Retrospective Evaluation of Fascial Plane Blocks in Cardiac Surgery With Median Sternotomy in a Tertiary Hospital.

BACKGROUND AND AIM: Cardiac surgery typically causes moderate to severe postoperative pain and discomfort. Inadequate pain management in the early postoperative period leads to pulmonary complications. The length of intensive care unit (ICU) stay and the hospital is typically prolonged. As a component of multimodal analgesia regimens, fascial plane blocks have become more popular. In our clinic, serratus anterior plane blocks (SAPB), pectoral nerve blocks (PECS I-II), and pectointercostal nerve fascial plane blocks (PIFB) are performed by ultrasonography. We wished to evaluate the postoperative visual pain scale, initial additional analgesic agent requirement time, extubation time, morbidity and mortality in patients who underwent open heart surgery with fascial plane blocks. MATERIALS AND METHODS: Forty-eight patients over 18 years who underwent open heart surgery with sternotomy between 01 September 2021 and 15 June 2022 were evaluated retrospectively. Only patients with chest wall blocks placed at the end of surgery were included in the study. In Group 1, the PECS II block was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery in the operating room. In Group 2, SAPB was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery. Data regarding patient demographics, anesthesia method applied, amount of opioid used intraoperatively, cardiopulmonary bypass time, anesthesia and surgery time, postoperative extubation time, mechanical ventilation time, Visual Analogue Scale (VAS) of patients at rest and movement at 6th, 12th, 18th, 24th, 48th hours post-extubation, time to and type of first postoperative analgesic, postoperative complications, length of cardiac intensive care unit (CICU) stay and hospital length of stay were recorded from hospital records. RESULTS:  The data of a total of 46 patients (Group 1: PECS II block + PIFB, n=20; Group 2: SAPB+ PIFB, n=26) were analyzed retrospectively. There was no difference in demographic variables between the groups. Intraoperative opioid usage, operation time, Cardiopulmonary bypass time, postoperative mechanical ventilation time, extubation time, ICU discharge time, and length of hospital stay were not statistically different between the groups. The first rescue analgesic requirement time was longer in group 2 than in group 1 but not statistically significant (18.76±15.36 h vs 12.62±10.61 h, p=0.162). The post-extubation VAS scores at rest and movement at the 6th hour were significantly lower in group 2 than in group 1 (1.73±1.28 vs 3.15±2.10, respectively, p=0.02). CONCLUSION: In our study, the VAS scores at the 6th hour were lower in SAPB + PIFB group than in PECS II + PIFB group. As these blocks can be easy to apply, we thought these combinations could be an alternative for pain relief in cardiac surgery. Prospective randomized studies are needed with a large number of patients.

The Roles of Liver Fibrosis Scores and Modified Stress Hyperglycemia Ratio Values in Predicting Contrast-Induced Nephropathy after Elective Endovascular Infrarenal Abdominal Aortic Aneurysm Repair.

Endovascular aortic repair (EVAR) methods are higher preferred for the treatment of patients with abdominal aortic aneurysms (AAAs). Various markers, including the neutrophil-lymphocyte ratio, have been used to predict the risk of contrast-induced nephropathy (CIN). In this study, we aimed to investigate the role of fibrosis-4 score (FIB-4), aspartate transaminase to platelet ratio index (APRI), and modified stress hyperglycemia ratio (mSHR) values in predicting CIN. Patients who had undergone elective endovascular infrarenal abdominal aortic aneurysm repair in our clinic between January 2015 and January 2022 were included in this retrospective study. Patients who did not develop contrast-induced nephropathy after the procedure were identified as Group 1, and those who did were referred to as Group 2. A total of 276 patients were included in the study. The two groups were similar in terms of age, gender, body mass index, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, hyperlipidemia, and left ventricular ejection fraction. In Group 2, the FIB-4 score, APRI, and mSHR values were significantly higher (p = 0.008, p < 0.001, and p < 0.001, respectively). In Group 2, the contrast volume and number of packed blood products used (median 1 (1-4) vs. 2 (1-5)) were significantly higher (p = 0.003 and p = 0.012, respectively). In this study, we demonstrated that we may predict the risk of CIN development with preoperatively calculated, noninvasive liver fibrosis scores and mSHR.

Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy.

Acute lower extremity ischemia (ALI) is a cardiovascular emergency resulting from embolic and thrombotic causes. Although endovascular techniques have advanced, surgical thromboembolectomy is still the gold standard. Emergency thromboembolectomy surgery involves an ischemia-reperfusion injury, which also poses a risk for acute renal injury (AKI). The stress hyperglycemia rate (SHR) has recently emerged as an important prognostic value in emergency cardiovascular events. In the present study, we aimed to analyze the impact of preoperative contrast-enhanced tomographic angiography (CTA) and the SHR value on postoperative AKI in emergency thromboembolectomy procedures in patients with insulin-dependent diabetes mellitus (DM). In this retrospective analysis, patients with DM who received emergency surgical thromboembolectomy after being hospitalized at our hospital with ALI between 20 October 2015, and 10 September 2022, were included. Patients were classified into two groups: Group 1 (N = 159), who did not develop AKI, and Group 2 (N = 45), who did. The 45 patients in Group 2 and the 159 patients in Group 1 had median ages of 59 (39-90) and 66 (37-93), respectively (p = 0.008). The percentage of patients in Group 2 with Rutherford class IIB and admission times longer than 6 h was higher (p = 0.003, p = 0.027, respectively). To determine the variables affecting AKI after surgical embolectomy procedures, multivariate logistic regression analysis was used. In multivariate analysis Model 1, age > 65 years (odds ratio [OR]: 1.425, 95% confidence interval [CI]: 1.230-1.980, p < 0.001), preoperative high creatinine (OR: 4.194, 95% CI: 2.890-6.156, p = 0.003), and Rutherford class (OR: 0.874, 95% CI: 0.692-0.990, p = 0.036) were determined as independent predictors for AKI. In Model 2, age > 65 years (OR: 1.224 CI: 1.090-1.679, p = 0.014), preoperative high creatinine (OR: 3.975, 95% CI: 2.660-5.486, p = 0.007), and SHR (OR: 2.142, CI: 1.134-3.968, p = 0.003), were determined as independent predictors for amputation. In conclusion, when an emergency thromboembolectomy operation is planned in insulin-dependent DM patients, renal risky groups can be identified, and renal protective measures can be taken. In addition, to reduce the renal risk, according to the suitability of the clinical conditions of the patients, the decision to perform a CTA with contrast can be taken by looking at the SHR value.

Syndecan-1 as a marker to predict acute kidney injury after isolated coronary artery bypass graft operations.

OBJECTIVE: Postoperative acute kidney injury is an important problem that can occur after coronary artery bypass graft operations, and it is important to identify risky patient groups preoperatively. This study aimed to investigate the importance of preoperative syndecan-1 levels in predicting acute kidney injury after elective coronary artery bypass graft operations accompanied by cardiopulmonary bypass. METHODS: Patients who underwent coronary artery bypass graft operation in our clinic between March 1 and May 10, 2022, were included in this prospective study. Patients who did not develop acute kidney injury in the postoperative period were recorded as group 1 and patients who developed it were recorded as group 2. RESULTS: A total of 79 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass were included in the study. There were 55 patients in group 1 and 24 patients in group 2. There was no difference between the groups in terms of age, gender, diabetes mellitus, body mass index, smoking, and hyperlipidemia rates. In multivariate logistic regression analysis, increased blood product use (odds ratio 1.634; 95%CI 1.036-2.579; p=0.035), preoperative high creatinine (odds ratio 59.387; 95%CI 3.034-1162.496; p=0.007), and high syndecan-1 (odds ratio 1.015; 95%CI 1.002-1.028; p=0.025) were independent predictors of acute kidney injury. CONCLUSION: This study revealed that elevated preoperative syndecan-1 is associated with acute kidney injury after isolated coronary artery bypass graft accompanied by cardiopulmonary bypass and has prognostic utility independent of other recognized risk factors.

Syndecan-1 as a marker to predict acute kidney injury after isolated coronary artery bypass graft operations

SUMMARY OBJECTIVE: Postoperative acute kidney injury is an important problem that can occur after coronary artery bypass graft operations, and it is important to identify risky patient groups preoperatively. This study aimed to investigate the importance of preoperative syndecan-1 levels in predicting acute kidney injury after elective coronary artery bypass graft operations accompanied by cardiopulmonary bypass. METHODS: Patients who underwent coronary artery bypass graft operation in our clinic between March 1 and May 10, 2022, were included in this prospective study. Patients who did not develop acute kidney injury in the postoperative period were recorded as group 1 and patients who developed it were recorded as group 2. RESULTS: A total of 79 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass were included in the study. There were 55 patients in group 1 and 24 patients in group 2. There was no difference between the groups in terms of age, gender, diabetes mellitus, body mass index, smoking, and hyperlipidemia rates. In multivariate logistic regression analysis, increased blood product use (odds ratio 1.634; 95%CI 1.036-2.579; p=0.035), preoperative high creatinine (odds ratio 59.387; 95%CI 3.034-1162.496; p=0.007), and high syndecan-1 (odds ratio 1.015; 95%CI 1.002-1.028; p=0.025) were independent predictors of acute kidney injury. CONCLUSION: This study revealed that elevated preoperative syndecan-1 is associated with acute kidney injury after isolated coronary artery bypass graft accompanied by cardiopulmonary bypass and has prognostic utility independent of other recognized risk factors.

Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation.

Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of <10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p > 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.

Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study.

OBJECTIVE: In this study, it was aimed to compare various parameters during surgery and postoperative cognitive functions in patients undergoing coronary artery bypass graft (CABG) surgery using different levels of perioperative oxygen. METHODS: One hundred patients scheduled for elective CABG surgery were included in the study. The patients were divided into two groups according to arterial oxygen levels during surgery. In the normoxia group (NG) (n = 50), partial arterial oxygen pressure (PaO2 ) was between ≥100 and <180 mmHg with at least 40% fraction of inspired oxygen (FiO2 ) mechanical ventilation (MV), and in the hyperoxia group (HG) (n = 50), PaO2 was ≥180 mmHg with 100% FiO2 MV. Hemodynamic parameters, peripheral oxygen saturation (SpO2 ), regional cerebral oxygen saturation (rSO2 ) measured from bilateral sensors, and blood gas values were recorded at the planned measurement times. Postoperative features (mortality and infection rates, length of stay in the hospital, and intensive care unit) and complications of the patients have been recorded (low cardiac output syndrome, renal failure, delirium). Mini-Mental State Examination (MMSE) test was applied to the patients before and at the 12th, 24th hours; on the first, third, sixth months after surgery. RESULTS: Extubation time was found to be shorter in NG (p < .05). Between the groups, rSO2 and mean arterial pressure were found to be significantly lower in HG at the time of T4 measurement (p = .042, p = .038, respectively). MMSE values of the groups at the first, third, and sixth months were found to be significantly higher in NG (p = .017, p = .014, p = .002, respectively). CONCLUSION: Hyperoxemia application during CABG may be associated with worse postoperative late-term cognitive functions.

Can blood urea Nitrogen-to-Albumin ratio predict mortality in patients with moderate-to-severe COVID-19 pneumonia hospitalized in the intensive care unit?

SUMMARY OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.

Effect of Various Modes of Mechanical Ventilation in Laparoscopic Cholecystectomies on Optic Nerve Sheath Diameter and Cognitive Functions.

Aim: In this study, we aim at investigating the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on changes in the optic nerve diameter and cognitive functions in laparoscopic cholecystectomy operations. Materials and Methods: Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into two groups based on the mode of mechanical ventilation provided: Group P; PCV, Group V; VCV. Optic nerve sheath diameter was measured when the patient was awake (T0), in the 10th minute after induction (T1), in the 10th minute after the initiation of gas insufflation (T2), when maximum gas pressure was reached in the reverse-Trendelenburg position (T3), and pre-extubation (T4). Partial oxygen saturation (PaO2), PCO2, end-tidal carbon dioxide (ETCO2), and peak airway pressure (pPEAK) were also recorded. A Mini-Mental State Examination (MMSE) was conducted on patients preoperatively and in the postoperative third month. Results: Between the groups, a statistically significant difference was found in Group P compared with Group V in terms of optic nerve diameter at measurement times T1 (P < .05). In the intragroup comparison, a significant difference was found in the initial values in all measurements except for measurement times T0 and T4 in both Group P and Group V (P < .05). pPEAK values were identified to be statistically significantly lower in Group P than Group V at all measurement times (P < .05). No difference was identified in the MMSE scores in the intergroup and intragroup comparisons. Conclusion: Laparoscopic cholecystectomy increases the optic nerve diameter due to the mechanical and systemic effects of the operation, and the PCV mode can be preferred. Clinical Trial Number: NCT04413903.

Can blood urea Nitrogen-to-Albumin ratio predict mortality in patients with moderate-to-severe COVID-19 pneumonia hospitalized in the intensive care unit?

OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.

Coronary arteriovenous fistulas in the adults: natural history and management strategies.

OBJECTIVE: To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies. METHODS: Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 +/- 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography RESULTS: All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients. CONCLUSION: Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.

Ability of B-type natriuretic peptide in predicting postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

OBJECTIVES: Atrial fibrillation (AF) is still the most frequent rhythm disturbance after coronary artery surgery. Our aim was to evaluate the predictive value of preoperative brain natriuretic peptide (BNP) levels for determining postoperative new-onset AF in patients undergoing isolated first-time coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). METHODS: We recruited 144 consecutive patients (51 women and 93 men) who underwent isolated CABG. Preoperative and postoperative data were collected. Preoperative BNP levels were measured the day before surgery. RESULTS: The median preoperative BNP level was 68 pg/mL. Postoperative AF occurred in 36 (25%) of the patients. Univariate analyses showed that both advanced age and median preoperative BNP levels were associated with postoperative AF (63.9 +/- 8 years versus 57.3 +/- 9.8 years, P < .001; 226 pg/mL versus 65.2 pg/mL, P <.001). Both variables remained independent predictors of postoperative AF after multivariate logistic regression analyses. For advanced age, the odds ratio was 1.074 (95% confidence interval [CI], 1.019-1.131; P = .008); for preoperative BNP level, the odds ratio was 1.004 (95% CI, 1.001-1.006; P = .002). A receiver operating characteristic (ROC) curve demonstrated that preoperative BNP level was a predictor of postoperative AF, with an area under the ROC curve of 0.750. A cutoff value of 135 pg/mL for AF demonstrated a 72.2% sensitivity, a 71.2% specificity, a 45.6% positive predictive value, a 88.5% negative predictive value, and a 71.5% accuracy for predicting postoperative AF. CONCLUSIONS: Elevated preoperative BNP levels and advanced age together are significant predictors for the development of postoperative AF in patients undergoing isolated CABG with CPB.

Aortocaval Fistula in a Behcet's Disease Patient.

Behcet's disease (BD) is a chronic, recurrent, systemic disease that is characterized by oral and genital ulcers and oculocutaneous inflammatory lesions. Cardiovascular involvement especially large artery involvement is a serious and vital complication of BD. Pseudoaneurysms in the major arteries may be the cause of sudden death in BD. In our case a pulsatile abdominal mass was determined to be an aortic pseudoaneurysm associated with BD and an aortocaval fistula. Here we report this case and a short review of literature because this is the first reported aortocaval fistula in a BD patient in English literature.

Extended durability of a cloth-covered star-edwards caged ball prosthesis in aortic position.

The Starr-Edwards caged ball valve is one of the oldest cardiac valve prosthesis and was widely used all around the world in the past decades. Despite the long-term results that have been reported there are only a few cases reported that exceed 30 years of durability. Here in, we report a 53-year-old patient with a well-functioning 35-year-old aortic Starr-Edwards caged ball prosthesis.