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Delirium is an organic dysfunction including the brain’s inflammatory response to injury, hormonal effects and changes in neurotransmission and neural network. Delirium is one of the major causes of weaning difficulty in intensive care unit (ICU) patients. In this case report, we tried to explain the successful weaning procedure in a patient using quetiapine after trying all treatment options due to delirium in the ICU. This report emphasizes that second-generation antipsychotics should be kept in mind in patients who cannot be disconnected from the mechanical ventilator due to delirium.

Objective:As a result of advanced mechanical ventilation and hemodynamic support applications, the duration of intensive care stay is prolonged. Investigation of effective causes of prolonged ICU stay is important in terms of effective use of intensive care units.Materials and Methods:Patients who were hospitalized for more than 24 hours in the ICU during one year were included into the study. Age, gender, Body Mass index, hospitalization, location (emergency, operating room, service), presence of operation, presence of emergency / elective operation, need for vasopressor, Glaskow coma score (GCS), Full Outline of Unresponsiveness score (FOUR), Acute Physiology and Chronic Health Evaluation score, simplified acute physiology (SAPS III) score, hemogram profile, biochemical profile and coagulation profile values were recorded. All patients were classified as stay in the intensive care unit for shorter than 14 days and 14 days and more. We tried to investigate factors affecting prolonged admission by comparing these values.Results:Advanced age, high urea value, low GCS, low FOUR score, high SAPS III value, need for MV and need for vasoactive agent were found to be effective factors in prolonged intensive care hospitalization.Conclusion:We think that extensive studies should be done in this area as more effective use of intensive care units may be possible as a result of trying to reveal the factors affecting prolonged intensive care.

Takotsubo cardiomyopathy (TC) is a disease mimicking Acute Coronary syndrome with electrocardiographic changes as well as temporary, reversible regional wall motion defect in the apical and middle segments of the left ventricle. It may be associated with emotional and physical stress caused by serious medical discomfort or surgical stress. Although it is more common in postmenopausal women, it is thought that stress-induced catecholamine discharge causes TC. Intensive care patients are at high risk for emotional and physical stress due to various factors such as multisystem diseases and problems due to prolonged hospitalization. In this case report, we aimed to present the characteristics of TC following long-term intensive care follow-up of our patient who was paraplegic due to cervical trauma and conscious, and to discuss the differential diagnosis and evaluate the literature.

Tracheal ruptures are one of the life-threatening situations in critical care unit and can be formed after trauma, intubation, tracheotomy, bronchoscopy or spontaneously. Significant risk factors for tracheal rupture include urgent intubation, use of stilet, high cuff pressure, recurrent intubation attempts, double lumen endotracheal tubes, very thick endotracheal tubes, female gender, short height, older age, tracheomalacia, tracheal stenosis, congenital tracheal abnormalities and chronic steroid therapy. Among these risk factors, corticosteroids can cause rupture by inhibiting collagen synthesis and reducing connective tissue stability. In this case report, a case with spontaneous recurrent tracheal rupture was defined and the underlying mechanisms and therapeutic approach to this complication that could be seen in patients using chronic steroids were discussed.

Posterior reversible encephalopathy (PRES) syndrome is a clinical-radiological condition characterized by headache, changes in consciousness, epilepsy and visual disturbances, and usually occurs in the posterior parietal and occipital regions with vasogenic edema due to different etiologic factors. Risk factors include preeclampsia/eclampsia as well as hypertension, human immunodeficiency virus infection, organ transplantation, immunosuppressive and cytotoxic therapy, and analgesics. Treatment is usually aimed at correcting the cause of PRES. The aim of this case report was to present the characteristics of PRES, which was secondary to eclampsia in two cases, to discuss the differential diagnosis and to review the literature.

Objective: Elevated intraabdominal pressure (IAP) is an important factor that increases morbidity and mortality in intensive care unit patients. In this study, it was aimed to investigate the risk factors related to IAP increase in intensive care unit patients. Materials and Methods: One hundred twenty five patients who stayed more than 24 hours in surgical and reanimation intensive care unit were included into the study. All patiens age, sex, body mass index, APACHE II and SOFA scores were recorded. IAP measurements were performed during the intensive care unit stay, intraabdominal hypertension (IAH) was approved by a sustained or repeated pathological elevation in IAP ≥12 mmHg. Abdominal compartment syndrome (ACS) was accepted as a sustained IAP >20 mmHg that is associated with new organ dysfunction. All patients’ duration of mechanical ventilator, intensive care unit stay and prognosis were determined. Risk factors for IAP such as trauma, sepsis, multiple blood transfusions, ileus, acidosis and pneumonia were all recorded. Result: In the study 45 patients were diagnosed with IAP and 5 patients with ACS. There was no difference in terms of IAH and ACS according to gender and age of the patients. Patients with high body mass index, multiple transfusions, sepsis and pneumonia, were found to have higher IAH (p

Objective: Delirium is frequently seen in intensive care patients and causes prolongation of mechanical ventilation and intensive care stay. In intensive care patients, the pre-delirium score is a test used to detect delirium. We aimed to determine the prognostic value of the pre-delirium score in patients who stayed more than 24 hours in our intensive care unit. Materials and Methods: Between January 1, 2016 and December 31, 2016, pre-delirium scores were calculated for all patients stayed more than 24 hours in surgery, reanimation and internal medicine intensive care units. Pre-delirium score ≥50 was accepted as group 1 and

Resumo Justificativa Apesar dos novos avancos em reanimacao cardiopulmonar (RCP), o dano cerebral muitas vezes ocorre apos a reanimacao. Objetivo Avaliar o valor prognostico de medir a saturacao de oxigenio cerebral (rSO2) para estimar o prognostico em pacientes apos a reanimacao cardiopulmonar. Projeto Analise retrospectiva. Medidas e resultados Foram avaliados apos RCP 25 pacientes (12 do sexo feminino e 13 do masculino). Todos os pacientes foram submetidos a hipotermia (temperatura alvo de 33‐34 °C). As mensuracoes da Escala de Coma de Glascow (GCS), dos reflexos corneanos (RC), dos reflexos pupilares (RP) e do excesso de base (EB) e rSO2 foram feitas na admissao. Na hipertermia, as mensuracoes de GCS, RC, RP, EB e rSO2 foram feitas depois que a temperatura atingiu 36 °C. Resultados Em sobreviventes, o valor basal de rSO2 foi de 67,5 (46‐70) e a diferenca percentual entre o valor basal e a hipertermia de rSO2 foi de 0,03 (0,014‐0,435). Em nao sobreviventes, o valor basal de rSO2 foi de 30 (25‐65) e a diferenca percentual entre o valor basal de hipotermia de rSO2 foi de 0,031 (‐0,08‐20). Nao houve diferenca estatistica nas variacoes percentuais entre os valores da rSO2 na fase basal e de reaquecimento. Uma diferenca estatisticamente significativa foi observada entre os valores da GCS na fase basal e de reaquecimento dos grupos (p = 0,004). Nao houve diferenca estatisticamente significativa entre GCS, RC, RP, EB e rSO2 para determinar o prognostico. Conclusao Embora os valores da rSO2 tenham sido mais elevados em sobreviventes do que em nao sobreviventes, nao observamos uma diferenca estatisticamente significativa dos valores da rSO2 entre os grupos na fase basal e de reaquecimento. Como a mensuracao e simples, e nao afetada por hipotensao e hipotermia, a rSO2 pode ser um indicador util para determinar o prognostico apos a RCP.

Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. Design: Retrospective analysis. Measurements and results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33–34 °C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36 °C. Results: In survivors, the baseline rSO2 value was 67.5 (46–70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014–0.435). In non-survivors, the baseline rSO2 value was 30 (25–65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (−0.08 to −20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. Conclusion: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR. Resumo: Justificativa: Apesar dos novos avanços em reanimação cardiopulmonar (RCP), o dano cerebral muitas vezes ocorre após a reanimação. Objetivo: Avaliar o valor prognóstico de medir a saturação de oxigênio cerebral (rSO2) para estimar o prognóstico em pacientes após a reanimação cardiopulmonar. Projeto: Análise retrospectiva. Medidas e resultados: Foram avaliados após RCP 25 pacientes (12 do sexo feminino e 13 do masculino). Todos os pacientes foram submetidos à hipotermia (temperatura alvo de 33-34 °C). As mensurações da Escala de Coma de Glascow (GCS), dos reflexos corneanos (RC), dos reflexos pupilares (RP), e do excesso de base (EB) e rSO2 foram feitas na admissão. Na hipertermia, as mensurações de GCS, RC, RP, EB e rSO2 foram feitas depois que a temperatura atingiu 36 °C. Resultados: Em sobreviventes, o valor basal de rSO2 foi de 67,5 (46-70) e a diferença percentual entre o valor basal e a hipertermia de rSO2 foi de 0,03 (0,014-0,435). Em não sobreviventes, o valor basal de rSO2 foi de 30 (25-65) e a diferença percentual entre o valor basal de hipotermia de rSO2 foi de 0,031 (−0,08-20). Não houve diferença estatística nas variações percentuais entre os valores da rSO2 na fase basal e de reaquecimento. Uma diferença estatisticamente significativa foi observada entre os valores da GCS na fase basal e de reaquecimento dos grupos (p = 0,004). Não houve diferença estatisticamente significativa entre GCS, RC, RP, EB e rSO2 para determinar o prognóstico. Conclusão: Embora os valores da rSO2 tenham sido mais elevados em sobreviventes que em não sobreviventes, não observamos uma diferença estatisticamente significativa dos valores da rSO2 entre os grupos na fase basal e de reaquecimento. Como a mensuração é simples, e não afetada por hipotensão e hipotermia, a rSO2 pode ser um indicador útil para determinar o prognóstico após a RCP. Keywords: Cardiopulmonary resuscitation, Cerebral oxygen saturation, Prognosis, Palavras-chave: Reanimação cardiopulmonar, Saturação de oxigênio cerebral, Prognóstico

ResumoJustificativaAs dificuldades no manejo das vias aéreas são a principal causa de morbidade e mortalidade relacionada à anestesia pediátrica.ObjetivoAvaliar o valor do teste modificado de Mallampati, teste da mordida do lábio superior, distância tireomentoniana e relação altura‐distância tireomentoniana para prever intubação difícil em pacientes pediátricos.ProjetoAnálise prospectiva.Mensurações e resultadosDados coletados de 250 pacientes pediátricos, com idades entre 5 e 11 anos, submetidos à intubação traqueal. A classificação de Cormack e Lehane foi usada para avaliar laringoscopia difícil. Os valores de sensibilidade, especificidade, preditivo positivo e AUC para cada teste foram registrados.ResultadosA sensibilidade e especificidade do teste modificado de Mallampati foram 76,92% e 95,54%, enquanto para o ULBT foram 69,23% e 97,32%. O ponto de corte ideal para a relação altura‐distância tireomentoniana e distância tireomentoniana para prever laringoscopia difícil foi 23,5 (sensibilidade, 57,69%; especificidade, 86,61%) e 5,5cm (sensibilidade, 61,54%; especificidade, 99,11%). O teste de Mallampati modificado foi o mais sensível dos testes. A relação entre altura‐distância tireomentoniana foi o teste menos sensível.ConclusãoEsses resultados sugerem que os testes de Mallampati modificado e da mordida do lábio superior podem ser úteis em pacientes pediátricos para a previsão de intubação difícil.AbstractBackgroundThe difficulties with airway management is the main reason for pediatric anesthesia‐related morbidity and mortality.ObjectiveTo assess the value of modified Mallampati test, Upper‐Lip‐Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients.DesignProspective analysis.Measurements and resultsData were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured.ResultsThe sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test.ConclusionThese results suggested that the modified Mallampati and Upper‐Lip‐Bite tests may be useful in pediatric patients for predicting difficult intubation.

ResumenIntroducciónLas dificultades en el manejo de las vías aéreas son la principal causa de morbimortalidad relacionada con la anestesia pediátrica.ObjetivoEvaluar el valor del test modificado de Mallampati, test de la mordida del labio superior, distancia tiromentoniana y relación altura-distancia tiromentoniana para prever la intubación difícil en pacientes pediátricos.ProyectoAnálisis prospectivo.Medidas y resultadosDatos recopilados de 250 pacientes pediátricos con edades entre 5 y 11 años sometidos a la intubación traqueal. La clasificación de Cormack y Lehane fue usada para calcular laringoscopia difícil. Se registraron los valores de sensibilidad, especificidad, predictivo positivo y AUC para cada test.ResultadosLa sensibilidad y la especificidad del test modificado de Mallampati fueron del 76,92 y del 95,54%, mientras que para el ULBT fueron del 69,23 y del 97,32%. El punto de corte ideal para la relación altura-distancia tiromentoniana y distancia tiromentoniana para prever la laringoscopia difícil fue 23,5 (sensibilidad, 57,69%; especificidad, 86,61%) y 5,5cm (sensibilidad, 61,54%; especificidad, 99,11%). El test de Mallampati modificado fue el más sensible de los test. La relación entre altura-distancia tiromentoniana fue el test menos sensible.ConclusiónEsos resultados indican que los test de Mallampati modificado y de la mordida del labio superior pueden ser útiles en pacientes pediátricos para la previsión de la intubación difícil.AbstractBackgroundThe difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality.ObjectiveTo assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients.DesignProspective analysis.Measurements and resultsData were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured.ResultsThe sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test.ConclusionThese results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients" ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p

Objective: Mallampati scoring is the most common examination method for predicting possible intubation problems. The purpose of this study is to investigate the relationship of facial anthropometric measurements with the modified Mallampati score (MMS). Material and Methods: The study population consisted of 153 male and 170 female volunteers (mean ages, 48,9±16,9 and 44,1±15,4 years, respectively). All participants were subjected to Mallampati scoring and facial anthropometric measurements during pre-operative visit. Anthropometric measurements included inter-incisor gap, lower face height, thyrogonial length, thyromental distance and bigonial distance. The relationship of anthropometric measurements with the MMS was investigated by statistical analysis. Results: Bigonial distance showed a positive correlation with the MMS (r=0.857; p113 mm, and at this cut-off point, the sensitivity rate was 94.8% and the specificity rate was 95.9%. BGD was the best predictor for discriminating MMS 3-4. Conclusion: We suggest that facial measurements such as bigonial distance may be used as alternatives for Mallampati evaluation when the patient's condition is not suitable for Mallampati scoring. Turkish Başlık: Antropometrik Ölçümler Mallampati Sınıflaması Hakkında Ne Söyleyebilir? Anahtar Kelimeler: Antropometri, Bigonial mesafe, kesici dişler arası mesafe, Modifiye Mallampati skoru, Tiromental mesafe Giriş: Mallampati skoru entübasyon ile ilgili olası sorunları tahmin etmek için en yaygın kullanılan yöntemidir. Bu çalışmanın amacı, modifiye Mallampati skoru (MMS) ile yüz antropometrik ölçümler arasındaki ilişkiyi araştırmaktır. Metod: Çalışma 153 erkek ve 170 kadın gönüllü ile (ortalama yaş, 48,9 ± 16,9 ve 44,1 ± 15,4 yıl, sırasıyla) yapıldı. Tüm katılımcılar pre-operatif ziyareti sırasında Mallampati skoru değerlendirmesi ve yüz antropometrik ölçümleri yapıldı. Antropometrik ölçümler arasında kesici dişler arası mesafe, alt yüz yüksekliği, tirogonial uzunluk, tiromental mesafe ve bigonial mesafe vardı. MMS ile antropometrik ölçümler arasındaki ilişki istatistiksel analizi ile araştırıldı. Sonuç: Bigonial mesafe MMS ile pozitif korelasyon olduğu gözlendi kesici dişler arası mesafe, alt yüz yüksekliği ve tiromental mesafe negatif korelasyon göstermekteydi (r = 0.857 p 113 mm idi ve bunun duyarlılık oranı % 94.8 ve özgüllük oranı % 95.9 idi. Bigonial mesafe MMS 3-4 için en iyi tanımlayıcı olduğu saptandı. Tartışma: Bu çalışma, hastanın genel durumunun Mallampati skorunun değerlendirmesi için uygun olmadığı zamanlarda bigonial mesafe gibi antropometrik yüz ölçümleri Mallampati değerlendirmesi için alternatif olarak kullanılabileceğini göstermektedir.

Objective: Over one hundred predictive models were defined in the past for head injury (HI) prognosis, but none of them have been widely used up to the present. The aim of this study is to predict the prognosis of isolated HI patients by simply using data from the first day after injury. Materials and Methods: Data of head injury patients in Trakya University Hospital between January 1996 and December 2006 were obtained from records. The age, gender, causes of HI, basic neurologic examination findings, radiologic findings and discharge status are examined. Results: Most of the data were simplified as absent (0) and present (1), and mortality rates for each groups were accepted weighted values. All data were processed statistically and two models were created. Model 1 with Glasgow Coma Scale (GCS) score predicted the mortality/vegetative event at a rate of 56.5%, and the conscious survival event at 98.7%. Model 2, without the GCS score, predicted the mortality/vegetative event at 55.1% rate and the conscious survival event at 99.2%. Conclusion: Both models could be used for informing the patient and relatives and helping them to understand the severity of HI in busy working conditions of emergency departments.

Intra-abdominal pressure (IAP) is the steady-state pressure concealed within the abdominal cavity and is influenced by body weight, body position and abdominal muscle activity.1–3 A transient increase in IAP, such as pneumoperitoneum during laparoscopic surgery, causes only minimal adverse effects. Several clinical conditions, such as ascites and blood accumulation, tumours, burn eschars, edema, bowel distension5 and closure of a swollen and noncompliant abdominal wall,6 can cause a persistent increase in IAP.4–8 There has been a growing interest in the concept of IAP and in the impact of intra-abdominal hypertension (IAH) on organ dysfunction in critically ill patients.8,9 A pathologic increase in IAP has negative effects on splanchnic, respiratory, cardiovascular, renal and neurologic function. Intra-abdominal hypertension is defined by a sustained or pathologic elevation in IAP equal to or above 12 mm Hg, whereas abdominal compartment syndrome (ACS) is defined as an IAP above 20 mm Hg. Intra-abdominal hypertension not only has harmful consequences for different organ systems, but also is associated with mortality.8–12 In addition, it is associated with splanchnic hypoperfusion; thus, monitoring of regional organ blood flow and function is often crucial for guiding therapy in critically ill patients and is highly recommended.10,11,13 The dynamic liver test indocyanine green plasma disappearance rate (ICG-PDR) should provide better direct measurement of liver function and has been suggested as a marker of global hepato-splanchnic blood fow.14 The ICG-PDR is the most commonly used ICG-derived parameter for clinical and experimental assessment of liver function; the normal range is 18%–25% per minute. Noninvasive means of measuring ICG elimination using dye densitometry have been described since 1967, and the advent of pulse oximetry and subsequently pulse dye densitometry have led to the development of commercially available equipment for pulse spectrophotometry.15 The only such device currently in use in Turkey is the noninvasive liver function monitoring system LiMON (Pulsion Medical Systems). Previous studies have shown the value of measuring ICG-PDR for assessing prognosis.16,17 The aim of this study was to assess the effects of IAH on liver function using the LiMON and to assess the prognostic value of IAP in critically ill patients.

The aim of this study was to determine the types nosocomial infections (NIs) and the risk factors for NIs in the central intensive care unit (ICU) of Trakya University Hospital. The patients admitted to the ICU were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory over a 9-month-period. The samples of urine, blood, sputum or tracheal aspirate were taken from the patients on the first and the third days of their hospitalization in ICU; the patients were cultured routinely. Other samples were taken and cultured if there was suspicion of an infection. Infections were considered as ICU-associated if they developed after 48 hours of hospitalization in the unit and 5 days after discharge from the unit if the patients had been sent to a different ward in the hospital. The rate of NIs in 135 patients assigned was found to be 68%. The most common infection sites were lower respiratory tract, urinary tract, bloodstream, catheter site and surgical wound. Hospitalization in ICU for more than 6 days and colonization was found to be the main risk factor for NIs. Prolonged mechanical ventilation and tracheostomy, as well as frequently changed nasogastric catheterization, were found to be risk factors for lower respiratory tract infections. For bloodstream infections, both prolonged insertion of and frequent change of arterial catheters, and for urinary tract infections, female gender, period and repeating of urinary catheterization were risk factors. A high prevalence rate of nosocomial infections was found in this study. Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in ICU. Important factors to prevent nosocomial infections are to avoid long hospitalization and unnecessary device application. Control and prevention strategies based on continuing education of healthcare workers will decrease the nosocomial infections in the intensive care unit.

The study looked at the antimicrobial resistance patterns, serotypes, molecular types, metallo beta-lactamase, and chromosomal betalactamase enzymes of P. aeruginosa strains isolated from the patients and the staffs of the intensive care unit. P. aeruginosa isolates from the patients as nosocomial pathogens and from the staffs were evaluated for their susceptibilities to the antimicrobials by the disk diffusion and E-test methods. Metallo beta-lactamase enzymes were investigated by E-test, the inducibility of β - lactamase enzymes were detected by the disk antagonism test. Serotyping was performed by slide agglutination method. The P. aeruginosa isolates were typed by pulsed field gel electrophoresis. Twenty-five P. aeruginosa strains from the patients and three from the staffs were isolated. Fifteen P. aeruginosa, eleven of which composed of MDR bacteria, were found in serogroup E, 7 strains in G, 4 strains in B, and 1 strain in serogroup A. In all 12 bacteria in the MDR and serogroup E, metallo beta-lactamase enzyme was found to be positive. And in other 15 strains, except the bacterium which could not be serotyped, chromosomal beta-lactamase was found to be positive. The result of the molecular typing showed PFGE A pattern. In conclusion, a pattern in PFGE which included bacteria from MDR and serogroup E, G which was observed in the P. aeruginosa strains which was isolated from the staff’s hands and from the 5 patients, and PFGE F pattern were found to be observed the most. Finally, the two different clonal strains were found to be established in the intensive care.

BACKGROUND: We investigated the effects of gabapentin and dexamethasone given together or separately 1 h before the start of surgery on laryngoscopy, tracheal intubation, intraoperative hemodynamics, opioid consumption, and postoperative pain in patients undergoing varicocele operations. METHODS: Patients were randomly divided into four double-blind groups: group C (control, n = 20) received placebo, group G (gabapentin, n = 20) received 800 mg gabapentin, group D (dexamethasone, n = 20) received 8 mg dexamethasone, group GD (gabapentin plus dexamethasone) received both 800 mg gabapentin and 8 mg dexamethasone IV 1 h before the start of surgery. Standard induction and maintenance of anesthesia were accomplished and continued by propofol and remifentanil infusion. Heart rate and arterial blood pressure were recorded before induction and after intubation. Intraoperative total remifentanil consumption was recorded. Hemodynamic variables and visual analog scale were recorded for 24 h. Side effects were noted. RESULTS: Hemodynamics at 1, 3, 5, and 10 min after tracheal intubation, total remifentanil consumption during surgery, postoperative visual analog scale scores at 30 min, 1, 2, 4, 6, and 12 h, and postoperative nausea and vomiting were found to be significantly lower in group GD than in group G and group D (P < 0.05 for both), and substantially lower when compared with group C (P < 0.001). All values in group C were also higher than in groups G and D (P < 0.05). CONCLUSION: Gabapentin and dexamethasone administered together an hour before varicocele surgery results in less laryngeal and tracheal intubation response, improves postoperative analgesia, and prevents postoperative nausea and vomiting better than individual administration of each drug.

Purpose To compare efficacy and patient outcome of wound infiltration with ropivacaine, lornoxicam, or their combination for control of pain following thyroid surgery.

UNLABELLED: We investigated, in a randomized, placebo-controlled, double-blind study, the efficacy and safety of gabapentin on pain after abdominal hysterectomy and on tramadol consumption in patients. The 50 patients were randomized to receive either oral placebo or gabapentin 1200 mg 1 h before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50% N(2)O/O(2) with a fresh gas flow of 2 L/min (50% N(2)O in O(2)) and fentanyl (2 microg/kg). All patients received patient-controlled analgesia with tramadol with a 50 mg initial loading dose, 20 mg incremental dose, 10-min lockout interval, and 4-h limit of 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after 1 h. Patients were studied at 4, 8, 12, 16, 20, and 24 h for visual analog (VAS) pain scores, heart rate, peripheral oxygen saturation, mean arterial blood pressure, respiratory rate, sedation, and tramadol consumption. The VAS scores in the sitting and supine position at 1, 4, 8, 12, 16, and 20 h were significantly lower in the gabapentin group when compared with the placebo group up to 20 h after surgery. The tramadol consumption at 12, 16, 20, and 24 h and total tramadol consumption were significantly less in the gabapentin group when compared with placebo group. Sedation scores were similar at all the measured times. There were no differences between groups in adverse effects. Preoperative oral gabapentin decreased pain scores and postoperative tramadol consumption in patients after abdominal hysterectomy. IMPLICATIONS: This randomized, controlled trial examined the effects of preoperative oral gabapentin 1200 mg on postoperative pain and tramadol consumptions. We conclude that preoperative oral gabapentin is effective in reducing postoperative pain scores and tramadol consumption in patients after abdominal hysterectomy.

Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA. They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 microg/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 microg/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects.This study was designed to evaluate the effect of dexmedetomidine when added to lidocaine for IV regional anesthesia. This is the first clinical study demonstrating that the addition of 0.5 microg/kg dexmedetomidine to lidocaine for IV regional anesthesia improves quality of anesthesia and intraoperative-postoperative analgesia without causing side effects.

This study was designed to evaluate the effect of sufentanil, tramadol or clonidine added to lignocaine for intravenous regional anaesthesia. We investigated the onset and duration of sensory and motor block, the quality of the anaesthesia, intraoperative and postoperative haemodynamics, intraoperative and postoperative pain and sedation. Sixty patients undergoing ambulatory hand surgery received intravenous regional anaesthesia using 35 ml of 0.5% lignocaine and either 5 ml saline (Group L, n=15); sufentanil 25 μg (Group LS, n=15); tramadol 100 mg (Group LT, n=15) or clonidine 1 μg.kg –1 (Group LC, n=15). Before and after the tourniquet application, haemodynamic data, tourniquet pain, sedation scores and analgesic use were recorded. After tourniquet deflation, haemodynamic data, pain and sedation, time to first analgesic requirement and analgesic use were noted. There were no differences among groups in intraoperative haemodynamic data, the time to recovery of sensory block, the onset and the recovery of motor block, sedation scores or postoperative pain. Compared to the other groups, in Group L the onset of sensory block was longer, the time to initial tourniquet pain was shorter and the intraoperative tourniquet pain scores and use of the opioid were higher (P In conclusion, the addition of sulfentanil, tramadol or clonidine to lignocaine shortened the onset of the sensory block, delayed the onset time of the tourniquet pain and reduced the intraoperative consumption of opioid, but did not affect postoperative pain.

UNLABELLED We studied pantoprazole, a new potent and fast-acting proton pump inhibitor. Its effects on preoperative gastric fluid volume and pH have not yet been determined. In this randomized, controlled trial, we examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. Ninety patients (ASA status I and II, scheduled for elective surgery) were studied. One hour before surgery, patients in Group I (n = 30) were given IV saline 5 mL, those in Group II (n = 30) were given 40 mg of pantoprazole IV, and those in Group III (n = 30) were given 50 mg of ranitidine IV. A nasogastric tube was inserted immediately after anesthesia induction. Gastric contents were aspirated, and volume and pH were recorded. The pH values determined in Group I were 3.73 +/- 0.82; in Group II, they were 5.30 +/- 1.84; and in Group III, they were 4.80 +/- 1.40. There was no statistical difference between Groups 2 and 3, but there was a significant difference between Group I and Groups 2 and 3 (P < 0.0005). The volume of the gastric contents was 28.67 +/- 10.98 mL in Group I, 15.20 +/- 15.52 mL in Group II, and 7.77 +/- 11.17 mL in Group III. There was no statistical difference between Groups 2 and 3, but there was a statistically significant difference between Group I and Groups 2 and 3 (P < 0.0005). The proportion of patients considered "at risk" of significant lung injury should aspiration occur was 20% of Group I, 10% of Group II, and 3.3% of Group III. When statistically evaluated, there was no difference among groups. We concluded that the administration of IV pantoprazole and ranitidine 1 h before surgery is effective in reducing gastric pH and volume. IMPLICATIONS This randomized, controlled trial examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. We concluded that IV pantoprazole and ranitidine, given 1 h before surgery, are effective in reducing gastric pH and volume.

The aim of our study was to assess the effect of methylene blue infusion on plasma levels of cytokines in severe sepsis. In a prospective, randomized, double-blind, placebo-controlled study, patients received either methylene blue 0.5 mg.kg -1 .h -1 (MB group, n=15) or similar volume of isotonic saline (control group, n=15) IV for 6 hours. Plasma concentrations of tumour necrosis factor-α, interleukin-1, interleukin-2 receptor, interleukin-6, interleukin-8 were measured by sensitive immunoassays at basal (15 min before start of the study), immediately after, and at 24 and 48 hours after methylene blue infusion. We evaluated haemodynamic parameters (mean arterial pressure, heart rate), blood gases, methaemoglobin levels, and biochemical parameters at the same time. Methylene blue administration had no significant effect on plasma cytokine levels, blood gases and biochemical parameters. When compared to placebo infusion in controls, methylene blue administration resulted in significantly higher mean arterial pressure (85±14 mmHg vs 74.1±10.3 mmHg; P We found that methylene blue infusion did not change cytokine levels or outcome in severe sepsis. The administration of methylene blue, however, resulted in a transient increase in arterial pressure. Because of the limited size of the present study, and the short period of observation, our findings need to be confirmed by larger clinical trials of methylene blue infused in a dose-titrated manner.

Neostigmine has been added to local anesthetics for central and peripheral nerve blocks resulting in prolonged, increased anesthesia and improved analgesia. We conducted this study to evaluate the effects of neostigmine when added to prilocaine for IV regional anesthesia (IVRA). Thirty patients undergoing hand surgery were randomly assigned to two groups to receive IVRA. The control group received 1 mL of saline plus 3 mg/kg of prilocaine diluted with saline to a total dose of 40 mL; the study group received 0.5 mg of neostigmine plus 3 mg/kg of prilocaine diluted with saline to a total dose of 40 mL. Sensory and motor block onset and recovery, anesthesia quality determined by an anesthesiologist, anesthesia quality determined by a surgeon, and dryness of the operative field were noted. Heart rate, mean arterial blood pressure, and oxygen saturation values were noted at 1, 5, 10, 20, and 40 min before surgery and after tourniquet release. Time to first analgesic requirement was also noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, improved quality of anesthesia, and prolonged time to first analgesic requirement were found in the neostigmine group. We conclude that neostigmine as an adjunct to prilocaine improves quality of anesthesia and is beneficial in IVRA.Neostigmine has been added to local anesthetics for central and peripheral nerve blocks. This study was conducted to evaluate the effects of neostigmine when added to prilocaine for IV regional anesthesia (IVRA). Neostigmine as an adjunct to prilocaine improves quality of anesthesia and is beneficial in IVRA.

This randomized controlled trial examined the effects of preoperative oral erythromycin or nizatidine on gastric pH and volume. Sixty patients, ASA 1 and 2 status scheduled for elective surgery were studied. All subjects received oral study medication with 10 ml of water 60 minutes prior to surgery. Patients in Group 1 (n=20) were given erythromycin 200 mg, in Group 2 (n=20) nizatidine 300 mg, and in Group 3 (n=20) placebo capsule. A nasogastric tube was inserted immediately after anaesthesia induction. Gastric content was aspirated, and volume and pH recorded.pH values determined in Group 1 were 5.6±1.87; in Group 2, 5.65±1.92 and in Group 3, 3.5±1.93. There was no statistical difference between Groups 1 and 2, but there was a statistically significant difference between Group 3 and Groups 1 and 2 (PWe conclude that oral erythromycin and nizatidine given one hour prior to surgery are effective in reducing gastric pH and volume.

We compared the efficacy of ondansetron, lidocaine, tramadol, and fentanyl in minimizing pain caused by the injection of rocuronium in 250 patients. After tourniquet application on the forearm, the patients were given saline (3 mL) (Group 1, n = 50), ondansetron (4 mg) (Group 2, n = 50), lidocaine (30 mg) (Group 3, n = 50), tramadol (50 mg) (Group 4, n = 50), or fentanyl (100 microg) (Group 5, n = 50) diluted into a 3-mL solution. The occlusion was released after 20 s and rocuronium was injected over 10-15 s. The patients were observed and asked immediately if they had pain in the arm, and the response was assessed. Reactions such as discomfort and pain, withdrawal of the hand, and so on after the administration of rocuronium were recorded as side effects for 24 h. Ten patients in Group 1, 28 patients in Group 2, 37 patients in Group 3, 30 patients in Group 4, and 15 patients in Group 5 reported no pain. Light pain was seen in 11 patients in Group 1, 14 patients in Group 2, 11 patients in Group 3, 12 patients in Group 4, and 20 patients in Group 5. Moderate pain was seen in 15 patients in Group 1, 6 patients in Group 2, 2 patients in Group 3, 8 patients in Group 4, and 10 patients in Group 5. Severe pain was seen in 14 patients in Group 1, 2 patients in Group 2, 0 patients in Group 3, 0 patients in Group 4, and 5 patients in Group 5. Correlation determined with log-linear analysis found in Group 1 pain score 0 (P0.001), Group 1 pain score 1 (P0.001), and Group 3 pain score 0 (P0.001). We conclude that ondansetron, lidocaine, tramadol, and fentanyl decrease the level of rocuronium injection pain. Among these drugs, lidocaine is the most effective, whereas fentanyl is the least effective.We compared the efficacy of ondansetron, lidocaine, tramadol, and fentanyl in minimizing the pain on injection of rocuronium in 250 patients. Ondansetron, lidocaine, tramadol, and fentanyl were effective in preventing and decreasing the level of rocuronium injection pain. Among these drugs, lidocaine was the most effective, and fentanyl was the least effective.

Objective: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death worldwide with a continued rising mortality rate, and it represents a major socioeconomic burden. The aim of this study was to examine the costs of acute exacerbation of COPD patients admitted to two different university hospital intensive care units. Material and Methods: We analyzed 156 patients (128 male and 28 female) who were admitted for treatment of acute exacerbations of COPD from January 1, 2005 to June 15, 2008. Results: The mean age of the patients was 68.2 years. The mean length of hospitalisation stay was 10.4 days. The costs were different between survivors and non-survivors. There was a statistically significant difference between survivors and non-survivors groups in all costs except bed costs, laboratory costs, radiology costs and consultation costs. Conclusion: These results suggest that the cost of patients with acute exacerbations of COPD represents a considerable economic burden for the health care system in Turkey. Turkish Başlık: Kronik Obstrüktif Akciğer Hastalığı Akut Alevlenmesi Olan Hastaların İki Üniversite Hastanesi Anahtar Kelimeler: Kronik obstrüktif akciğer hastalığı; akut alevlenme; maliyet analizleri Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) dünya çapında ölümlerin ana nedeni olup, mortalite hızı sürekli yükselmekte ve önemli sosyoekonomik yük oluşturmaktadır. Bu çalışmada iki farklı üniversite hastanesi yoğun bakım ünitesinde KOAH akut alevlenmesi olan hastaların maliyetlerinin incelenmesi hedeflenmiştir. Gereç ve Yöntemler: 1 Ocak 2005 ile 15 Haziran 2008 tarihleri arasında KOAH akut alevlenmesi nedeniyle tedavi olan 156 hasta (128 erkek ve 28 kadın) analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 68.2 olarak bulunmuştur. Ortalama hastanede kalış süresi 10.4 gün olarak saptanmıştır. Sağ kalan ve ölen hastaların maliyetleri birbirlerinden farklı bulunmuştur. Sağ kalanlar ve ölen hastalar arasında yatak ücreti, laboratuar ücreti, radyoloji ücreti ve konsültasyon ücretleri dışındaki diğer tüm tedavi maliyetlerinde istatistiksel farklılık saptanmıştır. Sonuç: KOAH akut alevlenmesi olan hastaların tedavi maliyetlerinin Türk sağlık sistemi içinde hatırı sayılır yer oluşturduğunu düşünmekteyiz., Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) dünya çapında ölümlerin ana nedeni olup, mortalite hızı sürekli yükselmekte ve önemli sosyoekonomik yük oluşturmaktadır. Bu çalışmada iki farklı üniversite hastanesi yoğun bakım ünitesinde KOAH akut alevlenmesi olan hastaların maliyetlerinin incelenmesi hedeflenmiştir. Gereç ve Yöntemler: 1 Ocak 2005 ile 15 Haziran 2008 tarihleri arasında KOAH akut alevlenmesi nedeniyle tedavi olan 156 hasta (128 erkek ve 28 kadın) analiz edilmiştir. Bulgular: Hastaların ortalama yaşı 68.2 olarak bulunmuştur. Ortalama hastanede kalış süresi 10.4 gün olarak saptanmıştır. Sağ kalan ve ölen hastaların maliyetleri birbirlerinden farklı bulunmuştur. Sağ kalanlar ve ölen hastalar arasında yatak ücreti, laboratuar ücreti, radyoloji ücreti ve konsültasyon ücretleri dışındaki diğer tüm tedavi maliyetlerinde istatistiksel farklılık saptanmıştır. Sonuç: KOAH akut alevlenmesi olan hastaların tedavi maliyetlerinin Türk sağlık sistemi içinde hatırı sayılır yer oluşturduğunu düşünmekteyiz.

Introduction. Dynamic tests for predict-ing fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion in-dex and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in deter-mining fluid responsiveness.Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and re-animation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontane-ous breathing, cardiac arrhythmia, and impaired peripheral circulation. We meas-ured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45° semi-recumbent position (SP) and then 15° Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 ± 10.57 to 12.66 ± 9.64; p > 0.05), while we did observe significant de-creases in PVI (from 21.91 ± 13.99 to 20.46 ± 14.12; p < 0.05). The PPV fluid respon-siveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specific-ity) and 18% (76.67% sensitivity, 72.46% specificity), respectively. The PVI fluid responsiveness cut-off value in the SP and TP was 20% (80.49% sensitivity, 81.03% specificity) and 16% (81.25% sensitivity, 62.69% specificity), respectively. The area under the ROC of the PPV and PVI was 0.843 and 0.858 in the SP, respectively, and 0.760 and 0.747 in the TP, respectively. The PPV and PVI were correlated in the SP (r = 0.578; p = 0.001) and the TP (r = 0.517; p = 0.001).Conclusions. Our results showed that the PPV and PVI were correlated independent of position change in sepsis patients. Both tests appear to be equivalently reliable. However, the ability of the PPV and PVI to predict fluid responsiveness decreased in the TP in our study.

DOI: 10.4328/JCAM. 617 Received: 16.02.2011 Accepted: 05.03.2011 Printed: 01.01.2013 J Clin Anal Med 2013;4(1): 58-60 Corresponding Author: Mehmet Turan Inal, Trakya Universitesi Tip Fakultesi, Anesteziyoloji ve Reanimasyon AD, 22030, Edirne, Turkiye. T.: +9

Purpose. Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy, but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion. We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests (ICG-PDR). Methods. We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy. The patients were randomly allocated to two groups. In Group I, the operation was performed using 10 mmHg pressure pneumoperitoneum. In Group II, 14 mmHg pressure pneumoperitoneum was used. The ICG-PDR measurements were made after induction (ICG-PDR 1) and after the end of the operation (ICG-PDR 2). Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels were all recorded preoperatively, 1 hour, and postoperative 24 hours after surgery. Results. The ICG-PDR 1 values for Groups I and II were as follows: 2 6 . 7 8 ± 4 . 2 % per min versus 2 6 . 0 1 ± 2 . 4 % per min ( 𝑃 > 0 . 0 5 ). ICG-PDR 2 values were found to be 2 5 . 6 3 ± 2 . 1 % per min in Group I versus 1 9 . 0 6 ± 2 . 2 % per min in Group II ( 𝑃 0 . 0 5 ). There was a statistically significant decrease between baseline and postoperative ICG-PDR values in Group II compared to Group I ( 𝑃 0 . 0 5 ). Statistically, there was an increase between baseline and postoperative 1st-hour serum AST and ALT level in Group II ( 𝑃 0 . 0 5 ) compared to Group I. No statistical differences were detected on postoperative 24st-hour serum AST and ALT levels and all the time bilirubin between groups ( 𝑃 > 0 . 0 5 ). Conclusion. In conclusion, the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels. We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.

Background. Prolonged mechanical ventilation is associated with adverse clinical outcomes for critically ill patients. Objective. To assess the the extubation times of protocolised versus automated weaning systems in patients after major surgery in intensive care unit. Design. Retrospective analysis. Measurements and results. We analyzed 70 patients with major abdominal or pelvic surgery. Patients that were used Draeger Evita2 Dura for weaning process named as the C (control) group (n=35) and patients that were used Draeger Evita2 XL Smartcare/PS named as the SC group (n=35). A physician evaluate the patient every 5 or 10 minutes in group C. Gender, age, weight, operation time, operation type, the total volume of intravenous infusion, bleeding, total dose of propofol, fentanyl citrate, rocuronium during surgery and extubation time were all recorded. All side effects included reintubation, bleeding, stroke, death, postoperative myocardial infarction were all recorded. The partial oxygen pressure (Pa02) and partial carbondioxide pressure (PaC02) were recorded before and after extubation. Results. Demographic data and operative data were similar between groups (p>0.05). The extubation time was similar between groups (SC group versus C group: 191,14±79,1 min versus 188,29±51,47 min, p=0,534. There was significant decrease in arterial PO2 and increase in arterial PCO2 after extubation in all groups. No side effects were observed. Conclusion. In conclusion, although we found no differences between SmartCare and control groups, the evaluating of the patient increased the workload in the control group. We think that SmartCare decreased the workload. Thus, it can be recommended for weaning process of patients after major surgery in intensive care unit.

IMPLICATIONS Magnesium sulfate, 2.48 mmol, injected 20 s before the administration of propofol significantly reduced the incidence of pain caused by a propofol injection and may be useful in minimizing this common side effect.