Yüksek riskli hastada karotis endarterektomi cerrahisi için ultrason eşliğinde karotis kılıf bloğu ve literatür taraması

Carotid endarterectomy (CEA) surgery is generally performed for patients who under the risk of ischemic cerebral stroke due to the critical obstruction of the carotid artery. Ischemic complications may occur during the surgery. So, the awakeness of the patient is very important during the surgery. Regional anesthesia techniques may be performed instead of general anesthesia for shunt placement during CEA surgery. Herein, we aimed to share our successful US-guided carotid sheath block experience for anesthesia management during CEA surgery.Karotid endarterektomi cerrahisi genellikle karotis arterin tıkanıklığından dolayı iskemik serebro-vaskuler olay riski altındaki hastalara uygulanır. Cerrahi sırasında iskemik komplikasyonlar gelişebilir. Bu nedenle cerrahi sırasında hastanın uyanıklığı çok önemlidir. Cerrahi sırasında şant yerleşimi için genel anestezi yerine rejyonal anestezi teknikleri tercih edilebilir. Bu makalemizde karotid endarterektomi cerrahisi sırasında anestezi yönetimi için ultrason eşliğinde uyguladığımız başarılı karotis kılıf bloğu deneyimimizi paylaşmayı amaçladık

Peripheral vs. central cannulation in cardiac reoperations: Technical considerations and outcomes

Objective: To compare peripheral and central cannulation techniques in cardiac reoperation.Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared.Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups.Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparison of the effects of percutaneous catheter insertion with anatomic landmark or ultrasonography- guided techniques on hospital cost in children

Amaç: Çocuklarda santral venöz kateter ve arter kateteri takılması damar çapı küçük olduğundan güçlükleriçerir. Ultrasonografi ile kateterizasyon zaman ve malzeme tasarrufu ile birlikte girişim başarısı artmış, komplikasyonlarda da azalma olmuştur. Bu çalışmanın amacı çocuklara anatomik işaret ve ultrasonografi eşliğindesantral venöz kateter ve arter takılması yöntemlerini; zaman, malzeme, cerrahi, atriyal kateter takma yönlerinden karşılaştılmasıdır.Yöntem: Hastane Etik Komite onayı alındıktan sonra, retrospektif, olgu kontrollü, ardarda 1’er yıllık sürelerde,1. yıl anatomik işaret (Grup A, n=151) ve 2. yıl ultrasonografi (Grup B, n=151) yöntemleri kullanılarak, 10 kg’ınaltı, santral venöz kateter ve/veya arter takılan olgular çalışmaya dâhil edildi.Bulgular: Grup A ve Grup B’de sırası ile tüm olguların toplam santral venöz kateter takma süresi 78 saat, 37saat, fark 41 saat idi (p<0.005). Grup A ve Grup B’de sırası ile tüm olguların toplam arter kateteri takma süresi96 saat, 63 saat, fark ise 33 saat idi (p<0.005). Kullanılan toplam kateter sayısı Grup A’da 203, Grup B’de 167ve aradaki fark 36 bulundu. Kateterizasyon için cerrahi set kullanımı 9 adet (Grup A: 8 set, Grup B: 1 set) idi(p<0.05). Toplam kateterizasyon süreleri (ameliyat odasının saatlik kullanım fiyatı olan 3.200 TL), kullanılankateter ve cerrahi set dikkate alındığında iki gruptaki aynı sayıdaki olgular için 241.620 TL net iyileştirme sağlandığı görüldü.Sonuç: Ultrasonografi kılavuzluğunda yapılan santral venöz kateter ve arter kateteri yerleştirilmesi, anatomikişaret ile karşılaştırıldığında anlamlı derecede daha kısa zamanda yapıldı. Ultrasonografi ile yapılan kanülasyonlarda daha az malzeme kullanıldı. Hastane maliyetlerinde azalma sağlaması nedeniyle özellikle düşükağırlıklı çocuk hastalarda ultrasonografi kullanılması akla getirilmelidir.Objective: Insertion of a central venous catheter and an arterial catheter in children involves difficulties because of the small vascular diameter. With the use of ultrasonography decreases in catheterization time and materials used have been achieved. The aim of this study is to compare the methods of arterial and central venous catheterization performed under the guidance of anatomic landmarks and ultrasonography with respect to time, and material spent, surgery, and atrial catheter insertion methods Method: After obtaining hospital ethics committee approval, in this prospective, case-controlled study, patients weighing less than 10 kg who underwent central venous and /or arterial catheterization first year under the guidance of anatomic landmarks (Group A, n=151) and second year ultrasonography (Group B, n=151) period catheter insertion into the superior vena cava and / or arteries in were included in the study. Results: In Groups A and B, the total duration of central venous catheterizations were 78, and 37 hours, respectively with a difference of 41 hours (p <0.005). In Groups A and B, total duration of arterial catheterization were 96 , and 63 hours, respectively with a difference of 33 hours (p<0.005). In all, greater number of catheters, were used in GroupA (n=203) when compared with Group B (n=16) with a difference of 36 catheters. For catheterization in Group A, 8, and in Group B only one surgical set was used (p<0.05). When total catheterization times (operating room hourly usage price is 3.200 TL), the catheter and surgical sets used in the same number of cases in the two groups taken into account a net saving of TL 241.620 was achieved. Conclusion: Ultrasonography- guided central venous catheter and arterial catheter placement were performed in a significantly shorter time compared to the catheterizations performed under the guidance of anatomical landmarks . Less material was used in the cannulations performed by ultrasonography. Due to the reduction in hospital costs, the use of ultrasonography should be considered in especially underweight children

Erector spinae plane block for a patient who underwent both bilateral mastectomy and right video-assisted thoracic surgery

Clinicians usually opt for a procedure that is easy and simple to perform and has low risk of complications duringpostoperative analgesia management. Techniques such as thoracal epidural analgesia (TEA) and paravertebral blockare invasive and difficult to use in practice (1). Opioids are usually preferred for intravenous analgesia, but their usemay cause adverse events, such as respiratory depression, nausea and vomiting (2). Thus, ultrasound (US)-guidedinterfascial plane blocks are increasingly being used in daily anaesthesia practice. Erector spinae plane block (ESPB)is a novel US-guided interfascial plane block that may provide both thoracic and abdominal analgesia (3, 4). Herewe would like to report our experience of performing ESPB for a patient who underwent multiple surgeries. Writteninformed consent was obtained from the patient for reporting of this case

The importance of good-quality saphenous vein segments for bypass procedures

We have read with great interest the manuscriptentitled ‘Saphenous vein graft preparation withconventional or Mayo vein stripper method: Whichone is better?’ written by Dr. Indelen.[1] The studycomprises some issues which need to be clarified.The author uses second plural, i.e. ‘we’; however,there is only one author listed in the manuscript. Didthe sole author conduct all surgical procedures andhistopathological examinations? These issues mighthave led to study bias. If these examinations wereexecuted by histopathologist(s), were they blinded tothe groups

Rainier hemoglobinopatisi olan bir hastada azalmış oksijen satürasyonuna rağmen genel anestezi ile septoplasti ameliyatının tamamlanması

Rainier hemoglobinopathy is an extremely rare hematologic disorder characterizedwith increased oxygen affinity of hemoglobin leading to decreased blood oxygensaturation. Up to date literature includes only 1 case who had been operated undergeneral anesthesia. In this report, we present a 27-year-old male patient with Rainierhemoglobinopathy who underwent nasal septoplasty under general anesthesia.Rainier hemoglobinopati, hemoglobinin düşük kan oksijen satürasyonuna yol açanarmış oksijen afinitesi ile karakterize, oldukça ender görülen hematolojik bir hastalıktır.Güncel literatür, genel anestezi ile ameliyat edilen yalnızca 1 olguyu kapsamaktadır. Bu makalede, genel anestezi ile nazal septoplasti yapılan, Rainier hemoglobinopatisi olan 27 yaşında bir erkek hastayı sunduk

Patient-specific atrial hemodynamics of a double lumen neonatal cannula in correct caval position

13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion -- SEP 28-30, 2017 -- Rome, ITALYWOS: 000430277400007PubMed ID: 29572879Clinical success of pediatric veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with the double lumen cannula cardiovascular device design as well as its anatomic orientation in the atrium. The positions of cannula ports with respect to the vena cavae and the tricuspid valve are believed to play a significant role on device hemodynamics. Despite various improvements in ECMO catheters, especially for the neonatal and congenital heart patients, it is still challenging to select a catalogue size that would fit to most patients optimally. In effect, the local unfavorable blood flow characteristics of the cannula would translate to an overall loss of efficiency of the ECMO circuit. In this study, the complex flow regime of a neonatal double lumen cannula, positioned in a patient-specific right atrium, is presented for the first time in literature. A pulsatile computational fluid dynamics (CFD) solver that is validated for cardiovascular device flow regimes was used to perform the detailed flow, oxygenated blood transport, and site-specific blood damage analysis using an integrated cannula and right atrium model. A standard 13Fr double lumen cannula was scanned using micro-CT, reconstructed and simulated under physiologic flow conditions. User defined scalar transport equations allowed the quantification of the mixing and convection of oxygenated and deoxygenated blood as well as blood residence times and hemolysis build-up. Site-specific CFD analysis provided key insight into the hemodynamic challenges encountered in cannula design and the associated intra-atrial flow patterns. Due to neonatal flow conditions, an ultra high velocity infusion jet emanated from the infusion port and created a zone of major recirculation in the atrium. This flow regime influenced the delivery of the oxygenated blood to the tricuspid valve. Elevated velocities and complex gradients resulted in higher wall shear stresses (WSS) particularly at the infusion port having the highest value followed by the aspiration hole closest to the drainage port. Our results show that, in a cannula that is perfectly oriented in the atrium, almost 38% of the oxygenated blood is lost to the atrial circulation while only half of the blood from inferior vena cava (IVC) can reach to the tricuspid valve. As such, approximately 6% of venous blood from superior vena cava (SVC) can be delivered to tricuspid. High values of hemolysis index were observed with blood damage encountered around infusion hole (0.025%). These results warrant further improvements in the cannula design to achieve optimal performance of ECMO and better patient outcomes.European Union (EU) [FP7 CIG-293931-CardioFluidMechanics]; European Research Council (ERC) Starting Grant [307460]; TUBITAK 1003 priority-research program grant [115E690]This work was supported in part by the European Union (EU) FP7 CIG-293931-CardioFluidMechanics, European Research Council (ERC) Starting Grant 307460 and TUBITAK 1003 priority-research program grant 115E690 (Principle Investigator: Kerem Pekkan). Micro-CT is kindly provided by Teknodent via Asm Horasan

Application of Artificial Neural Network for Predicting the Drying Kinetics and Chemical Attributes of Linden (Tilia platyphyllos Scop.) during the Infrared Drying Process

This study analyzes the possibility of utilizing artificial neural networks (ANNs) to characterize the drying kinetics of linden leaf samples during infrared drying (IRD) at different temperatures (50, 60, and 70 &deg;C) with sample thicknesses between 0.210 mm and 0.230 mm. The statistical parameters were constructed using several thin-layer models and ANN techniques. The coefficient of determination (R2) and root mean square error (RMSE) were utilized to evaluate the appropriateness of the models. The effective moisture diffusivity ranged from 4.13 &times; 10&minus;12 m2/s to 5.89 &times; 10&minus;12 m2/s, and the activation energy was 16.339 kJ/mol. The applied Page, Midilli et al., Henderson and Pabis, logarithmic, and Newton models could sufficiently describe the kinetics of linden leaf samples, with R2 values of &gt;0.9900 and RMSE values of &lt;0.0025. The ANN model displayed R2 and RMSE values of 0.9986 and 0.0210, respectively. In addition, the ANN model made significantly accurate predictions of the chemical properties of linden of total phenolic content (TPC), total flavonoid content (TFC), DPPH, and FRAP, with values of R2 of 0.9975, 0.9891, 0.9980, and 0.9854, respectively. The validation of the findings showed a high degree of agreement between the anticipated values generated using the ANN model and the experimental moisture ratio data. The results of this study suggested that ANNs could potentially be applied to characterize the drying process of linden leaves and make predictions of their chemical contents

Low velocity drop weight impact behaviour of Al2O3-Ni-ZrO2 and Al2O3-Ni-Cr2O3 ceramic composites

Particulate Al2O3 matrix nanocomposites containing 1 vol.% Ni were prepared by the heterogeneous precipitation method and the addition of 5 vol.% ZrO2 (ANZ) or 1 vol.% Cr2O3 (ANC). The prepared samples were subjected to the low energy drop weight impact tests to compare the behaviour of the composites under low energy impact and to investigate the damage mechanisms. The pure Al2O3, Al2O3/Ni, Al2O3/ZrO2 and Al2O3/Cr2O3 compositions with the same additive ratios were also produced to make the comparison systematically. Also, the Vickers hardness measurements were carried out and a significant increase in hardness was attained for both ANZ and ANC composites. The average hardness value around 24.8±1.0 GPa was measured for the ANZ and ANC composites which means ∼15% improvement compared to the pure Al2O3. Between all the compositions, the maximum force (Fmax) value was obtained for the ANZ (for 12 J impact energy level Fmax = 26617 N) according to the low energy drop weight impact test results. Tensile radial crack network formation, cone formation, fracture and crushing of the cone structure were observed as damage mechanisms for all compositions. The volume of conical frustum structure was evaluated for each composition and the effect of microstructure on possible ballistic performance was also discussed