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ABSTRACT: Tramadol is an analgesic drug, and its mechanism of action is believed to be mediated by the mu-opioid receptor. A further action of tramadol has been identified as blocking the reuptake of serotonin (5-HT). One of the most recently identified subtypes of 5-HT receptor is the 5-HT7 receptor. Thus, the authors aimed to examine the potential role of serotonergic descending bulbospinal pathways and spinal 5-HT7 receptors compared with that of the 5-HT2A and 5-HT3 receptors in the antinociceptive and antihyperalgesic effects of tramadol and its major active metabolite O-desmethyltramadol (M1) on phasic and postoperative pain models.
Nociception was assessed by the radiant heat tail-flick and plantar incision test in male Balb-C mice (25-30 g). The serotonergic pathways were lesioned with an intrathecal injection of 5,7-dihydroxytryptamine. The selective 5-HT7, 5-HT2, and 5-HT3 antagonists; SB-269970 and SB-258719; ketanserin and ondansetron were given intrathecally.
Systemically administered tramadol and M1 produced antinociceptive and antihyperalgesic effects. The antinociceptive effects of both tramadol and M1 were significantly diminished in 5-HT-lesioned mice. Intrathecal injection of SB-269970 (10 microg) and SB-258719 (20 microg) blocked both tramadol- and M1-induced antinociceptive and antihyperalgesic effects. Ketanserin (20 mumicrog) and ondansetron (20 microg) were unable to reverse the antinociceptive and antihyperalgesic effects of tramadol and M1.
These findings suggest that the descending serotonergic pathways and spinal 5-HT7 receptors play a crucial role in the antinociceptive and antihyperalgesic effects of tramadol and M1.
Anesthesiology 03/2010; 112(3):696-710. · 5.36 Impact Factor
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ABSTRACT: This study was undertaken to compare the in vivo effects of isoflurane, sevoflurane, and propofol anesthesia on ischemia- and reperfusion-mediated free-radical injury and oxidative stress during coronary artery bypass graft surgery. We also compared the effects of these anesthetic agents on levels of end products of lipid peroxidation and nitric oxide (NO) in human right atrial tissue and blood.
Sixty patients scheduled to undergo elective coronary surgery with cardiopulmonary bypass (CPB) were enrolled. Patients were randomly allocated to receive 1 of 3 different anesthetic protocols: propofol (group A), isoflurane (group B), or sevoflurane (group C). We recorded global hemodynamic data (mean arterial pressure, mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac output, cardiac index, and systemic vascular resistance index) just before the start of surgery, before the start of CPB, 15 minutes after the end of CPB, at the end of the operation, 6 hours after installation in the intensive care unit, and 12 and 24 hours later. Samples of the right atrial appendage were harvested before and after exposure of the heart to blood cardioplegia and short-term reperfusion under conditions of CPB. Biochemical and oxidative stress parameters were analyzed in both blood and tissue.
Hemodynamic parameters were kept stable throughout in all groups. Troponin I increased transiently with all used anesthetic regimens, but this increase was significantly lower in groups B and C. After clamp removal, lipid peroxidation in patients who received propofol (group A) was less than in patients who received isoflurane (group B) or sevoflurane (group C) (P= .001, P= .005, respectively). Although the 3 groups showed no statistically significant differences in tissue levels of thiobarbituric acid-reactive substances and superoxide dismutase, propofol significantly lowered NO production in atrial tissue after clamp removal and induced less NO production than sevoflurane (P< .05).
Inhalation anesthetics such as isoflurane and sevoflurane preserved cardiac function in coronary surgery patients after CPB with less evidence for myocardial damage than propofol. Furthermore, propofol induced lower blood levels of lipid peroxidation than isoflurane and sevoflurane. Propofol also increased glutathione peroxidase activity but induced less NO production compared to sevoflurane. These findings also support the cardioprotective properties that are demonstrated by hemodynamic parameters.
Heart Surgery Forum 02/2009; 12(1):E1-9. · 0.63 Impact Factor
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ABSTRACT: To quantitate the contractile effect of methylene blue on isolated human internal mammary artery (IMA) as used in the vasoplegic syndrome.
An in vitro experimental study.
Cardiovascular Pharmacology Laboratory, Department of Medical Pharmacology.
IMA segments were used from 24 patients undergoing coronary artery bypass surgery.
The responses to methylene blue, norepinephrine, and acetylcholine were recorded isometrically by a force-displacement transducer in an isolated organ bath.
Methylene blue (10 nmol/L-100 micromol/L) produced concentration-dependent contraction in the arteries. The maximal contraction to methylene blue was 44.2% +/- 3.8% of KCl (68 mmol/L) maximum contraction; the pEC(50) (-log(10) of 50% effective concentration) value was 5.5 +/- 0.1. Methylene blue caused an insignificant leftward shift of the concentration-response curve of norepinephrine. Acetylcholine-induced relaxation in submaximal contracted rings with phenylephrine recovered nearly 6 hours after the methylene blue challenge.
Methylene blue caused concentration-dependent contraction in human IMAs. Furthermore, the inhibition of ACh-induced relaxation for 6 hours after the methylene blue challenge points out an additional mechanism (ie, receptor occupation). The concentration-dependent contractile effect of methylene blue justifies its use in the vasoplegic syndrome. The findings also suggest that the time course of contraction is longer than the exposure to methylene blue.
Journal of cardiothoracic and vascular anesthesia 09/2008; 22(4):560-4. · 1.06 Impact Factor
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ABSTRACT: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias.
A prospective randomized study.
This study was performed in 2 different centers between April 2005 and February 2007: Gülhane Military Medical Academy and University of Süleyman Demirel.
Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers.
Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient's glycemic response during the prior 4 hours.
There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p = 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p = 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p = 0.045). Univariate analysis identified positive inotropic drug requirement (p = 0.011, odds ratio [OR] = 3.41), ejection fraction (EF) (p = 0.001, OR = 0.92), cross-clamp time (p = 0.046, OR = 0.97), left internal mammary artery (p = 0.023, OR = 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p = 0.009, OR = 2.02), intra-aortic balloon pump (p = 0.045, OR = 1.23), body mass index (p = 0.035 OR = 5.60), and CII (p < 0.001, OR = 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR = 0.91), positive inotropic drug requirement (p < 0.001, OR = 3.94), COPD (p = 0.036, OR = 2.11), and CII (p < 0.001, OR = 0.19).
Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.
Journal of cardiothoracic and vascular anesthesia 06/2008; 22(3):383-7. · 1.06 Impact Factor
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ABSTRACT: Levosimendan enhances cardiac contractility by increasing myocyte sensitivity to calcium, and induces vasodilatation. Although studies have evaluated the efficacy of levosimendan in heart failure, it is not clear whether it might produce functional influence on platelet response. In this study, the effect of levosimendan on platelet aggregation was investigated. Platelet function tests were performed in 12 healthy male volunteers. Three concentrations of levosimendan solution were prepared that would result in 10, 25, and 45 ng/ml levosimendan concentrations in the blood similar to that observed after clinical therapeutic intravenous application of 0.05-0.1 microg/kg/min. Each concentration of levosimendan solution and a control diluent without levosimendan were incubated with whole blood at 37 degrees C. After incubation for 15 min, aggregation responses were evaluated with adenosine diphosphate (ADP) (5 and 10 microM) and collagen (2 and 5 microg/ml) in platelet-rich plasma. Preincubation with all dilutions of levosimendan inhibited aggregation of platelets induced by ADP and collagen significantly. Levosimendan also inhibited significantly the secondary wave of platelet aggregation induced by ADP. The results showed that there was a relationship between levosimendan concentration and inhibition of platelet aggregation. In conclusion, this study with an in vitro model showed that levosimendan had a significant inhibitory effect on platelets in clinically relevant doses.
American Journal of Hematology 02/2008; 83(1):46-9. · 4.67 Impact Factor
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ABSTRACT: Mechanic ventilation with different modes is an option to be used in patient with respiratory failure. One of these modes is free lung ventilation. This mode can be used to prevent or to treat atelectasis. İn this case report; a patient who had diffuse atelectasis in the right lung will be discussed regarding independent lung ventilation theraphy and its follow up in intensive care unit.
The Anatolian Journal of Clinical Investigation. 01/2008;
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ABSTRACT: To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA).
Prospective, randomized study.
Tertiary-care military hospital.
Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus).
Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management.
Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared.
The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group.
Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.
Journal of Clinical Anesthesia 11/2007; 19(7):506-11. · 1.21 Impact Factor
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ABSTRACT: To investigate the direct effects of dexmedetomidine (DEX) on isolated human internal mammary artery (IMA).
In vitro experimental study.
Cardiovascular Pharmacology Laboratory, Department of Pharmacology, Gulhane School of Medicine, Ankara, Turkey.
IMA segments were obtained from 18 patients undergoing coronary artery bypass surgery.
The response in IMA was recorded isometrically by a force displacement transducer in isolated organ baths. DEX-induced contractions were tested in the presence of the alpha2-adrenoceptor antagonist yohimbine (10(-7) mol/L) and the alpha1-adrenoceptor antagonist prazosin (10(-8) M). The effect of DEX (10(-7), 10(-6), and 10(-5) mol/L) on phenylephrine (10(-9)-3 x 10(-4) mol/L)-induced contactions was also tested.
DEX (10(-9) mol/L-3 x 10(-5) mol/L) caused contraction in IMA segments. The contraction at lower concentrations of DEX (10(-9) mol/L-3 x 10(-7) mol/L) was attenuated by yohimbine (10(-7) mol/L), whereas prazosin (10(-8) mol/L) attenuated the contractions at higher concentrations of DEX (10(-6) mol/L-3 x 10(-5) mol/L). Incubation of IMA segments with high concentrations of DEX (10(-6) mol/L and 10(-5) mol/L) caused an inhibition of phenylephrine (10(-9) mol/L-3 x 10(-4) mol/L)-induced contraction.
These data suggest that DEX causes contraction by activating alpha2-adrenoceptors at lower concentrations, but it may also activate alpha1-adrenoceptors at higher concentrations in IMA. The action of DEX on phenylephrine-induced contraction may be related to an alpha1-adrenoceptor antagonistic effect produced via partial alpha1-adrenoceptor agonistic action.
Journal of Cardiothoracic and Vascular Anesthesia 11/2007; 21(5):696-700. · 1.64 Impact Factor
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ABSTRACT: N-acetylcysteine, beta-glucan, and coenzyme Q(10) were shown to have antioxidant and anti-inflammatory effects on reperfusion injury. The aim of our study was to determine and evaluate the effects of these agents on ischemia reperfusion injury of limb.
Forty-four New Zealand white rabbits, all female, weighing between 2.3 to 4.2 (mean 3.8) kg, were used in the study. Four study groups were arranged of 11 animals each, by randomization. The first group was the control group (Group C), the other groups were the Group Q, which was medicated with coenzyme Q10, the Group betaG, which was medicated with beta-glucan, and the Group N, medicated with N-acetylcysteine. After baseline measurements, for the ischemia-reperfusion experiments, common iliac artery was clamped and collateral flow was occluded by a rubber arterial tourniquet wrapped around the thigh at the proximal third of the leg. After 60 min of transient ischemic period, the limb was perfused for 180 min. After perfusion, biopsy was taken from the adductor magnus muscle. Second blood sampling was done after reperfusion period. Blood and tissue analysis were done and evaluated statistically.
Baseline and post-reperfusion levels of glutathione peroxidase (GPx), super oxide dismutase (SOD), malonyldialdehyde (MDA), and nitric oxide (NO) changed significantly. While MDA levels increased in the control group, it decreased in the other study groups. The increase in GPx and SOD levels were significant in all groups except the control group. Levels of NO were found to have decreased in the control group, whereas it had increased in the other groups.
Antioxidant medication may help lowering limb ischemia reperfusion injury. All mentioned medications in our study are shown to be able to have an effective role for preventing ischemia reperfusion injury to some extent through their antioxidant properties.
Journal of Surgical Research 06/2007; 139(2):274-9. · 2.25 Impact Factor
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ABSTRACT: Preliminary clinical studies of testosterone therapy in male patients with coronary artery disease obtained promising results. However, little is known about the in vitro effects of testosterone in human isolated arteries. We investigated the effect of testosterone on contractile tone of human isolated radial artery (RA). Testosterone was added (0.1 - 300 microM ) cumulatively to organ baths after precontraction with KCl (45 mM) and phenylephrine (PE, 10 microM). Testosterone-induced relaxations were tested in the presence of the cyclooxygenase inhibitor indomethacin (10 microM), nitric oxide synthase inhibitor N(omega)-nitro-L-arginine methyl ester (L-NAME, 100 microM), non-selective large conductance Ca(2+)-activated and voltage-sensitive K(+) channel inhibitor tetraethylammonium (TEA, 1 mM), ATP-sensitive K(+) channel inhibitor glibenclamide (GLI, 10 microM), and voltage-sensitive K(+) channel inhibitor 4-aminopyridine (4-AP, 1 mM). Testosterone produced relaxation in human RA (E(max): 53.03 +/- 2.76% and 66.83 +/- 1.97% of KCl and PE-induced contraction, respectively). Except for GLI, the relaxation to testosterone is affected by neither K(+) channel inhibitors (TEA, BaCl(2), and 4-AP), L-NAME, nor indomethacin. We report for the first time that supraphysiological concentrations of testosterone induces relaxation in RA. This response may occur in part via ATP-sensitive K(+) channel opening action.
Journal of Pharmacological Sciences 04/2007; 103(3):309-16. · 2.08 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the left ventricular functions and the regression of left ventricular hypertrophy after aortic valve replacement (AVR) in young male patients with pure aortic stenosis or aortic insufficiency with no additional disease.
Young male patients who underwent AVR because of pure aortic stenosis (AS = 68) and insufficiency (AI = 70) were enrolled in the study. The mean age was 23.2 +/- 1.3 and 22.6 +/- 1.6 years, respectively. The follow-up time was 5 years. The parameters checked by transthoracic echocardiography were interventricular septum diastolic thickness, left ventricular posterior wall diastolic thickness, left ventricular end-diastolic diameter, left ventricle mass, left ventricle mass index, ejection fraction, and peak aortic gradient. Relative ventricle wall thickness was also calculated. Both groups values from the preoperative, postoperative sixth month, second year, and fifth year time intervals were compared.
In the AS group, the preoperative left ventricular ejection fraction (%) value of 53.68 +/- 5.04 increased to 63.24 +/- 4.11 at the end of the fifth year. In the AI group, the preoperative left ventricular ejection fraction (%) value of 48.40 +/- 3.56 increased to 59.77 +/- 2.75 at the end of the fifth year. The other left ventricular geometric parameters were also compared within each group. At the end of the fifth year, there were significant and positive changes in each group.
The regression of the left ventricular parameters is a process that occurs over many years following the correction of the primary hemodynamic abnormality. Although the results were similar in the AI and AS group, in the AS group the remodeling process had earlier results than in the AI group.
Heart Surgery Forum 02/2007; 10(1):E57-63. · 0.63 Impact Factor
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Cengiz Bolcal, Vedat Yildirim,
Suat Doganci,
Murat Sargin,
Ahmet Aydin,
Erkan Kuralay,
Ertugrul Ozal,
Ufuk Demirkilic,
Bilgehan Savas Oz,
Ahmet Sayal,
Harun Tatar
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ABSTRACT: N-acetylcysteine, beta-glucan, and coenzyme Q10 have been shown to have antioxidant and anti-inflammatory effects on reperfusion injury. The aim of our study was to determine and evaluate the effects of these agents on myocardial ischemia-reperfusion injury.
Forty-four New Zealand white rabbits, all female, weighing 2.4 to 4.1 kg (mean, 3.6 kg) were used in the study. Four study groups of 11 animals were arranged by randomization. The groups were the control group (group C), a group premedicated with coenzyme Q10 (group Q), a group premedicated with beta-glucan (group betaT), and a group premedicated with N-acetylcysteine (group N). After exploration of the heart, a basal myocardial biopsy was taken from the anteroapical left ventricle, and the first blood sampling was done before ischemia. For the ischemia-reperfusion experiments, the major left anterior descending artery was occluded after baseline measurements. After a 45-minute transient ischemic period, the heart was perfused for 120 minutes. After perfusion, the second myocardial biopsy was taken from the anteroapical left ventricle, and the second blood sampling was done. Blood and tissue analysis were performed and evaluated statistically.
Baseline and reperfusion levels of glutathione peroxidase, superoxide dismutase, malonyldialdehyde, and nitric oxide changed significantly. While malonyldialdehyde levels increased in group C, they decreased in the other study groups (P =.001). The increases in glutathione peroxidase and superoxide dismutase levels were significant in all groups except group C (P =.0001 and P <.05, respectively). Levels of nitric oxide were found to be decreased in group C, whereas they increased in the other groups (P =.001).
Antioxidant medication may help in lowering the risk of myocardial ischemia-reperfusion injury. All the medications in our study are shown to have effective roles in preventing ischemia-reperfusion injury to some extent through their antioxidant properties.
Heart Surgery Forum 02/2007; 10(3):E222-7. · 0.63 Impact Factor
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ABSTRACT: The aim of this study was to establish the clinical course and importance of missed arterial injuries and disregarded venous repair after surgery for gunshot injuries.
This retrospective study was performed on the operative results of 275 shotgun vascular injury patients' presented to our clinic between January 1992 and December 2004. All patients were analyzed from their medical files and operative notes. The incidence of missed arterial injuries and ignored venous repair, localization and type of vascular complications, limb loss and mortality outcomes were documented.
Seventy-five patients (27.27%) for a delayed diagnosis of a missed arterial injury and 91 patients (33.09%) for an ignored venous repair were treated. Complications of missed arterial injuries were determined as followings: false aneurysm n=43 (57.33%), arteriovenous fistula n=20 (26.66%), occlusion n=12 (16%). The missed vascular injury was most commonly observed in superficial femoral artery (n=20). The venous injury was present in 167 patients. Complications of disregarded venous repair were determined as venous edema and deep vein thrombosis.
Missed arterial injuries and disregarded venous repairs during initial diagnosis or operation affect the morbidity and mortality in gunshot injury patients. After haemodynamic stabilization, gunshot patients should be evaluated by arteriography and venography to determine the anatomic localization of vascular injuries. All vascular continuity should be restored either by primary repair or by an autolog graft. All venous injuries located in popliteal and femoral area should be repaired.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2007; 13(1):43-8. · 0.33 Impact Factor
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ABSTRACT: Radio-cephalic arteriovenous fistulas (AVFs) have high early failure ratio. Increased sympathetic activity and spasm of radial artery during the surgery may responsible for early occlusion rate.
Fifty patients were randomized to two groups (each containing 25 patients). Stellate Ganglion Blockade (SGB) was performed in Group 1. Another group was considered as control group (Group 2) to make statistical comparisons. All AVFs were performed under local anesthesia in both groups.
Average fistula flow was 201.4+/-40.4 ml/min in Group 1 and 155.6+/-27.4 ml/min in Group 2 (p < 0.001). While average peak velocity of radial artery was 167.1+/-31.3 cm/sec in Group 1, it was 107.8+/-15.8 cm/sec in Group 2 (p < 0.001). Thrill was found in all Group 1 patients, but there was thrill only 13 of the Group 2 patients (p < 0.001). Mean maturation time was 41.4+/-6.8 days after surgery in Group 1 and 77.1+/-10.5 days in Group 2 (p < 0.001). Adequate vascular access was obtained 19 patients in Group 1 and 12 patients in Group 2 (p = 0.041).
AVF occlusion rate is much more common in early postoperative period. Diminished sympathetic tonus by preemptive SGB not only increases early patency rate but also increases fistula maturation rate.
Scandinavian Cardiovascular Journal 12/2006; 40(6):380-4. · 0.93 Impact Factor
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ABSTRACT: Levosimendan is a potent inotropic and vasodilator drug used in the treatment of decompensated heart failure. There is no study on in vitro effects of levosimendan in human isolated arteries.
We investigated the effect of levosimendan on contractile tone of human isolated internal mammary artery (IMA). The responses in IMA were recorded isometrically by a force-displacement transducer in isolated organ baths. Levosimendan was added to organ baths either at rest or after precontraction with phenylephrine (1 micromol/L). Levosimendan-induced relaxations were tested in the presence of cyclooxygenase inhibitor indomethacin (10 micromol/L), nitric oxide synthase inhibitor N122-nitro-L-arginine methyl ester (100 micromol/L), large-conductance calcium-activated potassium-channel inhibitor tetraethylammonium (1 mmol/L), adenosine triphosphate-sensitive potassium-channel inhibitor glibenclamide (10 micromol/L), and voltage-sensitive potassium-channel inhibitor 4-aminopyridine (1 mmol/L).
Levosimendan (10 nmol/L to 3 micromol/L) produced potent relaxation in human IMA (maximal effect, 75.3% +/- 4.9% of phenylephrine maximum contraction, 6.8 +/- 0.1, n = 15; -log10 of 50% effective concentration). Vehicle had no significant relaxant effect. The relaxation to levosimendan is not affected by either potassium-channel inhibitors (tetraethylammonium and 4-aminopyridine) or cyclooxygenase and nitric oxide synthase inhibitors. Glibenclamide (10 micromol/L) inhibited levosimendan-induced relaxation significantly (p < 0.01).
Levosimendan effectively and directly decreases the tone of IMA. The mechanism of levosimendan-induced relaxation in IMA appears in part to be adenosine triphosphate-sensitive potassium-channel opening action. Levosimendan may be a cardiovascular protective agent by its relaxing action on the major arterial graft, IMA.
The Annals of thoracic surgery 05/2006; 81(5):1715-9. · 3.74 Impact Factor
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ABSTRACT: To evaluate the role of preserved pleural integrity in postoperative pain and respiratory functional status in patients undergoing coronary revascularization.
Two hundred forty patients undergoing on-pump coronary artery bypass grafting between March 2004 and February 2005 were included in the present study. The patients were prospectively randomized and divided into either an opened pleura (OP) group (n=120, patients with an OP) or a closed pleura (CP) group (n=120, patients whose pleural integrity was preserved). Preoperative patient characteristics were similar. Postoperative respiratory functions were compared between the groups by chest x-rays, respiratory functional tests and arterial blood gas analyses. Postoperative pain was compared by using a multidimensional pain score. All the tests were examined by the same blinded clinician.
The mean age of the patients was 60.4+/-8.8 years. Postoperative bleeding and the duration of hospital stay were markedly higher in the OP group than in the CP group. The incidences of atelectasis and pleural effusion were also significantly higher in the OP group (P<0.01). Respiratory functions and postoperative pain scores were better in the CP group (P<0.01 and P=0.008, respectively).
Preserving pleural integrity has beneficial effects on the respiratory functions and postoperative pain after coronary revascularization. The preservation of pleural integrity results in better respiratory function, decreased hospital stay and cost, and as a consequence, a better surgical outcome.
Canadian respiratory journal: journal of the Canadian Thoracic Society 05/2006; 13(3):145-9. · 1.56 Impact Factor
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ABSTRACT: In our study we aimed to investigate the effects of paclitaxel-eluting stent on restenosis.
Sixteen porcine were randomly assigned to two groups (n=8 per group): control group animals received conventional stent implantation and study group animals -paclitaxel-eluting stent implantation. Both groups were treated with 300 mg acetylsalicylic acid and 75 mg clopidogrel daily. The degree of neointimal proliferation and effect of drug-eluting stent on restenosis were evaluated 6 weeks after by angiography and intravascular ultrasound (IVUS).
Angiographic in-stent restenosis was lower in paclitaxel-eluting stent group (12.50 +/- 7.07% versus 41.25 +/- 28.50%, p=0.001). The IVUS data demonstrated that paclitaxel group animals had larger minimal lumen area (8.76 +/- 1.09 mm2 versus 6.23 +/- 3.10 mm2, p=0.028), smaller mean neointimal proliferation area (1.03 +/- 0.75 mm2 versus 3.55 +/- 2.86 mm2, p=0.01) and mean percent stenosis (10.71 +/- 8.10% versus 36.85 +/- 30.93%, p=0.01).
This study suggests that drug-eluting stents may also have a preventive effect for the in-stent restenosis.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 04/2006; 6(1):18-23. · 0.44 Impact Factor
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ABSTRACT: Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling.
One hundred pediatric patients with congenital heart defects undergoing major cardiovascular surgery, who required a radial artery catheter, were included in the study. Patients were divided into 2 groups: group 1 included 50 patients who had radial artery cannulation with the direct technique, and group 2 included 50 patients who had a guidewire-assisted radial artery cannulation.
A radial artery was successfully cannulated in 48 patients in group 2 but only 38 patients in group 1. Mean elapsed time for radial artery cannulation was 22 +/- 4.6 minutes in group 1 and 7 +/- 4.2 minutes in group 2 (p = 0.001). The average number of attempts for cannulation was 4.5 in group 1 and 2.1 in group 2 (p = 0.022). The opposite radial or an alternative artery was used more commonly in the direct technique group. Satisfactory blood pressure monitoring and sampling of blood were obtained in 28 patients in group 1 and 46 patients in group 2 (p < 0.001).
The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery.
Journal of Cardiothoracic and Vascular Anesthesia 03/2006; 20(1):48-50. · 1.64 Impact Factor
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ABSTRACT: Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods.
This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared.
Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001).
The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.
Heart Surgery Forum 01/2006; 9(6):E866-70. · 0.63 Impact Factor
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ABSTRACT: This study measured the effectiveness of magnesium sulfate during and after coronary artery bypass grafting (CABG) on postoperative pain and respiratory functions, and compared it with 2 other well-known and widely used analgesic agents: codeine and diclofenac, a nonsteroidal anti-inflammatory drug (NSAID).
Prospective unblinded study. Setting: Single institution.
Patients undergoing CABG.
Patients were divided into 3 groups. In group A (n = 50), intraoperative magnesium sulfate, 2 g/70 kg, was infused intravenously and was continued during the first 3 days postoperatively. In group B (n = 50), codeine, 60 mg/70 kg, was given orally 4 times a day for 3 days. In group C (n = 50), diclofenac sodium, 75 mg, was given orally twice a day for 3 days.
On the first postoperative day the visual analog scale (VAS) score was greater than 5 in all groups. On the second day the VAS score was greater than 5 in groups B and C, and was less than 5 in group A. On the third day the VAS score was less than 5 in all groups. During the first 2 postoperative days the need for morphine was significantly less in group A than in the other 2 groups. Preoperative respiratory function tests (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) were similar in each group. The FEV1, FVC, and FEV1/FVC values on the postoperative first, second, and third days were significantly higher in group A.
Magnesium sulfate can be a beneficial adjuvant therapy for pain after CABG. In this respect, especially in patients with respiratory problems or intolerance to NSAIDs, magnesium sulfate can be a better choice than NSAIDs and opioids.
Journal of Cardiothoracic and Vascular Anesthesia 01/2006; 19(6):714-8. · 1.64 Impact Factor
