Koroner arter bypass greftleme cerrahisi sonrası hasta kontrollü analjezi ile morfin ve remifentanil karşılaştırılması

Koroner arter bypass greftleme cerrahisi (KABG) sonrası ağrının kontrol altına alınması postoperatif komplikasyonları azaltan ve bakım kalitesini artıran önemli etmenlerden biridir. Ancak, yeterli etkinliğe sahip ve yan etki profili kabul edilebilir bir tedavi modelinin oluşamaması nedeniyle kardiyak cerrahi sonrası ağrının kontrolünde henüz istenilen düzeye ulaşılamamıştır. Randomize çift-kör olarak planlanmış bu çalışmada amacımız, KABG cerrahisi sonrası parasetamol ve tramadol ile oluşturulmuş multimodal bir analjezi protokolünde intravenöz hasta kontrollü analjezi (IV-PCA) yöntemi ile morfin ve remifentanil uygulamasını etkinlik ve yan etki profili yönünden karşılaştırmaktır. KABG cerrahisine alınan, sol ventrikül atım oranı (LVEF) >%35 olan ASA III, 60 hasta prospektif, randomize, çift kör olarak 2 gruba ayrıldı. Hastalara ilk 24 saatte IV-PCA (Grup M: IV morfin PCA; infüzyon: 0.3 mg/saat, bolus: 1 mg, kilit süresi: 5 dk ve grup R: IV remifentanil PCA; infüzyon 0.05 μg/kg/dk, bolus 0.25 μg/kg, kilit süresi: 5 dk) ve parasetamol (ekstübasyon öncesi 4x1000mg/gün, ekstübasyon sonrası 4x500 mg/gün) uygulandı. Postoperatif 24. saat sonunda analjezik uygulaması parasetamol (4x500 mg) ve tramadol (4x50 mg) olarak değiştirildi. Hasta takipleri postoperatif 72. saate kadar yapıldı. İstirahat, hareket ve öksürük ile oluşan ağrı düzeyi rakamsal ağrı skalası (NRS), sedasyon düzeyi ise Ramsay sedasyon skoru ile değerlendirildi. Taburculuk öncesi hastaların ağrı tedavi memnuniyetleri değerlendirildi. Grup M’ye oranla grup R’de postoperatif 12. ve 24. saatte hareket ve öksürükle oluşan ağrı anlamlı derecede düşük idi. Postoperatif 6. saatte Ramsay sedasyon skorları grup R’de grup M’ye göre anlamlı derecede düşük idi. Grup M’deki hastalarda postoperatif 36 ile 72 saat arası bulantı grup R’ye göre daha yüksek oranda gözlendi. Sonuç olarak, KABG cerrahisi sonrası uygulanmakta olan multimodal analjezide IV-PCA remifentanilin IV-PCA morfine göre daha etkin bir analjezi ve daha az yan etki profili oluşturarak yüksek oranda hasta memnuniyeti sağladığı saptandı

Evaluation of Hepatitis C in 20 Years: A Turkish Experience

Objective: Hepatitis C virus (HCV) infection still maintains its importance since it is one of the most important causes of liver cirrhosis and hepatocellular carcinoma. Our hospital, located in İstanbul, which is the 10t most crowded city in the world, has a patient cohort where epidemiological change can be observed due to its deep-rooted history and serving people of different nations in terms of settlement. Main aim in this study is to evaluate the change in HCV epidemiology in our country over the years. Methods: Patients who were at the age of 18 and above and whose HCV-RNA was positive between January 2001 and January 2021 were evaluated. Results: 1.166 patients whose HCV genotype was determined were evaluated. The mean age of the population is 52±14.75 years, 83.53% of all patients was infected with genotype 1 (GT1), 8.23% with GT3, 5.83% with GT2, 2.23% with GT4 and 0.17% of them with GT5. While the GT1 rate decreased in patients over the years, an increase was found in other GTs. GT1 and GT2 were more common in females (p<0.001); GT3 and GT4 were more dominant in males (p<0.001). The mean age of females was high in all genotypes. The mean age of GT3 was significantly lower than the other groups (p<0.001). Conclusion: Although GT1 is still dominant in our country, GT3 and GT4 have been increasingly seen over the years, suggesting that the genotype distribution may change in the coming years due to uncontrolled migration and effective direct-acting antivirals

Does Pain Following Laparoscopic Cholecystectomy Differ in Diabetics?

Introduction:Individuals with diabetes differently respond to painful stimuli in the postoperative period than non-diabetic patients. This variation causes a scorching, tingling, numbness, or even hyperalgesic sensation due to a change in sensory perception. During routines sometimes we donot remember how patients’ pain differ in some situations. Diabetes mellitus is an important disease that we must remember when we plan our postoperative pain relief plan. This study aimed to assess the pain levels and analgesic requirements of individuals with diabetes following laparoscopic cholecystectomy (LC).Methods:Patients with symptomatic gallstones and cholecystitis underwent elective LC between April 2019 and April 2020. Patients’ records were prospectively registered and retrospectively received from the patients’ record system on the postoperative course. A total of 70 cases were evaluated within the scope of the study, 35 (50%) of whom were diagnosed with diabetes and 35 (50%) were control subjects.Results:When the results were examined, it was determined that there was a difference between the two groups that were statistically significant at the 5th and 10th minutes of the bispectral index (p<0.05). When the two groups were compared, patients in the control group had more pain on the postoperative course and mean score of 8 (p=0.049), 7 (p=0.016), 5 (p=0.02), 4 (p=0.032), 2 (p=0.014) respectively 1, 2, 4, 8, 12, 24 hours on the numeric rating scale, p<0.001). In the multivariable analysis, the group with diabetes was shown to be strongly related with a significantly lower dosage of tramadol consumption compared to the control group.Conclusion:According to our findings, the patient with diabetes who underwent LC experienced less postoperative discomfort than those without diabetes. In contrast to the previous studies, our findings show that patients with diabetes have less post-operative pain and require fewer analgesics

Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females) were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years). There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc.) and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM) and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9%) and individuals of young age (median age: 27.45 years). Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7