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AIM: This study aimed to examine the prognostic significance of the perfusion index (PI) in mechanically ventilated patients. METHODS: Study included sixty patients who had the risk factors for the development of acute respiratory distress syndrome and received mechanical ventilator (MV) support in intensive care unit (ICU) unit between January 2017/January 2018. The demographic characteristics, vital signs, blood gas parameters, lactate levels, prognostic scores, and use of inotropic drugs were recorded. Arterial blood gas and PI measurements at the frontal region were performed at the time of and 12th and 24th hours of admission to the ICU. The patients were followed up for 60 days, and the outcome was recorded. RESULTS: Twelve patients (20%) died during the first 7 days, and 27 patients (45%) died within 60 days of the admission. Multivariate analyses to determine potential predictors of 7 and 30-day mortality showed that only 24th-hour lactate level was independent predictor of 60-day mortality, and the PI at 24th was the sole independent predictor of 7-day mortality. CONCLUSION: The PI did not predict 60-day mortality in MV patients who had risk factors for the development of Acute Respiratory Distress Syndrome (ARDS). However, the PI at 24th may be a significant predictor of 7-day mortality.

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In pregnancy, infection with H1N1 influenza virus may produce symptoms similar to infection with seasonal influenza virus. Patients may rarely come with a clinical condition causing severe acute respiratory distress syndrome (ARDS) and death. Therefore, mechanical-ventilation strategies to manage these events are vital. We report a case of ARDS after an infection with H1N1 influenza A in a 33-year-old patient pregnant at 27-weeks. The ARDS was successfully managed by airway pressure release ventilation (APRV). APRV can be used successfully as an alternative to conventional mechanical ventilation modes in pregnant patients experiencing severe respiratory failure.

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OBJECTIVE: To compare the effects of intrauterine lidocaine, intrauterine lidocaine plus rectal diclofenac, and a placebo on analgesia and to determine the satisfaction of patients and surgeons in cases of endometrial biopsy. METHODS: The double-blind, randomised, placebo-controlled study was conducted in the Department of Obstetrics and Gynaecology of the Ondokuz Mayis University, Samsun,Turkey, from April 2013 to January 2014, and comprised patients scheduled for in-office endometrial biopsy.They were divided into three groups: Group P, 5ml of 0.9% saline intrauterine; Group L, 5ml of 2% lidocaine intrauterine; and Group LD, 5ml of 2% lidocaine intrauterine ± 10min before the procedure plus 50mg of rectal diclofenac sodium. Haemodynamic changes and visual analogue scale scores were recorded during the preoperative period, when the cervix was grasped with a tenaculum, immediately after intrauterine instillation, during uterine curettage and at postoperative 10 min. The patient and the surgeon were questioned about their satisfaction 15 min after the procedure. SPSS 21 was used for statistical analysis. RESULTS: The 90 patients in the study were divided into three equal groups of 30(33.33%) each. There were no statistically significant inter-group differences in age, bodyweight, parity, number of postmenopausal patients, haemodynamic parameters and American Society of Anesthesiologists scores (p>0.05 in all categories). In Group P, the visual analogue scale score estimated when the cervix was grasped with the tenaculum was lower when compared with Group L and Group LD (p=0.029 and p=0.007, respectively). At other measurement time points, the scores did not differ between the groups. The groups did not differ with respect to patient and surgeon satisfaction and complication rates (p>0.05). CONCLUSION: Intrauterine lidocaine or intrauterine lidocaine plus rectal diclofenac application had no effect on visual analogue scale scores, patient satisfaction and vasovagal reaction.

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BACKGROUND AND OBJECTIVES: The aim of this case was to describe the anesthetic approach to a patient with Kabuki syndrome. CASE REPORT: A patient with Kabuki syndrome had revision surgery for scoliosis. On physical examination, shown were long palpebral fissures, large, prominent fissures with an eversion of the lateral third of the lower eyelids, large, prominent malformed ears with low implantation, a short nasal septum, micrognathia, thoracolumbar scoliosis, a depressed left shoulder, a low-set occipital hairline and a short neck. The skin was elastic, and joints were lax. The laryngoscopy showed a Grade II Cormack and Lehane view of the larynx. The trachea was intubated easily. The patient was positioned carefully. Vital signs remained stable during surgery. The patient was extubated and transported to the post-anesthetic care unit. CONCLUSION: Anesthesiologists should be aware of possibly difficult tracheal intubation cardiac lesions, respiratory problems, neurological and musculoskeletal disorders, and a latex allergy when managing anesthesia for a patient with Kabuki syndrome.

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