ISSN 1305-5550 | e-ISSN 2548-0669
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - GKD Anest Yoğ Bak Dern Derg: 29 (4)
Volume: 29  Issue: 4 - 2023
OTHER
1.Full Issue

Page I (7 accesses)

RESEARCH ARTICLE
2.Effects of the Anesthesia Type on Hematological Parameters in Coronary Artery Bypass Grafting
Tuna Şahin, Semiha Görgün, Suat Karaca, İbrahim Özsöyler
doi: 10.14744/GKDAD.2023.83584  Pages 177 - 182 (9 accesses)
Objectives: This study evaluated the effects of sevoflurane-based inhalation anesthesia and propofol-based total intravenous anesthesia on hematological parameters in coronary artery bypass grafting (CABG).
Methods: In this study, 125 patients who underwent elective on-pump CABG between November 2021 and April 2022 were retrospectively analyzed. Patients aged 35–80 years with an ejection fraction of ≥25% were included. The patients were separated into two groups: The sevoflurane group (Group SEVO) and the total intravenous anesthesia group (Group TIVA). Patient characteristics, operative clinical data, and preoperative and postoperative hematological parameters: [white blood cell (WBC) count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR)] were analyzed. Results: The mean age of the patients was 62.0±8.7 years. Group SEVO comprised 70 patients, and Group TIVA comprised 55 patients. Significant increases in postoperative WBC count, RDW, and NLR values were observed in both groups. No statistically significant differences in WBC count, RDW, and NLR values were observed between the two groups (p>0.05).
Conclusion: The effects of sevoflurane-based inhalation anesthesia or propofol-based total intravenous anesthesia on WBC count, RDW, and NLR values among patients undergoing elective on-pump CABG were similar.

3.Anesthesia Management in Non-Intubated Thoracoscopic Surgery (NIVATS): A Retrospective Study
Mete Manici, Eren Yavuz Açıkalın, Yavuz Gürkan
doi: 10.14744/GKDAD.2023.38233  Pages 183 - 185 (10 accesses)
Objectives: Video-assisted thoracoscopic surgery (VATS) is a widely used technique for thoracic operations. Non-intubated VATS (NIVATS) under regional or local anesthesia can be performed in selected patients. Epidural analgesia or interfascial plane blocks can be used for successful NIVATS. Erector spinae plane block (ESPB) is a type of interfascial plane block that is effective for NIVATS procedures. At our clinic, we successfully perform NIVATS with ESPB or rhomboid intercostal plane block (RIB). In this paper, we assess the effectiveness of these anesthesia methods used during NIVATS procedures.
Methods: We retrospectively reviewed 61 patients that underwent NIVATS procedures at our clinic between November 2017 and August 2023. This study received ethical committee approval (2023.255.IRB1.084). These 61 patients were assessed based on their demographic information, ASA grades, procedure indication, procedure duration, post-procedure complications, and type of anesthesia.
Results: All 61 patients received intraoperative sedation. Of these,16 received epidural analgesia, 10 received ESPB, 6 received RIB, and 29 received local anesthesia. Perioperative care did not differ between groups and all surgeries were completed without complications. No patients required transition to general anesthesia.
Conclusion: Patients in the epidural group were younger, which we think correlates with increasing comorbidities and anticoagulant usage with age. Other parameters were similar between groups. Overall, we recommend further prospective studies with larger sample sizes to evaluate the outcomes of different anesthesia techniques for NIVATS procedures.

4.The Effects of Iron Therapy on Blood Transfusion, Length of Intensive Care Stay and Mortality in Patients with Iron Deficiency Anemia in the Intensive Care Unit
Yusuf Özgüner, Savaş Altınsoy, Eda Macit Aydın, Gülten Ütebey, Mehmet Murat Sayın, Jülide Ergil
doi: 10.14744/GKDAD.2023.75768  Pages 186 - 192 (10 accesses)
Objectives: The most prevalent form of anemia is iron deficiency anemia (IDA). In the intensive care unit (ICU) setting, frequent blood sampling for diagnostic purposes is one of the most important causes of anemia among patients. In our study, we aimed to retrospectively scan and compare patients diagnosed with IDA in our institution’s ICU, with and without iron therapy.
Methods: In this study, patients with IDA who were hospitalized in our ICU for more than 21 days were included. The patients were divided into two groups: group 1 (patients with iron therapy) and group 2 (patients without iron therapy). Information regarding demographics (age and sex), comorbidities, total volume of blood samples drawn, hemoglobin, hematocrit, ferritin values, requirement for blood transfusion, length of ICU stay, Acute Physiology and Chronic Health Evaluation II score, Glasgow coma scale, and mortality rates were recorded.
Results: In this study, 48 patients were analyzed, including 25 (18 women, 7 men) with iron therapy and 23 (13 women, 10 men) without iron therapy. A statistically significant difference was found in the mean blood volume per patient transfused over the 21-day period between the two groups.
Conclusion: We noted that oral iron therapy was effective in reducing blood transfusions in patients with prolonged ICU stays. We believe that studies with larger patient groups are warranted regarding this topic.

5.Early versus Late Application of Hemoadsorption in Critically Ill COVID-19 Patients with Cytokine Release Syndrome
Berrin Er, Sema Turan, Hayriye Cankar Dal, Çilem Bayındır Dicle, Nilgün Eren Çakaroğlu, Şeyda Özkan, Dilek Kazancı
doi: 10.14744/GKDAD.2023.16779  Pages 193 - 199 (10 accesses)
Objectives: Cytokine release triggered by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) depends on a dysregulated immune response and is associated with high mortality. Extracorporeal cytokine hemoadsorption (HA) can be considered a possible adjuvant therapy. This study aimed to review the outcomes of critically ill patients with COVID-19 treated with HA and analyze possible factors associated with mortality.
Methods: Data of patients who received HA for at least one cycle from April 17, 2020, to January 31, 2021, were collected. Clinical and laboratory features were recorded, and mortality was evaluated based on the extracorporeal treatment application time and intensive care units (ICU) admission.
Results: Data from 177 patients among 4733 ICU patients were analyzed. Their mean age was 60.9±10.9, and 40 (22.6%) of them were females. About 83% of them were mechanically ventilated, and the overall mortality was 76%. In univariate analysis, the mean age, median acute physiology and chronic health evaluation (APACHE)-II score, respiratory support rate, and duration between ICU admission and first cytokine filter were lower in the survivor group than in the non-survivor group. In binary logistic regression analysis, higher APACHE-II with an odds ratio of 1.06 (95% confidence interval [CI]: 1.005–1.128, p=0.033), invasive mechanical ventilation with an odds ratio of 138.4 (95%CI: 24.2–791.8, p<0.001), and later application of HA with an odds ratio of 1.190 (95%CI: 1.009–1.404, p=0.039) were independently associated with in-hospital mortality.
Conclusion: Cytokine HA was applied to a large number of patients at our center. Although this was conducted in a severe population with high mortality, besides invasive mechanical ventilation, late application of the cytokine filter was found as one of the factors independently associated with higher mortality.

6.Prognostic Efficacy of Red Cell Distribution Width and Neutrophil/Lymphocyte in Cardiac Surgery
Ferda Yaman, Tuğba Özyurt, Dilek Çetinkaya
doi: 10.14744/GKDAD.2023.92678  Pages 200 - 203 (10 accesses)
Objectives: This study aimed to examine the effect of neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) values on postoperative mortality and morbidity in patients who underwent off-pump cardiac surgery.
Methods: This study included patients who underwent off-pump coronary artery bypass surgery from January 1, 2018 to January 1, 2020. Correlations between the preoperative NLR and RDW values and postoperative complications, extubation time, length of intensive care unit stay, and length of hospital stay were evaluated.
Results: A total of 68 patients were evaluated. No correlation was found between preoperative RDW and NLR values and age, ejection fraction, extubation time, or length of hospital stay. The length of stay in the intensive care unit did not correlate with the preoperative RDW value but was correlated with the NLR value (p=0.042). In six patients, postoperative complications were observed. No statistically significant difference was found between patients with and without complications in terms of preoperative RDW and NLR values.
Conclusion: In this study, a high preoperative NLR value was associated with a prolonged intensive care unit stay, one of the early complications of cardiac surgery. However, the preoperative RDW value did not have a predictive relationship with early postoperative complications.

7.Effect of Cold Application on Pain After Chest Tube Removal in Patients Undergoing Bypass Surgery
Ezgi Karalar, Hatice Erdoğan
doi: 10.14744/GKDAD.2023.24482  Pages 204 - 210 (10 accesses)
Objectives: This study investigated the effect of cold application on pain after chest tube removal in patients undergoing bypass surgery.
Methods: Data of 56 patients who underwent bypass surgery between August 2021 and November 2021 (46 males, 10 females; mean age: 62.8±9.2 years) were analyzed. The patients were divided into two groups: the intervention group (n=28) with cold application and the control group (n=28) without cold application. Demographic characteristics, pain, and vital signs of the patients were compared.
Results: The groups mostly felt pain in the tube site 20 min before cold application, during the procedure, and 20 min after the procedure, and a significant difference in pain quality was observed between the groups (p<0.05). No significant differences in pain severity and skin and body temperatures were observed between the two groups 20 min before the procedure. Pain intensity and skin and body temperatures of the intervention group decreased during and 20 min after the procedure. No significant differences in systolic blood pressure, diastolic blood pressure, heart rate, and respiration were observed between the two groups (p>0.05). In the control group, systolic and diastolic blood pressures and pulse rate increased during the procedure. The SpO2 level of the intervention group was higher.
Conclusion: Cold application was effective in managing pain after chest tube removal in patients undergoing bypass surgery.

8.Totally Implantable Venous Access Devices: Study of 1,613 Patients and Complication Management
Nadide Örs Yıldırım
doi: 10.14744/GKDAD.2023.37640  Pages 211 - 217 (9 accesses)
Objectives: Totally implantable venous access devices (TIVADs) are crucial for treating patients with malignancy. However, reaching the intravenous route is rendered difficult owing to the consequences of chemotherapy. This retrospective study aimed to investigate the early and late complications associated with percutaneous insertion and TIVAD use.
Methods: A total of 1,647 TIVAD procedures in 1,613 patients between 2010 and 2023 were retrospectively analyzed. All TIVADs were placed in the cardiovascular surgeon operating room under sedation. A C-arm fluoroscopy machine and ultrasound were used during the procedure.
Results: A total of 1,613 patients were included in the study, of which 1,085 were males and 528 were females. The mean age of these patients was 49.8±19.2 (16–86) years. At the right side, 1,403 devices were implanted (791 right subclavian vein and 612 right internal jugular vein), while 210 were implanted at the left side (128 left subclavian vein and 82 left internal jugular vein). During the study period, 285 early and 142 late complications were detected. TIVAD insertions were performed successfully, with no recorded deaths.
Conclusion: This study revealed that TIVADs are relatively safe procedures. Majority of the early complications are related to the implantation technique, whereas late complications are associated with catheter fatigue or the use of inlabrate. These complications can be prevented by adhering to rules of the procedure and employing the appropriate technique. Although C-arm fluoroscopy is crucial for these procedures, a risk of accumulated radiation exposure exists but can be reduced with utmost care.

CASE REPORT
9.Perioperative Desaturation after Onyx (DMSO) Embolization before Surgery
Abdullah Aydın Özcan, Hüseyin Aybar, Alper Uçak
doi: 10.14744/GKDAD.2023.40370  Pages 218 - 221 (11 accesses)
Onyx consists of an ethylene–vinyl alcohol copolymer dissolved in dimethyl sulfoxide, used in blood vessel embolization. Preoperative embolization of some hypervascular tumors is commonly performed to reduce surgical time and blood loss. However, unwanted effects associated with Onyx can raise perioperative anesthetic concerns. A 19-year-old man, weighing 55 kg with an arteriovenous malformation located in the left popliteal region underwent Onyx embolization 1 day before surgery. Because of observed perioperative desaturation, extubation difficulty, and subsequent respiratory distress, the patient’s treatment was continued in the intensive care unit. We present the clinical developments and anesthetic concerns experienced during this study. In patients who have undergone Onyx embolization and exhibit preoperative respiratory distress, tachypnea, and desaturation, postponing surgery, except for emergency indications, may be appropriate. For those undergoing surgery, extubation and subsequent intensive care may be required. Steroids, diuretics, antithrombotic drugs, and antibiotics should be considered in the treatment. Oxygen support with a mask and, if necessary, advanced airway support should be provided.

LETTER TO THE EDITOR
10.Rhomboid Intercostal Plane Block After Thoracoscopic Pleurectomy
Mete Manici
doi: 10.14744/GKDAD.2023.65049  Pages 222 - 223 (11 accesses)
Abstract |Full Text PDF

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