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ResumoJustificativa e objetivoComparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina‐propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré‐medicadas com midazolam‐cetamina‐atropina programadas para procedimentos de circuncisão.Métodos60 crianças, estado físico ASA I‐II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo‐cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05mgkg−1+cetamina3mgkg−1+atropina0,02mgkg−1 por via intramuscular, na presença dos pais na área de intervenções pré‐operatórias. A indução foi realizada com propofol‐cetamina no Grupo I ou cetamina isolada no Grupo II.ResultadosNas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial (p>0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p

Resumen Justificativa y objetivos: La evaluacion de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las infecciones relacionadas con la asistencia a la sanidad (IRAS) entre las UCIs de diferentes hospitales y las unidades del mismo hospital. Material y metodos: De enero de 2007 a diciembre de 2010, un estudio de vigilancia retrospectivo fue realizado para identificar infecciones nosocomiales, tasas de infecciones relacionadas con los dispositivos y agentes causantes en la unidad de cuidados intensivos (UCI) de anestesiologia. Las IRAS se definieron de acuerdo con los criterios del Centro de Control y Prevencion de Enfermedades (CDC) y las infecciones relacionadas con los dispositivos invasivos definidas de acuerdo con los criterios del Sistema Nacional de Vigilancia de Infecciones Nosocomiales (NNIS). Resultados: Durante dos anos, se evaluaron 939 pacientes dentro de un universo de 7.892 pacientes/dia. Las tasas de IRAS alcanzaron el umbral del 53% en 2007, 29,15% en 2008, 28,85% en 2009 y 16,62% en 2010. La IRAS mas frecuente fue la infeccion de la corriente sanguinea. La tasa de infeccion de tejido suave y de la piel fue la segunda. Entre los pacientes con infecciones nosocomiales, los agentes causantes mas a menudo encontrados fueron Gr (-) 56,68%, Gr (+) 31,02% y la candidiasis 12,3%. Conclusiones: La incidencia de IRAS en la UCI de nuestro hospital fue alta en comparacion con las tasas turcas globales obtenidas en el Refik Saydam Center en 2007. Cuando las tasas de infecciones relacionadas con los dispositivos se compararon entre 2007 y 2008, fueron mayores en el 2007. Las tasas de infecciones relacionadas con los dispositivos en 2008 quedaron por debajo del promedio nacional a causa de las medidas de control de infeccion. Como la tasa de infecciones relacionada con el cateter urinario todavia permanece alta, debemos esforzarnos mas en el sentido de controlar las infecciones.

PURPOSE The effects of different body positions on the middle ear were reported in several studies, but there are no data about the effects on patients under general anesthesia. The aim of this study is to determine the effect of prone position on middle ear pressure (MEP) during general anesthesia without using nitrous oxide. METHODS Twenty patients under general anesthesia during prone position were included in the study. The performed anesthesia method was the same for all patients. Remifentanil was used for analgesia instead of nitrous oxide. MEPs were measured 5 times with a middle ear analyzer: before induction (BI), after intubation (AI), after turned to the prone position (PP1), at the end of the prone position (PP2), and after returned to the supine position (SP). Duration of prone position was also recorded. RESULTS Of the 20 patients were 11 women and 9 men with a 49 ± 13 mean age. BI-AI, AI-PP1, PP1-PP2, and PP2-SP comparisons of both MEPs were statistically significant (P < 0.0001). Right mean MEPs were BI, -1 ± 23 daPa; AI, 41 ± 51 daPa; PP1, 124 ± 76 daPa; PP2, 152 ± 59 daPa; and SP, 63 ± 29 daPa; whereas left mean MEPs were BI, -24 ± 55 daPa; AI, 28 ± 34 daPa; PP1, 132 ± 67 daPa; PP2, 162 ± 48 daPa; and SP, 70 ± 89 daPa. Significant increases were detected at the start and continuation of the prone position. The mean duration of prone position was 98 ± 51 per minute. CONCLUSIONS The significant MEP increases during the prone position under general anesthesia depend on a number of reasons. Among them are inhaler agents, pressure changes in mucosal blood vessels due to venous congestion, and the mastoid bone volume. Further researches are required to determine and explain the mechanisms of increase in MEP during prone position.

Aim: Infection is an important problem in intensive care units (ICU) which is a complication of nutritional support. In our institution, we aimed to determine the differences in infection rates of patients who were supported with parenteral nutrition (PN) and enteral + parenteral nutrition (EN+PN) combination retrospectively. Material and Method: In this study, we enrolled 156 patients from January 1, 2011 to Agust 1, 2011. There were 88 patients in the parenteral nutrition group (Group 1) and 68 patients in the enteral+ parenteral nutrition group (Group 2). On all 156 patients, retrospective chart reviews were performed and biweekly culture results were recorded. Specifically, soft tissue infections, skin infections, catheter related blood stream infections, pneumonia and urinary tract infections were recorded. HI (hospital infection) incidences and incidence densities were also calculated in both groups. Results: There were 16 recorded infections in 16 patients among Group 1. These were 4 cases of catheter related blood stream infections, 4 cases of pneumonia, 3 cases of urinary tract infections and 5 cases of soft tissue infections. In group 2, 8 patients showed signs of infection. These were, 4 cases catheter related blood stream infections, 2 cases of soft tissue infections and 2 cases of urinary tract infections. There were no reported pneumonia cases in group 2. Discussion: According to our results, with the exception of catheter related blood stream infections, infection numbers declined within the group of combination of enteral and parenteral nutrition group than parenteral nutrition group alone, but the results were not statistically significant. The intolerance to enteral nutrition can increase the cost of stay, mainly due to increased length of stay as a result of increased infection rates. We would recommend a combination nutrition regimen in such a similar situation, in order to decrease infection rates.

Among headache syndromes cervicogenic headache is a common problem which originates from region of the neck. When wide range of pharmacological treatment options are inadequate, interventional procedures are applied.[1] After trigger point injections, greater occipital nerve block (GONB) which is the most frequently applied technique among interventional methods has an important role in the treatment of cervicogenic headaches.[2] Although the possibility of complication after GONB is very low, some side effects e.g. bleeding, infection, and allergic reactions can be seen after the application. [3] Folliculitis is a skin condition which occurs with inflammation of the hair follicles.[4] No report was obtained about association of GONB and folliculitis after an extensive database search. We report a case of folliculitis as a rare complication of GONB.

The main aim of the study was to investigate the effects of age in pulmonary consultation and to evaluate differences between geriatric and adult patients. Consultation referrals to the clinic of chest diseases for patients from emergency, inpatient and outpatient clinics of a tertiary care general hospital between December 2010 and April 2011 were examined retrospectively. The patients were divided into two groups, namely those aged 65 years and over (geriatric patients) and those under the age of 65 years (adults). Out of 272 patients 135 (49.6 %) were geriatric patients and 137 (50.4 %) were adult patients. The mean age of the geriatric patients and adults was 75.6 ± 7.1 years and 49.7 ± 11.8 years, respectively. While the geriatric patients showed a significantly higher presence of pathologies in chest radiography, respiratory complaints and concomitant diseases compared to the adult group, the respiratory function test results were lower. The complaint of shortness of breath was higher in the geriatric group compared to the adult group (71 % in geriatric patients and 59.1 % in adults). The most common diagnosis was chronic obstructive pulmonary disease (COPD, 37 %) in the geriatric patients and asthma (27.7 %) in the adult patients. As to the results of consultations, treatment-oriented recommendations were given for 63 (46.6 %) geriatric patients and approval for operation was given for 75 (54.7 %) adult patients. Consultants should take the age of patients into consideration during evaluation in order to achieve the most appropriate treatment plan for these patients and reduce the potential postoperative complications to a minimum.

Background and objective: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam–ketamine–atropin who are prepared circumcision operation. Methods: 60 American Society of Anaesthesiologists physical status I–II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol–ketamine in Group I or ketamine alone in Group II. Results: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p

Congenital laryngeal cysts (CLCs) are rare and may be fatal. Although CLCs have the potential to cause severe airway obstruction and death, these are not common presentations at birth. The most common CLCs are the aryepiglottic cysts, with the epiglottic cysts being the least common. In this report, a newborn with severe airway obstruction at birth, caused by a giant congenital epiglottic cyst, is presented.

JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS) entre as unidades de terapia intensiva (UTI) de diferentes hospitais e unidades do mesmo hospital. MATERIAL E MÉTODOS: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identificar infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram definidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC) e as infecções relacionadas aos dispositivos invasivos definidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS). RESULTADOS: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (-) 56,68%, Gram (+) 31,02% e candidíase 12,3%. CONCLUSÕES: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refik Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções. BACKGROUND AND OBJECTIVES: Evaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. MATERIAL AND METHODS: A retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. RESULTS: During a two-year period, 939 patients were analyzed throughout a total of 7,892 patientdays. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(-) 56.68 %, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. CONCLUSIONS: The incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of devicerelated infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control. JUSTIfiCATIVA Y OBJETIVOS: La evaluación de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las infecciones relacionadas con la asistencia a la sanidad (IRAS) entre las UCIs de diferentes hospitales y las unidades del mismo hospital. MATERIAL Y MÉTODOS: De enero de 2007 a diciembre de 2010, un estudio de vigilancia retrospectivo fue realizado para identificar infecciones nosocomiales, tasas de infecciones relacionadas con los dispositivos y agentes causantes en la unidad de cuidados intensivos (UCI) de anestesiología. Las IRAS se definieron de acuerdo con los criterios del Centro de Control y Prevención de Enfermedades (CDC) y las infecciones relacionadas con los dispositivos invasivos definidas de acuerdo con los criterios del Sistema Nacional de Vigilancia de Infecciones Nosocomiales (NNIS). RESULTADOS: Durante dos años, se evaluaron 939 pacientes dentro de un universo de 7.892 pacientes/día. Las tasas de IRAS alcanzaron el umbral del 53% en 2007, 29,15% en 2008, 28,85% en 2009 y 16,62% en 2010. La IRAS más frecuente fue la infección de la corriente sanguínea. La tasa de infección de tejido suave y de la piel fue la segunda. Entre los pacientes con infecciones nosocomiales, los agentes causantes más a menudo encontrados fueron Gr (-) 56,68%, Gr (+) 31,02% y la candidiasis 12,3%. CONCLUSIONES: La incidencia de IRAS en la UCI de nuestro hospital fue alta en comparación con las tasas turcas globales obtenidas en el Refik Saydam Center en 2007. Cuando las tasas de infecciones relacionadas con los dispositivos se compararon entre 2007 y 2008, fueron mayores en el 2007. Las tasas de infecciones relacionadas con los dispositivos en 2008 quedaron por debajo del promedio nacional a causa de las medidas de control de infección. Como la tasa de infecciones relacionada con el catéter urinario todavía permanece alta, debemos esforzarnos más en el sentido de controlar las infecciones.

Tricyclic antidepressant overdose is one of the most common cause of serious drug poisonings. Sometimes amitriptyline intoxication can be difficult to treat with standard treatments. At that case hemodiafiltration (HD) can be an eligible choice. We report a successful treatment of severe case using hemodiafiltration in addition to the supportive measures. Management with gastric lavage, activated charcoal, alkalinization and supportive care is the common approach and not enough for patients in deep coma. We satisfied that HD may have a beneficial role in lethal doses of amitriptyline as an additional therapy.

Aims: The procedure of laryngoscopic orotracheal intubation (LOTI) has many impacts on several parts of the body. But its effect on middle ear pressure (MEP) is not known well. The purpose of this study is to evaluate the MEP changes subsequent to insertion of endotracheal tube with laryngoscope. Subjects and methods: 44 patients were included in this study with a normal physical examination of ear, nose and throat. A standard general anaesthesia induction without any inhaler agent was performed to the all patients. The MEP measurements for both ears were applied under 1 minute; before induction (BI) and after intubation (AI) with a middle ear analyzer. Also hemodynamic parameters were recorded before induction and after intubation. Results: Of the 44 patients were 25 women and 19 men with a 43.5±15.1 mean age. A statistically significant rise in MEP was seen in all patients subsequent to insertion of endotracheal tube (P