Background
Hypotension is often occurring after induction of general anesthesia (IGA) and can cause organ hypoperfusion and ischemia which associated with adverse outcomes in patients having both cardiac and non-cardiac surgery. Elderly patients are particularly more vulnerable and at increased risk to the depressant effect of anesthetic drugs. So, recognition and prevention of such event are of clinical importance. This study recruited patients aged above 60 years, with ASA physical status classification I-II-III who were scheduled for surgery under general anesthesia with the aim to assess the effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following IGA and its association with the volume status in elderly patients receiving general anesthesia, through measurements of the maximum inferior vena cava diameter (dIVCmax), minimum inferior vena cava diameter (dIVCmin), inferior vena cava collapsibility index (IVC-CI), and basal and post-induction mean arterial pressure (MAP).
Results
Thirty-nine (44.3%) of the 88 patients developed hypotension after IGA, and it was significantly more in patients who did not receive preoperative fluid (p = 0.045). The cut-off for dIVCmax was found as 16.250 mm with the ROC analysis. Specificity and sensitivity for the cut-off value of 16.250 mm were calculated as 61.2% and 76.9%, respectively. The cut-off for IVC-CI was found as 33.600% with the ROC analysis. Specificity and sensitivity for the cut-off value of 33.600% were calculated as 68.7% and 87.2%, respectively.
Conclusions
IVC ultrasonography may be helpful in the prediction of preoperative hypovolemia in elderly patients in the form of high IVC-CI and low dIVCmax. The incidence of hypotension was lower in patients who received fluid infusion before IGA.
Rapid and accurate diagnosis and treatment are crucial and problematic for patients admitted to an intensive care unit. The incorrect physical examination was extensively reported when the intensive care unit was admitted. Various methods of diagnostic imaging were developed, but most lacked sensitivity, availability and portability. When a short echocardiographic study is added to extend the physical examination, the diagnostic accuracy can be increased. Ultrasound (US) has grown rapidly and has been widely accepted. In a recent study up to 36 per cent of patients admitted to a non-cardiac intensive care unit had one or more occult heart defects. Intensive patients with thoracic and abdominal pathologies often require the ultrasound examination for prompt diagnosis and treatment, and prevent deterioration or death of the patient's disease. In this review article, we discussed the role of the United States in the intensive care unit and we concluded that the critical care community has a number of application points for ultrasound in the intensive care unit. The literature advances rapidly every year. Thoracic applications, such as lung, cardiac and diaphragm ultrasound, and brain ultrasound and procedural direction are the main topics of focus. The trend of the new studies is to demonstrate the diagnostic exactness of new ultrasound treatment methods and their impact on the daily practise of critical care.
Background: Femoral nerve block (FNB) is a prevalent technique for analgesia following knee surgeries, but it also results in quadriceps weakness and greater chances of falling. Adductor canal block (ACB) is advertised as a motor nervesparing alternative to FNB. Objectives: The aim of the study was to compare adductor canal block with femoral nerve block as regard different surgical procedures of the knee. Study design: Meta-analysis was used to address this concern. Sittings: Meta-analysis-based study following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods: The database MEDLINE, EMBASE, PubMed, and Cochrane were systemically searched to detect all published randomized and prospective clinical trials comparing adductor canal block with femoral nerve block as regard different surgical procedures of the knee in the last five years. Results: Eighteen studies were identified for inclusion in this study, involving a total of 1457 patients. The risk of bias was low. Meta-analysis revealed that groups receiving femoral nerve blocks experience a significant decrease in pain scores and analgesic medication usage. However, adductor canal block groups have a significantly lower rate of quadriceps muscle weakness than FNB groups.
Conclusion:Femoral nerve block provides more analgesia and reduces analgesic consumption. On the other hand, adductor canal block, in the early postoperative period, preserves quadriceps function.
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