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.
We found that obesity does not increase short-term mortality for open heart surgery; however, it increases the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity.
O besity rates are increasing dramatically in most developed countries in the world. Although obesity is not necessarily a risk factor for mortality after cardiac surgery, it is a risk factor for morbidity. This retrospective study was undertaken to investigate the prognostic factors and incidence of early clinical outcomes in normal, obese, and morbidly obese patients undergoing open heart surgery.The records of 1000 patients who had open heart surgery were reviewed; 637 patients who had coronary, heart valve, or other heart surgery using cardiopulmonary bypass were divided into groups according to body mass index (BMI) scores. The nonobese reference group (NRG; n = 279) had a BMI of 18 to less than 30 kg/m 2 . The obese group (OG; n = 166) had a BMI of 30 to less than 35 kg/m 2 . The extremely obese group (EOG, n = 192) had a BMI of 35 kg/m 2 or greater. Age, sex, smoking status, ejection fraction, and American Society of Anesthesiologists physical status score were obtained. The standard European System for Cardiac Operative Risk Evaluation (EuroSCORE) was calculated for each patient. Early postoperative clinical conditions were defined as neurologic conditions, prolonged mechanical ventilation (924 hours), renal complications, perioperative myocardial infarction, arrhythmias, pulmonary/gastrointestinal/ infective complications, revision, multisystem failure, pulmonary embolism, and tamponade.Female sex and the incidence of preoperative diabetes mellitus, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease increased with increasing obesity. Obesity decreased with increased smoking status. Mallampati scores of 3 and 4 were higher in OG and EOG groups compared with the NRG group. The groups did not differ in intraoperative durations and transfusion values. However, EuroSCORE levels were significantly higher in the EOG group compared with the NRG group.The EOG group had higher rates of pulmonary and infective complications. After adjusting for the effects of age, sex, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and smoking, the incidence of pulmonary and gastrointestinal complications in the EOG was higher compared with the NRG group. The groups did not differ in perioperative myocardial infarction and infective complications. The groups did not differ in length of intensive care unit stay or the length of hospital stay. The OG and EOG groups had higher rates of discharge with morbidity. The EOG group had no mortality, and the OG and NRG groups did not differ in mortality rates.Obesity does not increase short-term mortality for open heart surgery but does increase the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity. To more clearly understand the relationship between obesity and heart surgery in future studies, waist circumference and the waist-to-hip ratio, instead of BMI, should be used, definitions of complications should be standardized, and larger population samples should be used. COMMENTThis stud...
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