Duygu Kara

Pheniramine Maleate is more effective than Lidocaine on Fentanyl Induced Cough.

Objective: Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough. Methods: This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection. Results: Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p<0.05); however, differences between Group L and Group C or Group F and Group L were not statistically significant (p>0.05). Conclusions: Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.

Increased heart rate on first day in Intensive Care Unitis associated with increased mortality

Objective: To investigate the association of maximum HR during the first day of intensive care unit (ICU) and mortality. Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR≥100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization (ICU and total), mortality (ICU and total), and CHARLSON & APACHE-II scores. Results: The mean age of patients was 63±12 years and 86% were after non-cardiac surgery. Maximum HR was 83±11 in Group-I and 115±14/min in Group-II (p=0.002). Group-II patients had more frequent vasopressor and inotropic drugs usage, (p<0.001), anemia, mechanical ventilation (p<0.005), higher CHARLSON & APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I (p<0.05). APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not. Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit.

Pneumocephalus Following Combined Spinoepidural Anesthesia: A Case Report -

Various complications may develop as a result of epidural anaesthesia. Pneumocephalus is a rare complication during epidural catheter insertion. In this case report, 61 years old patient was admitted for hip fracture and planned to have hip replacement surgery. Combined spinoepidural anesthesia was planned during surgery as anesthetic tehchnique. Epidural catheter was inserted for postoperative pain control. Forty-five minutes after the operation, he had a sudden blunt headache, and generalized tonic, clonic status for two minutes. We aimed to present a case of pneumocephalus after combined spinoepidural anesthesia.

Continuous Spinal Anesthesia for Hip Fracture Surgery in a very Old Patient With Pulmoner Hypertension

Elderly patients have increased risk for perioperative and postoperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Anesthesia and surgery in patients with pulmonary hypertension (PH) are associated with high perioperative morbidity and mortality, and elective surgeries should generally be avoided fort this reason. Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with PH due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Regional anesthesia techniques are usually preferred in high-risk patients due to some advantages, such as the maintenance of cardiovascular stability and early postoperative mobilisation. This case presents the anaesthetic approach in a 87-year-old male patient with atrial fibrilation, chronic obstructive pulmonary disease and pulmonary hypertension who underwent hip fracture surgery. In the present case, continuous spinal anesthesia with low-dose hyperbaric bupivacaine provided safe and effective anaesthesia during surgery with minimal haemodynamic changes and analgesia during the first 24 hours after surgery.

From Respiratory Distress to Diagnosis of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of motor neurons, which results in weakness and atrophy of voluntary skeletal muscles. ALS is the most common form of motor neuron disease (MND). It is currently incurable and treatment is largely limited to supportive care. Family history is associated with an increased risk of ALS. The disease usually does not affect cognitive abilities, but causes muscle weakness. Respiratory function in the early stages of the disease is generally normal, shortness of breath occurs as the disease progresses. This paper has been submitted about ALS patient who was diagnosed and treated in intensive care unit followed by severe respiratory failure.