Background: We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation.Methods: We included 72 consecutive patients who underwent elective cardiac surgery in this prospective observational study. Each patient had failed at least 1 trial of continuous positive airway pressure (CPAP) and had agitation. Patients were assessed with the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 12 to 18 hours after their admission to the ICU. Midazolam and fentanyl were then given to all patients according to the sedation protocol. At 36 hours in the ICU, patients who had agitation and an inability to wean were randomly divided into 2 groups: group M, 34 patients who continued to follow the routine sedative protocol; and group D, 38 patients who were given dexmedetomidine. Arterial blood gas measurements, hemodynamic parameters, and time to extubation were recorded. Statistical analysis was performed with GraphPad InStat (version 2.02 for DOS).Results: All patients tested positive in the CAM-ICU assessment, and all had a delirium diagnosis. The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean (+/- SD) of 49.619 +/- 6.96 hours. The 2 groups had significantly different extubation times (58.389 +/- 3.958 hours versus 49.619 +/- 6.96 hours). The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO 2 values at 12 and 24 hours. The 2 groups showed no significant differences with regard to hemodynamic parameters.Conclusions: Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.

BACKGROUND AND AIM:Patients undergoing surgical procedures through median sternotomy have reduced pulmonary function in the postoperative period. Our study was designed to evaluate the effect of pleural integrity in terms of respiratory functions and pain score after coronary bypass procedures. METHODS:In a randomized, prospective study we evaluated 320 patients in two groups. Group I (n = 160) patients were the patients whose pleural cavity was intact while internal mammary artery (IMA) harvesting, and in group II (n = 160) the pleural cavity of the patients was opened. They matched in terms of postoperative respiratory functions and pain score. RESULTS:FEV1 (%) and FEV1/FVC levels at the postoperative fifth day were significantly lower in group II (I = 71.5 +/- 4.9 vs. II = 63.5 +/- 8.3 and I = 24.1 vs. II = 22.1), respectively (p < 0.05). The rate of postoperative pleural effusions and atelectasis at the postoperative fifth day were significantly higher in group II (I = 35%, 15% vs. II = 48%, 35%), respectively (p < 0.05). The pain score was higher in group II at postoperative fifth day. CONCLUSIONS:All patients undergoing cardiac surgery suffer deterioration in pulmonary functions. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions. Moreover, preserving pleural integrity provides beneficial effects on pain score after coronary operations especially in the early postoperative period.

Objective(s) : To evaluate the use of bilevel positive airway pressure (BiPAP) ventilation in early extubation after fast-track cardiac surgery. Design : Prospective observational study. Setting : Postoperative intensive care. Patients : Sixty consecutive patients eligible for early extubation after cardiac surgery. Patients were predominantly male (42 men [70%]) and middle aged (54.62 ± 10.66 years). Interventions : Patients were randomly assigned to continuous pressure or BiPAP (Group I or Group II, respectively) and were extubated as soon as possible. Measurements : Blood gases and haemodynamics were determined on arrival in the ICU (baseline, or T0) and 1, 2, 4, 6, 8, and 12 hours later. All data were expressed as (±SD) and analysed using the Student t-test and Mann-Whitney test (continuous data) or χ2 test (categorical data). P < 0.05 was considered statistically significant. Main results : PaCO2 levels were statistically significantly higher in Group II than in Group I at 2, 4, 6, 8, and 12 hours (P < 0.05, P < 0.01). Within each group, PaCO2 levels were statistically significantly higher at 4, 6, 8, and 12 hours than at baseline (P < 0.01 ). Extubation time was significantly longer in Group I than in Group II 7.90 (7.90 [2.13] vs 3.83 [1.20], P=0.001). Respiratory rates were significantly higher in Group II than in Group I after 2, 4, and 6 hours (P < 0.01). Pmax was higher in Group I than in Group II after 1 hour but similar up to 4 hours. Conclusions : Early extubation and weaning to BiPAP ventilation after cardiac surgery is safe and effective.

Siyami Ersek Thoracic and Cardiovascular Surgery Center, Anaesthesiology and Reanimation Clinic, Istanbul, Turkey

Hydatid disease rarely involves the aortic wall. We report a case of hydatidosis involving the ascending aorta and the left atrium. The patient underwent replacement of the ascending aorta with a prosthetic Dacron graft and left atrial cystectomy. At the 6-month follow-up, she was leading a normal life.

Çoruh, T.; Maçika, H.; Çinar, B.; Denizalti, T. B.; Göksel, O.; Eren, E.; Aykaç, Z. Author Information

Gebelikde kalp kapakcigi degisimi gerektiren trombus olusumunun en onemli nedeni, oral antikoagulan tedavinin dusuk molekuler agirlikli heparin tedavisi ile yer degistirilmesidir. Gebelik sirasinda acik kalp cerrahisinin amaci, anne ve fetus mortalitesinin azaltilmasidir. Optimum kosullarin saglanmasi ile bebek olumleri en aza indirilmistir. Bizim olgumuzda, 27 haftalik gebeye prostetik mitral kapakda olusan trombus nedeniyle, mitral kapak replasmani yapilmistir. Ancak, olguda fetus postoperatif 24. saatte kaybedilmistir.

Yapici, N.; Çoruh, T.; Orhan, G.; Sargin, M.; Yüksel, M.; Maçika, H.; Kurç, E.; Yücel, O.; Aka, S. A.; Aykaç, Z. Author Information

Yilmaz, O.; Yapici, N.; Çoruh, T.; Yilmaz, C.; Maçika, H.; Aykaç, Z. Author Information

Objectives. Endarterectomy of a stenotic internal carotid artery in the presence of contralateral carotid occlusion (CCO) is Often assessed as a high-risk procedure. We have assessed the requirementfor shunting in patients with CCO operated under local anaesthetic.Materials and methods. Between 1998 and 2003,429 patients (319 males and 110 females, mean age 65.7+/-6.2, range 4884) underwent 500 carotid endarterectomies under local anaesthetic with awake neurological testing. Fifty-five patients (12.8%) had CCO. Preoperative risk factors, intra- and postoperative events were noted and analyzed. Short-term and midterm follow-up (mean 16.4+/-5.8 months, range 3-38 months) was also recorded.Results. The rate of shunting in patients with or without CCO (10.9% vs. 9.1%,) was not significantly different. Stroke rates for CCO and non-CCO groups were 3.6 and 0.5%, respectively. Only the presence of preoperative cerebral infarction increased the risk of stroke. Patients that needed shunting were found to have significantly higher overall rate of adverse events, mortality and stroke.Conclusions. Routine use of intravascular shunting for a stenotic carotid artery with contralateral occlusion may not be necessary. The choice of using a shunt is safe when made intraoperatively by assessing the neurological status of the patient continuously. This requires expertise and strong cooperation between the anaesthesiologist and the surgical teams.

s: European Association of Cardiothoracic Anaesthesiologists; 17th Annual Meeting; Dublin, Ireland; June 12-15, 2002: The Postoperative Period

Yapici, N.; Unal, O.; Yapici, F.; Coruh, T.; Tarhan, A.; Serbetcioglu, A.; Ozler, A.; Aykac, Z. Author Information

Coruh, T.; Yilmaz, C.; Yildiz, Y.; Yapici, N.; Denizaltí, T.; Maçika, H.; Karabacak, Ö.; Aykac, Z. Author Information

Background. After mobilization, vasospasm often reduces flow through the internal thoracic artery. An established method of relaxing the artery and increasing flow is to use papaverine at ambient temperature (20 degrees to 22 degrees C) as a topical vasodilator. However, the pharmacologic actions of papaverine generally have been assessed at 37 degrees C.Methods. In 60 patients in whom the left internal thoracic artery was used for myocardial revascularization, we investigated the effects of normal saline solution at 20 degrees C (group I), papaverine at 20 degrees C (group II), and papaverine at 37 degrees C (group III). Under controlled hemodynamic conditions, free flow was measured before any pharmacologic intervention and a median of 16 minutes after the pedicle had been sprayed with one of the agents.Results. Normal saline solution at 20 degrees C produced a small increase in flow from 37.5 +/- 8.1 mL/min to 50 +/- 10.2 mL/min. A significant increase occurred with papaverine at 20 degrees C, from 38.05 +/- 6.5 mL/min to 78.75 +/- 21.2 mL/min (p < 0.0001). Papaverine at 37 degrees C, however, produced an increase in now from 36.9 +/- 12.6 mL/min to 103.3 +/- 44.6 mL/min (p < 0.0001) and proved to be more effective than papaverine at room temperature (p = 0.0174).Conclusions. We recommend topical use of papaverine at 37 degrees C to relieve intraoperative spasm of the internal thoracic artery.