Murat Sayin

The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on postcraniotomy pain: a prospective randomized study.

BACKGROUND: Gabapentin is an anticonvulsant drug that has analgesic properties for acute postoperative pain. However, the analgesic effect of gabapentin as an antiepileptic prophylactic drug on patients undergoing craniotomy is unclear. In this study, we evaluated the postoperative effectiveness of gabapentin on acute postoperative pain when it is used for antiepileptic prophylaxis in patients undergoing craniotomy for supratentorial tumor resection. METHODS: Eighty patients undergoing craniotomy for supratentorial tumor resection were randomly assigned into two groups. Patients in Group G (n = 40) received oral gabapentin (3 × 400 mg), and patients in Group P (n = 40) received oral phenytoin (3 × 100 mg) for 7 days before the operation and postoperatively. An identical anesthesia protocol was performed for both the groups. Anesthesia was maintained with propofol and remifentanil infusion. Patient-controlled analgesia with morphine was used, and pain levels were measured. The antiepileptic-related side effects, anesthetic consumption, duration of anesthesia and surgery, tracheal extubation time, postoperative pain scores, morphine consumption, and sedation scores were recorded. RESULTS: Thirty-seven patients in Group G and 38 patients in Group P completed the study. During the preoperative period in Group G, one patient had severe fatigue, one had severe dizziness, and one patient’s surgical procedure was changed. The median plasma levels of gabapentin were 34 &mgr;mol/mL (range, 23-51 &mgr;mol/mL) in 34 patients. In Group P, one patient withdrew from the study preoperatively and one developed transient neurological symptoms postoperatively. The demographic data and mean duration of anesthesia and surgery were similar in both the groups. The total propofol and remifentanil consumption in Group G (1847 ± 548 mg/3034 ± 1334 &mgr;g) was significantly less than that of Group P (2293 ± 580 mg/4287 ± 1282 &mgr;g) (P = 0.01). However, tracheal extubation could be done earlier in Group P (4.5 ± 2 min) than in Group G (16.6 ± 22 min) (P < 0.001). Pain scores were significantly higher in Group P at 15 min, 30 min, and 1 h (P < 0.001). The total morphine consumption was also significantly higher in Group P (33 ± 17 mg vs 24 ± 19 mg) (P = 0.01). The postoperative sedation scores were significantly higher in Group G at 15 min, 30 min, 1 h, and 2 h (P < 0.001). CONCLUSIONS: The administration of gabapentin to patients undergoing craniotomy for supratentorial tumor resection was effective for acute postoperative pain. It also decreased analgesic consumption after surgery. However, it may lead to side effects such as delayed tracheal extubation and increased sedation postoperatively.

Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG.

During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 microg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

Effects of Single-Dose Gabapentin on Postoperative Pain and Morphine Consumption After Cardiac Surgery

OBJECTIVE The purpose of this study was to evaluate the analgesic effect of single-dose preoperative gabapentin on postoperative pain and morphine consumption after cardiac surgery. DESIGN A randomized, double-blind, placebo-controlled, clinical study. SETTING A single university hospital. PARTICIPANTS Sixty patients undergoing coronary artery bypass graft surgery. INTERVENTIONS Patients were randomly allocated into 2 groups preoperatively either to receive 600 mg of oral gabapentin (GABA) or placebo (PLA) 2 hours before the operation. After extubation, an anesthesiologist blinded to the groups recorded pain scores both at rest and with cough with a 10-point verbal rating scale and sedation scores at 2, 6, 12, 18, 24, and 48 hours. Cumulative morphine consumption and the incidence of side effects were recorded during the study period. MEASUREMENTS AND MAIN RESULTS The total morphine consumption was lower in the GABA group (6.7 ± 2.5 mg) than in the PLA group (15.5 ± 4.6 mg, p < 0.01). Pain scores at rest were significantly lower in the GABA group than in the PLA group throughout the study period (p < 0.05 in all measurement times). Pain scores at 2, 6, and 12 hours during coughing were significantly lower in the GABA group (p < 0.05). The number of oversedated patients was significantly higher in the GABA group at 2, 6, and 12 hours of study compared with PLA (p < 0.001 at 2 and 6 hours and p < 0.02 at 12 hours). The postoperative mechanical ventilation period was significantly prolonged in the GABA group (6.6 ± 1.2 hours) compared with the PLA group (5.5 ± 1 hours, p < 0.01). Nausea incidence was significantly lower in the GABA group (n = 9) than in the PLA group (n = 18, p = 0.02). CONCLUSIONS Oral GABA at a dose of 600 mg given before cardiac surgery significantly reduced postoperative morphine consumption and postoperative pain both at rest and with cough.

Internal jugular vein diameter in pediatric patients: are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound.

Aim:  This study investigates whether the diameters of right internal jugular vein (RIJV) are suitable for the use of ‘big radius curved J‐tip’ Seldinger wires in pediatric patients.

Fate of vena saphena magna stump after endovenous laser ablation with 980-nm diode laser: 12-month follow-up.

OBJECTIVE The aim of this study was to investigate the fate of VSM stump and its relation to the incidence of thrombosis during a-12 mo follow-up. BACKGROUND DATA Varicose veins are a common problem. There are several treatment alternatives available. Conventional surgical treatment is associated with high recurrence and complications. However, with the recent development of minimal invasive surgery, various techniques have been developed. Endovenous laser ablation (EVLA) is one of these techniques, which has proven to be safe and effective. Since EVLA is safe and has minor adverse reactions, residual VSM stump and its association with thrombosis after EVLA has not been well studied in literature. MATERIALS AND METHODS Sixty-nine patients underwent EVLA with a 980-nm diode laser (Ceralas D, Biolitec AG, Jena, Germany), and retrospectively obtained data were analyzed over a 12-mo period. Twenty-six patients were excluded due to the lack of follow-up. All EVLA procedures were performed by the same surgeon, who has experience of EVLA. Laser power was set at 10-15 W depending on the size of targeted vein. The saphenous vein was percutaneously punctured with an 18-gauge needle under ultrasonography guidance. Patients were reassessed at 1 wk, and at 3, 6, and 12 mo after the procedure. RESULTS Technical success was accomplished in all patients. One patient had flow signals with patent segment of the VSM visualized by venous duplex ultrasonography at 1 mo, which persisted until the 12-mo follow-up. None of the patients developed acute deep-venous thrombosis. CONCLUSIONS The present study shows that residual VSM stump-length measurement differences at 7 d and 12 mo were statistically significant. In future, large-scale studies are needed, focusing on the proper position of the catheter tip to the saphenofemoral junction and timing the intervals of follow-up after EVLA.

First Turkish experiences of assisted beating-heart coronary artery bypass graft with the Impella Microaxial Ventricular Assist Device.

The importance of minimally invasive cardiac operations, performed off-pump, without the support of cardiopulmonary bypass (CPB), is continuously increasing. Complete revascularization of obstructed coronary arteries is needed to obtain a better long-term outcome. Insertion into the left ventricle of an efficient microaxial pump can be useful when targeting an important coronary artery located at posterior wall of the heart in a patient with hemodynamic deficiency. The use of such a device can enable surgeons to avoid conversion from a preplanned off-pump strategy to traditional on-pump coronary bypass surgery. The Impella Microaxial Ventricular Assist Device (VAD) (Abiomed, Aachen, Germany) is a miniature pump with a 7-mm catheter and a flow rate of approximately 2.5-5 L/min. This device can enable cardiovascular surgery to be performed without damaging the left ventricle and causing serious aortic deficiency. Therefore, in patients with serious comorbidity, complete revascularization may be performed off pump, with the heart beating, because of the hemodynamic stability provided with the support of the microaxial intracardiac pump. If required, this pump can also support the heart during the early postoperative period. We report the first assisted beating-heart coronary artery bypass graft surgery performed with the Impella Microaxial VAD in our country. The surgery was performed on 2 patients considered high risk on the basis of EUROSCORE testing.

High-risk left main coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device: an alternative insertion technique.

Patients with high-risk coronary lesions such as left main stenosis and a severely depressed left ventricular ejection fraction are at risk of death and morbidity-related complications during coronary artery bypass surgery. Several alternative methods have been developed for managing this problem, but it is still challenging, even for highly experienced and well-equipped cardiac surgery centers. We report the case of a successful coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device and using an alternative insertion technique for the ascending aorta in a patient with high-risk coronary lesions, such as left main disease.