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    Öğe
    A Novel Approach for Arteriovenous Fistula Maturation; Effects of Melatonin Loaded PLGA Nanofibers in Rats
    (Galenos Publ House, 2025) Aykora, Damla; Sahin, Serpil; Aydeger, Cemre; Yulek, Ozden; Alkan, Sevil; Oral, Ayhan; Jajere, Muhammad Umar
    Aim: Arteriovenous fistula (AVF) is a cannulation method that is accessed by a peripheric vein and an artery. AVF provides vascular access for chronic kidney disease patients so they can receive hemodialysis. AVF could be created by surgical intervention and facilitates arterial to venous circulation for rapid recovery. However, AVF maturation depends on venous proliferation and luminal diameter which allows the optimum flow rate for continuing circiulation and hemodialysis. Due to multiple unexpected conditions, non-maturation of AVFs limits the efficacy of the hemodialysis so patients must receive another surgery for AVF cannulation. Materials and Methods: In this study, we aimed to utilize the effects of melatonin (MT), which is known to have antioxidant, anti-inflammatory, and antiapoptotic effects, to provide longer and more effective use of AVFs via a novel technique. For this purpose, firstly by electrospinning method, polylactic-co-glycolic acid (PLGA) nanofiber membranes were developed. After MT is loaded into the PLGA and characterized. Biodegradation and drug release profiles were analyzed. An in vivo study was performed in Wistar Albino male rats (n=18). Rats were randomly divided into three experimental groups; Sham, PLGA, and MT/PLGA respectively (n=6). AVF model was established in all groups between arteria carotica and vena jugularis under general anesthesia. The Sham group did not receive any treatment or biomaterial application. The developed membranes were placed onto the AVFs in PLGA and MT/PLGA groups. All rats were sacrificed on the 28th of the experiment. The anastomosis sites of all animals were harvested for histopathological analysis. Results: Our results showed MT/PLGA group indicated increased maturation levels conmpared to Sham group (p<0.05). Conclusion: The results showed that PLGA/MEL may be a promising material for early AVF maturation.
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    Öğe
    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.