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  • ISSN: 2333-6641
    Volume 8, Issue 1
    Research Article
    Burcu Tanay Demirdoven*, Ridvan Atilla, Basak Bayram, Gulcim Saracoglu, and Ugur Koca
    Objectives: In this study, we aimed to determine the mortality, readmission and cardiac intervention rates of the patients with elevated cardiac troponin I (cTnI) levels, who had no acute coronary syndrome (ACS), and who were discharged from Emergency Department (ED).
    Methods: The 28-day mortality rate of the patients with elevated cTnI levels, who were admitted to a university hospital ED within a 30-month period, and who were discharged from ED, was retrospectively investigated. The Control Group was consisted of the patients with normal/low cTnI levels and who were discharged from ED. Both groups were compared in terms of mortality, readmission and cardiac intervention rates within a 28-day period.
    Results: 3,288 (1.5% of all ED admissions) of patients had elevated cTnI levels. 336 (10.2%) patients with elevated cTnI and without ACS were discharged from the ED. The mortality rate (7.1% vs. 0.5%, p=0.00), the readmission rate (34.2% vs. 6.2% p=0.00) and the mortality rate for short-term readmission (20.8% vs. 8.3% p=0.00) were found to be significantly higher in patients with elevated cTnI levels compared with the control group. However, there was no significant difference between the two groups in terms of cardiac intervention rate for readmissions (12.2% vs. 12.5%).
    Conclusion: The results of our study show that the readmission rates and the mortality rates (especially due to heart failure) at readmission significantly increased in the patients with elevated cTnI levels compared to normal/low cTnI levels.
    Guillermo García-March, Pau Capilla-Guasch*, Félix Pastor Escartín, Rafael Badenes, Guillermo García-Catalán, Luís Real Peña, and José M. González-Darder
    Background: Spinal cord stimulation (SCS) is used to treat chronic pain and requires an alert patient to locate paresthesia for optimal lead positioning. Epidural anesthesia may be a suitable anesthetic but has not been evaluated in larger cohorts.
    METHODS: We performed an open-label, prospective, observational, single-center study in 138 patients to evaluate the safety and efficacy of laminectomy lead placement under epidural anesthesia for neuropathic chronic pain treatment.
    Results: There were statistically significant differences between intraoperative and postoperative (at 24 h) stimulation variables needed to produce paresthesias. Thus, the mean deviations of intra- and postoperative stimulation intensity (V) were 4.3 ± 1.5 and 3.2 ± 1.3, respectively (P <0.05) with single-channel stimulation, and 4.6 ± 1.3 and 3.4 ± 1.1 (P <0.05) with dual-channel simulation.
    Conclusions: This is the first study of epidural anesthesia for SCS lead implant by laminectomy in a wide patient sample. The technique seems to be safe and effective.
    Case Report
    Khaleel Ahmad Najar*
    Ischemic heart disease may occur in isolation, or in combination with the pathological process of vascular ageing, arteriosclerosis. These two conditions have differing impacts on the haemodynamic changes in response to anaesthesia and surgery. Hypertension is not a feature of ischemic heart disease, and viceversa, but where the two conditions co-exist; hypertension aggravates and accelerates the pathological processes of ischemic heart disease. Patients older than 40 yrs. presenting for anaesthesia and surgery must therefore be considered at risk of any combination of these three conditions. Anaesthetic techniques must also be chosen to minimize haemodynamic changes which in the normal healthy patient cause no serious morbidity, but which, in the patient with ischemic heart disease, can lead to serious morbidity or death.
    Khaleel Ahmad*, Shaheen Parveen and Shahnaz Gilani
    Skininfiltration of adrenalineis a common practice in ENT surgeries and has been in use for many years to providehemostasis. However, accidental intravascular injection of adrenaline can result in adverse cardiovascular effects, such as arrhythmias, pulmonary oedema, and even cardiac arrest. We report a case of adrenaline-induced hypertensive crisisfollowed by ventricular tachycardia dueto subcutaneous infiltration of 1: 200,000 adrenaline in 2% lignocaine solution in a patient undergoing thyroid lobectomyprocedure. Wesuccessfully provided advanced cardiac life support in the operating room and cardioverted the patient back into a sinus rhythm with no untoward effects and completed the surgical procedure. The patient recovered without any apparent sequelae after intensive care.
    Mahmood Ghazawy, Mohamed Shaaban Ali*, Fatma Zoro, Hisham Mohamed Abd El Fattah, and Ali ME Alsanousi
    Charcot-Marie-Tooth disease (CMTd) is the most common form of peripheral neuropathy characterized by progressive distal muscle weakness and atrophy. Although life expectancy is normal, quality of life is lessened due to deformity, immobility or chronic pain. Limited safety data for the kind of anesthesia to be administered in such patients has caused an argumentative concern for the anesthesia provider. The purpose of this case report is to emphasize the prospective edge of total intravenous anesthesia (TIVA) using propofol and remifentanil in CMTd patient without getting into litigious or controversial methods of administering drugs, gases or regional techniques.
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