BackgroundMaintaining brain oxygenation status is the main goal of treatment in severe traumatic brain injury (TBI). Jugular venous oxygen saturation (SjvO2) monitoring is a technique to estimate global balance between cerebral oxygen supply and its metabolic requirement. Full Outline of Responsiveness (FOUR) score, a new consciousness measurement scoring, is expected to become an alternative for Glasgow Coma Scale (GCS) in evaluating neurologic status of patients with severe traumatic head injury, especially for those under mechanical ventilation.MethodsA total of 63 patients with severe TBI admitted to emergency department (ED) were included in this study. SjvO2 sampling was taken every 24 hours, until 72 hours after arrival. The assessment of FOUR score was conducted directly after each blood sample for SjvO2 was taken. Spearman’s rank correlation was used to determine the correlation between SjvO2 and FOUR score. Regression analysis was used to determine mortality predictors.ResultsFrom the 63 patients, a weak positive correlation between SjvO2 and FOUR score (r=0.246, p=0.052) was found upon admission. Meanwhile, strong and moderate negative correlation values were found in 48 hours (r=−0.751, p<0.001) and 72 hours (r=−0.49, p=0.002) after admission. Both FOUR score (p<0.001) and SjvO2 (p=0.04) were found to be independent mortality predictors in severe TBI.ConclusionThere was a negative correlation between the value of SjvO2 and FOUR score at 48 and 72 hours after admission. Both SjvO2 and FOUR score are independent mortality predictors in severe TBI.
Background: Fasting, anesthesia and surgery lead to metabolic stress response. Increase of cortisol level lead to insulin resistance and hyperglicemic state has significant effect to the wound healing and increase morbidity and mortality to the patient undergoing surgery. The aim of this research is to prove that preoperative oral glucose loading can decrease metabolic stress response and also the difference effect on preoperative oral glucose that given twice and once time to decrease metabolic stress response in patient undergoing major oncology surgery.
Objectives: The purpose of this study was to assess that qSOFA validity is equal with SOFA as the predictor of mortality, both in sepsis and nonsepsis patients.Design: Diagnostic test with a retrospective design.
Setting:Intensive Care Unit in Sanglah General Hospital, Bali. Indonesia.
Subjects:Patients admitted to the ICU Sanglah General Hospital, from July 2015 to December 2016 (n=192), that have complete data and able to be evaluated with SOFA score.
Interventions: None
Measurement and Main Results:With the total population sampling techniques, 192 patients have met the criteria as the samples. The descriptive statistical analysis were performed, and the area under the ROC curve (AuROC) were used. The cutoff points will also be determined and will conclude the sensitivity and specificity of each score. From the 192 patients, the cutoff point for the SOFA and qSOFA are 11 and 2. While the AuROC from SOFA and qSOFA are 0.9307 and 0.9241, with p=0.7037 (95% confidence interval).
Conclusion:In this study, we conclude that the validity of qSOFA is equal to SOFA, both in sepsis and nonsepsis. So, for the reasons of efficiency and effectiveness, qSOFA can be used to replace SOFA score in predicting mortality in ICU.
Esophageal atresia (EA) is a congenital anomaly commonly found with tracheoesophageal fistula (TEF) of neonates in the first week of life. This anomaly can cause several complications including aspiration, reduction in respiration, and complication from other concomitant congenital anomalies, mostly from the heart origin. The treatment for this anomaly is a surgery. Intraoperatively, the patient may develop hypoxia due to lung retraction and hemodynamic instability from bleeding or hypothermia. Anaesthesiologists play an important role in the management of EA during the perioperative period. Careful examination of the preoperative period must be done to discover any other concomitant anomaly and complication. Good anticipation of any complication during surgery and continuous monitoring post surgery can elevate the prognosis of the patient.
Background: Myastenia gravis (MG) is a neuromuscular junction disorder that causes significant disability in the patient. Plasmaparesis and thymectomy are some therapeutic modalities in MG patients. Patients with MG of 10-15% had thymoma and 60% occurred thymic hyperplasia. Thymectomy may improve MG outcomes in 54-94% of patients (thymoma cases) or 21-42% of patients (cases of thymic hyperplasia). Plasmaparesis perioperatif still controversial. Case report: The 60-year-old man comes with a complaint both eyelids often close and both hands and feet experience fluctuating weakness, improved at rest. Patients with a history of DM and pulmonary TB. On the physical examination obtained eyelid twitch response and improved ptosis on ice test. Laboratory shows hyperglycemia and thrombocytopenia. Electrophysiological examination supports neuromuscular junction lesions. In thoracic and thoracic rectal images the mediastinal mass was obtained. Patients were diagnosed with myastenia gravis with suspected thyroid mediastinal mass. Treatment given mestinon 60 mg every 8 hours peroral, thymectomy plan, platelet transfusion, and plasmaparesis. Obtained a tumor with a large 10x8x7 cm with adhesions around the organ. Microscopic features support a thymoma A. Patients receive perioperative plasmaparesis 1 series (5x administration) divided, 2 preoperative and 3 postoperative times. The patient used mechanical ventilation for less than 24 hours and no residual symptoms. Conclusion: Myastenia gravis grade IIa (Osserman) with thymoma A performed extended thymectomy. Plasmaparesis given pre and post surgery showed clinical improvement and duration of short ventilator use. Good prognosis associated with mild MG degree, no myastenia crisis. Keywords: myastenia gravis, thymectomy, plasmaparesis
3-day-old neonate, given a diagnosis of esophageal atresia (EA) with tracheoesophageal fistula (TEF), which is large and just above the carina, was scheduled for TEF repair. Routine anesthetic management focuses on adequate ventilation and avoidance of gastric distension during positive pressure ventilation. Using a balloon-tipped embolectomy catheter or a Fogarty catheter to block the fistula under the guidance of fiberoptic scope has been described. In most of the medical centers, however, the pediatric fiberoptic scope may not be available. We present a case of a neonate undergoing type C EA/TEF repair and describe a simple intraoperative technique that could temporarily occlude the gastroesophageal junction, which allowing stable vital signs of the patient and definitive repair of the tracheoesophageal fistula.
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