Tramadol use in a patient with Brugada syndrome and morphine allergy: a case report.

Brugada syndrome is a rare syndrome characterized by arrhythmias and sudden death, particularly in younger individuals. A mutation in a gene encoding the human cardiac sodium channels is responsible for this syndrome. In the literature, there are several case reports of Brugada syndrome in association with the use of several anesthetic agents. Herein, we present our anesthetic practice and the use of tramadol in a 75-year-old female patient who underwent pulmonary lobectomy under general anesthesia and was diagnosed with Brugada syndrome.

Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery.

BACKGROUND: Fluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications. PATIENTS AND METHODS: In this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively. RESULTS: The mean age of the study population was 56.9±14.4 years and 75% of the patients were male. SVV was used in fluid therapy in 48.9% of the patients. The use of SVV resulted in an increased use of crystalloids and colloids with increased urine output per hour (p<0.05). Of patients in the SVV group and the CVP group, 44.1% and 51.1% developed at least one complication, respectively (p=0.531). The rate of respiratory complications including atelectasis, pneumonia, hypoxemia, and an increased production of secretions was 21% in the SVV group and 37.7% in the CVP group (p=0.104). The rate of complications and the length of hospital stay were comparable between the groups (p>0.05). CONCLUSION: Our study results showed that the use of SVV increased the use of crystalloids and colloids and favorably affected urine output per hour but did not reduce complications in thoracic surgery.

Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery in Adults.

OBJECTIVE: Prolonged intensive care unit (ICU) stay prevents the use of ICU equipment by other patients and increases hospital cost. This retrospective study aimed to investigate the risk factors for prolonged ICU stay in patients undergoing open heart surgery. METHODS: The medical records of 513 patients who underwent coronary artery bypass grafting and valvular heart surgery were retrospectively evaluated. Patients were divided into two groups based on their ICU stay: groups I (<48 h) and II (≥48 h). The effect of patient variables on the ICU stay duration was investigated using logistic regression analysis. RESULTS: The mean age of the patients was 61.5±10 years, and 69% were males. The ICU stay of ≥48 h was observed in 20.1% of the patients. Diabetes mellitus and low ejection fraction (pre-operative variables); long aortic cross clamp, cardiopulmonary bypass time and intra-aortic balloon pump requirement (intra-operative variables); arrhythmia, myocardial infarction, renal dysfunction and need for haemodialysis, use of ≥2 inotropic agents, infection, sepsis and respiratory complication (post-operative variables) were found to prolong the ICU stay. In multivariate logistic regression analysis, intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for haemodialysis were found to be independent risk factors for prolonged ICU stay (p<0.05). Early mortality was 0.97% (5 patients). CONCLUSION: Intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for post-operative haemodialysis are independent risk factors for patients undergoing open heart surgery. Selection of methods for protecting the myocardium and renal functions during the intra-operative period would reduce the duration of ICU stay.

Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery.

BACKGROUND: This study aimed to investigate the correlation between perioperative arterial lactate levels and morbidity and mortality in children undergoing cardiac surgery. METHODS: A total of 236 patients who underwent open heart surgery due to congenital heart disease (121 males, 115 females; mean age 56.4 month (median: 42 month): range, 1 day to 204 month) between June 2014 and May 2016 were retrospectively analyzed. The arterial blood gas analysis results at baseline (after insertion of arterial cannula), during the cooling and warming-up phases in cardiopulmonary bypass, during the sternal closure, and at 0, 6, 12, and 24 hours in the postoperative intensive care unit stay were recorded. The patients were divided into two groups according to their lactate levels: Group 1 (lactate level <4.5 mmol/L, n=183) and Group 2 (lactate level ≥4.5 mmol/L, n=53). Correlation between the lactate groups and demographic data, intraoperative and postoperative variables, postoperative complications, and mortality were investigated. RESULTS: Sixty-nine patients (29.2%) had cyanotic heart disease. A total of 53 patients (22.5%) had lactate levels of ≥4.5 mmol/L. At least one complication occurred in 41% of the patients. Development of at least one complication (p=0.027) and mortality rate (p<0.001) were significantly higher in the patients with lactate levels of ≥4.5 mmol/L. Seventeen patients (7.2%) died in the postoperative period, and 15 of them had lactate levels of ≥4.5 mmol/L at least once within the first 24 hours. In terms of mortality, lactate levels of ≥4.5 mmol/L at any time, prolonged mechanical ventilation (>48 hours), and undergoing complex surgery (high the Risk-adjusted Classification for Congenital Heart Surgery-1 score, category 4-6) were the independent risk factors for mortality. CONCLUSION: Blood arterial lactate level of ≥4.5 mmol/L was found to be a risk factor for postoperative morbidity and mortality in pediatric patients undergoing congenital heart surgery.

The relationship between the Trendelenburg position and cerebral hypoxia inpatients who have undergone robot-assisted hysterectomy and prostatectomy

Background/aim: This study aimed to evaluate the relationship between the Trendelenburg position and cerebral hypoxia in robot-assisted hysterectomy and prostatectomy.Materials and methods: A standardized mini-mental state examination was administered to 50 patients enrolled in the study 1 h before and after surgery. Near infrared spectroscopy (NIRS) values and hemodynamic and respiratory parameters were recorded after induction of anesthesia (baseline) and once every 20 min in the Trendelenburg position and supine positions. The relationship between the development of cerebral desaturation and the patient's position was examined. Results: For all patients, the baseline mean cerebral oxygen saturation (RSO2) on the right and left were 70.5 ± 7.3% and 70.6 ± 6.7%, respectively. Right RSO2 values at 20 min and 60 min in the Trendelenburg position decreased significantly, but they increased at 120 min. A significant positive correlation was found between right RSO2 and EtCO2 in the supine period following surgery, and between left RSO2 and EtCO2 at 60 min in the Trendelenburg and supine positions. The relationship between NIRS values and cognitive dysfunction was not significant.Conclusion: We found that cerebral saturation decreases as age increases, and cerebral desaturation may occur owing to the Trendelenburg position. There was no correlation between patients? cognitive function and NIRS values.

A Venous Catheter Complication: Venous Perforation and Lung Injury.

Central venous catheters are frequently used for different causes, like fluid infusions, haemodialysis, and measurement of central venous pressure. Complications that occur at the time or after the placement of these catheters can give harm to the patient or can cause need for a new attempt. Complications, like malfunction of the catheter, arterial puncture, haemothorax, or pneumothorax, can be seen in 5%-26% of the patients, and early detection is very important. We want to present a venous perforation and lung injury case according to the catheter based upon the literature.

Apolipoprotein E epsilon4 allele and neurobehavioral status after on-pump coronary artery bypass grafting.

UNLABELLED: Abstract Background and Aim: The presence of apolipoprotein E epsilon4 allele is being considered as a risk factor for cognitive decline after cardiac surgery. We sought the effect of apolipoprotein E epsilon4 allele on neurobehavioral status after on-pump coronary artery bypass grafting. METHODS: Prior to the operation, neurologic examination and neurobehavioral cognitive status test (COGNISTAT) were performed. Both procedures were repeated on the day of discharge and 3 months after surgery. Apolipoprotein E epsilon4 allele positive and apolipoprotein E epsilon4 allele negative patients' performance on COGNISTAT were compared. RESULTS: There was no statistically significant demographic and operative data difference between two groups. No neurological impairment was observed on examinations. There was no statistically significant neurocognitive decline difference between two groups' postoperative performances. CONCLUSIONS: It seems that apolipoprotein E epsilon4 allele may not affect neurobehavioral status in the intermediate period after on-pump coronary artery bypass grafting.