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    Endotracheal intubation without the use of muscle relaxants: Comparisons three different remifentanil bolus doses following propofol induction
    (2004) Cengiz M.; Ganida?li S.; Ölmez G.
    Endotracheal intubation without neuromuscular blockade has been performed using several doses of propofol and remifentanil. In this study we investigated the effects of three different doses of remifentanil on endotracheal intubation following propofol induction. Forty-five healthy patients were randomly assigned to one of three equal groups. After intravenous bolus doses of propofol 2.5 mg kg-1, Group I, II and III received intravenous remifentanil 0.5 mg kg-1, 1 mg kg-1 and 2 mg kg-1 respectively. Remifentanil was injected in 30 seconds. Laryngoscopy and intubation was performed sixty seconds after remifentanil injection. Intubation conditions were assessed on the basis of the case of ventilation, jaw relaxation, position of vocal cords, and patients'response to intubation and inflation of endotracheal tube cuff. Hemodynamic responses to intubation were also recorded. Total intubation quality scores in Group III were higher than those of Group I and II (p<0.05). Mean arterial pressures after anaesthesia induction were lower than the control values in all groups (p<0.05). In Group I and Group II; heart rates after intubation were found to be significantly higher when compared with the pre-induction values (p<0.05). Heart rates in Group III were significantly lower at after induction periods when compared with the pre-induction values (p<0.05). It is concluded that; bolus of remifentanil 2 ?g kg-1 after propofol induction provides better intubation conditions without the use of muscle relaxants.
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    Sonographic assessment of fatty liver: Intraobserver and interobserver variability
    (E-Century Publishing Corporation, 2014) Cengiz M.; Sentürk S.; Cetin B.; Bayrak A.H.; Bilek S.U.
    Non-alcoholic fatty liver disease (NAFLD) is a common liver disease worldwide and ultrasonography is widely used in the diagnosis and the follow-up we purposed to assess intraobserver and interobserver variability in the sonographic evaluation of the existence and steatosis grades of NAFLD. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and AST to ALT (AST/ALT) ratio were compared between the grades of hepatosteatosis. Hepatic ultrasonography (US) examinations consisted of 5-10 static images of 113 successive adult patients, whose records were in the picture archiving and communication system (PACS) of our hospital were retrospectively evaluated by two experienced radiologists. Hepatic images were graded into 4 groups; as normal, mild, moderate or severe hepatic steatosis. Evaluation of hepatic steatosis of the same set of images was repeated after one month under the same conditions. Interobserver and intraobserver agreement was assessed by using kappa (?) statistics. In each group, the percentage of individuals with high ALT and/or AST, or AST/ALT ratio over 1 was calculated. The intraobserver agreement was 51%, fair kappa (?=0.356) for observer 1; and 68%, moderate (?=0.591) for observer 2. The interobserver agreements in the initial and second readings were 39% and 40%, fair (?=0.208) and (?=0.225), respectively. Elevations of ALT and/or AST levels were similar between groups depending on the degree of hepatosteatosis among the patients. Visual assessment of NAFLD by ultrasonography has substantial interobserver variability, and reproducibility of results is limited. More objective imaging modalities are needed to evaluate the degree of hepatosteatosis. © 2014, E-Century Publishing Corporation. All rights reserved.