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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]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. The results with the technique of DSC over a 4-year period are examined with regard to mortality and morbidity. Methods We retrospectively reviewed records of 38 patients who had undergone DSC among 1100 congenital cardiac operations. Indication of DSC, time to sternal closure, pre and post closure cardiopulmonary and metabolic status, mortality, rate of wound and bloodstream infections were recorded. Results The mean sternal closure time was 2.9 days. The mortality rate was 34.2% (n = 13). Twenty (52.6%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were 4 (10.5%) patients with postoperative mediastinitis. Postoperative infection rate statistically increased with cardiopulmonary bypass time (CPBT), sternal closure time (SCT) and intensive care unit (ICU) stay time (p = 0.039;p = 0.01;p = 0.012). On the other hand, the mortality rate significantly increased with increased cross clamp time (CCT), SCT, and extracorporeal membrane oxygenation (ECMO) use (p = 0.017; p = 0.026; p = 0.03). Single ventricular physiology was found to be risk factor for mortality in delayed sternal closure (p Conclusions Elective DSC does not reduce the morbidity. The prolonged sternal closure time is associated with increased rate of postoperative infection rate; therefore early closure is strongly advocated.

Copyright of Istanbul Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO2) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery. Methods: The study was designed in 50 patients who had elective coronary bypass surgery. Patients were assessed for arterial lactate levels, arterial partial oxygen pressure (PaO2), cardiac output (CO) and PuO2 in bladder urine at 180, 360 and 540 min postoperatively. Results: Tissue perfusion parameters were found to be similar throughout the surgery in addition to no significant rise in plasma creatinine levels. PuO2 was found to be 91±22, 99±22 and 97±13 mmHg, respectively, at the time points described above. Any correlation between PuO2 and other measurements was not determined at any time points. Conclusion: The present study suggests that urine PuO2 has no relationship with routine systemic tissue perfusion parameters, such as PaO2, lactate levels and CO. In our opinion, since the COs of the patients were within the normal limits, and none of the patients developed renal injury, the present study might have been unable to determine any correlation. Further studies focused on patients with transient renal ischaemia are needed. [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]

Background/aim: The aim of the current study was to assess the accuracy of cardiac output (CO) measurements obtained by the Nexfin finger cuff method as compared with the FloTrac/Vigileo and echocardiography methods in coronary artery bypass grafting (CABG) patients. Materials and methods: First-time elective CABG patients were prospectively enrolled in this study and divided into three groups according to CO measurement method. CO measurements were performed simultaneously by three different contributors and were collected by the fourth one 24 h postoperative in the intensive care unit (ICU). Data were statistically analyzed. Results: Seventeen female and 13 male patients between 42 and 78 years of age (with a mean of 56 ± 4) were the subjects of this study. The mean CO measurements were 5.9 ± 1.4 L/min, 5.8 ± 1.1 L/min, and 6.0 ± 1.1 L/min for the Nexfin, FloTrac/Vigileo, and echocardiography methods, respectively (P > 0.05). The correlation values between Nexfin and FloTrac/Vigileo, Nexfin and echocardiography, and FloTrac/Vigileo and echocardiography were r = 0.445, r = 0.377, and r = 0.384, respectively (P < 0.05). Conclusion: Nexfin yielded results comparable to those obtained with FloTrac/Vigileo and echocardiography for the postoperative CO assessment of CABG patients. Nexfin may be used in uncomplicated, hemodynamically stable patients in ICU as a reliable and totally noninvasive method of CO measurement. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Discussions continue on the ideal priming fluid in adult cardiac surgery. The purpose of this prospective study was to evaluate the effects of different types of priming fluids on extravascular lung water, cell integrity and oxidative stress status., Methods: Thirty elective coronary artery bypass surgery patients were randomised prospectively into two groups. The first group received colloid priming fluid, while the second group received crystalloid priming fluid. Extravascular lung water index, advanced oxidative protein products, total thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels were measured. Moreover, intra-operative and postoperative outcomes were reviewed., Results: There were no significant differences between the groups with regard to extravascular lung water index, oxidative stress parameters or cell integrity ( p > 0.05). Similarly, no significant differences were observed between the patients with regard to intra-operative and postoperative outcomes ( p > 0.05)., Conclusions: The presumed superiority of colloidal priming for cardiopulmonary bypass could not be confirmed in our study.

Background: Despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model., Methods: Male Wistar rats were randomly assigned into two groups (n=6/group): Normoxic (FiO2: 0.3) or hyperoxic (FiO2: 1.0) ventilation for 4 h. The injury was evaluated in bronchoalveolar lavage (BAL), blood, lung, liver, kidney, and heart was evaluated in terms of cell surface integrity, extracellular matrix (sialic acid, syndecan-1), osmotic stress (free hemoglobin), and redox homeostasis-lipid peroxidaation (malondialdehyde). BAL and wet/dry weight ratio were also evaluated for cellular permeability., Results: Four hours of hyperoxic ventilation did not lead to significant changes in (1) sialic acid, syndecan-1, (2) malondialdehyde levels and wet/dry weight ratio in liver, kidney, heart, and lung compared to normoxic ventilation., Conclusion: Mechanical ventilation with hyperoxia seems to have almost similar effects compared to ventilation with normoxia. However, the long term effect of hyperoxia should be evaluated.

Background: The aim of this study was to compare clinical outcomes of blood transfusion in patients with diabetes mellitus undergoing isolated on-pump coronary artery bypass grafting., Methods: The medical records of a total of 1,912 patients (1,300 males, 612 females; mean age 60.7±10.0) with diabetes who underwent isolated on-pump coronary artery bypass grafting between January 1999 and June 2019 were retrospectively analyzed. The patients were divided into two groups as patients with and without blood transfusions. The mortality rates were compared between the two groups., Results: The mortality rate was 14 times higher in the patients receiving blood transfusion (odds ratio: 14.80; 95% confidence interval 5.05 to 43.34; p<0.001). However, in the multivariate logistic regression analysis, there were no statistically significant difference in mortality between the patient groups, when diabetes mellitus was a covariate factor (Odds ratio: 8.34; 95% confidence interval 3.94 to 17.66 vs. odds ratio 8.36; 95% confidence interval 3.95 to 17.70)., Conclusion: The propensity score-matched analysis of patients with diabetes showed that clinical outcomes were more severely affected by blood transfusion., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish Society of Cardiovascular Surgery.)

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.

Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.