Altta yatan kalp hastalığı olup, doğum indüksiyonu geçirenlerde ve spontan doğum yapan gebelerde maternal ve perinatal çıktıları karşılaştırmaktır. Gereç ve Yöntemler: Kardiyo-obstetrik kliniğine kayıtlı, kalp hastalığı olan, 38-41 hafta arası gebelik dönemindeki toplam 50 kadın art arda değerlendirildi. Otuz sekizinci haftada Bishop skorları uygun olan hastalar iki gruba randomize edildi. Birinci grupta oksitosin ile doğum indüksiyonu gerçekleştirilirken, ikinci gruba spontan başlangıçlı doğum yapıldı. Ortalama, standart sapma ve yüzde cinsinden tanımlayıcı analiz yapıldı. SPSS istatistik yazılımı kullanılarak iki grubun karşılaştırılmasında eşleşmemiş t-testi uygulandı. Bulgular: İki grup arasında maternal komplikasyon oranlarında anlamlı farklılık gözlenmemiştir. Doğum indüksiyonu yapılan gebe kadınlarda kardiyak komplikasyonlar bildirilmemiştir. Hastaların %52'si doğum indüklendiğinde çalışma saatleri içerisinde doğum yaparken, spontan doğum yapan gebe kadınların sadece %24'ü çalışma saatleri içerisinde doğum yapmıştır. Maternal veya neonatal ölüm rapor edilmemiştir. Sonuç: Oksitosin ile doğum indüksiyonu, kalp hastalığı olan kadınlarda oldukça güvenli olup, herhangi bir kardiyak komplikasyona neden olmamaktadır. İsteğe bağlı olarak indüklendiğinde gündüz daha fazla hasta doğum yapmış olup; obstetrik, anesteziyolojist, kardiyolog ve perinatolog uzmanlarının gündüzleri kolaylıkla hazır bulunması maternal ve fetal riskleri en aza indirmiştir.
Background: Although gastric reserve volume (GRV) is a surrogate marker for gastrointestinal dysfunction and feeding intolerance. There is ambiguity in its estimation in most of the international guidelines due to problems associated with its measurement. Ever since point of care ultrasound has entered into the armamentarium of anesthetists, it has kindled interest for its efficient use for this estimation. Methods: In this prospective observational study we recruited 57 critically ill patients and thus analyzed 586 samples of GRV obtained by both ultrasonographic (USG) and manual aspiration method done simultaneously on these patients.Results: USG-guided GRV was significantly correlated (r=0.788, P<0.0001)and in positive agreement with manual aspiration technique by Bland-Altman plot with mean average of difference of 8.5±14.84 (95% confidence interval [CI], 7.389–9.798) The upper and lower limit of agreement were 37.7 and –20.5 which too were within the ±1.96 standard deviation (P<0.0001).The sensitivity and positive predictive value, specificity and negative predictive value, AUC (95% CI) of the USG for finding out the feed intolerance was (66.67%, 98.15%, 0.8) in our study with 96.49% diagnostic accuracy.Conclusions: Ultrasonographic estimation of GRV was positively, significantly correlated and was in agreement with manual aspiration method. It estimated feed intolerance earlier than manual aspiration technique. With routine use of gastric USG, its use could possibly be extrapolated in clinical situations where feeding status is unclear and there is high risk of aspiration and we hope it will eventually become a standard practice of critical care.
Introduction: Ventilator-associated Pneumonia (VAP) is one of the leading causes of morbidity and mortality in intensive Intensive Care Unit (ICU) and is diagnosed by clinical symptoms, Chest X-ray (CXR), Computerised Tomography (CT) and microbiology test in routine practice. Aim: To compare the diagnostic accuracy of Lung Ultrasound (LUS) with gold standard CXR, with or without modified Clinical Pulmonary Infection Score (CPIS) score, for the diagnosis of VAP in ICU. Materials and Methods: This prospective observational study was carried out on 40 mechanically ventilated patients in Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India over the duration of one year from November 2018 - October 2019. The study was continued till VAP was diagnosed by all three modalities (CXR, LUS and microbiology) or to the maximum of 10 days postintubation whichever was less. Data was analysed with appropriate statistical tools “MedCalc”. Results: The mean age of patients was 45.78±15.99 years and there were 28 male and 12 females. The diagnosis of VAP was earliest with LUS (3.1±0.81 days) and (4.22±1.23 days) with CXR when studied alone (p<0.0001). However, when LUS was incorporated in CPIS score instead of CXR the diagnostic accuracy were statistically similar (p>0.05). During the early days (3 &4 day) the diagnostic accuracy (AUC), sensitivity and specificity of LUS was better and was (0.70-0.74, 57-90%) than (0.5; 16.7-83%) with CXR. Fifth day onwards AUC was better with CXR (0.79-0.81) as compared to (0.54-0.70) with LUS. Total leucocyte count (TLC), fever, P/F ratio and sputum quantity were observed individually between the VAP and non VAP group patients and were found to be similar (p>0.05). Conclusion: According to the present observational study, LUS can accurately diagnose VAP when other objective tools like CPIS, CXR and microbiology are inconclusive.
Background
Ultrasound imaging of optic sheath nerve diameter [ONSD] is reported to reflect changes consistent with intracranial pressure changes seen in traumatic brain injury and also in documented serum hyponatremia. We hypothesized that hyponatremia and hypervolemia seen during trans urethral resection of prostate [TURP] surgery may also have some association with different ONSD readings from the baseline perioperatively, resulting in early detection of TURP syndrome. In this prospective observational study, 50 adult male patients scheduled for TURP surgery meeting inclusion criteria were included and the ONSD measurements were serially recorded perioperatively. Patients with measurements ≥ 5.2 mm with either clinical symptoms or electrolyte changes suggested TURP syndrome were taken as true positive.
Results
The sensitivity, specificity, area under the curve, positive predictive, and negative predictive value at 95%CI of ONSD for early detection of TURP syndrome was {100% [15.81 to 100.00%], 91.67% [80.02 to 97.68%], 0.96 [0.86 to 0.99%], 33.33% [4.33 to 77.72%], 100% [91.96 to 100.00%]} with a diagnostic accuracy of 95.83%. In univariate logistic regressions, the duration of surgery had a positive association with TURP syndrome [odd ratio 1.066, β coefficient 0.064, p = 0.015]. In multivariate logistic regression, we could not validate the association between these factors and TURP syndrome [p > 0.050].
Conclusions
The ONSD measurements have good diagnostic accuracy for detecting TURP syndrome, but we advocate more multi-centric studies with large sample sizes to validate this association in the multivariate regression model.
Background: Epidural is a versatile neuraxial anesthetic technique with an expanding area of indications. Fentanyl is an established adjuvant to be used in epidural for prolonging analgesia. Dexmedetomidine, a newer α2 agonist exhibits synergism with local anesthetics in epidural,prolonging the sensory/motor block duration time and postoperative analgesia.We compared fentanyl with dexmedetomidine in epidural anesthesia along with ropivacaine in infraumbilical surgeries regarding efficacy and side effects. Methods: The study was conducted in ASA, I-II patients aged between 40-70 years for total abdominal hysterctomy. Group 1 (FR) received Ropivacaine 0.75% , 20ml + Fentanyl 1µg /kg and Group 2 (DR) received Ropivacaine 0.75% , 20 ml + Dexmedetomidine 1µg /kg in single shot epidural anesthesia. They were evaluated for onset of sensory and motor block, hemodynamics, total duration of analgesia and motor block and any side effects associated with it. Results: Demographic profile and baseline hemodynamic parameters were comparable in both groups. Mean onset of sensory block (min) in group FR was 9.76 ± 1.69 & in group DR was 7.93 ± 0.98 (p<0.001). Mean total duration of sensory block was 354.66 ± 66.88 (min) in FR group whereas 413.33 ± 66.71 (min) in DR group (p<0.05).Mean total duration of motor block was 191.83 ± 28.45 min in FR group and 234.33 ± 24.66 min in DR group (p<0.001). Conclusion: Dexmedetomidine when added to ropivacaine as adjunct in epidural anesthesia provides better analgesia, good operating conditions and excellent sedation profile.
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