Analgaesic Effect of Erector Spinae Plane Block in Coronary Surgery: A Randomised Controlled Trial.

OBJECTIVE: To investigate the effect of preemptive erector spinae plane (ESP) block application on postoperative pain scores and opioid demand in off-pump coronary artery bypass graft (CABG) surgery. STUDY DESIGN: Randomised-controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Abant Izzet Baysal University (AIBU) Medical School, Bolu, Turkiye, from November 2020 to April 2021. METHODOLOGY: Fifty patients between the ages of 50 and 75 years, received CABG surgery. These participants who were at risk of the American Society of Anesthesiologists (ASA) III were randomly divided into two groups: ESP (Group E) and Control (Group C). Intervention in Group E was performed bilaterally at the T5 level before the operation. In the study, the primary outcome was postoperative opioid demand while the secondary outcomes consisted of intraoperative opioid demand, visual analogue scale scores, and the duration of hospital stay. RESULTS: Tramadol demand was significantly decreased in Group E at 0-1, 1-12, 12-24, and 0-48 hours (p <0.05). Intraoperative fentanyl demand for Group E was also statistically significantly decreased (p= 0.001). In Group E, the visual analogue scale scores at 30 minutes, 1st, 2nd, 4th, 8th, 12th hour, and 16th hour after postoperative extubation were observed to be significantly lower than those of Group C (p <0.05). CONCLUSION: Preemptive ESP block application in CABG surgery patients reduced postoperative tramadol demand, intraoperative fentanyl demand, and postoperative pain scores. KEY WORDS: Coronary artery bypass surgery, Erector spinae plane block, Acute postoperative pain.

Surgical Treatment of Extracranial Internal Carotid Artery Pseudoaneurysm in an Infant Due to Falling from Height: An Unusual Case.

Pseudoaneurysms of the internal carotid artery (ICA) caused by non-penetrating trauma are extremely rare. Patients with ICA pseudoaneurysms may present with cerebral ischemia, cervical masses, neck swelling, hematoma, rupture, pain, or cranial nerve dysfunction. We present a case of a left ICA pseudoaneurysm that developed in a 7-month-old infant because of a fall from height. The patient developed left-sided neck swelling that caused severe airway obstruction and respiratory arrest. The patient was urgently intubated and underwent emergency surgery under general anesthesia to repair the defect in the left ICA. Primary repair was performed to treat the pseudoaneurysms. The pseudoaneurysm sac was not removed because it was complicated and had extended into the respiratory tract. The patient was extubated on the 2nd day and discharged on the 7th day without complications. Follow-up of the patient after two weeks was unremarkable. Extracranial ICA pseudoaneurysms should be identified in patients presenting with blunt trauma. Emergency surgery should be considered for patients with progressive pseudoaneurysms.

Predictive Value of QT Interval for Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

ABSTRACT Introduction: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. Methods: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. Results: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). Conclusion: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.

Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker.

OBJECTIVE: To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA). METHODS: A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates. RESULTS: A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004-1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64-0.851). CONCLUSIONS: Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Systemic immune-inflammation index as a novel predictor of atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: This study aims to examine the predictive role of systemic immune-inflammation index on postoperative new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. METHODS: A total of 722 patients undergoing elective off-pump coronary artery bypass grafting between January 2017 and September 2021 were included in this study and divided into two groups as the atrial fibrillation group (n=172) and the non-atrial fibrillation group (n=550). Both groups were compared in terms of patients' baseline clinical features, operative and postoperative variables, and preoperative hematological indices derived from the complete blood count analysis. Multivariate logistic regression and receiver-operating characteristic curve analyses were performed to detect the independent predictors of postoperative new-onset atrial fibrillation. RESULTS: The median age and length of hospital stay in the atrial fibrillation group were significantly higher than those in the non-atrial fibrillation group. The median values of white blood cell, platelet, neutrophil, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammation in the atrial fibrillation group were significantly greater than in those in the non- atrial fibrillation group. Logistic regression analysis demonstrated that age, platelet, platelet/lymphocyte ratio, and systemic immune-inflammation were independent predictors of postoperative new-onset atrial fibrillation. receiver-operating characteristic curve analysis revealed that systemic immune-inflammation of 706.7×103/mm3 constituted cut-off value to predict the occurrence of new-onset atrial fibrillation with 86.6% sensitivity and 29.3% specificity. CONCLUSION: Our study revealed for the first time that systemic immune-inflammation predicted new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

A successful surgical repair of a gunshot injury to the left common carotid artery without neurological deficiency: A case report.

Introduction and importance: Penetrating neck trauma is serious and has a high fatality rate, especially in individuals who suffer injuries to the common carotid artery. The mortality rates for penetrating neck trauma are estimated to be 3%-6%. Accidents that cause a lot of blood to flow, like being stabbed, shot, or hurt in a car accident, can cause a person to lose a lot of blood quickly and in a short amount of time, which can be fatal if not treated right away. Clinical presentation: we present a 26-year-old young male patient with penetrating neck trauma caused by a gunshot. The gunshot entered the right sternocleidomastoid muscle at the level of the hyoid bone and exited the left sternocleidomastoid muscle on the mid side. Clinical discussion: In a recent report on the management of major vascular injuries to the neck, carotid artery injuries accounted for about 17% of all patients presenting with penetrating neck injuries. In this case, previously published literature adds that carotid artery injury early surgical and primary repair in young patients has a good outcome. Conclusion: Considering the high morbidity and mortality associated with penetrating neck injuries, In young patients, they can be successfully managed with early surgical and primary repair with a good outcome.

Predictive Value of QT Interval for Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery.

INTRODUCTION: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. METHODS: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. RESULTS: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). CONCLUSION: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.

Localized massive staphylococcal pericardial abscess with atypical presentation.

Introduction and importance: Localized staphylococcal pericardial abscess (PA) is extremely rare and highly mortal complication of Staphylococcus aureus bacteremia with only a few reported cases in English-language medical literature. Clinical manifestations are fulminant, and early management is necessary. Case presentation: Here we report a case of end stage renal disease (ESRD) with isolated localized massive staphylococcal PA and had masked signs and symptoms of pericardial staphylococcal infection. Contrast-enhanced computed tomography scan suggested anterior massive localized pericardial cyst like image. Surgical drainage of the abscess with localized pericardiectomy conjugated with antibiotic therapy led to a successful management. Clinical discussion: Staphylococcus aureus is the leading cause of hemodialysis catheter-related bloodstream infections, contributing 33-80% of the organisms cultured from blood samples. Nature of staphylococcal pericardial infection is aggressive and life threatening with generalized involvement of the pericardium although our patient presented with masked signs and symptoms. Conclusion: CT image of localized pericardial lesion with masked signs and symptoms does not exclude the presence of live threating pericardial infection, especially in immunocompromised patients.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

SUMMARY OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study.

BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study

ABSTRACT BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Bomb blast: imaging findings, treatment and clinical course of extremity traumas.

BACKGROUND: To describe the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the associated factors affecting the treatment management and clinical course. METHODS: The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of penetrating fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. The Gustilo-Anderson classification was used for open fractures. According to their severity, open fractures classified as types 1 and 2 were included in Group 1 and those classified as type 3A, 3B and 3C in Group 2. RESULTS: As a result of blast exposure, 101 (57.7%) patients had extremity injuries, of which 76 (75.2%) presented with at least one fracture. Of the total of 103 fractures, nine (8.8%) were closed and 94 (91.2%) were open. Thirty-eight (40.4%) of the open fractures were located in the upper extremities, and 56 (59.6%) in the lower extremities and pelvis. Open fractures were most frequently localized in the femur (n = 20; 21.2%), followed by the tibia (n = 18; 19.1%). The majority of patients with open fractures were in Group 1 (71.4%). The duration of hospital stay was longer in Group 2 (12.1 ± 5.8 vs. 6.3 ± 6.7 days, p <  0.0001, respectively). Mortality among patients in Group 2 (45.0%) was significantly higher than in Group 1 (8.0%) (p <  0.0001). Similarly, the injury severity score (ISS) was higher in Group 2 (median 20 vs. 9, p <  0.0001). VI was present in 13 (12.9%) of all patients, and amputation in seven (7.9%). CONCLUSION: The presence of severe open fractures, VI, and high ISS score can be considered as important factors that increase morbidity and mortality. In extremity traumas, through the secondary blast mechanism, contaminated-fragmented tissue injuries occur. Therefore, we believe that it will be beneficial to apply damage control surgery in places with low socioeconomic level and poor hygienic conditions.

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions.

BACKGROUND: Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. METHODS: A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. RESULTS: Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). CONCLUSION: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.