Arterial Oxygen Saturation Values Research Articles

Objective Approach for Titration of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Using Daytime Continuous Positive Airway Pressure Titration Based on Respiratory Movement Regularity.

Background/Objectives: Continuous positive airway pressure (CPAP) is used to treat patients with obstructive sleep apnea (OSA) and has proven clinical efficacy for this condition. However, the objective method to determine the appropriate CPAP level for treatment is still unclear. Patients with OSA typically exhibit irregular respiratory efforts due to obstruction or narrowing of the upper airway during sleep. Treatment with an adequate CPAP level alleviates airway obstruction or narrowing, leading to more regular respiratory patterns. We aimed to develop an objective CPAP titration method using the respiratory regularity index (RRI) derived from respiratory movements. Methods: We conducted daytime CPAP titration in 10 patients with OSA. Respiratory movements were recorded by inductance plethysmography in three conditions: wake, apnea, and during CPAP therapy. The RRI of respiratory movements was calculated in each condition, and the CPAP level with the lowest RRI was identified as the appropriate air pressure level in each patient. CPAP therapy at the appropriate level determined by the study method was conducted for 2 months, after which efficacy was assessed by night polysomnography in the hospital. Results: The fixed air pressure level for the CPAP device was determined as 7.8 ± 0.7 cmH2O based on our daytime CPAP titration method using the RRI. The apnea-hypopnea index improved significantly from before CPAP therapy (43.1 ± 15.3 h-1) to during CPAP therapy (3.0 ± 2.1 h-1) (p < 0.006). The Epworth Sleepiness Scale score decreased significantly during CPAP therapy. The lowest percutaneous arterial oxygen saturation values in each sleep stage also improved significantly with the CPAP determined by our daytime CPAP titration method. Conclusions: The study findings showed that our daytime CPAP titration method based on the RRI is an effective method for determining individualized appropriate CPAP levels in patients with OSA. The RRI-based daytime CPAP titration method offers a simplified approach to determining the adequate CPAP level for patients with OSA.

Physiological effects of hand grip and cold pressor tests in young Saudi adults.

The risk of cardiovascular disease differs among various ethnic groups, highlighting disparities in cardiovascular health among different populations. While multiple studies from other countries have looked at changes in physiological parameters during autonomic function tests like isometric handgrip and cold pressor tests, no correlational research has been done in Saudi Arabia. This lacuna underscores the importance of examining the relationship between cardiorespiratory parameters in young Saudi Arabian individuals during these tests. This study aimed to determine the correlation between the isometric handgrip and cold pressor tests and physiological parameters in healthy young Saudi Arabian college students. A single-arm interventional study was conducted with a cohort of 65 healthy young adult Saudi college students, including male and female participants. A point estimate was calculated with a 95% confidence level. Physiological parameters were analyzed and compared at rest and during isometric handgrip and cold pressor tests. The study involved participants with an average age of 21.12 ± 1.02, predominantly male students. A significant impact was observed only in respiratory rate (P = 0.007) during the isometric handgrip and cold pressor tests. In contrast, blood pressure parameters and arterial oxygen saturation values showed no statistical significance during both tests. This sheds light on their autonomic responses to physiological stressors and contributes to our understanding of cardiovascular health across diverse populations, guiding future interventions for global improvements in cardiorespiratory outcomes.

Coinherited Hemoglobin Lansing-Ramathibodi/Southeast Asian Deletional α0-thalassemia and Hemoglobin E Causing Falsely Low Oxygen Saturation on Pulse Oximetry

OBJECTIVE Hemoglobin (Hb) variants resulting from mutations in globin genes and leading to qualitative abnormalities of globin proteins can result in a spectrum of clinical presentations. Herein we describe a case of a 10-year-old boy with an Hb variant, Hb Lansing-Ramathibodi (HBA1:c.264C&gt;G, codon 87 His&gt;Gln), who was incidentally found to have low pulse oximetry oxygen saturation readings (low SpO2). Laboratory investigations revealed mild microcytic anemia. Arterial blood gas showed normal partial pressure of oxygen (PaO2) and arterial oxygen saturation (SpO2) values, indicating an oxygen saturation gap. Subsequent Hb analysis identified an abnormal peak, prompting further molecular studies which confirmed the coinheritance of Hb Lansing-Ramathibodi, Southeast Asian deletional α0-thalassemia and the Hb E trait. The patient’s mother, carrying the Hb Lansing-Ramathibodi and Hb E traits without Southeast Asian deletional α 0-thalassemia, was asymptomatic. This case underscores the importance of identifying and characterizing rare Hb variants presenting with an oxygen saturation gap for informed clinical management and genetic counseling. KEYWORDS alpha-thalassemia, coinheritance, hemoglobin Lansing- Ramathibodi, low SpO2, oxygen saturation

Comparison of the vitality test with sensitivity tests in mature and immature teeth: clinical trial.

One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is not completed, the response to sensitivity tests may not yield definite results. Pulse oximetry (PO) which is considered as a vitality test, measures the arterial oxygen saturation (SpO2). This study aims to compare PO, electric pulp test (EPT) and cold test in mature and immature permanent teeth. 20 immature and 20 mature permanent incisors of 6-12-year-old ASA1 children who did not use any analgesics, were included in the study. Pulp vitality of the teeth was determined by EPT, cold test and PO. An infant probe of PO device (CMS60D, Contec Medical Systems Co. Ltd, China) was used to determine the SpO2 of the teeth. The SpO2 level is controlled on the patient's finger by a children's probe and an infant probe of PO. Shapiro-Wilk, Spearman rank correlation test and Kruskal-Wallis test/Dunn post-hoc analysis were used for statistical comparisons. There was no significant correlation between finger SpO2 and the mature/immature teeth SpO2 (r=-0.026, r = 0.253). Arterial oxygen saturation values in the immature teeth were significantly higher than in the mature teeth (p = 0.002). There was a high correlation between the vitality response of the EPT, cold test and PO. Pulse oximetry can be used as an effective vitality test compared to sensitivity tests in both immature and mature permanent incisors.

COVID-19-associated morbidity and mortality outcomes in pregnant patients admitted to intensive care unit

Background: Our study aimed to evaluate the clinical characteristics and maternal-fetal outcomes of pregnant women admitted to the ICU due to COVID-19 pneumonia. Materials and Methods: Demographic data, presenting complaints, laboratory values, pregnancy outcomes, delivery method, and ICU mortality were recorded. Results: A total of 10 pregnant patients were admitted to the intensive care unit of our hospital due to SARS-COV-2 infection during the 2-year period. Arterial blood oxygen saturation values measured at admission to the ICU were higher in the surviving patients. Six of the 10 patients died. Only one of the 7 patients requiring invasive mechanical ventilation survived. Conclusions: We found that COVID-19-infected pregnant women with severe symptoms have several maternal morbidities and poor obstetric outcomes, such as prolonged intensive care unit stay, increased mortality, neonatal deaths, and caserean section.

Effects of progressive muscle relaxation exercises on the vital signs and fatigue in kidney transplant patients: a randomized controlled trial.

Multiple effective nursing interventions are needed to manage deviations from normal vital signs and fatigue experienced by kidney transplant patients. In this study, we investigated the effect of progressive muscle relaxation (PMR) exercises on vital signs and fatigue in kidney transplant patients. We conducted a randomized controlled experimental study with 52 patients (intervention = 26, control = 26) who underwent kidney transplantation at a university hospital in Turkey and met the inclusion criteria. The "Descriptive Characteristics Form", "Vital Signs Monitoring Form", and "Fatigue Severity Scale" were used to record data on the patients. Then, the patients in the intervention group (baseline assessment) were trained to perform PMR exercises, asked to practice, and followed up (first follow-up). Patients were recommended to perform PMR exercises for 20min every day for four weeks. The second follow-up in the second week after discharge and the third follow-up at the end of the fourth week were performed in the outpatient clinic. We found that the pulse rate, body temperature, and arterial blood pressure decreased over time and oxygen saturation increased in the patients of the intervention group. The PMR exercises decreased fatigue in these patients. The arterial blood pressure and oxygen saturation values differed significantly across different time points among the patients in the control group. The difference in the scores of fatigue severity between the pre-follow-up and the third follow-up in the control group was not significant. PMR exercises were found to be an effective nursing intervention in regulating vital signs and reducing fatigue in renal transplant patients.

Comparison of the Sedative Effects of Dexmedetomidine and Remifentanil in Vitrectomy Surgery: A Retrospective Study.

Background Vitrectomy surgery is a painful and lengthy procedure. Therefore, administering sedation to reduce patient agitation provides both surgical comfort and hemodynamic stability. However, various complications can arise during the perioperative period depending on the sedation agent used. In our study, we aimed to evaluate the effects of dexmedetomidine and remifentanil sedation applications on patient hemodynamics and perioperative complications in vitrectomy surgery. Methods Our retrospective study included patients aged 18-70 who underwent vitrectomy surgery between 2021 and 2022 with complete file data and ASA scores of 1-3 after obtaining approval from our hospital's ethics committee. Patients were classified into two groups based on the sedation agent used: Group D for dexmedetomidine and Group R for remifentanil. Demographic data of patients, heart rate, mean arterial pressure, oxygen saturation, and bispectral index values during perioperative monitoring, operation duration, and complications such as perioperative nausea, vomiting, and low saturation were recorded. The data of both groups were statistically evaluated, with p<0.05 values considered statistically significant. Results Because of missing data in 18 out of 58 patient files, these cases were excluded from the study. A total of 40 patients were included in the study, with 20 in Group D and 20 in Group R. The mean age of the patients was 64. Among them, 18 (45%) were male, and 22 (55%) were female. The mean operation duration was 61.8 ± 24.1 minutes in Group D and 56.3 ± 17.2 minutes in Group R. The heart rate in Group D was statistically significantly lower than in Group R, starting from the 20th minute of the perioperative period. There were no significant differences between the groups in terms of mean arterial pressure, oxygen saturation, and bispectral index values. One case of bradycardia occurred in Group D, requiring intervention. Conclusion In vitrectomy surgery, both dexmedetomidine and remifentanil infusions can be used for sedation, but caution is advised regarding bradycardia in Group D. Anticipating potential complications with an experienced anesthesia team is crucial for both patient and surgical comfort.

Arterial oxygen saturation in healthy Mexican full-term newborns at different altitudes above sea level.

Arterial oxygen saturation (SaO2) values are used to make clinical decisions that might change a patient's prognosis, and it has been proposed as the fifth vital sign. This study aimed to determine the variation of SaO2 at different altitudes above sea level (ASL) in healthy Mexican full-term newborns. From July 2018 to June 2019, a cross-over study was conducted in six hospitals at different altitudes ASL in Mexico. SaO2 was measured in 4015 newborns after the first 24 h of birth and before leaving the hospital using pulse oximetry. We analyzed three groups: < 250 m ASL (group 1), 1500 m ASL (group 2), and 2250 m ASL (group 3). The mean SaO2 was 97.6 ± 1.8%. For group 1, mean oxygen saturation was 98.2 ± 1.9%; for group 2, 96.7 ± 1.9%, and for group 3, 96.0 ± 2.1%. A statistically significant difference was observed among the groups (p < 0.001), and this difference was higher between groups 1 and 2 (1.5%, p < 0.001). Linear regression analysis showed a decrease in oxygen saturation of 1.01% for every 1000 m ASL. We demonstrated a statistically significant reduction in SaO2 levels at higher altitudes. This observation can be relevant for clinical decision-making based on pulse oximetry such as critical congenital heart disease screening in Mexico, where more than half of the population lives above 1500 m ASL.

Unexpected cardiac arrest in the neurosurgical ward

Objective: This study aimed to identify possible predictors of unexpected cardiac arrest (CA) in the neurosurgical ward.Methods: A retrospective review of 24 patients who experienced unexpected CA between December 2012 and March 2022 was conducted. Data on demographics, diagnoses, comorbidities, CA timing, pre-CA vital signs, transfer interval from intensive care unit (ICU) to ward, cardiac rhythm, neurological outcomes, and probable causes were collected. We excluded patients who died in the ICU and those with a do-not-resuscitate order.Results: The average age was 70.3 years. Vascular diseases and head traumas were common diagnoses. About 70.8% of arrests occurred during on-call time and 62.5% took place on weekends. The mean interval between ICU transfer and CA was 13.8±29.7 days, with 54.2% occurring within 4 days and 83.3% within 14 days. Pulseless electrical activity was the most frequent initial cardiac rhythm when CA occurred. Respiratory issues were the leading cause of CA (54.2%), and 91.7% of patients had poor neurological outcomes. Within 48 hours before CA, the average value of the lowest arterial oxygen saturation significantly deteriorated from 95.8±2.9% to 90.1±11.4%.Conclusion: Unexpected CA often occurred on weekends and during night duty. Half of the cases took place within 4 days and over 80% within 2 weeks of transferring from the ICU to the ward, with respiratory problems being the main cause. Greater attention should be given to patients’ breathing patterns during night shifts and weekends, especially within the first 2 weeks after patients leave the ICU.

Effects of fentanyl and sucrose on pain in retinopathy examinations with pain scale, near-infrared spectroscopy, and ultrasonography: a randomized trial.

This study aimedto compare the efficacy of intravenous, intranasal fentanyl and oral sucrose inreducing the pain response during retinopathy of prematurity examinations using premature infant pain profile (PIPP) scores. The study included 42 infants who underwent retinopathy screening examinations. The infants were divided into three groups: oral sucrose, intranasal fentanyl, and intravenous fentanyl. Vital signs (heart rate, arterial oxygen saturation, and mean arterial pressure) were recorded. The PIPP was used to determine pain severity. Cerebral oxygenation and middle cerebral artery blood flow were evaluated using near-infrared spectroscopy and Doppler ultrasonography, respectively. The data obtained were compared between groups. There was no significant difference between the three groups regarding postconceptional and postnatal ages or birth weights and weight at the time of examination. All babies had moderate pain during the examination. No correlation was observed between analgesia method and pain scores (P = 0.159). In all three groups, heart rate and mean arterial pressure increased, whereas oxygen saturation decreased during the exam compared with pre-examination values. However, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation (sPO2) values did not differ between groups (HR, P = 0.150; MAP, P = 0.245; sPO2, P = 0.140). The cerebral oxygenation (rSO2) values between the three groups were found to be similar [rSO2: P = 0.545, P = 0.247, P = 0.803; fractional tissue oxygen extraction (FTOE): P = 0.553, P = 0.278]. Regarding cerebral blood flow values, we also did not find any difference between the three groups [mean blood flow velocity (Vmean): P = 0.569, P = 0.975; maximum flow velocity (Vmax): P = 0.820, P = 0.997]. Intravenous and intranasal fentanyl and oral sucrose were not superior to each other in preventing pain during the examination for retinopathy of prematurity (ROP). Sucrose may be a good alternative for pain control during ROP examination. Our findings suggest that ROP exam may not affect cerebral oxygenation or cerebral blood flow. Larger scale studies are needed to determine the best pharmacological option to reduce pain during ROP exams and evaluate the effects of this procedure on cerebral oxygenation and blood flow.

The Effect of Oxygenation on Mortality in Patients With Head Injury.

Introduction In this study, we planned to investigate the effect of hyperoxygenation on mortality and morbidity in patients with head trauma who were followed and treated in the intensive care unit (ICU). Methods Head trauma cases (n = 119) that were followed in the mixed ICU of a 50-bed tertiary care center in Istanbul between January 2018 and December 2019 were retrospectively analyzed for the negative effects of hyperoxia. Age, gender, height/weight, additional diseases, medications used, ICU indication, Glasgow Coma Scale score recorded during ICU follow-up, Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of hospital/ICU stay, the presence of complications, number of reoperations, length of intubation, and the patient's discharge or death status were evaluated. The patients were divided into three groups according to the highest partial pressure of oxygen (PaO2) value (200 mmHg) in the arterial blood gas (ABG) taken on the first day of admission to the ICU, and ABGs on the day of ICU admission and discharge were compared. Results In comparison, the first arterial oxygen saturation and initial PaO2 mean values were found to be statistically significantly different. There was a statistically significant difference in mortality and reoperation rates between groups. The mortality was higher in groups 2 and 3, and the rate of reoperation was higher in group 1. Conclusion In our study, mortality was found to be high in groups 2 and 3, which we considered hyperoxic. In this study, we tried to draw attention to the negative effects of common and easily administered oxygen therapy on mortality and morbidity in ICU patients.

Reliability of smartphone measurements of peripheral oxygen saturation and heart rate in hypotensive patients measurement of vital signs with smartphones

ObjectiveWith the increasing use of wearable technologies (smartphones and smartwatches), it has become possible to measure vital signs outside healthcare institutions without the need for an additional medical device. With the advancement in technologies, the accuracy of vital signs measured by smartphones and smartwatches has also increased. In this study, the accuracy of smart devices in the measurement of heart rate and saturation, which are two vital signs that are difficult to detect in conditions such as hypotension were investigated. Materials and methodsThe study was prospectively conducted in a tertiary healthcare center. In hypotensive patients who presented to the emergency department (ED) and required an arterial blood gas evaluation, oxygen saturation and heart rate values measured by a smartphone, those measured with a vital signs monitor (VSM) at the time of admission to the ED and oxygen saturation values measured by a blood gas analyzer (BGA) were compared. ResultsA total of 200 patients, 117 women and 83 men, were included in the study. It was determined that the correlation coefficients of the heart rate values measured by the vital signs monitor and smartphone were in a high statistical agreement. When the saturation values measured by the vital signs monitor, smartphone, and blood gas analyzer were compared, it was found that the intra-class correlation coefficients of the saturation values measured by the smartphone with reference to the blood gas analyzer and vital signs monitor were 0.957 and 0.949, respectively, indicating an excellent agreement. ConclusionSmartphones have as high efficiency as reference devices in measuring heart rate and saturation in hypotensive patients. In this way, hypotensive patients who need medical help can also have the opportunity to measure their vital parameters with their smartphones, without the need for any other medical device, before applying to the hospital or emergency health system. This may contribute to the improvement of the quality of life of the patients and the early and accurate information of the health care providers about the patient's health parameters.

Racial effects on Masimo pulse oximetry: a laboratory study

Recent publications have suggested that pulse oximeters exhibit reduced accuracy in dark-skinned patients during periods of hypoxemia. Masimo SET® (Signal Extraction Technology®) has been designed, calibrated, and validated using nearly equal numbers of dark and light skinned subjects, with the goal of eliminating differences between pulse oximetry saturation (SpO2) and arterial oxygen saturation (SaO2) values due to skin pigmentation. The accuracy concerns reported in dark-skinned patients led us to perform a retrospective analysis of healthy Black and White volunteers. Seventy-five subjects who self-identified as being racially Black or White underwent a desaturation protocol where SaO2 values were decreased from 100 to 70%, while simultaneous SpO2 values were recorded using Masimo RD SET® sensors. Statistical bias (mean difference) and precision (standard deviation of difference) were − 0.20 ± 1.40% for Black and − 0.05 ± 1.35% for White subjects. Plots of SpO2 versus SaO2 show no significant visible differences between races throughout the saturation range from 70 to 100%. Box plots grouped in 1% saturation bins, from 89–96%, and plotted against concomitant SaO2 values, show that occult hypoxemia (SaO2 < 88% when SpO2 = 92–96%) occurred in only 0.2% of White subject data pairs, but not in any Black subjects. There were no clinically significant differences in bias (mean difference of SpO2-SaO2) found between healthy Black and White subjects. Occult hypoxemia was rare and did not occur in Black subjects. Masimo RD SET® can be used with equal assurance in people with dark or light skin. These laboratory results were obtained in well-controlled experimental conditions in healthy volunteers—not reflecting actual clinical conditions/patients.

Accuracy enhancement in reflective pulse oximetry by considering wavelength-dependent pathlengths

Objective. Noninvasive measurement of oxygen saturation (SpO 2) using transmissive photoplethysmography (tPPG) is clinically accepted and widely employed. However, reflective photoplethysmography (rPPG)—currently present in smartwatches—has not become equally accepted, partially because the pathlengths of the red and infrared PPGs are patient-dependent. Thus, even the most popular ‘Ratio of Modulation’ (R) method requires patient-dependent calibration to reduce the errors in the measurement of SpO 2 using rPPGs. Approach. In this paper, a correction factor or ‘pathlength ratio’ β is introduced in an existing calibration-free algorithm that compensates the patient-dependent pathlength variations, and improved accuracy is obtained in the measurement of SpO 2 using rPPGs. The proposed pathlength ratio β is derived through the analytical model of a rPPG signal. Using the new expression and data obtained from a human hypoxia study wherein arterial oxygen saturation values acquired through Blood Gas Analysis were employed as a reference, β is determined. Main results. The results of the analysis show that a specific combination of the β and the measurements on the pulsating part of the natural logarithm of the red and infrared PPG signals yields a reduced root-mean-square error (RMSE). It is shown that the average RMSE in measuring SpO 2 values reduces to 1 %. Significance. The human hypoxia study data used for this work, obtained in a previous study, covers SpO 2 values in the range from 70 % to 100 %, and thus shows that the pathlength ratio β proposed here works well in the range of clinical interest. This work demonstrates that the calibration-free method applicable for transmission type PPGs can be extended to determine SpO 2 using reflective PPGs with the incorporation of the correction factor β. Our algorithm significantly reduces the number of parameters needed for the estimation, while keeping the RMSE below the clinically accepted 2 %.

Accuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review.

One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy in adults under poor perfusion conditions. A multiple database search was conducted from inception to December 2020. The inclusion criteria were as follows: (1) adult participants (> 18years) with explicitly stated conditions that cause poor peripheral perfusion (conditions localized at the oximeter placement site; or systemic conditions, including critical conditions such as hypothermia, hypotension, hypovolemia, and vasoconstricting agents use; or experimental conditions) (2) a comparison of arterial oxygen saturation and arterial blood gas values. A total of 22 studies were included and assessed for reliability and agreement using a modified Guidelines for Reporting Reliability and Agreement Studies tool. We calculated the accuracy root mean square error from bias and precision we extracted from the studies. Most oximeters (75%) were deemed accurate in patients with poor perfusion. Modern oximeters utilizing more complex algorithms were more likely to be accurate than older models. Earlobe placement of oximeters seemed more sensitive, with greater measurement accuracy, than on fingertip placement. Only one study controlled for skin pigmentation, and none strictly followed Food and Drug Association recommendations for experiments to determine oximeter accuracy. Oximeters are accurate in poorly perfused patients, especially newer oximeter models and those placed on earlobes. Further studies are needed that examine multiple oximeter models used on a diverse selection of patients while following FDA recommendations to examine oximeter accuracy.

Preemptive analgesic effect of ultrasonography-guided transversus abdominis plane block performed by adding dexamethasone to bupivacaine

The objective of this study was to evaluate the preemptive analgesic effect of ultrasound-guided transversus abdominis plane block performed with bupivacaine or adding dexamethasone on bupivacaine in laparoscopic cholecystectomy. This retrospective study was conducted on a total of 84 patients who underwent ultrasound-guided TAP block in laparoscopic cholecystectomy. Patients were divided into two groups: Group Bupivacaine (Group B) and Group Bupivacaine+Dexamethasone (Group B+D). Intraoperative hemodynamic changes, intraoperative remifentanil consumption, postoperative visual analog scale scores, tramadol consumption in 24 hours postoperatively, and postoperative first analgesic time were obtained from the records and compared between the groups. There were no statistically significant differences between both groups in terms of intraoperative heart rate, mean arterial pressure, oxygen saturation, and end-tidal CO2 values. Postoperative visual analog scale scores, doses of remifentanil and total tramadol, and time of receiving the first analgesic were similar. Dexamethasone can be added to the bupivacaine for the TAP block without major side effects. Adding dexamethasone to bupivacaine in transverse abdominis plane block performed in laparoscopic cholecystectomy procedures did not create a significant difference in VAS score. We think that the use of dexamethasone does not have an additional analgesic effect. However, our results should be supported by further studies.

Effect of bronchoscopy on intracranial hypertension during different regimen of sedation by optic nerve sheath diameter

Objectives: Fiberoptic bronchoscopy (FOB) is a useful method for ventilator-associated pneumonia (VAP), aspiration, and atelectasis, especially in intensive care units. (ICU) We aimed to investigate the effect of FOB on intracranial pressure by ultrasonographic optic nerve sheath diameter (uONSD) during different sedation protocols in a tertiary ICU. Methods: Prospective randomized study included the patients with two groups as superficial (Group M; midazolam) and deep sedation (Group P; propofol). FOB was performed for VAP or aspiration and intracranial hypertension (ICH) was measured with uONSD, noninvasively. The values of uONSD were noted pre-procedure, on sedation, 1st – 5th, and 15th minute of the procedure. In addition, mean arterial pressures (MAP), oxygen saturation, and heart rate values were recorded from the monitor. Results: The mean age and indications of FOB for 33 patients as Group M (n=17) and Group P (n=16) were similar to each other. ONSD was increased with the procedure in both groups but in group P it was stabilized from the 5th minutes of FOB whereas became higher progressively in group M (p&lt;0,001). Postoperative MAP values that may have an important role for ICH were also increased in Group M (MAP was 70.65 ± 16.18 at time of sedation in Group P and 75.63 ± 13.76 in Group M). Conclusion: This study showed that bronchoscopy results as a significant increase for OSND in both groups but that was less high in patients who had deep sedation with propofol and it returned to baseline after the procedure.

Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department.

Background: High-flow nasal cannula (HFNC) oxygen is becoming an integral part of respiratory failure management. Effects of HFNC on arterial blood gas (ABG) parameters especially partial carbon dioxide (PaCO2) require further investigation to provide insight into the efficacy and safety of the treatment.Methods: Acute respiratory failure patients with sequential ABG parameters before and after initiating HFNC between June 2015 and June 2017 were analyzed in a tertiary academic center. Patients' baseline characteristics were evaluated and sequential ABG changes were compared and subgrouped as chronic obstructive pulmonary disease (COPD), respiratory acidosis, hypercapnia, and high lactate.Results: A total of 120 patients were enrolled in the study. There was a significant difference between the mean partial pressure of oxygen in arterial blood (PaO2), lactate, and peripheral oxygen saturation (SpO2) values between sequential ABGs after HFNC (P <0.001). In the COPD group (n=32), there was a significant difference between initial ABG means of PaO2, lactate, and SpO2 values and sequential ABG means (p<0.001). Hypercapnic patients PaCO2 levels were significantly lower after HFNC (p<0.001), while in the COPD group there was no significant change in PaCO2 values (p=0.068).Conclusions: Treatment with HFNC produced improvement of blood gas parameters in subjects with acute respiratory failure in the emergency department (ED). These results suggest that HFNC can be used in hypercapnic patients as well as hypoxemic patients. Further randomized controlled studies required to establish the impact of HFNC in the ED.

Comparison of General Anesthesia (Sevoflurane) and Spinal Anesthesia (Levobupivacaine) Methods on QT Dispersion in Inguinal Hernia Operations.

IntroductionArrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II).MethodsThe study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method.ResultsWhen the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group.ConclusionIn our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.

Effect of non-steroidal anti-inflammatory drugs on glomerular filtration rate and urinary N-acetyl-β-D-glucosaminidase activity in cats after dental surgery

ObjectiveTo compare the effects of meloxicam or carprofen on glomerular filtration rate (GFR), and to evaluate the effect of meloxicam on urinary N-acetyl-β-D-glucosaminidase (NAG) activity, of cats after dental surgery. Study designRandomized, blinded, controlled trial. AnimalsA total of 24 mixed breed cats. MethodsCats were randomly assigned to one of three groups (n = 8 per group): meloxicam (0.2 mg kg–1); carprofen (4 mg kg–1); or saline (2 mL). Acepromazine (0.04 mg kg–1) and buprenorphine (0.02 mg kg–1) were administered intramuscularly as preanaesthetic medication. Test drugs were injected subcutaneously at the time of preanaesthetic medication. Anaesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. Mean arterial blood pressure (MAP), respiratory rate (fR), heart rate (HR) and haemoglobin oxygen saturation values (SpO2) were recorded. All cats underwent ultrasonic dental scaling with polishing. Teeth extraction involved mucosal flap creation, removal of alveolar bone and flap closure. Plasma iohexol clearance (ICL), a measure of GFR, was estimated before and 24 hours after anaesthesia induction in all cats. Urinary NAG index was estimated in saline and meloxicam groups at the same time points as GFR. Between-group and -time point differences in GFR and NAG index were compared using mixed model analyses. Data are presented as mean ± standard deviation (p < 0.05). ResultsThere was no significant difference in plasma ICL rate (range: from 1.22 ± 0.05 to 1.27 ± 0.04 mL kg minute–1) between groups or between time points. Urinary NAG index (range: from 1.0 ± 0.19 to 1.36 ± 0.29 Units gram–1) was not significantly different between meloxicam and saline groups. MAP, HR, fR and SpO2 did not differ significantly between groups. Conclusions and clinical relevanceMeloxicam and carprofen appeared to produce nonsignificant effects on GFR, and meloxicam did not affect the urinary NAG activity, of cats after dental surgery.