Deniz Karakaya

Background The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery. Methods This prospective, randomized, controlled, single-blind trial included 63 patients aged 18–80 years with American Society of Anesthesiologists physical status II–III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively. Results The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, pConclusions The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months.

Background: Acute Type A Aortic Dissection (ATAAD) is a life-threatening condition requiring emergency surgical intervention. This retrospective study evaluates the impact of femoral and axillary arterial cannulation techniques on ischemic neurological damage and mortality.Materials and Method: A total of 60 patients who underwent emergency surgery for ATAAD between 2016 and 2021 were analyzed. Patients were divided into two groups based on the arterial cannulation technique: Group A (axillary cannulation) and Group F (femoral cannulation). Preoperative, intraoperative, and postoperative variables were compared between the groups. The primary outcome was incidence of ischemic cerebral injury and secondary outcomes included 30-day all-cause mortality, intensive care unit and hospital length of stay and postoperative complications.Results: There were no statistically significant differences between the two groups in terms of ischemic cerebral injury (p=0.13). There was no significant difference in 30-day mortality between the groups (p= 0.27). Logistic regression analysis revealed that the cannulation type was a risk factor for ischemic cerebral injury development (OR [95% CI]; 119.034 [1.612–8791.314], p=0.029).Conclusions: Our findings indicate that the type of cannulation may be a risk factor for the development of ischemic cerebral injury. Further studies are needed to determine the optimal arterial cannulation technique for improving outcomes in ATAAD surgery.

Background: We aimed to compare the effectiveness of bilateral erector spinae plane (ESP) block and superficial parasternal intercostal plane (S-PIP) + ESP block in acute post-sternotomy pain following cardiac surgery. Methods: Forty-seven patients aged between 18 and 80 years of age with American Society of Anesthesiologists class II–III due to undergo median sternotomy for cardiac surgery were included in this prospective, randomized, double-blinded study. Following randomization into two groups, one group received bilateral ultrasound-guided ESP and the other S-PIP plus ESP block. Morphine consumption within the first 24 h after surgery was the primary outcome of the study while NRS scores at rest, NRS scores when coughing, time taken until extubation, use of rescue analgesic, presence of nausea/vomiting, length of hospital and intensive care unit (ICU) stay, and patient satisfaction were secondary outcome measures. Results: Morphine use up to 24 h following surgery was statistically significantly different between the ESP block and ESP + S-PIP block groups (18.63 ± 6.60 [15.84–21.41] mg/24 h vs 14.41 ± 5.38 [12.08–16.74] mg/24 h, p = 0.021). The ESP + S-PIP block group had considerably reduced pain scores compared to the ESP block group across all time points. Rescue analgesics were required in 21 (87.5%) patients in the ESP block group and seven (30.4%) in the ESP + S-PIP group (p < 0.001). PONV, length of stay in the ICU and hospital, and time to extubation were similar between groups. Conclusions: In open cardiac surgery, the combination of ESP and S-PIP blocks lowers pain scores and postoperative morphine requirement of patients. Trial registration: Clinicaltrials Registration No: NCT05191953, Registration Date: 14/01/2022.

Nowadays, 10% povidone-iodine is a topical antiseptic solution that is commonly used in surgical areas’ sterilization, wound cleaning and daily wound dressing. Severe complications may arise from povidone-iodine when it is not used carefully and in adequate proportion. Povidone-iodine-induced chemical skin reactions is one of the severe complications. Given the widespread use of povidone-iodine, clinicians need to be aware of this possible adverse drug reaction and of preventive cautions. This report presents two cases about povidone-iodine related skin reaction (these reactions are also called as chemical burns or chemical skin reactions) which are encountered in our hospital (Ondokuz Mayıs University, Samsun, Turkey) to point this important issue.

New coronavirus (COVID-19) outbreak, which started in Wuhan, China and spread rapidly all over the world, has become the most important cause of the emotional distress for susceptible people. Because the people also remained in fear and anxiety during the period when the elderly population in the whole country was desperate due to the COVID-19 outbreak and was asked to stay at home in fear of death. In addition, the fact that the patients were hospitalized together with COVID-19 patients caused his psychological distress to be experienced even more. Takotsubo Syndrome (TTS) is known as a distress-induced transient left ventricular dysfunction. In our patient with TTS, it was found that a new apical thrombus, which was not seen in the left ventricle, was seen in previous echo and computerized tomographic investigation, and that it was a source of thromboemboli, by stress triggering neurocardiac reactions. While under the medical treatment of viral pneumonia, under the Coronavirus transmission measures, thrombus in the LV was removed by being taken to the emergency open heart surgery. Our case is the first patient in the literature where a new thrombus developed in the LV and splenic infarction in TTS triggered by the pandemic. In this article; We have presented the experience of TTS triggered by pandemic, etiopathogenesis of left ventricular thrombus, open heart surgery indications when COVID-19 is suspected, coronavirus transmission measures in the surgical approach, the postoperative treatment and literature is reviewed.

Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.