Incidence of perioperative complications in COVID-19 survivors: Prospective observational clinical trial.

BACKGROUND: As long as the COVID-19 pandemic continued, the continuation of elective surgery had been unavoidable. There is still no consensus on the timing of elective surgery in patients who have recovered from COVID-19. The primary aim of this study was to determine the effect of time after COVID-19 infection on perioperative complications. METHODS: This prospective observational single center included adult patients who had recovered from COVID-19 and underwent surgery between February and July 2021. Data were prospectively collected from the patient and hospital database, the preoperative evaluation form and the perioperative anesthesia forms. RESULTS: A total of 167 patients were included in our study. Preoperative COVID-19 RT-PCR test results were negative in all patients. The mean time of positive COVID-19 diagnosis was 151.0 ± 74.0 days before the day of surgery. Intraoperative general and airway complications occurred in 33 (19.8%) and 17 (10.2%) patients, respectively. Although the time from COVID-19 positivity to surgery was shorter in patients with intraoperative general and airway complications, the difference between the groups did not reach statistical significance (P = .241 and P = .133, respectively). The median time from COVID-19 positivity to surgery in patients with and without postoperative complications was 156.0 (min: 27.0-max: 305.0) and 148.5 (min: 14.0-max: 164.0) days, respectively (P = .757). In patients with and without oxygen support in the postoperative period, the median time from COVID-19 positivity to surgery was 98.0 (min: 27.0-max: 305.0) and 154.0 (min: 14.0-max: 364.0) days, respectively. In patients who received oxygen support in the postoperative period, the time from COVID-19 positivity to surgery was shorter and the difference between the groups was statistically significant (P = .014). CONCLUSIONS: The incidence of perioperative complications decreased with increasing time after a positive SARS-CoV-2 infection, but there was no difference in perioperative complications between the groups. As the time between COVID-19 positivity and surgery increased, the need for oxygen support in the postoperative period decreased. It is not possible to share clear data on the timing of operation after SARS-CoV-2 infection.

Overnight hospital stay and/or extended recovery period may allow long-duration oral and maxillofacial surgeries in the operating room of a dental hospital in an outpatient setting: a single-center experience.

Objectives: The requirement for overnight hospital stay should be considered preoperatively according to patient-related factors, type of surgery, and anesthetic management plan. In this study, we aimed to define the major factors that influence consideration of overnight hospital stay in patients undergoing oral and maxillofacial (OMF) surgery in an operating room (OR) of a dental hospital in an outpatient setting. Materials and Methods: The records of patients who underwent oral procedures under general anesthesia between 2014-2017 were reviewed. Results: A total of 821 patients underwent oral procedures under general anesthesia; 631 of them underwent OMF surgery in the OR of a dental hospital, and 174 of these patients were hospitalized for overnight stay. There was no significant difference in the number of patients with comorbidities between the outpatient and hospitalized patient groups (P=0.389). The duration of surgery was longer in the hospitalized patient group (105.25±57.48 vs 189.62±82.03 minutes; P<0.001). Double-jaw (n=15; 310.00±54.21 minutes) and iliac crest grafting surgeries (n=59; 211.86±61.02 minutes) had the longest durations. Patients who underwent iliac crest grafting had the highest rates of hospitalization (79%). The overall recovery period was longer in outpatients (119.40±41.60 vs 149.83±52.04; P<0.001). Conclusion: Duration of surgery was the main determinant in considering whether a patient required overnight hospital stay. However, patients with an American Society of Anesthesiology physical status score <3 may be scheduled for OMF surgery in the OR of a dental hospital in an outpatient setting regardless of duration of surgery if overnight hospital stay is planned or an extended recovery period is provided until patients meet the discharge criteria.

Factors affecting the preference of anesthesia residents regarding subspecialty training.

BACKGROUND: There is scant information about the factors that influence the career decisions of anesthesia residents in Turkey. The aim of this study was to determine the preferences of anesthesia residents in Turkey regarding future career and subspecialty training plans and practice location, and to determine the factors that influence those preferences. METHODS: A 21-item e-questionnaire was administered to anesthesia residents who were registered with at least one of the two societies of anesthesiologists in Turkey. Data were collected on demographics and preferences regarding subspecialty training and future practice location. RESULTS: The response rate of the survey was 41.04%. The percentages of participants who intended to pursue a fellowship in intensive care and algology were 12.1 and 23.1%, respectively; 21.7% of participants did not intend to pursue any fellowship training and the decision of 43.1% of the participants was uncertain. The most popular reasons for pursuing a fellowship were to perform compulsory service in a better place (47.2%) and improve earning potential (43.1%). Forty-two percent of participants did not intend to pursue any fellowship training because of their attention to general anesthesiology practice and 15.2% because of the additional compulsory service obligation following the training. CONCLUSIONS: This study showed that the desirability of sub-specialization among anesthesia residents in Turkey could be accepted as low. This result seems to be associated with the additional compulsory service obligation.

Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities.

Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.

Tracheal laceration as a complication of out-of-hospital emergency tracheal intubation in a patient with COPD.

Tracheobronchial injuries related to emergency endotracheal intubations are reported to be associated with an increased risk of mortality. Many mechanical risk factors may become more frequent in an emergency setting leading to such injuries. Aside from these factors that may complicate endotracheal intubation, this procedure is not recommended a priori for ventilation due to the resulting interruptions in external chest compressions, by 2010 cardiopulmonary resuscitation (CPR) and external chest compression guidelines. We present a 78-year-old woman with known chronic obstructive pulmonary disease who had a tracheal laceration after emergency endotracheal intubation during CPR. Thorax computed tomography revealed an overinflated tube cuff. The trachea was repaired surgically; however, our patient died on the fourth postoperative day due to multiple-organ failure. Prehospital providers must remain especially vigilant to priorities in airway management during CPR and aware of the dangers associated with field tracheal intubation under less than ideal conditions.

The effect of HES (130/0.4) usage as the priming solution on renal function in children undergoing cardiac surgery.

BACKGROUND: Experience with hydroxyethyl starch (HES) in children is limited. This study was conducted to observe the effects of HES or Ringer's lactate (RL) usage as the priming solution on renal functions in children undergoing cardiac surgery. METHODS: After ethical committee approval and parent informed consent, 24 patients were included in this prospective, randomized study. During cardiopulmonary bypass (CPB), Group I received RL and Group II received HES (130/0.4) as priming solution. Serum creatinine, blood urea nitrogen (BUN), ß2-microglobulin, cystatin C, and urinary albumin and creatinine, serum, and urine electrolytes were analyzed after the induction (T1), before CPB (T2), during CPB (T3), after CPB (T4), at the end of the operation (T5), on 24th hour (T6), and on 48th hour postoperatively (T7). Fractional sodium excretion (FENa), urinary albumin/creatinine ratio, and creatinine clearance were calculated. Drainage, urine output, inotropes, diuretics, and blood requirements were recorded. RESULTS: In both the groups, ß2-microglobulin was decreased during CPB and cystatin C was decreased at T3,T4, and T5 periods (p < 0.05) and the levels remained within the normal range. Creatinine clearance did not differ in the HES group, but increased in the RL group (p < 0.05). Urine albumin/creatinine ratio was increased (p < 0.05) after CPB in the HES group, and it increased at T3, T4, and T5 in the RL group (p < 0.05). There were no differences in cystatin C, ß2-microglobulin, FENa, urine albumin/creatinine ratio, creatinine clearance, total fluid amount, urine output, drainage, and inotropic and diuretic requirements between the groups. CONCLUSION: We conclude that usage of HES (130/0.4) did not have negative effects on renal function, and it can be used as a priming solution in pediatric patients undergoing cardiac surgery.

Anesthesia for percutaneous transcatheter closure of atrial and ventricular septal defects in pediatric patients.

We aimed to investigate the anesthetic management of percutaneous closure of atrial and ventricular septal defects (ASD/VSD) in pediatric patients. A retrospective review of the anesthetic data of 351 patients who underwent transcatheter closure of ASD/VSD was conducted. The mean age was 8.42 ± 5.71 years (4 months-18 years). VSD closure was performed in 52 patients and the remaining 299 had a procedure for ASD closure. All patients were premedicated with midazolam. All procedures were performed under general anesthesia in the catheterization laboratory. After anesthesia induction with sevoflurane or intravenous anesthetics, all patients were intubated. The procedure was completed without any complications in 98.3% of patients. Many anesthetic drugs have been used for pediatric cardiac catheterization, but it cannot be concluded whether there is an ideal anesthetic method. Regardless of the method, the anesthesiologist must consider not only the need for adequate analgesia and immobility but also that for hemodynamic stability during the procedure.

Comparison of the effects of sevoflurane, isoflurane, and desflurane on microcirculation in coronary artery bypass graft surgery.

OBJECTIVE: This investigation was performed to compare the effects of inhalation agents on microcirculation in coronary artery bypass grafting (CABG) using orthogonal polarization spectral imaging. DESIGN: This prospective and randomized study was performed in patients scheduled for CABG surgery from March through September 2010. SETTING: Tertiary care university hospital. PARTICIPANTS: Thirty patients undergoing elective CABG. INTERVENTIONS: Patients were assigned to sevoflurane, desflurane, or isoflurane. MEASUREMENTS AND MAIN RESULTS: Orthogonal polarization spectral imaging was used to evaluate the sublingual microcirculation. Hemodynamic variables (heart rate, mean arterial pressure, central venous pressure, cardiac output, and pulmonary capillary wedge pressure), laboratory parameters (hematocrit, lactate, and potassium), and microcirculatory variables (total vascular density [TVD] [mm/mm(2)], microvascular flow index [MFI] [arbitrary units], perfused vessel density [PVD] [mm/mm(2)], and proportion of perfused vessels [PPV] [percentage] were obtained before induction, after induction, during cardiopulmonary bypass, at the end of surgery, and 24 hours after surgery. The greatest alterations in microcirculation parameters were found during cardiopulmonary bypass. In the sevoflurane group, TVD (14.7%), PVD (22%), PPV (5.97%, p < 0.05), and MFI (7.69%, p > 0.05) were decreased. In the isoflurane group, TVD (14.7%) and PVD (20.3%) were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p < 0.05). In the desflurane group, there were no changes in TVD and PVD, but MFI (8.99%, p > 0.05) and PPV (1.48%, p < 0.05) were increased in the small vessels. These changes returned to their initial values 24 hours postoperatively. CONCLUSIONS: Sevoflurane had a negative effect on the microcirculation. Isoflurane decreased vascular density and increased flow. Desflurane produced stable effects on the microcirculation. These inhalation agents induced transient alterations in microvascular perfusion.

The effects of sevoflurane anesthesia and cardiopulmonary bypass on renal function in cyanotic and acyanotic children undergoing cardiac surgery.

BACKGROUND: There are few data on the effects of anesthesia and cardiopulmonary bypass (CPB) on perioperative renal function in children with cyanotic congenital heart disease undergoing open heart surgery. This study aims to investigate the perioperative renal function in cyanotic versus acyanotic children undergoing sevoflurane anesthesia for open heart surgery. METHODS: After receiving ethical committee approval, 12 acyanotic patients (preoperative oxygen saturation: SaO(2) > 85%) and 12 cyanotic children (SaO(2) < 85%) were included. Sevoflurane was administered at concentration levels of 2% before CPB and 1-2% during CPB after standard anesthesia induction. Inorganic fluoride, electrolytes, creatinine, urea nitrogen in serum and urine samples, and N-acetyl-ß-d-glucosaminidase (NAG) in urine samples were measured before induction, before CPB, during CPB, after CPB, at the end of surgery, and at 24th h postoperatively. RESULTS: The levels of serum uric acid levels were higher in the cyanotic group (p < 0.05). There were no differences in the levels of serum creatinine and urine creatinine, urea nitrogen, and electrolytes between the two groups. Serum inorganic fluoride levels were always higher in the acyanotic group than in the cyanotic group, but these differences between the groups reached statistical significance at two measurement times (before CPB and end of surgery) (p < 0.05). Urinary inorganic fluoride levels increased with time in both groups. Although urinary NAG increased significantly after the CPB in the cyanotic group, the differences between the two groups did not reach statistical significance. CONCLUSIONS: We have concluded that renal function was not affected during open heart surgery with sevoflurane anesthesia, in both cyanotic and acyanotic children.

Peroperative effects of fresh frozen plasma and antithrombin III on heparin sensitivity and coagulation during nitroglycerine infusion in coronary artery bypass surgery.

Nitroglycerin (NTG) reduces the anticoagulant effects of heparin and may lead to heparin resistance. Fresh frozen plasma (FFP) and antithrombin III (ATIII) may be used for the treatment of heparin resistance. We aimed to compare the effects of FFP and ATIII on heparin requirement, coagulation parameters, and bleeding in patients undergoing coronary artery bypass graft surgery (CABGS) with moderate dose of intraoperative NTG infusion. Forty-eight patients undergoing CABGS with NTG infusion were randomly allocated to three groups. Group C served as control, whereas the patients in group P received FFP and those in group A received ATIII after anesthesia induction. ATIII activity and coagulation parameters were measured at five different times intraoperatively. Total heparin requirement, heparin consumption, and heparin sensitivity were calculated. ATIII activity and ACT were significantly higher and activated partial thromboplastin time and fibrinogen level were significantly lower during cardiopulmonary bypass in group A than in groups P and C. Heparin sensitivity was significantly higher and total heparin requirement and consumption were significantly lower in ATIII group than in other groups. ATIII administration increases heparin sensitivity and decreases heparin requirements compared with FFP in patients undergoing CABGS with peroperative NTG infusion. ATIII may be preferred to FFP in patients with heparin resistance due to NTG infusion undergoing CABGS.

[Entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature during right pneumonectomy]. / Sag pnömonektomi cerrahisinde sag pulmoner arterde dikilen Swan-Ganz kateteri.

Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complication that may lead to fatal complications such as pulmonary artery injury. We describe entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature in a patient undergoing right pneumonectomy. This situation resulted with removal of catheter safely without any complication. We concluded that with early recognition of the complication during thoracotomy, is golden standard in preventing pulmonary artery catheter entrapment and surgeons should be aware of the risk of accidentally transfixing pulmonary artery catheter in every type of operation that takes place in thorax.

Heat shock protein70: a new marker for subsequent atrial fibrillation development?

Atrial fibrillation (AF) is a common arrhythmia, after cardiac surgery, and it is associated with a twofold increase in cardiovascular mortality and morbidity. Reperfusion injury and inflammation associated with cardiac surgery are thought to be involved in its pathogenesis. Heat shock proteins (HSPs) are a family of chaperone proteins which assist in preservation of cellular integrity by maintaining proteins in their correctly folded state. The aim of this study was to investigate pre-postoperative heat shock protein70 (HSP70) and high-sensitivity C-reactive protein in serum from patients in preoperative sinus rhythm. We prospectively screened 45 consecutive patients admitted to the hospital for elective coronary artery bypass surgery (CABG). Electrocardiogram characteristics and cardiovascular risk profile were documented. Pre- and postoperative blood samples were collected. HSP70 value was 8.9 +/- 4.8 ng/mL in Group A (study group) preoperatively and decreased to 7.7 +/- 7.0 ng/mL postoperatively. In contrast, preoperative value of HSP70 was 4.2 +/- 2.2 ng/mL and decreased to 2.7 +/- 2.6 ng/mL postoperatively in Group B (control group). Statistical analysis showed significant difference regarding preoperative HSP70 levels in Group A compared to Group B. To our knowledge, with this study, the association of pre- and postoperative circulating HSP70 with postoperative AF was demonstrated for the first time.

Heat shock protein 60 antibody. A new marker for subsequent atrial fibrillation development.

OBJECTIVE: To examined the pre- and post- operative anti-HSP60 antibodies of serum from patients in preoperative sinus rhythm. METHODS: We prospectively studied 45 consecutive patients admitted for elective CABG from 2004 to 2005. We randomly selected 10 patients developing AF (study sample [Group A]) and 10 postoperative patients without AF (control [Group B]. The study took place at the Department of Cardiovascular Surgery, Hacettepe University, Ankara, Turkey. RESULTS: Anti-HSP60 IgG value was 27.76 +/- 12.69 absorbance units (AU) in Group A preoperatively and decreased to 13.73 +/- 5.51 AU postoperatively. Controversially, preoperative value of anti-HSP60 IgG was 9.94 +/- 2.92 AU and decreased to 6.72 +/- 1.89 AU, postoperatively in Group B. Statistical analysis showed significant difference regarding preoperative anti-HSP60 IgG levels in Group A compared to Group B, which might be interpreted as an association between postoperative AF and preoperative levels of anti-HSP60 IgG. CONCLUSION: We provide the first evidence demonstrating the association of pre- and post- operative circulating anti-HSP60 antibodies with postoperative AF. These results suggest that serum HSP60 antibody levels may be a marker for subsequent development of AF.

The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study.

BACKGROUND: Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive outcome and S100 beta protein (S100 BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). MATERIALS AND METHODS: Forty-two male patients were prospectively randomized and classified into 3 groups according to the volatile agents used; isoflurane, sevoflurane, desflurane. All patients had a sufficient education level to participate in neuropsychological testing and a normal carotid Doppler ultrasonography. Blood samples for analysis of S100 BP were collected before anesthesia (T1), before heparinization (T2), 15 minutes into CPB (T3), following protamine administration (T4), postoperatively (T5), 24 hours after the operation (T6), postoperative day 3 (T7), and postoperative day 6 (T8). The neuropsychological tests, including Mini-Mental State Examination (MMSET) and visual-aural digit span test (VADST), were administered 1 day prior to surgery and on the third and sixth postoperative days. RESULTS: The postoperative third and sixth day MMSET scores and third day visual-written subtest scores in the sevoflurane group were significantly lower than in the isoflurane and desflurane groups (P < .05). S100 BP levels increased with the beginning of anesthesia in the sevoflurane and desflurane groups. Although S100 BP decreased to baseline levels on postoperative day 1 in the sevoflurane group, this was significantly higher on the third and sixth days postoperatively in the desflurane group (P < .05). In the isoflurane group, the S100 BP level was significantly higher than the baseline level only after CPB (P < .05). CONCLUSION: Our study suggests that isoflurane is associated with better neurocognitive functions than desflurane or sevoflurane after on-pump CABG. Sevoflurane seems to be associated with the worst cognitive outcome as assessed by neuropsychologic tests, and prolonged brain injury as detected by high S100 BP levels was seen with desflurane.

The effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery.

Renal insufficiency after cardiac surgery is associated with increased mortality, morbidity, and length of stay in the intensive care unit. We investigated the effect of isoflurane, halothane, sevoflurane and propofol anesthesia on perioperative renal function following elective coronary artery surgery. The medical records of 224 patients, in the Hacettepe University Medical Faculty Hospital who had undergone cardiac surgery in one year, were retrospectively reviewed. 65 (29%) patients received isoflurane, 68 (30%) patients received halothane, 64 (29%) patients received sevoflurane, and 27 (12%) patients received propofol infusion as part of maintenance anesthesia for coronary artery bypass surgery. Patient characteristics (age, sex, preoperative ejection fraction), operative data (duration of CPB, duration of operation, number of distal anastomoses, usage of diuretic, intraoperative crystalloid and blood transfusion), intraoperative urinary output, preoperative and postoperative (6th hours and 24th hours) BUN and plasma creatinine levels, were not statistically significant between and within groups. Intraoperative inotropic agent (dopamine) was used in 8 (12.3%) patients in the isoflurane group, in 10 (14.7%) patients in the halothane group, in 11 (17.2%) patients in sevoflurane group and in 9 (33.3%) patients in the propofol group. Postoperatively fluid and blood transfusion, postoperative drainage, urinary output, diuretic usage were smiliar between the four groups (p>0,05). Inotropic agent was used in 8 (12.3%) patients in the isoflurane group, in 9 (13.2%) patients in the halothane group, in 16 (25%) patients in the sevoflurane group and in 7 (25.9%) patients in the propofol group. It is concluded that, halothane, isoflurane, sevoflurane and propofol infusion anesthesia as part of anesthesia maintenance for elective coronary artery bypass surgery does not affect early postoperative renal functions.

[The use of tissue glue and its effect on hospital cost in patients undergoing pulmonary surgery]. / Pulmoner rezeksiyon yapilan hastalarda doku yapistiricisi kullanimi ve hastane maliyetine etkisi.

Prolonged air leak following pulmonary resections is an important cause of morbidity and increased hospital costs. We compared 19 homologous/autologous tissue glue (fibrin glue) applied patients (FG group), 12 beriplast-P applied patients (beriplast group) and 27 control patients with respect to prolonged air leak, chest tube removal time and hospital costs. The mean ages for FG group (19 patients), beriplast group (12 patients) and control group (27 patients) were 48.5 +/- 14, 50.5 +/- 6.8 and 55 +/- 12.9 respectively. The groups were comparable with respect to age (p= 0.210), sex (p= 0.287) and the surgical procedure performed (p= 0.289). The incidence of prolonged air leak in FG group, beriplast group and the control group was 48%, 50% and 63%, respectively (p= 0.533). The mean chest tube removal time in FG group, beriplast group and the control group was 10.7 +/- 8.7, 9 +/- 4.1 and 8 +/- 3.1 days, respectively (p= 0.282). Mean hospital costs in FG group, beriplast group and the control group were 4633 +/- 3272 YTL, 4611 +/- 1583 YTL and 4015 +/- 911 YTL, respectively (p= 0.547). Fibrin glue had no effect on the incidence of prolonged air leak, chest tube removal time and hospital costs.