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    Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?
    (Springernature, 2020) Pala, Arda Aybars; Urcun, Yusuf Salim; Cicek, Omer Faruk; Sahin, Serpil
    Introduction Effective treatment of postoperative pain due to median sternotomy speeds up hemodynamic healing of patients. For this purpose, opioids with a wide range of side effects are widely used at high doses. The aim of this study is to investigate the effect of continuous local anesthetic (bupivacaine) infusion on opioid use on cardiac surgery patients undergoing median sternotomy. Methods A total of 215 patients undergoing isolated coronary artery bypass grafting surgery were included in the study; and 105 patients who underwent parasternal continuous local anesthetic infusion (0.5% bupivacaine at 4 mL/h, for 48h) were determined as local anesthesia group and other patients were as control group. The primary outcomes evaluated between the groups in the postoperative period were pain scores (VAS: Visual Analogic Score, PHHPS: Prince Henry Hospital Pain Score) and the number of opioids used. Secondary outcomes were mechanical ventilation time, intensive care unit and hospital stay duration, development of atrial fibrillation and atelectasis. Results Postoperative pain was found to be significantly lower in the local anesthesia group compared to the control group (VAS: 3 +/- 1.9 vs 6.4 +/- 1.8, p < 0.001; PHHPS: 0.9 +/- 0.8 vs 1.62 +/- 0.82, p < 0.001). As a result of this, opioid drug use was significantly lower in the local anesthesia group compared to the control group (0 (0 - 4) vs 1 (0 - 8), p < 0.001). Mechanical ventilation time, intensive care unit and hospital stay duration, and development of atelectasis were significantly lower in the local anesthesia group. In terms of the development of atrial fibrillation, no significant difference was found between the groups. Conclusion Parasternal continuous local anesthetic infusion reduces postoperative opioid use and speeds up hemodynamic healing by preventing possible side effects of opioids. It is a simple and effective method in the treatment of postoperative pain due to median sternotomy.
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    DOES A BASIC BLOOD TEST TELL THE LOCATION OF PERIPHERAL ARTERIAL LESIONS?
    (Carbone Editore, 2015) Yener, Ali Umit; Cicek, Omer Faruk; Cicek, Mustafa Cuneyt; Ozkan, Turgut; Korkmaz, Kemal; Yener, Ozlem; Genc, Bahadir
    Aim: In this retrospective study, We investigated if neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can suggest at hospital admission the location of lesion according to TASC 2 classification, in patients with peripheral arterial disease(PAD). Methods: In patients who underwent peripheral angiography, the routine blood tests performed before the procedure were collected. 241 patients between January 2010 and March 2013 were included in the study. The relationship between blood parameters and the location of peripheral arterial lesions was investigated. The patients were divided into 4 groups according to their TASC 2 (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease)classification; group A,B,C and D. Results: According to blood tests of patients, NLR and PLR were 3.47 +/- 2.69 and 154.1 +/- 71.2, respectively. When NLR and PLR values were evaluated separately in each group, in patients of Group D according to TASC 2. median NLR and PLR values were significantly higher compared to other groups. In high PLR group, concomitant coronary artery disease was observed in 30.9% of patients, and this difference was statistically significant compared to the low PLR group. Conclusion: Widespread of the PAD may be predicted with the help of a simple blood test at the limited conditions of outpatient clinics and time will be saved in terms of prevention of PAD.
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    Does a basic blood test tell the location of peripheral arterial lesions?
    (Acta Medica Mediterranea, 2015) Yener, Ali Umit; Cicek, Omer Faruk; Cicek, Mustafa Cuneyt; Ozkan, Turgut; Korkmaz, Kemal; Yener, Ozlem; Genc, Bahadir
    Aim: In this retrospective study, we investigated if neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can suggest at hospital admission the location of lesion according to TASC 2 classification, in patients with peripheral arterial disease(PAD). Methods: In patients who underwent peripheral angiography, the routine blood tests performed before the procedure were collected. 241 patients between January 2010 and March 2013 were included in the study. The relationship between blood parameters and the location of peripheral arterial lesions was investigated. The patients were divided into 4 groups according to their TASC 2 (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease )classification; group A,B,C and D. Results: According to blood tests of patients, NLR and PLR were 3.47 ± 2.69 and 154.1 ± 71.2 , respectively. When NLR and PLR values were evaluated separately in each group, in patients of Group D according to TASC 2 , median NLR and PLR values were significantly higher compared to other groups. In high PLR group, concomitant coronary artery disease was observed in 30.9% of patients, and this difference was statistically significant compared to the low PLR group. Conclusion: Widespread of the PAD may be predicted with the help of a simple blood test at the limited conditions of outpatient clinics and time will be saved in terms of prevention of PAD.
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    Is hyperbaric oxygen or ozone effective in experimental endocarditis?
    (Academic Press Inc Elsevier Science, 2016) Ozkan, Muhammed Turgut Alper; Vural, Ahmet; Cicek, Omer Faruk; Yener, Ali Umit; Ozcan, Sedat; Toman, Huseyin; Unver, Ahmet
    Background: Infective endocarditis, a disease with high mortality and morbidity, is most commonly caused by Staphylococcus aureus; mortality and morbidity further increase in the presence of methicillin-resistant strains of S. aureus. Linezolid is the first of the oxazolidinones, a new antibiotic group that has been approved for the treatment of infections caused by gram-positive cocci. Linezolid reduces the quantity of microorganisms in vegetation to some extent; in addition, the use of hyperbaric oxygen (HBO) and ozone (O-3) therapies is likely to improve targeted antibacterial effect. Materials and methods: Fifty-six adult male Wistar rats weighing 300-350 g were used. The subjects were divided into groups as follows: Group 1 (n = 8): control group that was not inoculated with microorganisms and was untreated; Group 2 (n = 8): control group that was inoculated with microorganisms but was untreated; Group 3 (n = 8): linezolid treatment group; Group 4 (n = 8): O-3 therapy group; Group 5 (n = 8): HBO therapy group; Group 6 (n = 8): linezolid + O-3 therapy group; Group 7 (n = 8): linezolid + HBO therapy group. Results: In terms of reducing the number of colonies in the aortic valve, linezolid + HBO therapy was found to be the most effective treatment. Then, respectively linezolid + O-3, linezolid, HBO, and O-3 were found to be effective. Conclusions: We found that linezolid significantly reduced the number of bacteria in the vegetation in the experimental endocarditis model, and HBO therapy increases the effectiveness of linezolid and makes this better than O-3. (C) 2016 Elsevier Inc. All rights reserved.
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    Magnesium; the electrolyte that delays the formation of atrial fibrillation
    (Pulsus Group Inc., 2014) Yener, Ali Umit; Ozkan, Turgut; Cicek, Mustafa Cuneyt; Baysal, Erkan; Dogan, Emre; Cicek, Omer Faruk; Genc, Bahadir
    Atrial fibrillation is one of the most common undesirable situation seen after open-heart surgery because of increasing the length of hospital stay, morbidity and mortality. It is revealed that atrial fibrillation may occur as a result of various electrolyte deficiencies such as magnesium. In this retrospective study, we aimed to compare the rhythm outputs of different cardiopulmonary bypass protocols,magnesium included in study group and without magnesium used patients was inserted in control group. The incidence of atrial fibrillation between 2 groups was not statistically significant. Furthermore magnesium treatment delayed the onset of atrial fibrillation in patients after coronary bypass graft surgery.
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    The effects of 21 and 23 milimeter aortic valve prosthesis on hemodynamic performance and functional capacity in young adults
    (2014) Yener, Ali Umit; Ozcan, Sedat; Budak, Ali Baran; Genc, Serhat Bahadir; Ozkan, Turgut; Cicek, Omer Faruk
    Objective: Early and medium-term improvement of functional capacity and regression of left ventricular hypertrophy was evaluated in the young adult patient group following application of 21 mm or 23 mm bileaflet aortic mechanical valve prosthesis due to aortic stenosis. Methods: Twenty two patients (10 male, 12 female; mean age 27+-8.2 (19-43)) who underwent isolated aortic valve replacement due to rheumatic aortic stenosis, were included in the study. 21 mm and 23 mm bileaflet mechanical prosthesis was used respectively in eight and fourteen patients. The mean body surface area was 1.86 m2 and 1.68 m2 respectively in 23 mm and 21 mm prosthesis while 1.73 ±0.25 m2 for the whole group. Functional capacity was New York Heart Association (NYHA) class II in 9 patients and class III in thirteen patients. Implantation was performed without enlarging the aortic root in all except four patients. In all patients transvalvular gradients, effective orifice area and the diameter of left ventricle were measured with transthoracic echocardiography during rest and after maximal exercise. Mean followup was 34±12 months (range 11-57 months). Results: There were no postoperative complications or deaths. All the patients were assessed as NYHA class I with regards to functional capacity (p=0.01). Significant improvements were determined in postoperative mean transvalvular gradient (p=0.005) and left ventricular mass index (p=0.01) when compared with preoperative values. Conclusion: Our findings show that replacement with 21 mm and 23 mm mechanical prosthesis provides a significant improvement in regression of symptoms and increase of functional capacity in young adults in early and mid-period without increasing mortality and morbidity.
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    Use of Extracorporeal Membrane Oxygenation in Adults
    (Elsevier Science Inc, 2014) Lafc, Gokhan; Budak, Ali Baran; Yener, Ali Umit; Cicek, Omer Faruk
    Since the first successful application of the heart lung machine in 1953 by John Gibbon [1], great efforts have been made to modify the bypass techniques and devices in order to allow prolonged extracorporeal circulation in the intensive care unit (ICU), commonly referred to as extracorporeal membrane oxygenation (ECMO). ECMO uses classic cardiopulmonary bypass technology to support circulation. It provides continuous, non-pulsatile cardiac output and extracorporeal oxygenation [2]. Veno-venous ECMO (VV ECMO) provides respiratory support, while veno-arterial ECMO (VA ECMO) provides cardio-respiratory support to patients with severe but potentially reversible cardiac or respiratory deterioration refractory to standard therapeutic modalities. ECMO is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. Despite the advent of newer ventricular assist devices that are more suitable for long term support, ECMO is simple to establish, cost-effective to operate.