Objective: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. Methods: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. Results: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. Conclusion: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.
We noted a steady decrease in repeated IOP measurements except for the transient increase in CPB values on 5th min. The IOP values were higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements; however, the difference was not significant in the repeated measurements.
Pregabalin is an antiepileptic, analgesic and anxiolytic drug that GABA analogue with similar structure and actions to gabapentin. There are very few reports about pregabalin intoxication in the literature. A 24-year-old male presented following ingestion of 3 g of pregabalin in this report. He was managed with General Supportive Care and Symptomatic Approach (GSCSA) such as discontinuation of the drug, hydration with IV fluids, oxygenation, gastric lavage and activated charcoal administration and enhanced elimination techniques. But, it is to be noted that either the kidneys of the patients are in good functioning state or there is a hemodialysis facility in the immediate vicinity.
It has been reported that repeated sevoflurane exposure induces cognitive impairment. On the other hand, there is evidence that rivastigmine can attenuate or antagonize the cognitive dysfunctions caused by anesthetic agents. The aims of this study were to determine the effect of repeated sevoflurane exposure on spatial learning and memory (SLM) in weanling rats and to assess whether rivastigmine provides protection against the neurotoxic effects of sevoflurane at this early developmental stage. Methods: Thirty-two weanling rats were randomly divided into four equal groups: sevoflurane (S: 2% sevoflurane for 2 hours), sevoflurane + rivastigmine (SR: 2% sevoflurane and 2 mg/kg rivastigmine), rivastigmine (R: 2 mg/kg), and control (C: 100% oxygen for 2 hours). Rats were treated four times over 10 days. Four days after the last treatment, the rats were subjected to a Morris water maze test protocol to examine SLM. Results: The escape latencies of all groups gradually decreased day by day during the training trials performed to evaluate spatial learning (ρ<0.05). Group R showed more improvement than other groups as the rats in this group learned significantly more slowly on the first and second days of the training trials but reached the same levels as Group S and Group SR on the third and last days (ρ<0.05). In the probe trial to evaluate spatial memory, no significant difference was found among the groups for time spent in the 'platform' quadrant (ρ>0.05). Conclusion: Sevoflurane negatively affects learning in weanling rat pups but has no detrimental effect on spatial memory. On the other hand, it can be claimed that sevoflurane offsets the memory-sparing effects of rivastigmine.
Yirminci yüzyıl başından beri sağlık alanında kullanılmakta olan radyasyonun, ameliyathane içinde ve dışında kullanım yaygınlığının giderek artması, anestezistlerin radyasyon maruziyetinin artmasına yol açmaktadır. Bu yüzden hem çalışanların güvenliğini hem de hasta güvenliğini sağlamak ve radyasyona maruz kalmanın potansiyel zararlı etkilerini en aza indirmek için, radyasyonun temel kavramları, radyasyon fiziği, radyasyon güvenliği konuları hakkında bilgi sahibi olmak çok önemlidir. Bu yazının amacı anestezistleri bilgilendirme, mesleki radyasyon maruziyetlerini minimumda tutmalarına yardımcı olmaktır.
ÖZ Serum sodyum (Na) değerinin 135 mEq/L'nin altında bulunması hiponatremi olarak değerlendirilir. Hiponatremi en sık karşılaşılan ve özellikle hastanede yatan hastalarda görülen elektrolit bozukluğudur. Hipovolemik hipoosmolar hiponatremi en sık gözlenen klinik tablodur. Bunun nedenlerinden biri de serebral tuz kaybı sendromudur (STKS). STKS düşük plazma osmolalitesi, 100-150 mOsm/kg'ın üzerinde idrar osmolalitesi ve 20 mEq/L üzerinde idrar Na konsantrasyonu ile seyreden nadir bir durumdur. Merdivenden düşme nedeniyle 79 yaşındaki kadın hastanın yoğun bakımdaki takibinin 16. günü ani bilinç kaybı gelişmesi üzerine yapılan kan ve idrar örnek analizinde kan biyokimya Na değeri 120 mEq/L, plazma osmolalitesi 250 mOsm/kg, idrar Na değeri 180 mEq/L, idrar osmolalitesi 1200 mOsm/kg, idrar diürezi >3 mL/kg/saat olarak tespit edildi. Santral venöz basınç 2 mmHg ölçüldü. Serebral tuz kaybı sendromu düşünülen hasta %9 NaCl ve %3'lük hipertonik salin solüsyonu ile tedavi edildi. Tablosu 18. günde düzeldi. Sonraki takibinde septisemiye sekonder 81. günde eks oldu. Bu yazıda kafa travmasına maruz kalmış yoğun bakım hastalarında düşük yüzde ile seyreden ve sıklıkla uygunsuz antidiüretik hormon sendromu ile karışan ve ayırıcı tanısı iyi yapılmadığı takdirde mortal seyreden STKS'li bir olgu sunumu amaçlandı. Anahtar Kelimeler: Hiponatremi, kafa travması, serebral tuz kaybı sendromu, sodyum SUMMARY A serum sodium (Na) value below 135 mEq/L is evaluated as hyponatremia. Hyponatremia is the most common electrolyte abnormality observed in hospitalized patients in particular. Hypovolemic hypoosmolar hyponatremia is the most frequent clinical table. One of the reasons of this is cerebral salt-wasting syndrome (CSWS). CSWS is a rare condition progressing with low plasma osmolality, urine osmolality above 100-150 mOsm/kg and urine-Na concentration above 20 mEq/L. In the blood and urine sample analysis performed upon sudden loss of consciousness on the 15 th day of the intensive care unit follow-up of 79-year-old female patients due to falling from stairs, blood biochemistry Na value was 120 mEq/L, plasma osmolality was 250 mOsm/kg, urine Na value was 180 mEq/L, urine osmolality was 1200 mOsm/ kg, urine diuresis was >3 mL/kg/hour. The central venous pressure was 2 mmHg. The patient, considered to be diagnosed with CSWS, was treated with 9% NaCl and 3% hypertonic saline solution. Her clinical course was improved on the 18 th day. She died on the 81 st day secondary to septicemia in the subsequent follow-up. In this article, it was aimed to report a patient with CSWS which progresses with low percentage in intensive care unit patients with head trauma, is frequently confused with inappropriate antidiuretic hormone syndrome and progresses mortally when not diagnosed distinctively well.
Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI <30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p> 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.
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