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Amaç: Koroner arter baypas greftlemesinde (KABG) postoperatif hiperlaktateminin ayırıcı tanısını yapabilmek ve erken müdahale edebilmek komplikasyonların önlenmesinde önemlidir. Biz de çalışmamızda bu ayırımı yapabilmek için noninvaziv monitörizasyon yöntemi olan “Near-Infrared Spectroscopy (NIRS)”den faydalanmayı amaçladık. Yöntem: Etik kurul ve hasta onamı alınan, KABG planlanan 60 hasta çalışmaya dahil edildi. Yaş, ağırlık, vücut yüzey alanı, cinsiyet, vücut ısısı, preoperatif komorbiditeler, intraoperatif ve postoperatif hemodinamik parametreler, laktat ve diğer arteryel kan gazı değerleri, kardiyopulmoner baypas ve aortik kros klemp süresi, idrar çıkışı, kan ürünü ve inotropik ajan kullanımı kaydedildi. Bölgesel serebral oksijen satürasyonu (rSO2), hastanın alnına yerleştirilmiş bir sensör ve cihaz (INVOS 5100C, Medtronic) aracılığıyla sürekli olarak izlendi. Postoperatif periyot 10 zaman noktasına ayrıldı. T1 yoğun bakım ünitesine kabul, T2-T9 sırasıyla birer saat arayla yoğun bakım ünitesi takipleri, T10’da ise yoğun bakım ünitesinden çıkış olarak değerler kaydedildi. Bulgular: Yoğun bakıma yatıştan 1, 2, 3, 4, 5, 6, 7 ve 8. saatlerdeki kalp hızı (atım/dakika), ortalama arter basıncı (mmHg), vücut sıcaklığı (°C), pH, pCO2 (mmHg), pO2 (mmHg), Hct (%) başlangıç zaman noktası (T1) ile karşılaştırıldığında anlamlı bir değişim tespit edilemedi (p>0,050). Postoperatif kan laktat düzeyinin ise T1’den T9 periyoduna kadar artma gösterdiği, ancak bu süreçte rSO2 ’nin ise buna paralel bir değişim göstermediği tespit edildi (p>0,05). Sonuç: KABG sonrasında görülen erken hiperlaktateminin ayırıcı tanısında NIRS izlemi faydalı bir noninvaziv yöntemdir. Bu nedenle, hasta güvenliğini sağlamak için klinik pratikte postoperatif dönemde de NIRS izlemini tavsiye ediyoruz. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG). Methods: Overall, 42 patients undergoing CABG were retrospectively included in this study. Blood samples which preserved at -70°C for a previous study were used for this study. The participants were divided into two groups. Patients in the Group A were administered alprazolam before the operation, whereas melatonin was used for premedication in the Group M. Blood samples were collected at three time points [T0: before anaesthesia induction, T1: admittance to intensive care unit (ICU), T2: 24 h after ICU admission], and oxidative stress parameters and glicocalyx integrity were evaluated. Furthermore, Mini-Mental State Examination was recorded to measure neurocognitive function. Results: The total thiol levels which were measured as an antioxidant parameter were significantly higher, and free Hb values were significantly lower in the Group M compared to the Group A (p<0.05). No significant differences were found in order to oxidative stress parameter levels, extubation time, length of hospital stay, durations of cross-clamp, cardiopulmonary bypass and operation and Mini-Mental State Examination results between the two groups (p>0.05). Conclusion: In light of positive effects on oxidatif stress parameters, melatonin may be considered as a good and safe premedication agent with its anxiolytic, antioxidant and minimal haemodynamic and respiratory effects. [ABSTRACT FROM AUTHOR]

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The quadratus lumborum block (QLB) is a unilateral facial plane block, which extends from T4 to L1 at the paravertebral space. Injecting local anesthetic between the facial plane of the quadratus lumborum muscle and the psoas major muscle provides the block of the referred dermatomes. However, the number of published studies for QLB used in various surgical procedures is limited. In this case report, we share the results of a 46-years-old ASA I female patient, who underwent open surgery for cholecystectomy and right-sided nephrectomy in the same session. After general anesthesia was induced, QLB was performed in the left lateral decubitus position. A convex probe was placed in transversely between the iliac crest and the costal margin at the midclavicular line. 20cc of 0.25% bupivacaine was injected to the facial plane between the quadratus lumborum and psoas major muscles. The surgery lasted 4 hours and completed uneventfully. In the postoperative period, the patient was provided with morphine PCA. After 24 hours, the VAS score was 0, and the total demanded morphine dose was 13 mg. This case report recommends that QLB may be an adequate choice in the postoperative pain management for patients undergoing cholecystectomy and nephrectomy.