Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion.

Objective: We aimed to evaluate the effects of cardiopulmonary bypass (CPB) machines used in coronary artery bypass grafting surgeries on cerebral perfusion by performing cerebral oximetry monitoring [near-infrared spectroscopy (NIRS)], S100-ß protein measurements, and neurocognitive function assessment tests using both pulsatile and non-pulsatile modes. Methods: A total of 44 patients, 22 non-pulsatile (Group NP) and 22 pulsatile (Group P), were included in the study. Hemodynamic parameters, arterial blood gas values, NIRS values and blood S100ß protein levels were analyzed at five points: pre-induction (T1), initiation of CPB (T2), termination of CPB (T3), end of surgery (T4), and postoperative 24 h (T5). Two different neuropsychological tests were administered to patients in the preoperative and postoperative periods. Results: There were no significant differences between the groups for demographic characteristics such as age, gender, body mass index, aortic cross-clamping, CPB, and operation durations. The mean arterial blood pressure and PaO2 values for the T2 measurements were significantly higher in group NP (P < 0.05). Regional cerebral oxygen saturation (rSO2) (NIRS) values at T3 and T4 were significantly higher in group P (P < 0.05). Serum S100ß measurement values at T3 and T5 were significantly higher in group NP than in group P (P < 0.05). Serum S100ß protein levels at T3 correlate with rSO2 results. There was no statistically significant difference between the two groups in terms of pH, lactate, glucose, partial pressure of carbon dioxide, and peripheral oxygen saturation values. Conclusion: Despite no difference between the two groups for neurocognitive function tests, we believe that pulsatile perfusion may be more beneficial for cerebral perfusion when S100ß protein and NIRS values are considered. Further clinical studies are needed to evaluate the benefits of the pulsatile technique for cerebral perfusion.

The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A Preliminary Study.

Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG. Methods Double-blind, randomized, clinical trial was performed. Forty-four patients undergoing CABG surgery were randomized into two groups. The patients in group A received preprocedural hypnosis by an anesthesiologist. Patients in group B (control) had only information on the surgical intervention by the same anesthesiologist. State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI) were performed preoperatively in both groups. Visual analog scale (VAS) and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th, 8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety level, analgesic drug consumption, and duration of ventilator assistance and intensive care unit (ICU) stay were also documented. Results When anxiety and depression levels were compared, significantly lower STA-I and BDI values were detected in group A after hypnotherapy (p = 0.001, p = 0.001, respectively). Significantly less total doses of remifentanil (34.4 ± 11.4 vs. 50.0 ± 13.6 mg) and morphine (4.9 ± 3.3 vs. 13.6 ± 2.7 mg) were administered in group A in the postoperative period. Ventilator assistance duration (6.8 ± 2.0 vs. 8.9 ± 2.7 hours) was also shorter in group A when compared with that in group B (p = 0.007). Conclusion Hypnosis session prior to surgery was an effective complementary method in decreasing presurgical anxiety, and it resulted in better pain control as well as reduced ventilator assistance following CABG surgery.

[The effect of day and night shift working on the attention and anxiety levels of anesthesia residents]. / Gece ve Gündüz Vardiya Calismasinin Bir Grup Anestezi Asistaninin Dikkat ve Anksiyete Düzeyleri Uzerine Etkisi.

OBJECTIVE: To evaluate the attention, learning and memory related cognitive functions after 12-hour day versus night shift-work in anaesthesia residents. METHOD: Fifteen residents working on the day shift and 18 working on the night shift volunteered. All were interviewed with the Rey Auditory Verbal Learning Test (AVLT), Visual Aural Digit Span Test (VADST), and State Trait Anxiety Inventory (STAI) before and after the shifts. Residents' self-evaluations of their fatigue, stress, sleep quality and duration of sleep were sought. RESULTS: The two groups were similar regarding age, gender, attention, fatigue, stress, affection, sleep quality and duration of sleep. The number of words learned in the first trial of the Rey AVLT decreased after the shifts in both groups. Before the night shift the word list could be learned more effectively and with fewer trials compared to the pre-day shift. The learning deteriorated, and repetitions and forgotten words increased after the night shift. The aural oral, aural written and visual written subtest scores deteriorated after the night shift. State anxiety levels did not differ between the night and day shift groups or before and after the shifts. CONCLUSION: The cognitive functions of residents may be impaired after the night shift. We think that close supervision of residents and provision of more rest for them during night shifts would be beneficial in decreasing their errors, which may affect patients.