Effects of postoperative analgesia on acute phase response in thoracic surgery.

The aim of this research is to determine: the influence of continuous opiate and intermittent non-opiate postoperative analgesia on thoracic surgical patients' acute phase response, based on acute phase response protein serum values (IL-6 and C-reactive protein) 24, 48 and 72 hours aftersurgery; to analyze the acute phase responses in those thoracic surgical patients in which the postoperative complications have developed and in those in which they haven't. The study itself has a prospective character involving 60 patients divided into two homogenous groups, 30 patients each, which are of the same age, sex, pathological substrate, and are the patients of the University Clinical Centre in Tuzla. The first group of patients were those to whom the non-opiate intermittent analgesia of methamisol natrium was applied, and the second group were the patients to whom the continuous tramadol chloride opiate analgesia was applied after the thoracic surgical procedure had been performed. According to the examined patients and applied types of analgesia, the following results were obtained: CRP values enhanced in both groups, all three measurements, with no significant statistical differences (p = 0.051; p = 0.054; p = 0.1). While the IL-6 values enhanced in all measurements in group I, in group II they remained within reference range, with a significant statistical difference (p = 0.042; p = 0.039; p = 0.035). This study suggests that CRP enhanced values in both groups are the result of the response to surgery. The enhanced IL-6 values in group I, and maintained IL-6 values within reference range in group II, are the result of continuous tramadol chloride opiate analgesia, which turned out to be more efficient and safer.

[Coronary bypass in treatment of high-risk patients]. / Koronarno premostavanje u tretmanu visoko rizicnih pacijenata.

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit, total length of hospitalisation and number of complication in two groups of patients operated with these methods. Patients with EuroScore > or =5 with CABG operated in Cardiovascular Clinic Tuzla, from May 2000 to May 2005 divided in two groups, were included in this study. There were 100 patients in the first group operated with CPB and 100 patients in the second group operated without CPB. The average time spent on respirators was shorter in patients operated without CPB (3.7 vs.9.74 hours, p = 0.023) and the time spent in Intensive care shorter too (19 vs. 23 days, p = 0.008). Volume of postoperative bleeding was less in patients operated without CPB (574.9 vs. 988.9 ml, p = 0.038), as volume after blood transfusion (168.8 vs. 350.3 mi, p = 0.001). Intraoperative inotrope support was less in patients operated without CPB (8.0 vs. 19.0%, p = 0.038) as postoperative inotrope support (6.0 vs. 17.0%, p = 0.027). The most usual postoperative complication was atrial fibrillation and there was no difference between patients operated with CPB and without CPB (24% vs. 17%, p = 0.293). Mortality was not different in patients operated with or without CPB (2.0% vs. 6.0%, p = 0.140). The average time of total hospitalisation was also shorter in patients operated without CPB (8.0 vs. 9.5 days, p = 0.039. In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care. The total hospitalisation time is also reduced.