RESUMEN
Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.
Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.
Asunto(s)
Humanos , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Intubación Intratraqueal/métodos , Cuello/cirugía , Disección del Cuello/estadística & datos numéricos , Glándula Tiroides/cirugía , Neoplasias de la Lengua/cirugía , Neoplasias Nasofaríngeas , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Rango del Movimiento Articular , Sensibilidad y Especificidad , Evaluación de Resultado en la Atención de Salud , Avance Mandibular , Neoplasias de Cabeza y Cuello/cirugía , Intubación Intratraqueal/instrumentación , Laringectomía/estadística & datos numéricos , Traumatismos Maxilofaciales/cirugía , Persona de Mediana Edad , Boca/fisiología , Cuello/anatomía & histologíaRESUMEN
BACKGROUND AND OBJECTIVES: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. METHODS: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion, and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. RESULTS: A total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. CONCLUSIONS: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.
Asunto(s)
Intubación Intratraqueal/métodos , Cuello/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Intubación Intratraqueal/instrumentación , Laringectomía/estadística & datos numéricos , Avance Mandibular , Traumatismos Maxilofaciales/cirugía , Persona de Mediana Edad , Boca/fisiología , Neoplasias Nasofaríngeas , Cuello/anatomía & histología , Disección del Cuello/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Rango del Movimiento Articular , Sensibilidad y Especificidad , Glándula Tiroides/cirugía , Neoplasias de la Lengua/cirugía , Adulto JovenRESUMEN
Abstract Background and objectives: YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on YouTube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source. Methods: The YouTube search was performed using keywords associated with brachial plexus nerve blocks and the final 86 videos out of 374 were included in the watch list. The assessors scored the videos separately according to the Questionnaires. Questionnaire-1 (Q1) was prepared according to the ASRA guidelines/Miller's Anesthesia as a reference text book, and Questionnaire-2 (Q2) was formulated using a modification of the criteria in Evaluation of Video Media Guidelines. Results: 72 ultrasound-guided and 14 nerve-stimulator guided block videos were evaluated. In Q1, for ultrasound-guided videos, the least scores were for Q1-5 (1.38) regarding the complications, and the greatest scores were for Q1-13 (3.30) regarding the sono-anatomic image. In videos with nerve stimulator, the lowest and the highest scores were given for Q1-7 (1.64) regarding the equipment and Q1-12 (3.60) regarding the explanation of muscle twitches respectively. In Q2, 65.3% of ultrasound-guided and 42.8% of blocks with nerve-stimulator had worse than satisfactory scores. Conclusion: The majority of the videos examined for this study lack the comprehensive approach necessary to safely guide someone seeking information about brachial plexus nerve blocks.
Resumo Justificativa e objetivos: O YouTube, site de compartilhamento de vídeos mais popular, contém um número significativo de vídeos médicos, incluindo bloqueios do plexo braquial. Apesar do uso generalizado dessa plataforma como fonte de informação médica, não há regulamentação para a qualidade ou o conteúdo dos vídeos. O objetivo deste estudo é avaliar o conteúdo do material no YouTube relevante para o desempenho do bloqueio do plexo braquial e sua qualidade como fonte de informação visual digital. Métodos: A pesquisa no YouTube foi realizada usando palavras-chave associadas ao bloqueio do plexo braquial e, de 374 vídeos, 86 foram incluídos na lista de observação. Os avaliadores classificaram os vídeos separadamente, de acordo com os questionários. O questionário-1 (Q1) foi preparado de acordo com as diretrizes da ASRA/Miller's Anesthesia como livro de referência e o Questionário-2 (Q2) foi formulado usando uma modificação dos critérios em Avaliação de Diretrizes para Mídia de Vídeo. Resultados: No total, 72 vídeos sobre bloqueios guiados por ultrassom e 14 vídeos sobre bloqueios com estimulador de nervos foram avaliados. No Q1, para os vídeos apresentando bloqueios guiados por ultrassom, os menores escores foram para Q1-5 (1,38) em relação às complicações e os maiores escores foram para Q1-13 (3,30) em relação à imagem sonoanatômica. Nos vídeos que apresentaram bloqueios com estimulador de nervos, os menores e os maiores escores foram dados para Q1-7 (1,64) em relação ao equipamento e Q1-12 (3,60) em relação à explicação das contrações musculares, respectivamente. No Q2, 65,3% dos bloqueios guiados por ultrassom e 42,8% dos bloqueios com estimulador de nervos apresentaram escores abaixo de satisfatórios. Conclusões: A maioria dos vídeos examinados para este estudo carece da abordagem abrangente necessária para orientar com segurança as pessoas que buscam informações sobre o bloqueio do plexo braquial.
Asunto(s)
Humanos , Información de Salud al Consumidor/métodos , Medios de Comunicación Sociales/normas , Bloqueo del Plexo Braquial , Grabación en Video , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Encuestas y Cuestionarios , Información de Salud al Consumidor/normasRESUMEN
BACKGROUND AND OBJECTIVES: YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on YouTube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source. METHODS: The YouTube search was performed using keywords associated with brachial plexus nerve blocks and the final 86 videos out of 374 were included in the watch list. The assessors scored the videos separately according to the Questionnaires. Questionnaire-1 (Q1) was prepared according to the ASRA guidelines/Miller's Anesthesia as a reference text book, and Questionnaire-2 (Q2) was formulated using a modification of the criteria in Evaluation of Video Media Guidelines. RESULTS: 72 ultrasound-guided and 14 nerve-stimulator guided block videos were evaluated. In Q1, for ultrasound-guided videos, the least scores were for Q1-5 (1.38) regarding the complications, and the greatest scores were for Q1-13 (3.30) regarding the sono-anatomic image. In videos with nerve stimulator, the lowest and the highest scores were given for Q1-7 (1.64) regarding the equipment and Q1-12 (3.60) regarding the explanation of muscle twitches respectively. In Q2, 65.3% of ultrasound-guided and 42.8% of blocks with nerve-stimulator had worse than satisfactory scores. CONCLUSIONS: The majority of the videos examined for this study lack the comprehensive approach necessary to safely guide someone seeking information about brachial plexus nerve blocks.
Asunto(s)
Bloqueo del Plexo Braquial , Información de Salud al Consumidor/métodos , Medios de Comunicación Sociales/normas , Información de Salud al Consumidor/normas , Humanos , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Encuestas y Cuestionarios , Grabación en VideoRESUMEN
Abstract Introduction Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. Results Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium, or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg.mL-1 concentration and significantly decreased bacterial growth rate. Conclusion Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.
Resumo Introdução Propofol e efedrina são fármacos comumente usados durante a manutenção da anestesia, o primeiro como agente hipnótico e o segundo como vasopressor. A adição de propofol à efedrina ou a administração de efedrina antes da injeção de propofol é útil para diminuir ou prevenir alterações hemodinâmicas e dor vascular relacionadas ao propofol. Este estudo in vitro avaliou o efeito antibacteriano de efedrina, isolada ou em combinação com propofol, em patógenos comuns implicados em infecção hospitalar. Material e método O estudo foi feito em duas etapas. Na primeira, a concentração inibitória mínima (CIM) de propofol e de efedrina isolada e em combinação foi calculada para Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa e um isolado clínico de Acinetobacter spp às 0, 6, 12 e 24 horas, com o método de microdiluição. Na segunda etapa, o mesmo fármaco e sua combinação foram usados para determinar seus efeitos no crescimento bacteriano. As soluções bacterianas foram preparadas em soro fisiológico a 0,9% em 0,5 McFarland e diluídas a uma concentração de 1/100. Os números das colônias foram medidos como ufc.mL-1 às 0, 2, 4, 6, 8, 10 e 12 horas. Resultados Efedrina isolada ou em combinação com propofol não apresentou efeito antimicrobiano sobre E. coli, E. faecium ou P. aeruginosa, um resultado semelhante ao de propofol. Porém, efedrina isolada e em combinação com propofol apresentou efeito antimicrobiano sobre Staphylococcus aureus e Acinetobacter spp, em concentração de 512 mcg.mL-1, e redução significativa da taxa de crescimento bacteriano. Conclusão Efedrina tem atividade antimicrobiana em S. aureus e Acinetobacter spp, patógenos frequentemente identificados como causa de infecções nosocomiais.
Asunto(s)
Pseudomonas aeruginosa/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Vasoconstrictores/farmacología , Acinetobacter/efectos de los fármacos , Propofol/farmacología , Enterococcus faecium/efectos de los fármacos , Efedrina/farmacología , Hipnóticos y Sedantes/farmacología , Vasoconstrictores/administración & dosificación , Pruebas de Sensibilidad Microbiana , Propofol/administración & dosificación , Efedrina/administración & dosificación , Escherichia coli/efectos de los fármacos , Hipnóticos y Sedantes/administración & dosificación , AntibacterianosRESUMEN
INTRODUCTION: Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. MATERIAL AND METHOD: The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. RESULTS: Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512mcg.mL-1 concentration and significantly decreased bacterial growth rate. CONCLUSION: Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.
Asunto(s)
Acinetobacter/efectos de los fármacos , Enterococcus faecium/efectos de los fármacos , Efedrina/farmacología , Hipnóticos y Sedantes/farmacología , Propofol/farmacología , Pseudomonas aeruginosa/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Vasoconstrictores/farmacología , Antibacterianos , Efedrina/administración & dosificación , Escherichia coli/efectos de los fármacos , Hipnóticos y Sedantes/administración & dosificación , Pruebas de Sensibilidad Microbiana , Propofol/administración & dosificación , Vasoconstrictores/administración & dosificaciónRESUMEN
Abstract Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. Results After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p > 0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p > 0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 ± 4.28 vs. 5.84 ± 2.90, p = 0.044 and 3.89 ± 5.43 vs. 1.19 ± 3.35, p = 0.01 respectively). Conclusion Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions.
Resumo Introdução As mídias sociais como o YouTube tornaram-se uma parte do cotidiano e muitos estudos avaliaram vídeos do YouTube relacionados à saúde. Nosso objetivo foi avaliar os vídeos disponíveis no YouTube para identificar a existência de conformidade com as informações em livros didáticos e sua suficiência como fonte de informação para o paciente. Material e método Uma pesquisa no site YouTube foi feita com as palavras-chave spinal anesthesia, epidural anesthesia, combined spinal-epidural anesthesia (raquianestesia, anestesia peridural, anestesia combinada raquiperidural). Em primeiro lugar, avaliamos 180 vídeos e observamos suas características e se eram referentes à anestesia neuraxial. O questionário de avaliação da qualidade do vídeo (Q1) relativa à anestesia neuraxial foi criado com um livro didático como referência e o questionário 2 (Q2) foi criado para avaliar as informações ao paciente. Resultados Após exclusões, 40 vídeos foram incluídos no estudo. Não houve diferença nos escores de Q1 ou Q2 quando os vídeos foram agrupados em quatro categorias de acordo com a ordem de aparecimento, tempo de upload ou taxa de tempo de visualização (p > 0,05). Não houve diferença estatística entre os escores de Q1 ou Q2 para os vídeos raquianestesia, peridural ou combinada (p > 0,05). Os vídeos preparados por um instituto de saúde obtiveram escores mais elevados em ambos Q1 e Q2 (10,87 ± 4,28 vs. 5,84 ± 2,90, p = 0,044 e 3,89 ± 5,43 vs. 1,19 ± 3,35, p = 0,01, respectivamente). Conclusão Os vídeos elaborados por institutos, sociedades etc. apresentaram um valor educativo maior, mas ainda muito incompleto. Os vídeos devem ser preparados em conformidade com as diretrizes atualizadas e disponíveis, com explicações adequadas e detalhadas sobre cada procedimento, segurança do paciente e perguntas mais frequentes.
Asunto(s)
Educación del Paciente como Asunto , Medios de Comunicación Sociales/normas , Anestesia Epidural , Anestesia RaquideaRESUMEN
INTRODUCTION: Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. MATERIAL AND METHOD: A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. RESULTS: After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). CONCLUSION: Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions.