Suha Kucukaksu

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.

Giant hydatid cyst of the interventricular septum mimicking acute myocardial infarction on ECG: an unusual cause of ST segment elevation

Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus, which is still endemic in many cattle-raising areas. Cardiac involvement is a rare, but potentially a very serious complication of the hydatid disease. The diagnosis of cardiac cyst hydatid may be difficult due to the nonspecific symptoms and varying clinical presentations. With this report, we describe a case of giant hydatic cyst of the interventricular septum that caused ischemic changes on ECG, mimicking acute myocardial infarction. The final diagnosis was made by combining echocardiography, MRI, and serological tests. Surgical resection of the cyst, followed by albendezol treatment yielded a favorable outcome.

Design of a Centrifugal Blood Pump: Heart Turcica Centrifugal

A prototype of a new implantable centrifugal blood pump system named Heart Turcica Centrifugal (HTC) was developed as a left ventricular assist device (LVAD) for the treatment of end-stage cardiac failure. In the development of HTC, effects of blade height and volute tongue profiles on the hydraulic and hemolytic performances of the pump were investigated. As a result, the prototype was manufactured using the best blade height and volute tongue profiles. Performance of the prototype model was experimentally evaluated in a closed-loop flow system using water as the medium. The hydraulic performance requirement of an LVAD (5 L/min flow rate against a pressure difference of 100 mm Hg) was attained at 2800 rpm rotational speed.

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.

Flow Simulation and Optimization of a Left Ventricular Assist Device

Artificial assist devices offer a promising treatment option for patients with congestive heart failure, especially when the patient is not eligible for heart transplantation. In order to develop a left ventricular assist device an interdisciplinary research, involving engineering and medical research teams, is conducted. The left ventricular assist device investigated in this study is the MicroMed DeBakey VAD [1], an axial blood pump that provides flow from the left ventricle to the aorta. The geometry of this baseline design is generated via parametric modeling. An optimization surface around the baseline design is formed by using the design of experiments method. Accordingly, eighty parameter sets and the corresponding CAD models are created. Flow through these pumps is simulated at the operation point. Flow data are evaluated to predict the pump performance, blood damage and bearing friction. An axial pump, closer to the optimum, is found that provides 8635 Pa pressure increase at a flow rate of 6 l/min and a rotational speed of 10000 rpm. Pressure head of the selected pump is 18% higher and blood damage is 4% less than the baseline design.Copyright

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.

Control strategies for the left ventricular assist devices

In this study numerical models for the cardiovascular system and an axial left ventricular assist device were developed and control studies have been done in the scope of a TUBITAK funded project entitled “Design, analysis, and prototype production of a miniature implantable rotary blood pump.” Diseased cardiovascular system model was obtained by adjusting the parameters of the cardiovascular system model and the rotary blood pump model was integrated to this model. At first the effects of the rotation speed of the pump was considered and then control studies have been done for the pressure difference between outlet and inlet of the pump and the pump flow.

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.