The effect of body mass index on complications in cardiac implantable electronic device surgery.

BACKGROUND: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED-related complications. METHODS: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non-obese (BMI < 25 kg/m2 ), overweight (25 ≤ BMI < 30 kg/m2 ), and obese (BMI ≥ 30 kg/m2 ). The primary endpoint was accepted as cumulative events, including the composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of cumulative events. RESULTS: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p = .001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p = .04; 1.0%, 1.4%, 3.3%, p = .04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156-3.064, p = .01), hypertension (OR:4.768, 95%CI:2.470-9.204, p < .001), BMI (OR:1.069, 95%CI:1.012-1.129, p = .01) were independent predictors of cumulative events rates. CONCLUSIONS: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI.

Blood transfusion in pediatric intracranial tumor surgery.

BACKGROUND: Pediatric central nervous system tumors are the most common solid tumors in children and leading cause of cancer-related morbidity and mortality. Various factors may influence the practice of blood transfusion during this tumor diagnosis. The primary aim of this study was to determine the factors that may influence intraoperative blood transfusion in pediatric patients undergoing surgery for intracranial tumors and to predict patients who may require blood transfusion. METHODS: A retrospective study was performed in all pediatric patients younger than 15 years who underwent craniotomy for brain tumor removal from January 2018 to December 2023 in our institution. Preoperative, intraoperative and postoperative data were collected from medical and store anesthesia records. The predictors of intraoperative blood transfusion were determined using multivariate logistic regression. RESULTS: A total of 138 patients were enrolled in the study, of whom 62 (44.9%) required intraoperative blood transfusion. In multivariate regression analysis age < 4 years and operating time > 490 min were determined as independent variables in terms of need for intraoperative blood transfusion. It was determined that the need for transfusion was higher in patient who were operated on urgently and patients with comorbidities (p = 0.023, p = 0.005). CONCLUSION: In conclusion, the findings obtained in this study suggest that age and surgical duration are independent risk factors for intraoperative blood transfusion in pediatric patients undergoing surgery for intracranial tumors. Particularly, in younger patients and prolonged surgeries, closer monitoring and awareness may enhance early detection, leading to the prevention of complications.

Effect of non-invasive bilateral sphenopalatine ganglion block on postoperative pain in patients undergoing septorhinoplasty surgery: a randomized controlled study.

BACKGROUND: The objective of this study was to assess the impact of preoperative sphenopalatine ganglion block (SPGB) on postoperative pain and assess intraoperative and postoperative analgesic consumption in patients undergoing septorhinoplasty. METHODS: In this prospective, randomized controlled study, 72 patients were included and divided into two groups: group 1 (36 patients) received the sphenopalatine ganglion block (SPGB), while group 2 (36 patients) served as the control group. Patient assessments, using the numerical rating scale (NRS), were conducted at the postoperative first hour, fourth hour, and 24th hour. Additionally, intraoperative hemodynamics, analgesic requirements, and postoperative analgesic requirements were documented. RESULTS: The patients in group 1 exhibited significantly lower NRS scores at postoperative first, fourth, and 24th hour than those in group 2 (P<0.001 for all three time points). Additionally, the mean Riker Sedation-Agitation Scale (RSAS) scores were significantly lower in group 1 than in group 2 (P=0.006). Both intraoperative remifentanil use and postoperative analgesic consumption were significantly higher in patients in group 2 (P<0.001 and 0.004, respectively) than those in group 1. Analysis of intraoperative heart rate and mean arterial pressure (MAP) revealed that patients in group 1 had lower postoperative heart rates (P=0.040) than those in group 2, and MAP values after intraoperative block, at 30 min, and postoperatively were significantly lower (P=0.005, P=0.001, and P=0.034, respectively) than those in group 2. CONCLUSIONS: We advocate for the adoption of the noninvasive SPGB method in patients undergoing septorhinoplasty surgery. This approach significantly reduces the need for intraoperative analgesics, alleviates postoperative pain, and reduces the demand for postoperative analgesics. Moreover, it improves the overall surgical experience because of its ease of application, contributing to a more comfortable surgical process.

Evaluation of Index of Cardiac Electrophysiological Balance in Patients With Myotonic Dystrophy Type 1.

BACKGROUND: Myotonic dystrophy type 1(MD1), which is characterized by decreased muscle tone, progressive muscle weakness, and cardiac involvement, is an autosomal dominant and progressive congenital muscle disease. Cardiac involvement more often manifests as conduction abnormalities and arrhythmias (such as supraventricular or ventricular). Approximately one-third of MD1-related deaths occur due to cardiac causes. The index of cardiac-electrophysiological balance (ICEB) is a current parameter calculated as QT interval/QRS duration. The increase in this parameter has been associated with malignant ventricular arrhythmias. In this study, our aim was to compare the ICEB values ​​of MD1 patients and the normal population. MATERIAL AND METHOD: A total of 62 patients were included in our study. They were divided into two groups - 32 MD patients and 30 controls. The demographic, clinical, laboratory, and electrocardiographic parameters of the two groups were compared. RESULTS: The median age of the study population was 24 (20-36 IQR), and 36 (58%) of these patients were female. Body mass index was higher in the control group (p = 0.037). While in the MD1 group creatinine kinase was significantly higher (p <0.001), In the control group creatinine, aspartate aminotransferase, alanine aminotransferase, calcium, and lymphocyte levels were significantly higher (p=0.031, p= 0.003, p=0.001, p=0.002, p=0.031, respectively). ICEB [3.96 (3.65-4.46) vs 3.74 (3.49-3.85) p=0.015] and corrected ICEB (ICEBc) [4.48 (4.08-4.92) vs 4.20 (4.03-4.51) p = 0.048] were significantly higher in the MD1 group. CONCLUSION: In our study, ICEB was found to be higher in MD1 patients than in the control group. Increased ICEB and ICEBc values ​​in MD1 patients may precipitate ventricular arrhythmias in the future. Close monitoring of these parameters can be helpful in predicting possible ventricular arrhythmias and in risk stratification.

Platelet-to-Hemoglobin Ratio Is an Important Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Despite effective interventional treatments, the mortality of acute ST-segment elevation myocardial infarction (STEMI) is still high. Several mortality predictors are known in STEMI. Platelet-to-hemoglobin ratio (PHR) is a recently used mortality parameter in cardiac or non-cardiac diseases. We aim to investigate the relationship of PHR with in-hospital mortality in patients with STEMI. METHODS: Eight hundred eighty-four patients were included in the study. All of them underwent coronary intervention due to STEMI. Demographic characteristics, laboratory, electrocardiographic and echocardiographic parameters were analyzed from hospital records. A cut-off value for PHR was determined using receiver operating characteristic (ROC) curve analysis. Then, patients were divided into two groups PHR < 1.99 and PHR ≥ 1.99. The data of both groups were compared. RESULTS: The median age of the study population was 64 (54-75). Of these 633 (71.6 %) were male and 251 (28.4 %) were female. All cause mortality of the study population was 9.7% (n=86). In multivariable logistic regression analysis, PHR was independently associated with a significantly increased risk of in-hospital mortality for STEMI (OR: 2.645, CI: 1.641-4.263, p< 0.001). Also, age (OR: 1.044, CI: 1.021-1.067, p< 0.001), mean arterial pressure (MAP) less than 87 mmHg (OR: 2.078, CI: 1.185-3.645, p= 0.011), prior coronary artery disease (CAD) (OR: 2.839, CI: 1.345-5.993, p= 0.006), anterior myocardial infarction (MI) (OR: 1.912, CI: 1.069-3.421, p= 0.029), creatinine (OR: 3.710, CI: 2.255-6.106, p<0.001), alanine transaminase (ALT) (OR: 1.004, CI: 1.001-1.007, p=0.002), and neutrophil-to-lymphocyte ratio (NLR) (OR: 1.122, CI: 1.014-1.242, p= 0.025) were determined as independent predictors of in-hospital mortality. CONCLUSION: In conclusion, we found that PHR is an independent predictor of in-hospital mortality in patients with STEMI.

Relationship between fragmented QRS complexes in leads V4-V6 and left ventricular apical thrombus formation in patients presenting with first acute anterior myocardial infarction.

OBJECTIVE: The present study was an investigation of the relationship between fragmented QRS (fQRS) and left ventricular apical thrombus (LVAT) in patients presenting with first acute anterior myocardial infarction (MI). METHODS: Consecutive 148 patients (mean age: 60.1±10.1 years; male: 75.6%) with first acute anterior MI who underwent primary percutaneous coronary intervention (PCI) were included. Study population was divided into 2 groups based on presence of LVAT. fQRS was defined as presence of various RSR' patterns, which included additional R wave or notching of R wave or S wave, and presence of more than 1 R in 2 contiguous leads corresponding to major coronary artery territory on 12-lead electrocardiogram. Patients with bundle branch block were excluded from the study. RESULTS: Of these, 32 (21.6%) had LVAT. Patients with LVAT had higher prevalence of fQRS (53.1% vs. 22.4%; p<0.001) and lower rate of successful PCI (75% vs. 94%; p=0.002) compared with patients without LVAT. More patients in LVAT group had left ventricular ejection fraction of <30% (87.5% vs 65.5%; p=0.010). Groups were similar with respect to other baseline characteristics (p>0.05 for all). Presence of fQRS was independent predictor of LVAT (odds ratio [OR], 2.795; 95% confidence interval [CI], 1.058-7.396) in multivariable logistic regression analysis. CONCLUSION: Presence of fQRS in leads V4-V6 is independently associated with LVAT in patients presenting with first acute anterior MI.