Background: Glycemic variability (GV) is a prevalent and significant condition observed in critically ill patients. This study aimed to investigate the relationship between early glycemic variability parameters and 28-day mortality in critically ill patients. Methods: A multicenter, prospective, and observational study was performed at five tertiary intensive care units (ICUs) in Turkey. All patients who had more than six blood glucose level (BGL) measures per 24 h were included. The parameters of GV including the SD, MGL, MGD (the difference between the maximal and minimal glucose level), and the CV (the percentage of SD to the MGL) in the first 24 h were recorded. Results: A total of 578 eligible patients were enrolled in the study, of whom 43.6% were women. The mean age of the patients was 68.09 ± 16.62 years. Overall mortality was 31.5% (n = 182). The glycemic parameters of the CV, SD, and MGD were significantly higher in the non-survivor group than in the survivor group (p = 0.040, 0.006, and 0.002, respectively). The multivariate logistic regression analysis revealed that the CV (OR 1.023; 95% CI 1.004–1.042; p = 0.017) was an independent factor that increased mortality. Spearman’s rho correlation analysis revealed a strong (r:0.871) and statistically significant correlation (p < 0.001) between the CV and MGD. Conclusions: The CV calculated within the first 24 h of ICU admission is independently associated with 28-day mortality. The MGD is correlated with the CV and is maybe a practical tool to predict increased risk of mortality at the bedside. However, further studies are needed to establish the independent association of the MGD with mortality.

A prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5mgkg(-1) propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6mgkg(-1) rocuronium, a tourniquet was applied to one arm and inflated to 50mmHg greater than systolic pressure. The patients were divided into 3 groups; 1mgkg(-1)h(-1) esmolol was given as the loading dose and in Group Es50 50μgkg(-1)min(-1), in Group Es150 150μgkg(-1)min(-1), and in Group Es250 250μgkg(-1)min(-1) esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p<0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.In clinical practise we believe that after 1mgkg(-1) loading dose, 150μgkg(-1)min(-1) iv esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects.

Background: Remifentanil, an ultra-short-acting μ-receptor agonist, is used with propofol or thiopental for tracheal intubation without muscle relaxants. While effective with both, its combination with thiopental provides better hemodynamic stability. Thiopental has long been a standard intravenous agent for anaesthesia induction and remains a cost-effective alternative to propofol in resource-limited settings. To date, no study has directly compared the effects of thiopental–remifentanil and propofol–remifentanil combinations on LMA insertion conditions. This study aims to compare the effects of thiopental or propofol with 2 µg·kg⁻¹ remifentanil on laryngeal mask airway (LMA) insertion conditions and success in a prospective, randomised double-blind study. Method: The study included 80 premedicated ASA I-II patients, aged 18–65, randomised into Group P (propofol) and Group T (thiopental). Anaesthesia induction was with 2 μg·kg⁻¹ remifentanil, followed by 5 mg·kg⁻¹ thiopental or 2.5 mg·kg⁻¹ propofol. LMA insertion occurred 90 s post-induction. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values were recorded at baseline, 1 min pre-insertion, and at 1, 2, 3, 4, and 5 min after insertion. Apnoea duration, loss of eyelash reflex duration, insertion duration, number of attempts, and perioperative complications were also documented. Results: Demographic data were similar. Group P showed significantly shorter eyelash reflex loss and LMA insertion durations, longer apnoea duration, and higher rates of full mouth opening, excellent LMA insertion condition, and hypotension or bradycardia compared to Group T (p < 0.05). Group P had significantly lower HR, SAP, DAP, and MAP at various time points (p < 0.05). There were no significant differences in blood presence on LMA, sore throat, or dysphagia (p > 0.05). Conclusions: In our study, administration of 2 μg·kg⁻¹ remifentanil before induction along with thiopental or propofol was shown to provide acceptable LMA insertion conditions at comparable levels. As hemodynamic parameters were less affected, we believe the remifentanil–thiopental combination may be a suitable alternative.

ResumoObjetivoAvaliar os efeitos de três doses diferentes de gabapentina como pré‐tratamento sobre a incidência e a gravidade dos movimentos mioclônicos associados à injeção de etomidato.MétodoCem pacientes, entre 18‐60 anos, estado físico ASA I‐II, programados para cirurgia eletiva sob anestesia geral, foram incluídos no estudo. Os pacientes foram randomicamente divididos em quatro grupos e duas horas antes da operação receberam cápsulas orais de placebo (Grupo P, n = 25), 400mg de gabapentina (Grupo G400, n = 25), 800mg de gabapentina (Grupo G800, n = 25) e 1.200mg de gabapentina (Grupo G1.200, n = 25). Os efeitos colaterais antes da cirurgia foram registados. Após pré‐oxigenação para a indução da anestesia, etomidate (0,3mg.kg−1) foi administrado por 10 segundos. Um único anestesista, cego para a medicação do estudo, avaliou a sedação e os movimentos mioclônicos com uma escala de 0 a 3. Dois minutos após a indução, fentanil (2μgr.kg−1) e rocurônio (0,8mg.kg−1) foram administrados para a intubação traqueal.ResultadosOs dados demográficos foram semelhantes. A incidência e a gravidade da mioclonia nos grupos G1.200 e G800 foram significativamente menores do que no Grupo P; a incidência e o nível de sedação foram consideravelmente maiores comparados com o Grupo P e o Grupo G400. Enquanto não houve diferença na incidência de mioclonia entre os grupos P e G400, a gravidade da mioclonia no Grupo G400 foi menor do que no grupo placebo. No período de duas horas antes da indução, nenhum dos efeitos colaterais relacionados à gabapentina, exceto sedação, foi observado em qualquer paciente.ConclusãoO pré‐tratamento com 800mg e 1.200mg de gabapentina duas horas antes da operação aumentou o nível de sedação e reduziu a incidência e a gravidade dos movimentos mioclônicos associados ao etomidato.AbstractAimTo evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection.MethodOne hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I–II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg−1 etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2μgkg−1 fentanyl and 0.8mgkg−1 rocuronium were administered for tracheal intubation.ResultsDemographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two‐hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient.ConclusionPretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate

Background and objectivesGuillain–Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain–Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain–Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit.Case reportA 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain–Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain–Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service.ConclusionsOur case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain–Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis

AimTo evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection.MethodOne hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I–II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg−1 etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2μgkg−1 fentanyl and 0.8mgkg−1 rocuronium were administered for tracheal intubation.ResultsDemographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient.ConclusionPretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate