Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

BACKGROUND: This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery. METHODS: Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed. RESULTS: Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05). CONCLUSION: By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report.

Chilaiditi syndrome (CS) is an uncommon case of the asymptomatic radiographic finding of an intestinal loop between the liver and the diaphragm. The most crucial phases in the diagnosis process are a thorough physical examination and precise imaging, particularly in challenging disorders such as CS. The presence of free air under the right hemidiaphragm in this syndrome, the diagnosis of which is based on radiographic imaging, might direct the start of treatment without the need for surgical intervention. An 86-year-old man, with asthma and chronic obstructive pulmonary disease (COPD) was checked out in our hospital's emergency department (ED) after experiencing nausea and vomiting. Having abdominal breathing while the patient was in an internal medicine department owing to a urinary tract infection (UTI) and acute kidney injury (AKI), he was moved to the intensive care unit (ICU). The patient was treated with respiratory physiotherapy, inhaler bronchodilator treatment, antibiotic therapy, enema, and laxatives. Medical imaging is the primary diagnostic tool for CS, guided by the symptoms. In patients like this elderly patient who was taken to ICU from internal medicine due to acute respiratory failure and abdominal breathing, when free air is detected in the subdiaphragmatic region, control should be provided with computed tomography (CT), and non-invasive mechanical ventilation should be applied.

The effect of anesthetic agents on intraocular pressure during laparoscopic gynecological surgery performed in the Trendelenburg position: A randomized clinical trial.

BACKGROUND: Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery. METHODS: Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated. RESULTS: Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p>0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001). CONCLUSION: To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter: a prospective study.

BACKGROUND AND OBJECTIVES: To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. METHODS: A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5minutes after intubation in the supine position); T2 (30minutes after CO2 insufflation); T3 (120minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. RESULTS: The mean IOP was 12.4mmHg at T1, 20mmHg at T2, 21.8mmHg at T3, and 15.6mmHg at T4. The mean ONSD was 4.87mm at T1, 5.21mm at T2, 5.30mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. CONCLUSIONS: A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.

What are the factors affecting the progression of kidney failure, mortality and morbidity after cardiac surgery in patients with chronic kidney disease?

BACKGROUND AND AIM: Acute kidney injury occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases and associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. We aimed to investigate the factors affecting the progression of kidney disease during cardiac surgery in preoperative chronic kidney disease patients (CKD). METHODS: The demographic data of patients and preoperatively studied parameters are: American Society of Anesthesiologists Classification, diabetes mellitus, hypertension, left ventricular ejection fractions, estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. The pre and postoperative parameters recorded were glucose, blood urea nitrogen (BUN), creatinine, hemoglobin, and eGFR. In the intensive care follow-up, discharge status, revision status and 30-day mortality rates and complications were analyzed. RESULTS: One hundred and thirty-eight patients (87 males, 51 females; mean age 61.7 years) were included, the mean preoperative Euro score II value was 8.72 ± 7.09 (7.3 ± 6.2 in the survival group and 13.1 ± 7.9. 83 in the deceased group). The number of patients who underwent revision surgery due to postoperative bleeding were 36 (26.09%) and the 30-day surgical mortality was 24.64% (n = 34). CONCLUSION: Age, complication, euro score, cross-clamp time, pulmonary artery pressure, postoperative BUN, creatine, and CKD-EPI-GFR were found to be significantly effective in predicting 30-day mortality of the patients.

Comparison of epidural and intravenous route for acute and chronic postoperative pain control in patients with gynecological malignancy.

OBJECTIVES: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy. METHODS: Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase. RESULTS: The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p<0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p>0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p>0.05). CONCLUSION: The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.

Comparison of sciatic nerve block quality achieved using the anterior and posterior approaches: a randomised trial.

BACKGROUND: The co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches. METHODS: In total, 58 study patients were randomly assigned to receive either anterior (group A, n = 29) or posterior (group P, n = 29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018. RESULTS: The time to initiation of sensory block was significantly shorter in group P than in group A (7.70 ± 2.05 min and 12.88 ± 4.87 min, respectively; p = 0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00 ± 00.00 min for group P and 4.05 ± 7.47 min for group A; p < 0.01), significantly higher mean fentanyl dose per patient after block but before the start of the operation (44.03 ± 23.78 µg for group P and 31.20 ± 27.79 µg for group A), significantly longer time to first fentanyl requirement after the start of the operation (16.24 ± 7.13 min for group P and 00.00 ± 00.00 min for group A; p = 0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51 ± 2.87 µg for group P and 147.75 ± 22.30 µg for group A). Patient satisfaction (p < 0.01), anaesthesia quality (p = 0.006), and surgical quality (p = 0.047) were significantly higher in group P. CONCLUSIONS: Anterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

Single-center experience with the Tigertriever device for the recanalization of large vessel occlusions in acute ischemic stroke.

BACKGROUND: Tigertriever (Rapid Medical, Yoqneam, Israel) is a new design of stent retriever. PURPOSE: To evaluate the feasibility, safety, and efficacy of the Tigertriever in patients with acute ischemic stroke who have undergone mechanical thrombectomy. MATERIALS AND METHODS: Two different techniques-namely, standard unsheathing (SUT) and repetitive inflation-deflation (RID) techniques, were used. Modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b and 3 were considered as successful recanalization. RESULTS: A total of 61 thrombectomy procedures with Tigertriever were retrospectively evaluated. The mean age of patients was 60.7 years and their National Institutes of Health Stroke Scale score was 14.7. Overall, the percentage of patients with a mTICI score of 0, 2b, and 3 was 24.6, 26.2, and 49.2, respectively. Successful recanalization and first-pass success rates were 75.4% and 37.7%, respectively. There were no statistical differences between the results of the SUT and RID techniques. No vessel rupture, dissection, or device detachment was observed. The number of patients with a good clinical outcome (modified Rankin Scale score 0-2) was 17 (27.9%). CONCLUSION: Our results showed that the Tigertriever device is safe and efficient for mechanical thrombectomy.