BACKGROUND: Transbronchial needle aspiration using endobronchial ultrasonography (EBUS-TBNA), a new minimally invasive diagnostic procedure, has been used to evaluate intrathoracic lymph nodes. It has been reported that EBUS-TBNA can be performed safely under sedation and provides a high level of patient satisfaction. We aimed to describe perianesthetic data, and compare results regarding the agents of subjects undergoing EBUS-TBNA under deep sedation. METHODS: After ethics committee approval, perianesthetic data of 571 subjects undergoing EBUS-TBNA were analyzed retrospectively. Data were collected from anesthesia evaluation and observation forms. Four groups received anesthesia in the operating room as follows: propofol-midazolam (group PM), propofol-ketamine (group PK), propofol-ketamine-midazolam (group PKM), or propofol (group P). Dosage, number of anesthetic injection, hemodynamic variables, recovery time, complications, and patient satisfaction were also recorded. RESULTS: Propofol consumption was higher in groups P and PM compared with groups PK and PKM. Midazolam requirement was higher in group PM than in group PKM. Recovery time was shorter in group P compared with groups PK, PM, and PKM. It was also shorter in groups PK and PM compared with group PKM. All of these differences were statistically significant. Temporary desaturation (n ؍ 41; 7%) and increased blood pressure (n ؍ 78; 14%) were predominant complications. In groups PK and PKM, risk of developing hypertension was higher than in groups PM and P (P < .001). The percentage of subjects satisfied with the procedure was 99%. CONCLUSIONS: Independent from the sedative agent, deep sedation can be safe, and provide high patient satisfaction during EBUS-TBNA. The combination of ketamine with propofol or midazolam required lower doses of these anesthetics. However, the incidence of increased blood pressure was higher in groups administered ketamine. Recovery time was the shortest in group P, and the longest in group PKM. There was no relation between recovery time and total dose of anesthetics or presence of chronic disease.
When the diagnostic benefits and complication rates were considered, two cryobiopsies were found to be optimal for endobronchial tumors. In patients with non-diagnostic conventional bronchoscopy, endobronchial tumors may be diagnosed by cryobiopsy.
Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.
İnternal juguler ven (İJV) kanulasyonu anatomik varyasyonlar nedeniyle zor olabilir. Yoğun bakımda 66 yaşındaki kadın olguya ultrasonografi eşliğinde sağ İJV kanülasyonu planlandı. Sağ İJV olgunun pozisyonunu değiştirmemize ve Valsalva manevrası uygulamamıza rağmen görüntülenemedi. Sonrasında Sol İJV kolayca görüntülenerek ultrasonografi eşliğinde kanülasyon yapıldı. Anatomik işaretlere göre santral ven kanülasyonu birçok hastada başarılı olmakla birlikte, anatomik varyasyonların oranı çoktur ve buna bağlı komplikasyon oranı da oldukça yüksektir. Santral ven kanülasyonlarında ultrasonografi eş zamanlı kullanılmasa dahi iş-lem öncesi anatomik yapıların ultrasonografi ile doğrulanmasının başarılı santral ven kanülasyonu için önemli olduğunu vurgulamak istedik.Anahtar Kelimeler: Sağ internal juguler ven, ultrasonografi, komplikasyon, anatomik varyasyon Cannulation of the internal jugular vein (IJV) may be diffucult because of anatomical variations. A 66-year-old female patient, who was in the intensive care unit, underwent ultrasound-guided cannulation ofthe right IJV. The right IJV could not visualized by ultrasonography despite positional changes of the patient and Valsalva maneuvre. The left IJV was easily determined by ultrasonography and cannulated. Although the landmark technique may be sufficient for most of the central vein cannulations, the rate of anatomical variations and related complications is quite high. We point out that even if ultrasound cannot be used in real-time, the ultrasonographic confirmation during the pre-insertion period may be crucial for successful central vein cannulation.Keywords: Right internal jugular vein, ultrasonography, complication, anatomic variation Abstract / Özet
ÖZETKOAH (Kronik Obstrüktif Akciğer Hastalığı) olan hastalarda akut atağa bağlı solunum yetmezliğinde standart tedaviye ilave noninvaziv pozitif basınçlı ventilasyon (NPBV) uygulaması; endotrakeal entübasyon ve mekanik ventilasyon gereksinimini ve ilişkili komplikasyonları azaltır. Helmet, şeffaf, yüze bası uygulamadığı için toleransı daha iyi olan ve NPBV uygulamasında kullanılan ventilatör-hasta bağlantı cihazıdır. Bu olgu sunumunda; KOAH akut atağına bağlı akut solunum yetmezliği tanısı ile yoğun bakım ünitesine alarak helmetle NPBV uyguladığımız üç olgu sunulmuştur. Olguların helmetle takipleri sırasında, oksijenizasyon ve kliniklerinde hızlı iyileşme gözlenirken, PCO 2 düzeylerinde daha yavaş seyreden düzelme gözlenmiştir. Bu olgular aracılığıyla, KOAH akut atağında NPBV uygulamasında; helmetle kan gazlarında düzelme sağlanarak başarılı sonuçlar alınabileceği gösterilmiş ve ideal ventilatör-hasta bağlantı seçimi irdelenmiştir.Anahtar kelimeler: Akut solunum yetmezliği, kronik obstrüktif akciğer hastalığı, noninvaziv pozitif basınçlı ventilasyon, helmet SUMMARY Noninvasive Positive Pressure Ventilation by The Helmet in Respiratory Failure due to Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseNoninvasive positive pressure ventilation (NPPV) in addition to the standard treatment in the respiratory failure due to acute exacerbation in the patients with chronic obstructive pulmonary disease (COPD) decreases the need for endotracheal intubation, mechanical ventilation and their related complications. Helmet is a transparent interface device which has better tolerance in that it does not exert pressure on the face and ensures the connection between the patient and the ventilator device in the NPPV application. Herein, we presented three cases whom we applied NPPV with helmet in the intensive care unit for acute respiratory failure because of acute exacerbation of COPD. During the follow-up of cases with Helmet, while the rapid improvement was observed in their oxygenation and clinical status, levels of PCO 2 improved relatively slowly. These cases have demonstrated that the successful results would be able to be obtained by normalizing blood gases via NPPV application with helmet in the acute exacerbation of COPD. Besides, the optimal interface selection is discussed in this study.
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