Karotis ameliyatlarında anestezik ve cerrahi yaklaşımın birincil hedefi, kalp ve beyni iskemik hasardan korumaktır. Bu nedenle, ameliyat sırasında kanı ana karotis arterden internal karotis artere taşıyan bir şant uygulaması gerekebilir. Şant sıklıkla karşı taraf karotis arterde darlık bulunan ya da Wills halkası yetersizliği bulunan hastalarda kullanılmaktadır. Ameliyat sırası şant kullanımı gerekliliğine karar vermede çeşitli izlem yöntemleri bulunmaktadır. Bu makalede, karotis cerrahisinde şant kullanımı kararının verilmesinde serebral oksimetri izlem yönteminin kullanımına ilişkin klinik deneyimlerimiz sunuldu.
ÖZET Amaç: Çalışmamızda, elektif koroner arter baypas greft (KABG) ameliyatlarında off-pump ve kardiyopulmoner baypas (KPB) tekniklerinin deliryum gelişimi üzerine etkilerinin karşılaştırılmasını amaçlandı. Gereç ve Yöntem: 20-80 yaş arası KPB tekniği ile ameliyat olacak 40 olgu (Grup 1) ve off-pump teknikle ameliyat olacak
Objectives There are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital. Methods This study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020–15.01.2021 in a tertiary care intensive care unit in a university hospital. Results Bacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032–1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063–1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group. Conclusion Bacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.
Giriş Sezaryen ameliyatlarında annenin yanı sıra, annede oluşan her türlü değişiklikten etkilenen fetusun güvenliğinin de sağlanması gereklidir (1).Rejyonal anestezi yöntemlerinin, genel anesteziye pek çok üstünlükleri mevcut olmakla birlikte uzamış duyu ve motor bloğunun hipotansiyon, idrar retansiyonu ve baş ağrısı gibi dezavantajları bulunmaktadır. Sezaryen için rejyonal anestezi yöntemlerinden en sık kullanılanı spinal anestezi tekniğidir (2).Spinal anestezide bupivakain sık kullanılmaktadır. Ancak uzun süren motor blok ve kardiyotoksik etki profili, yeni lokal anestetik arayış-larına neden olmuştur. Etki başlangıç zamanı bupivakaine benzeyen, motor blok zamanı daha kısa, kardiyovasküler ve santral sinir sistemi 126Objective: The aim of this study is to compare the effects of intrathecal levobupivacaine and bupivacaine in caesarean operations. Methods:A randomised, double-blind study was applied to 60 ASA I-II, 18-40 year-old women scheduled for caesarean section; levobupivacaine patients in Group L (n=30) and bupivacaine applied Group B (n=30) were used. In the sitting position, L3-4 or L4-5 level, with a combined spinal-epidural anaesthesia technique, spinal anaesthesia was administered. In Group L: 11 mg isobaric levobupivacaine, and in Group B 11 mg hyperbaric bupivacaine was injected intratechally. The sensory block and motor block onset time, a one level lower degree time of motor block, two segment regression time of sensory block, the first analgesic requirement, the side effects such as nausea, vomiting, hypotension and bradycardia were recorded. Results:The time to reach the T4-6 level in Group L was significantly longer than group B; regression time to level T12 was significantly shorter in Group L (p<0.05). The first analgesic requirement in Group L was statistically significantly shorter than Group B (p<0.05). Motor block regression time was statistically significantly longer in Group B than Group L (p<0.05). Conclusion:In caesarean section, early motor and sensory block is an advantage but prolonged motor block is a disadvantage as discharge to the ward and breast feeding is delayed. Due to the early onset of sensory and motor block, bupivacaine seems to be superior to levobupivacaine. However, the motor block is longer with bupivacaine and levobupivacaine has less cardiac side effects. Because of this, we believe that more comprehensive, randomised controlled trials need to be done in spinal anaesthesia of caesarean cases with a choice of local anaesthetics.Key Words: Anaesthesia, spinal, epidural, levobupivacaine, obstetric Amaç: Çalışmamızda kombine spinal-epidural blok ile elektif sezaryen ameliyatı geçirecek olgularda, intratekal levobupivakain ve bupivakainin, motor ve duyu bloku başlama ve sonlanma süreleri, hemodinamik parametreler, komplikasyonlar, analjezi kalitesi açısından karşılaştırıldı.Yöntemler: Randomize, çift kör olan çalışmamıza; ASA I-II, 18-40 yaş arası sezaryen seksiyo uygulanacak 60 kadın dahil edildi ve olgular Levobupivakain uygulananlar Grup L (n=30) ve bupivakain uyg...
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