ISSN 1305-5550 | e-ISSN 2548-0669
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - GKD Anest Yoğ Bak Dern Derg: 30 (2)
Volume: 30  Issue: 2 - 2024
1.Front Matter

Pages I - XII (2 accesses)

2.Importance of Echocardiography in Patients Supported by Extracorporeal Membrane Oxygenation
Türkan Kudsioğlu
doi: 10.14744/GKDAD.2024.17048  Pages 53 - 59 (3 accesses)
ECMO is a mechanical support system applied in cases of severe heart and/or lung failure unresponsive to all treatments. The use of ECMO is increasing. Technological advancements in ECMO systems (oxygenator, pump, cannula systems, and cannulation techniques), careful patient selection, and the use of echocardiography (ECHO) contribute to improving survival rates. Additionally, the establishment of ECMO teams and increased experience in this field have also enhanced its applications. Knowledge of ECMO indications and contraindications, technical and intraoperative anesthesia management, and potential complications necessitates collaborative implementation in the operating room, intensive care unit, or during the e-CPR process. This review emphasizes the importance and guidance of transthoracic and transesophageal echocardiography (TTE and TEE) in peripheral or central ECMO applications, including ECMO cannulation, hemodynamic monitoring, and separation processes.

3.Early Postoperative Hyperlactatemia After Extracorporeal Circulation: The Role of Standard Base Excess and Anion Gap in Differential Diagnosis
Serap Aktaş Yıldırım, Melis Tosun, Bülent Güçyetmez, Fevzi Toraman
doi: 10.14744/GKDAD.2024.80388  Pages 60 - 66 (3 accesses)
Objectives: This study aimed to determine whether follow-up with standard base excess (SBE) and anion gap (AG) aids in the differential diagnosis of early postoperative hyperlactatemia, specifically in distinguishing between low cardiac output and lactate washout.
Methods: The study involved 1203 patients who underwent isolated coronary bypass surgery with the help of Extracorporeal Circulation (ECC). These patients were divided into two groups based on their cardiac index (CI): Group 1 consisted of 1162 patients with CI ≥ 1.8 L/min/m², while Group 2 had 41 patients with CI<1.8 L/min/m². Blood gas measurements were taken at five different time points to examine the correlation between lactate, SBE, and AG.
Results: The correlation between lactate and SBE in Group 1 was weak (r=-0.07, p<0.001). Similarly, the correlation between lactate and anion gap was weak (r=0.08, p=0.005). On the other hand, in Group 2 (CI<1.8 L/min/m²), a much stronger correlation was observed between lactate and SBE (r=-0.49, p<0.001). However, there was no correlation between lactate and anion gap (r=-0.007, p=0.964).
Conclusion: Relying solely on SBE (standard base excess) and anion gap to distinguish hyperlactatemia is limited because they depend on various variables. Therefore, we recommend assessing hyperlactatemia by examining the patient's clinical condition, other tissue perfusion parameters, flow measurements, plasma chloride, and albumin values.

4.Retrospective Comparison of the Effects of Intrathecal Morphine and Erector Spinae Plane Block on Postoperative Analgesia in Patients Undergoing VATS
Buket Kocamanoğlu, Cengiz Kaya, Esra Turunç, Halil Cebeci, Elif Bengi Şener, Ismail Serhat Kocamanoğlu
doi: 10.14744/GKDAD.2024.60566  Pages 67 - 75 (3 accesses)
Objectives: This study evaluates the analgesic effects of intrathecal morphine (ITM) and ultrasound-guided erector spinae plane block (ESPB) in managing postoperative pain following video-assisted thoracoscopic surgery (VATS).
Methods: This retrospective observational study examined hospital records and anesthesia documents of 40 patients who underwent VATS at a university hospital between January 2021 and January 2022. The patients were divided into two groups: ITM and ESPB. The comparative analysis included cumulative morphine consumption within the initial 12/24 h after VATS, Numeric Rating Scale (NRS) resting/activity scores, rescue analgesic requirements, and the side effect profile.
Results: During the first 12 h postoperatively, the ITM group exhibited lower median morphine consumption than the ESPB group (ITM: 1.9 mg [0.85–3] vs. ESPB: 3.65 mg [3–4.23], p=0.003). Further, within the initial 24 h postoperatively, the ITM group also exhibited lower median morphine consumption compared to ESPB (ITM: 4 mg [1.54–5.38] vs. ESPB: 10 mg [10–10], p<0.001). The NRS resting/activity scores were consistently lower in the ITM group than in the ESPB group at all measurement times (p<0.001). The number of patients receiving rescue analgesic medication was lower in the ITM group than in the ESPB group (ITM, n=6 [30%] vs. ESPB, n=20 [100%]; p<0.001). The side effect profiles of both groups were comparable.
Conclusion: ITM reduced morphine consumption, pain scores, and the requirement for rescue analgesia compared with ESPB, with a comparable side effect profile after VATS.

5.Ultrasound-Guided Central Venous Catheterization of the Internal Jugular Vein in Cardiovascular Surgery
Manolya Aksoy Dark, Nilay Boztaş, Şule Özbilgin, Hasan Hepağuşlar
doi: 10.14744/GKDAD.2024.92693  Pages 76 - 81 (3 accesses)
Objectives: Central venous catheterization (CVC) of the internal jugular vein (IJV) has been performed with landmark techniques for many years. In recent years, ultrasound (US) guidance has become the preferred method. In this observational study, we aimed to obtain the durations of IJV puncture and catheterization during US-guided CVC in patients undergoing cardiovascular surgery.
Methods: After ethics committee approval, patients over the age of eighteen who underwent cardiovascular surgery were included. Central venous catheters were inserted via the right IJV with the aid of US guidance after standard anesthesia induction. Demographic data, characteristics of surgical interventions, number of attempts for IJV puncture, duration of puncture, success rate of puncture, duration of catheterization, success rate of catheterization, and complications were recorded. Data were presented as mean±SD (min-max) and/or number (%).
Results: Fifty patients (31 M, 19 F) were included. The mean age was 64.22±11.02 years, the mean weight was 77.12±11.81 kg, and the mean height was 166.48±9.53 cm. Coronary artery bypass grafting surgery (64%), valve replacement (VR) surgery (24%) [single VR (10%), double VR (12%), and triple VR (2%)], coronary artery bypass grafting surgery with mitral VR surgery (4%), Bentall procedure (4%), Bentall procedure with aortic VR surgery (2%), and ASD repairment surgery (2%) were performed on the patients. The mean number of puncture attempts was 1.0±0.00, the mean puncture duration was 5.08±3.85 (1-16) seconds, and the mean catheterization duration was 92.86±30.85 (68-232) seconds. Vein puncture and catheterization were both successfully performed in all patients. No complications were observed.
Conclusion: The anatomical relationship and variation of IJV and CA could be easily detected with the use of US. Thus, catheterization of the IJV can be performed successfully with the aid of US guidance. Our results are in accordance with the results of studies present in the literature.

6.Is Erector Spinae Plane Block a Good Solution for Managing Pain Associated with Rib Fractures? Reviewing Literature Through Case Series
Hatice Güneş, Çiğdem Yıldırım Güçlü, Büşra Gülşen Erol, Özgün Ömer Asiller, Yusuf Kahya, Gökhan Kocaman
doi: 10.14744/GKDAD.2024.43255  Pages 82 - 86 (3 accesses)
Rib fractures are a significant cause of morbidity and mortality due to potential respiratory complications. Pain is one of the most critical factors affecting respiratory functions. Therefore, pain management is a crucial component of treatment. The erector spinae plane block, a newly defined technique, has been used for postoperative acute pain control and chronic pain syndromes. Its use has become widespread in rib fractures due to its ability to provide effective analgesia and its safe application under ultrasound guidance. Data is needed to determine if it is the best method compared to other techniques. In this article, we aim to review the literature through our case series.

7.Enhancing Minimally Invasive Thoracic Surgery: Efficacy of Serratus Posterior Superior Intercostal Plane Block in VATS Procedures
Mete Manici, Ilayda Kalyoncu, Yasemin Sincer, Yavuz Gürkan
doi: 10.14744/GKDAD.2024.22448  Pages 87 - 88 (4 accesses)
Abstract |Full Text PDF

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