Comparison of the Effect of Different Anesthesia Maintenance on Hemodynamics in Coronary Artery Bypass Grafting Surgery: A Retrospective Cohort Study

Objective:General anesthesia management in coronary artery bypass graft surgery (CABGC) should preserve myocardial function, prevent ischemic damage, and maintain stable hemodynamics. There is not a universally accepted technique for anesthetic management during CABGC. Drugs or drug combinations and maintenance of infusions are decided based on the pathophysiological condition of the patient and the individual preference and experience of the anesthesiologist (1). Although there are many studies about an anesthesia induction in CABGC, studies about anesthetic maintenance are very limited. In this study, we compared the hemodynamic effects of three different methods that were used in anesthetic maintenance in CABGC.Method:The retrospective records of 108 patients in ASA II-III group who underwent elective CABGC were divided into 3 groups according to their anesthetic maintenance methods. Group I was maintained with 1-3% sevoflurane and fentanyl 4 mcg/kg/hour infusion, group II with propofol 1.5-4 mg/kg/hour and fentanyl 4 mcg/kg/hour infusion, and group III with propofol 1.5-4 mg/kg/hour and remifentanil infusion of 0.03 mg/kg/hour. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and heart rate (HR) were measured and recorded after induction (T0), after sternotomy (T1), after pericardiotomy (T2), 5 minutes after cardiopulmonary bypass (CPB) (T3), after thorax closure (T4), at the end of the operation (T5). The vasodilator requirements in the time period before CBP and the inotropic agent requirements after CPB were noted.Results:Data of 108 patients (88 men/20 women) were analyzed. Demographic characteristics of the patients were similar in all the groups. Statistical analysis was made among the groups depending on coronary artery bypass graft number, cross-clamp time, total fluid administration, total blood transfusion, total urine volume, inotropic agent requirement after CPB, postoperative central venous pressure, and pre- and postoperative lactate levels; however, there was no statistical difference. There was not change more than 20-25% in MAP and HR in group I than the others.Conclusion:Better hemodynamic results were achived with sevoflurane and fentanyl in the anesthetic maintenance of CABGC

Effect of Different Inorganic Substrates on Growth Performance of African Catfish (Clarias gariepinus, Burchell 1822) and Lettuce (Lactuca sativa L.)

Lettuce (Lactuca sativa L.) and African catfish (Clarias gariepinus) were preferred to grow in aquaponics due to their high and fast productivity growth. However, limited research was conducted on the impact on different inorganic substrates’ growth performance in aquaponics. In this study, lettuce’s growth performance was determined in four different kinds of inorganic substrates in Nutrient Film Technique (NFT) aquaponics by measuring final weight, daily growth rate, stem diameter, plant and root lengths, leaf number per plant and shoot/root ratio. Polyester fiber, rock wool, zeolite, and gravel were used as inorganic substrate materials. A constant flow rate of 0.3 L/min was maintained using with a submersible pump motor. At the end of the study, the African catfish’s feed conversion ratio was estimated to be 0.66, while the specific growth rate (SGR) was 2.3%. Total lettuce yields for polyester fiber, rock wool, zeolite and gravel were obtained as 5.072,22 kg/m2 , 4.934,03 kg/m2 , 6.067 kg/m2 , and 5.382,64 kg/m2 respectively. There were statistically significant differences for daily growth rate between the inorganic substrates that the significantly highest values were recorded in the zeolite. The results revealed that initial plant length and shoot/root ratio were the significant factors on the growth performance for lettuce in aquaponic system tested. The best lettuce yield performance was observed in zeolite substrate but, economically available option was found as gravel for hydroponic troughs

Early Outcomes of a High PaO2 /FiO2 Ratio during Cardiopulmonary Bypass

© 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.Background: In cardiac surgery, supraphysiological oxygen levels are frequently applied perioperatively. In this study, we examined the postoperative effect of perioperative hyperoxemia in cardiac surgery. Methods: All patients who underwent mitral valve replacement via the standard sternotomy method between 2010 and 2021 were analyzed by scanning the hospital data system. The patients were divided into 2 groups: the hyperoxemic group (partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] >500 mmHg) (Group I) and the normoxemic group (300 mmHg < PaO2/FiO2 < 500 mmHg) (Group II) according to the mean of 3 PaO2/FiO2 values calculated by using 3 PaO2 and 3 FiO2 levels. Postoperative complications, the mechanical ventilation time, the need for noninvasive mechanical ventilator support, the length of intensive care unit (ICU) stay, the hospitalization period, and the mortality rate of the groups were compared. Results: A total of 78 patients were included in the study, and 53 of the patients (67.9%) were female. The mean age of the patients was 58.89±12.60 years. The total mechanical ventilation time was significantly higher in the hyperoxemic group than in Group II (P<0.001) (18.18±12.90 h and 11.45±7.85 h, respectively). The amount of postoperative bleeding was significantly higher in Group I (P=0.003) (539.47±201.74 mL and 417.50±186.93 mL, respectively). The total amount of blood products administered during surgery and ICU stay was higher in Group I (P=0.041) (3.55±1.59 units and 2.87±1.89 units, respectively). Conclusion: We observed that the group with hyperoxemia during cardiopulmonary bypass had a higher amount of postoperative bleeding and the need for transfusion, as well as a longer duration of mechanical ventilation and intensive care

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 μm) when compared to the AFB (450.5 ± 122.6 μm) and RNB (442 ± 116 μm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments