Procalcitonin Levels as an Early Marker in Patients with Multiple Trauma under Intensive Care

This prospective study investigated the levels of procalcitonin (PCT) and C-reactive protein (CRP) in patients with various types and severity of multiple trauma, and their relationship to trauma-related complications. Adult multiple-trauma patients ( n = 113) admitted to the intensive care unit (ICU) in the first 24 h after trauma were included. The Injury Severity Scores (ISS), and PCT and CRP levels were measured in the first 24 h (day 1), on day 7 and on the final day of their ICU stay. Survival at 30 days was recorded. Mean PCT and CRP levels were both significantly higher on day 7 compared with day 1 and the final assessment day in patients with an ISS > 20. Levels of PCT were significantly higher in cases with sepsis, severe sepsis or septic shock compared with cases who developed systemic inflammatory response syndrome (SIRS), however levels of CRP were significantly higher only in cases with severe sepsis or septic shock, but not in cases with sepsis alone. These data support the view that PCT levels may be a better indicator than CRP levels in the early diagnosis of septic complications in patients with multiple trauma.

Comparison of Entropy and Bispectral Index during Propofol and Fentanyl Sedation in Monitored Anaesthesia Care

Comparison of entropy (state entropy [SE] and response entropy [RE]) with the bispectral index (BIS) during propofol sedation in monitored anaesthesia care (MAC) was carried out in patients undergoing hand surgery. Thirty candidates for elective hand surgery were pre-medicated with midazolam 0.06 mg/kg and atropine 0.01 mg/kg. Sedation was induced with intravenous propofol and fentanyl was also administered. The Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) was used to determine sedation level and pain was maintained at < 4 on a 0-10 verbal rating scale. The BIS, entropy, MOAA/S and pain values were recorded before initiation of sedation (control), during initiation of sedation, during surgery, and for 30 min after the end of surgery and anaesthesia. On initiation of sedation, entropy decreased more rapidly than BIS. At 10 min after initiation of sedation, the mean ± SD values for MOAA/S, BIS, RE and SE were 3.00 ± 0.36, 85.45 ± 0.15, 74.00 ± 0.60 and 72.02 ± 0.12, respectively. During recovery, BIS and RE and SE increased in parallel with MOAA/S. It is concluded that entropy monitoring is as reliable as BIS monitoring in MAC.

Effectiveness of oxygenation and suction in cataract surgery: is suction of CO2-enriched air under the drape during cataract surgery necessary?

PURPOSE

To investigate the effectiveness of aspiration of expired air by a suction system on peripheral oxygen saturation (SpO(2)) and end tidal carbon dioxide (EtCO(2)) during cataract surgery.

MATERIALS AND METHODS

In total, 160 pre-medicated patients aged between 40 and 70 years (ASA I-III, classification of patients according to the American Society of Anesthesiologists) scheduled for cataract surgery under retrobulbar or peribulbar block were examined in a randomised, single-blind manner. The patients were sedated with 3 mg midazolam i.v. 15 min before operation and were monitored with an anaesthesia monitor. Heart rate (HR), non-invasive mean arterial pressure (MAP), SpO(2) and EtCO(2) were continuously measured using a standardised monitor. The first group (non-suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule while the second group (suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule, and the expired air was aspired with a Y-piece suction system. EtCO(2) was measured with the line of the sampling tube in the anaesthesia monitor. Respiratory rate (RR) was counted for a period of 1 min at each measurement time with thoracic excursions. The results were evaluated by unpaired t-test and analysis of variance.

RESULTS

Severe reduction of SpO(2) and raising of EtCO(2) were observed significantly in the first group during the operation. RR, HR and MAP increased due to hypoxaemia. In the second group, SpO(2) was stabilised at high levels and EtCO(2) did not increase. RR, HR and MAP levels remained within the normal limits. Differences between the two groups were statistically significant (P < 0.05).

CONCLUSION

During cataract surgery with local anaesthesia, SpO(2) decreases and RR, HR and MAP increase because of reinspiration of expired air under the drape. Insufflation of O(2) and aspiration of expired air with a suction system have prevented severe reduction of SpO(2) and raising of EtCO(2). It was suggested that O(2) delivery and use of an aspiration system decreased the risk of hypoxaemia significantly in the patients undergoing the cataract surgery.