Objectives Platelet/lymphocyte ratio is considered to be a recent biomarker which is not only related with inflammation but also associated with the atherosclerotic process. In this study, we aimed to investigate the relationship between carotid artery stenosis, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and mean platelet volume in patients undergoing carotid endarterectomy. Methods A total of 160 patients (127 males, 33 females; mean age 69.98 ± 9.76 years; range 48–92 years), who were undergoing carotid endarterectomy due to severe carotid artery stenosis, were evaluated and compared with 201 patients (140 males, 61 females, mean age 66.30 ± 9.24 years, range 41–90 years) without severe carotid artery stenosis. The patients were divided into four groups with respect to the carotid artery stenosis as: Group I (<50% stenosis), Group II (50–70% stenosis), Group III (70–90% stenosis), and Group IV (90–99% stenosis). Results Platelet/lymphocyte ratio, neutrophil/lymphocyte ratio and mean platelet volume were found higher in Group IV (patients with severe carotid artery stenosis) (p < 0.01) and were positively correlated with the degree of stenosis (p < 0.01). Platelet/lymphocyte ratio is an independent predictor for post operative stroke (p = 0.047) at multivariate analysis. A threshold level of 145.304 of platelet/lymphocyte ratio combined with a sensitivity 83.3% and specificity 73.8% (95% CI, 0.802–0.921, area under the curve = 0.862 ± 0.03; p = 0.002) for the identification of post operative stroke. Conclusions This retrospective study suggests that platelet/lymphocyte ratio in the blood which was taken preoperatively could be considered as an additional, easy, and inexpensive method to predict a possible higher incidence of postoperative stroke after carotid endarterectomy.
Introduction
The aim of this study was to examine the association of inter-arm systolic
blood pressure difference (IASBPD) with carotid artery stenosis, subclavian
artery stenosis and vertebral artery stenosis in patients who underwent
carotid endarterectomy.
Methods
A total of 141 patients (29 females, 112 males; mean age 71.2±10.4
years; range 47 to 92 years) who underwent carotid endarterectomy between
September 2010 and December 2017 were retrospectively evaluated. We
classified patients into four groups according to the IASBPD ˂ 10 mmHg,
≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of
both subclavian and vertebral arteries was considered as ≥ 50%.
Results
Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥
20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%)
were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of
them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD
≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery
stenosis. We found a significant correlation between preoperative symptoms
and subclavian artery stenosis (
P
=0.018) and overall
perioperative stroke was seen more frequently in patients with subclavian
artery stenosis (
P
=0.041). A significant positive
correlation was observed between vertebral artery stenosis and subclavian
artery stenosis (
P
=0.01).
Conclusion
Patients who were diagnosed with both subclavian artery stenosis and IASBPD
(≥ 20 mmHg) had a higher risk of postoperative stroke and death, had
higher total cholesterol, LDL-C, blood creatinine level, and were more
symptomatic.
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.
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