ISSN 1305-5550 | e-ISSN 2548-0669
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - GKD Anest Yoğ Bak Dern Derg: 30 (1)
Volume: 30  Issue: 1 - 2024
1.Front Matter

Pages I - XI (37 accesses)

2.Causes of Excessive Bleeding in Patients Who Underwent Open-Heart Surgery During the Early Postoperative Period
Ismahangül Özbayrak, Dilşad Amanvermez Şenarslan, Funda Yıldırım, Olcay Yaldır Kayalı, Arzu Açıkel, Tülün Öztürk
doi: 10.14744/GKDAD.2024.13285  Pages 1 - 8 (32 accesses)
Objectives: This study aimed to identify the incidence and causes of excessive bleeding during the early postoperative phase of open-heart surgery.
Methods: The files of patients who underwent elective open-heart surgery between January 2019 and January 2021 were reviewed. Excessive bleeding was defined according to the amount of hemorrhage during the first 24 h. The patients were divided into the bleeding group (with excessive bleeding, Group B) and control group (no excessive bleeding, Group C). Patients’ demographic data, clamping and pumping times, intraoperative interventions, and clinical data, such as the need for blood and blood product replacement in the intensive care unit, were obtained. Measurements were performed using Student’s t-test, Mann–Whitney U test, Pearson’s chi-squared test, and correlation test.
Results: The incidence of bleeding was 9.7%, and the rate of re-exploration was 33%. The presence of chronic obstructive pulmonary disease was significantly higher in Group B (p=0.006). The preoperative use of antiaggregants was significantly higher in Group B than in Group C (p=0.001). No significant difference was observed between the groups in terms of bleeding and coagulation laboratory values as well as the need for intraoperative replacement of blood and blood products. However, the need for postoperative replacement of blood and blood products was significantly higher in Group B (p<0.001). Female sex was found to be negatively correlated with bleeding (p=0.032). Furthermore, a positive correlation was observed between chronic obstructive pulmonary disease, presence of CRF, use of anticoagulant, EuroSCORE, ECD duration, cross-clamping (CC) duration, and bleeding. The incidence of anemia among the patients was 41%.
Conclusion: The incidence of excessive bleeding in the early postoperative period was 9.7%. Of the patients, 33% required surgical reopening. The presence of chronic obstructive pulmonary disease, preoperative antiaggregant use, high EuroSCORE, and long CC and CPB durations may lead to excessive bleeding and may be helpful parameters in the prediction of bleeding. To reduce the risk of postoperative bleeding, We believe that it is crucial to maintain patients' optimal health conditions in terms of comorbidities before surgery. This also includes discontinuing any medications that increase the risk of bleeding for appropriate periods before surgery. Additionally, the use of tranexamic acid and reducing the duration of surgery are other preventive measures that can be taken to minimize risks.

3.Is the Intraoperative Lactate–standard Base Excess Relationship Strong in Cardiac Surgery?
Serap Aktaş Yıldırım, Melis Tosun Canlı, Bülent Güçyetmez, Fevzi Toraman
doi: 10.14744/GKDAD.2024.21703  Pages 9 - 15 (38 accesses)
Objectives: In this study, changes in lactate and standard base excess (SBE) values, which are indirect indicators of tissue perfusion, in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were examined, and whether there was a correlation between them was investigated.
Methods: In total, 2,068 patients >18 years of age who underwent elective cardiac surgery with CPB were included in the study. Hemodynamic and blood gas parameters were recorded at four different time points: before and after anesthesia induction and at the beginning and end-of-extracorporeal circulation.
Results: Before anesthesia induction, the average lactate level was 1.0±0.5 mmol/L, and the average SBE level was 0.9±2.1. SBE and lactate had very weak correlations in all four intraoperative periods (r2=0.01, r2=0.02, r2=0.06, r2=0.06; p<0.001). At the end of the extracorporeal period, SBE and lactate were correlated (r2=0.11; p<0.001) in patients with lactate values >2 mmol/L, but no correlation was found in patients with a lactate value <2 mmol/L (r2=0.0003; p=0.526). The Kappa test revealed that lactate and SBE changes were incompatible in 274 (13.3%) patients. Hyperchloremia was detected in 1683 (94.5%) of 1781 patients in whom lactate increase and simultaneous SBE decrease were observed.
Conclusion: Lactate levels were weakly correlated with SBE throughout the intraoperative period. Because SBE is a calculated parameter and not a measured parameter, it should be evaluated together with lactate rather than interpreted alone.

4.Usage of Cardiac Risk Scores During Anesthetic Assessment Before Cardiovascular Surgery: A Survey Study
Pelin Gürel, Hasan Hepağuşlar, Manolya Aksoy, Muhammed Burak Yücel
doi: 10.14744/GKDAD.2023.88609  Pages 16 - 21 (36 accesses)
Objectives: There are different risk scoring systems (RSSs) for preoperatively determining the risk of cardiovascular surgery. Herein, we aimed to determine which of the current RSSs are used at the national level to assess patients who are planned for cardiovascular surgery.
Methods: A survey was conducted electronically or via face-to-face interviews. The number and rate of physicians using RSSs in combination with the American Society of Anesthesiologists (ASA) Physical Status Classification (ASA PSC) were determined. Additionally, the extent to which patients and their relatives were informed about the preoperatively predicted cardiac risk was determined.
Results: Of the 139 participating physicians, only 125 were analyzed. The ASA PSC (n=123, 98.4%), EuroSCORE II (n=48, 38.4%), and CARE score (n=23, 18.4%) were the most commonly used scoring systems for determining the risk level. Among the physicians who used the ASA PSC, 67 (53.6%) only used the ASA PSC. The other 56 (44.8%) physicians used one or more RSSs in combination with the ASA PSC. EuroSCORE II (n=48, 38.4%) was commonly used to determine the risk. Only 16 physicians (12.8%) reported using the ASA PSC, EuroSCORE II, and CARE score in combination, (the most frequent triplet combination). Furthermore, 74 physicians (59.2%) informed the patients and their relatives about the preoperative risk.
Conclusion: In our study, the ASA PSC was used by almost all the participants. However, current cardiac RSSs were not frequently used in clinical practice at the national level. Thus, we believe that current RSSs should be more widely used to determine the risk level in patients awaiting cardiovascular surgery.

5.Effect of Age on Estimated Glomerular Filtration Rate and the Relationship between eGFR and Extubation Time in Patients Undergoing Open Heart Surgery
Feyza Çalışır, Yavuz Orak, Süleyman Alper Kozak, Ziya Kurşun, Sefa Mert Alkan, Abdulhamit Şehid Kılınç, Adem Doğaner
doi: 10.14744/GKDAD.2024.87049  Pages 22 - 28 (41 accesses)
Objectives: Extracorporeal circulation, while facilitating coronary artery bypass grafting (CABG) surgery, accelerates inflammatory processes and increases morbidity and mortality in elderly patients. The primary aim of this study was to evaluate the effect of aging on postoperative renal function after open heart surgery using an estimated glomerular filtration rate (eGFR) biomarker. The secondary aim was to evaluate the relationship between postoperative extubation times and other laboratory parameters and age and eGFR.
Methods: The data of 90 patients in the American Society of Anesthesiologists score (ASA) I–II groups who underwent CABG with cardiopulmonary bypass under general anesthesia were retrospectively analyzed. Patients were divided into two groups according to age (Group 1 aged ≥65 years and Group 2 aged <65 years). Statistical differences between the groups were evaluated according to the eGFR of the patients (eGFR <60 and >60 mL/min).
Results: The number and percentage of patients with preoperative eGFR <60 mL/min were similar in both groups (p=0.052). However, the number and percentage of patients with eGFR <60 mL/min postoperatively were higher in Group 1 than in Group 2 (p=0.024). Extubation times were found to be higher in Group 1, with 540 and 390 min in Groups 1 and 2, respectively (p=0.002).
Conclusion: The results of this study show that the renal and pulmonary systems of patients aged ≥65 years will be more affected by cardiovascular surgery and anesthesia than those of patients aged <65 years. In CABG surgery, we can obtain an idea about the postoperative extubation time by monitoring preoperative and postoperative eGFR changes.

6.Comparison of the Efficacy between Thoracic Epidural Analgesia and Paravertebral Block in Patients Undergoing Pneumonectomy: A Retrospective Cohort Study
Özal Adıyeke, Onur Sarban, Ergün Mendeş, Taner Abdullah, Funda Gümüş Özcan
doi: 10.14744/GKDAD.2024.91668  Pages 29 - 34 (45 accesses)
Objectives: This study aimed to compare the efficacy of epidural catheter and paravertebral block methods for the management of postoperative pain in patients undergoing thoracotomy and pneumonectomy and to develop clinical routines for optimal pain control.
Methods: Hemodynamic data, arterial blood gas values, VAS scores (at ICU admission and postoperative 8, 16, and 24 h), total amount of rescue analgesics for 24 h, and mortality rates of patients undergoing pneumonectomy treated with preoperative thoracic epidural analgesia (TEA) and paravertebral block were compared.
Results: Patients’ pain scores upon admission to the ICU and 8, 16, and 24 h postoperatively and the total amount of rescue analgesia administered during the study period were compared. VAS scores 8 and 16 h postoperatively were statistically similar between the groups. Additionally, postoperative ICU admission and 24-h VAS follow-up were significantly lower in the TEA group (p<0.05). The mean total dose (mg) of additional morphine at 24 h in PVB group was found to be statistically significantly higher than that in the TEA group (p=0.0001).
Conclusion: The data of 2,422 operations were analyzed, and 34 patients were included in this study. No statistically significant difference was observed between the groups in terms of mortality. In this study, we observed that postthoracotomy pain can be managed by paravertebral block with preoperative bolus bupivacaine. This study confirmed that paravertebral block is an effective method for achieving analgesia during pneumectomy, as recommended by the PROSPECT guidelines.

7.Comparison of Four Different Block Techniques for Postoperative Analgesia in Thoracotomy
Fatih Doğu Geyik, Gülten Arslan, Jülide Sayın Kart, Ummahan Dalkılınç Hökenek, Mahmut Talha Doğruyol, Recep Demirhan, Kemal Tolga Saracoğlu
doi: 10.14744/GKDAD.2024.57224  Pages 35 - 40 (49 accesses)
Objectives: Postthoracotomy pain requires multimodal perioperative management, including systemic and regional techniques. This prospective, randomized study aimed to evaluate postthoracotomy pain scores using the visual analog scale (VAS) as well as consumption of analgesic in 24 h and complications.
Methods: The patients were randomly assigned into four groups (25 patients each group) according to the analgesia technique used: Intercostal nerve block (ICB), thoracic epidural block (TEB), ultrasonography-guided erector spinae plane block (ESPB), and ultrasonography-guided thoracic paravertebral block (TPVB) groups. Multimodal analgesia was achieved with tramadol, paracetamol, and intravenous pethidine via patient-controlled analgesia (PCA) for all patients. The VAS scores at 30, 60, 90, 120 min, 6, 12, and 24 h postoperatively, consumption of analgesic at the first 24 h, rescue analgesic requirement, and side effects were recorded.
Results: The VAS scores were the highest in the ICB group and the lowest in the TPVB group at all time periods after thoracotomy (p<0.05). Likewise, total pethidine dose, number of PCA trials, and PCA data were determined to be at least in the TPVB group. However, only the number of PCA trials was found to be statistically significant (p=0.03). In terms of side effects, no difference was observed between the groups. Nausea and vomiting occurred in two patients in the ICB and ESPB groups, whereas hypotension occurred in two patients in the TEB group.
Conclusion: In conclusion, ultrasound-guided single-injection TPVB is more reliable and preferable in thoracotomy, as it is associated with low pain scores and has no side effects.

8.Overview of the Pathophysiology of Extravasation of Anesthetic Drugs
Sevinç Açışlı Ersan, Ahmet Şen
doi: 10.14744/GKDAD.2024.96977  Pages 41 - 49 (55 accesses)
Intravenous administration of drugs is frequently employed to achieve rapid and effective systemic effects. However, it is undesirable to administer drugs into the tissue as a result of extravasation of the intravenous cannula. Both the closed extremities to which the IV route is applied due to the surgical method to be applied make it difficult to access the vascular access during surgery and the use of pressurised instruments in the administration of drugs through the IV route makes the work of the anaesthetist difficult. In addition, patients cannot report their pain due to unconsciousness. In the operating theater and intensive care unit for anesthesia practice, induction, fluid therapy, nutrition, etc., although rare, difficulty in vascular access maintenance and drug extravasation cause serious complications in many procedures. This study aimed to emphasize the importance of perioperative anesthetic drug extravasation and its physiopathology by presenting current information.

9.Simultaneous Visualization of an Iatrogenic Cuff Rupture in a Patient Intubated with a Video-Double Lumen Tube
Hija Yazıcıoğlu, Bilfer Özler, Alkın Yazıcıoğlu, Mahmut Subaşı, Ayşegül Özgök
doi: 10.14744/GKDAD.2023.65477  Pages 50 - 52 (43 accesses)
VivaSightTM Video-Double Lumen Tube (V-DLT) is a new DLT with an embedded camera. It is connected to a monitor that continuously demonstrates the position of the tube relative to that of the carina. It is very effective for the rapid placement of the DLT. Additionally, it recognizes tube repositioning and maintains one-lung ventilation. There is no risk of contamination because it is disposable. Herein, we present the case of a patient where simultaneous visualization allowed the detection of an iatrogenic cuff rupture in a patient intubated with VivaSight V-DLT and the challenging anesthetic management following air leakage during remainder of the procedure.

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