsis
No full textBACKGROUND: Rapid, accurate, and reproducible assessment of intravascular volume status is crucial in order to predict the efficacy of volume expansion in septic patients. The aim of this study was to verify the feasibility and usefulness of the internal jugular vein collapsibility index (IJV-CI) as an adjunct to the inferior vena cava collapsibility index (IVC-CI) to predict fluid responsiveness in spontaneously-breathing patients with sepsis. METHODS: Three stages of sonographic scanning were performed. Hemodynamic data were collected using the Ultrasonic Cardiac Output Monitor IA system (Uscom, Ltd., Sydney, NSW, Australia) coupled with paired assessments of IVC-CI and IJV-CI at baseline, after passive leg raise (PLR), and again in semi-recumbent position. Fluid responsiveness was assessed according to changes in the cardiac index (CI) induced by PLR. Patients were retrospectively divided into 2 groups: fluid responder if an increase in CI (Delta CI) >= I5% was obtained after PLR maneuver, and non-responder if Delta CI was <15%. RESULTS: Total of 132 paired scans of IJV and IVC were completed in 44 patients who presented with sepsis and who were not receiving mechanical ventilation (mean age: 54.6 +/- 16.1 years). Of these, 23 (52.2%) were considered to be responders. Responders had higher UV-CI and IVC-CI before PLR maneuver than non-responders (p<0.001). IN-CI of more than 36% before PLR maneuver had 78% sensitivity and 85% specificity to predict responder. Furthermore, less time was needed to measure venous diameters for IN-CI (30 seconds) compared with IVC-CI (77.5 seconds; p<0.001). CONCLUSION: UV-CI is a precise, easily acquired, non-invasive parameter of fluid responsiveness in patients with sepsis who are not mechanically ventilated, and it appears to be a reasonable adjunct to IVC-Cl
Direct Transapical Implantation of an Endocardial Pacing Lead to the Left Ventricle: An Alternate Pacing Site After Tricuspid Valve Replacement
No full textIn this paper, we report an alternative approach for implantation of ventricular pacing lead for complete atrioventricular block after tricuspid valve replacement. doi: 10.1111/jocs.12288 (J Card Surg 2014;29:290-292
Geriatrik hastalarda spinal ve epidural anestezinin kognitif fonksiyonlar üzerine etkisi
No full textÇalışmamızda transüretrai prostat rezeksiyonu planlanan yaşlı hastalarda spinal ve epidural anstezinin postoperatif kognitif fonksiyonlar üzerine etkilerini saptamaya amaçladık. Benign prostat hipertrofîsi tanısı ile transüretrai prostat rezeksiyonu planlanan 60 yaş ve üstü olan ASA I-III risk grubundaki 60 erkek hasta çalışmaya hadil edildi. Grup Fde 7.5 mg bupivakain + 20 u.g fentanil, grup IF de ise 10 mg %0.5 bupivakain kullanılarak spinal anestezi gerçekleştirildi. Grup IU'de 15 mi %0.5 bupivakain ile epidudural anestezi uygulandı. Olguların kan basınçları, periferik oksijen satürasyonlan minimental durum muayenesi, peroperatif dönemde değerlendirildi. Olguların ağrıları ve sedasyon düzeylerinde postoperatif dönemde değerlendirildi. Grup I ve IF deki kan basmcı değerleri grup İÜ 'e göre daha düşüktü. Mini mental durum muayenesi skoru, postoperatif ağrı ve sedasyon skorları yönünden gruplar arası farklılık saptanmadı. Kullandığımız anestezi yöntemlerinin postoperatif kognitif fonksiyon bozukluğu yapmadığı sonucuna varıldı
Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections
No full textObjective: Excessive fluid administration during lung resections is a risk for pulmonary injury. We analyzed the effect of intraoperative fluids on postoperative pulmonary complications (PCs). Methods: Patients who underwent anatomic pulmonary resections during 2012 to 2013 were included. Age, weight, pulmonary function data, smoking (pack-years), the infusion rate and the total amount of intraoperative fluids (including crystalloid, colloid, and blood products), duration of anesthesia, hospital stay, PCs, and mortality were recorded. PCs were defined as acute respiratory distress syndrome, need for intubation, bronchoscopy, atelectasis, pneumonia, prolonged air leak, and failure to expand. Univariate analyses and multivariate logistic regression were performed. A Lowess curve was drawn for intraoperative fluid threshold. Results: In 139 patients, types of resections were segmentectomy-lobectomy (n = 69; extended n = 37; video-assisted thoracoscopic surgery n = 19) and pneumonectomy (n = 9; extended n = 5). One hundred sixty-one PCs were observed in 76 patients (acute respiratory distress syndrome [n = 5], need for intubation [n = 9], atelectasis [n = 60], need for bronchoscopy [n = 19], pneumonia [n = 26], prolonged air leak [n = 19], and failure to expand [n = 23]). Overall mortality was 4.3% (6 out of 139 patients). Mean hospital stay was 8.5 +/- 4.8 days. Univariate analyses showed that smoking, intraoperative total amount of fluids, crystalloids, blood products, and infusion rate as well as total amount of crystalloids and infusion rate during the postoperative first 48 hours were significant for PCs (P = .033, P < .0001, P = .001, P = .03, P < .0001, P = .002, and P < .0001, respectively). In multivariate logistic regression analysis intraoperative infusion rate (P < .0001) and smoking were significant (P = .023). An infusion rate of 6 mL/kg/h was found to be the threshold. Conclusions: The occurrence of postoperative PCs is seen more frequently if the intraoperative infusion rate of fluids exceeds 6 mL/kg/h
Oral ketamine premedication in pediatric cases
No full textÇalışmamızda çocuklarda oral ketaminin değişik dozlarının premedikasyondaki etkinliğini, yan etkilerini ve bunlara bağlı olarak optimal dozu bulmayı amaçladık. Çalışmamız Dicle Üniversitesi Tıp Fakültesi Araştırma Hastanesi' nde cerrahi operasyon planlanan ASA I-II grubunda, 2-14 yaş arası ve 10-42 kg ağırlıklarındaki 80 çocuk üzerinde planlandı. Olgular rastgele dört gruba ayrılarak, I.gruba (n=20) 4mg/kg, Il.gruba (n=20) 6mg/kg, IILgruba (n=20) 8 mg/kg ketamin HC1, indüksiyondan 30 dakika önce oral yoldan vişne suyu ile karıştırılarak verildi. Dördüncü grup (n=20) kontrol grubu olarak alındı ve sadece vişne suyu verildi. Ketamin ve vişne suyu karışım miktarı 0.4 ml/kg olacak şekilde ve karışım volümü 10 mi' yi aşmayacak şekilde ayarlandı. Hastaların kalp atım hızı, kan basıncı, solunum sayısı ve transkütan oksijen satürasyonları monitörize edildi. Bu değerler ile birlikte, sedasyon skalası (SS) ve emosyonel durum skalası (EDS) kullanılarak sedasyonları ve emosyonel durumları her beş dakikada bir kaydedildi. Grupların hiç birisinde solunum depresyonu, anlamlı hemodinamik değişiklikler, sekresyon artışı, bulantı ve kusma gibi ketamine bağlı olabilecek komplikasyonlar anlamlı düzeyde oluşmadı. Sonuç olarak kontrol grubu hariç tüm gruplarda belirli ölçülerde sedasyon oluştu. Grup II ve grup III' ün sedasyon skorlarının istatistiksel olarak anlamlı düzeyde ve kabul edilebilir sınırlar içinde olduğu bulundu. Ancak grup III' de kullanılan 8 mg/kg ketaıninin postoperatif derlenmeyi anlamlı şekilde uzattığı tespit edildiğinden çocuklarda oral premedikasyon için en ideal ketamin dozunun 6mg/kg olduğu kanısına varıldı
Pediatrik hastalarda kullanılan kaflı ve kafsız endotrakeal tüpün karşılaştırılması
No full textPediyatrik Hastalarda Kullanılan Kaflı ve Kafsız Endotrakeal Tüpün Karşılaştırılması Amaç: Bu çalışmamızda uygun boyutta ETT seçiminde, yaş ve kilo bazlı formüllerin, serçe parmak çapının, USG ile ölçülen subglottik çapın ve son olarak laringoskopi sırasında gözlem yaparak tahmin yöntemlerinden hangilerinin uygun boyutta tüpü saptamada daha etkin olduğunu bulmaya çalıştık. Ayrıca kaflı ve kafsız tüpleri komplikasyonlar yönünden karşılaştırdık. Son olarak, ultrasonografik olarak ölçtüğümüz subglottik çap ile endotrakeal tüp dış çapı arasındaki farkın hava yolu komplikasyonlarıyla olan ilişkisini araştırdık. Gereç ve Yöntem: Genel anestezi altında opere olacak ve endotrakeal entübasyon uygulanacak, 6 ay-5 yaş arası, 133 çocuk çalışmaya dahil edildi. Hastalar randomize olarak kaflı ya da kafsız entübe olanlar Ģeklinde iki gruba ayrıldı. Hastalar % 100 oksijen altında yüz maskesi ile ventile edilirken ultrason ile transtrakeal subglottik çap ölçümü yapıdı. Entübasyon öncesi tüp hazırlığı için yaĢ bazlı formüller kullanıldı. Entübasyonda kullanılacak tüp direk laringoskopi sırasında gözleme dayalı olarak seçildi ve hastalar endotrakeal yoldan entübe edildi. Kumpas yardımıyla ölçülen serçe parmak distal falanks çapı kaydedildi. Gözleme dayalı olarak seçilen ilk tüp numarası, entübasyon sayısı, tüp değişim gerekçeleri ve uygun olduğuna karar verilen son tüpün numarası kaydedildi. Ekstübasyon sonrası laringospazm, stridor ve krup kaydedildi. Bulgular: Yaş bazlı formüllerin doğru endotrakeal tüpü saptama oranları %5-43; kilo bazlı olanların ise %25-38 olarak saptandı. Kullandığımız tüm yöntem ve formüllerin içinde uygun endotrakeal tüp boyutunu en iyi tahmin eden yöntem ultrosonografi ikinci olarak da gözlem metodu olarak bulundu. Subglottik çap ile tüpün dıĢ çapı arasındaki fark 1.95 mm‟nin üstüne çıktığı hiçbir hastada postoperatif stridor gözlemedi. Yine bu iv çapın 2.3 mm üstüne çıktığı hastalarda kaçak miktarı % 30‟u geçti. En çok kaçak nedeniyle tüp değiĢtirildi. Kafsız tüplerde kaçak miktarı ve reentübasyon oranı kaflı tüp kullanılan gruba göre anlamlı derece yüksek bulundu (p<0.0001). Komplikasyon açısından değerlendirildiğinde iki grup arasında istatistiksel olarak anlamlı bir fark gözlenmedi. Sonuç: YaĢ ve kilo bazlı formüllerin doğru endotrakeal tüp saptamadaki baĢarıları düĢüktür. Ultrasonografi ile ölçülen subglottik çap ve direkt gözlem yöntemi, uygun tüp boyutu belirlemede diğer yöntemlerden daha baĢarılıdır. Tüpün kaflı veya kafsız olmasının havayolu komplikasyonları üzerine anlamlı bir etkisi yoktur. DıĢ çapı subglottik çaptan 1.95 mm küçük tüplerin seçilmesi ile postoperatif hava yolu komplikasyonları azaltılabilir. Endotrakeal tüp, pediyatrik hasta, ultrasonografi, subglottik çap, havayolu komplikasyonlarıComparison of Cuffed and Uncuffed Endotracheal Tubes in Pediatric Patients Objective: In this study, we aimed to determine the most efficient method, among which are age and weight based formulas, fifth finger diameter, measurement of subglottic diameter with ultrasound and estimating the size by inspection during laryngoscopy, to choose the appropriate endotracheal tube size. We also compared cuffed and uncuffed tubes by the complications encountered. Finally, we tried to determine the relation of the difference between the subglottic diameter measured by ultrasound and outer diameter of endotracheal tube on airway complications. Methods: 133 children aged between 6 months to 5 years, who were to be endotracheally intubated and operated under general anesthesia were enrolled in the study. Patients were randomized into two groups as intubated with a cuffed or uncuffed endotracheal tube. Transtracheal subglottic diameter measurement was carried out by ultrasound while the patient was ventilated via facemask with 100% oxygen. Endotracheal tube selection was executed according the formulas regarding age before the intubation. The size of the endotracheal tube was determined by inspection during direct laryngoscopy and then patients were intubated. The diameter of the distal phalanx of the fifth finger was measured by a caliper and recorded. The size of the endotracheal tube determined by inspection, number of intubation attempts, the reason of changing the endotracheal tube and the size of the tube considered to be appropriate in the end, were also recorded. Laryngospasm, stridor and, croup encountered after extubation were also noted. Results: The success rates in detecting appropriate endotracheal tube size were lower when age based and weight based formulas were used (% 5-43 and % 25-38, vi respectivelly). Measuring the subglottic diameter by ultrasound was the best, inspection method was the second best method of all the methods and calculations we have used to estimate the appropriate size of the endotracheal tube. None of the patients suffered postoperative stridor if the difference between his subglottic diameter and external diameter of the endotracheal tube used is above 1,95 mm. Also, if this difference is above 2,3 mm, the leak was more than 30%. Leakage was the leading cause of tube switching. Uncuffed tubes had statistically higher rates of reintubation and higher amount of leakage as compared to cuffed tubes (p<0.0001). There was no statistical difference between the two groups in regard of complications. Result: Age and weight based formulas have low success rates in detecting appropriate endotracheal tube size. Measuring subglottic diameter by ultrasound and direct visualization are better than the other methods in assessing the correct tube size. Having the tube uncuffed or cuffed has no significant effect on airway complications. Postoperative airway complications may be diminished if tubes, which have an external diameter 0,95mm less then subglottic diameter, are preferred. Key Words: endotracheal tube, pediatric patient, ultrasonography, subglottic diameter, airway complication
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