Introduction: We aimed to investigate whether normoxic cardiopulmonary bypass would limit myocardial oxidative stress in adults undergoing coronary artery bypass grafting. Methods: Patients scheduled to undergo elective isolated on-pump coronary artery bypass grafting were randomized to normoxia and hyperoxia groups. The normoxia group received 35% oxygen during anesthetic induction, 35% during hypothermic bypass, and 45% during rewarming. The hyperoxia group received 70%, 50%, and 70% oxygen, respectively. Coronary sinus blood samples were taken prior to initiation of cardiopulmonary bypass and after reperfusion for myocardial total oxidant and antioxidant status measurements. The primary endpoint was myocardial total oxidant status. Secondary endpoints were myocardial total antioxidant status and length of intensive care unit and hospital stay. Results: Forty-eight patients were included. Twenty-two received normoxic management. Mean ± standard deviation of age was 58 ± 9.07 years. Groups were balanced in terms of demographics, risk factors, and operative data. Myocardial total oxidant status was significantly lower in the normoxia group following reperfusion (p = 0.03). There was no statistically significant difference regarding myocardial total antioxidant status and length of intensive care unit and hospital stay (p = 0.08, p = 0.82, and p = 0.54, respectively). Conclusions: Normoxic cardiopulmonary bypass is associated with reduced myocardial oxidative stress compared to hyperoxic cardiopulmonary bypass in adult coronary artery bypass patients.
ÖZAmaç: Bu çalışmada açık kalp cerrahisi yapılan hastalarda deliryum insidansı ve muhtemel risk faktörleri belirlendi.Ça lış ma pla nı: Nisan 2011 -Kasım 2011 tarihleri arasında, açık kalp cerrahisi uygulanan 400 hastanın (276 erkek, 124 kadın; ort. yaş 59.7 yıl; dağılım 19-91 yıl) ameliyat öncesi, ameliyat sırası ve ameliyat sonrası verileri kaydedildi. Ameliyat sonrası 24. ve 72. saatlerde hastalara Yoğun Bakım Ünitesi-Konfüzyon Değerlendirme Ölçeği (YBÜ-KDÖ) uygulandı. Yoğun bakım hekimleri tarafından deliryum öntanısıyla konsülte edilen hastalar ile YBÜ-KDÖ sonucu pozitif olan hastalar karşılaştırıldı.Bul gu lar: Deliryum insidansı 24. ve 72. saatlerde sırasıyla %3.8 ve %1.8 idi. Deliryum olduğu bildirilen hastalar ile YBÜ-KDÖ uygulanarak deliryum tanısı konulan hastaların klinik gözlemleri arasında istatistiksel olarak anlamlı fark bulundu (p<0.001). Klinisyenlerin ameliyat sonrası 24. ve 72. saatlerde hipoaktif deliryumu tanımada yetersiz oldukları saptandı (p<0.001). Yirmi dördüncü saatte değerlendirildiği üzere, ameliyat öncesi dönemde yaş, işitme cihazı kullanımı, koroner arter hastalığı varlığı, ameliyat sırası ve ameliyat sonrası dönemde hematokrit düzeyi, drenaj miktarı, tekrar cerrahi, yatağa bağlanma öyküsü ve kan transfüzyonu deliryum açısından öngördürücü risk faktörleri idi (p<0.05). Yetmiş ikinci saatteki risk faktörleri ise ameliyat öncesi yaş, ameliyat sırası hematokrit düzeyi ve ameliyat sonrası kan transfüzyonu ve ameliyat öncesi, ameliyat sırası ve ameliyat sonrası dönemdeki mekanik ventilasyon süresi idi (p<0.05).So nuç: Açık kalp cerrahisi sonrası YBÜ-KDÖ gibi kolay uygulanabilir bir ölçeğin kullanılması, deliryumun erken tanı ve tedavisinde yararlı olabilir.Anah tarsöz cük ler: Kardiyovasküler cerrahi işlemler; konfüzyon; deliryum; yoğun bakım ünitesi. ABSTRACTBackground:This study aims to determine the incidence of delirium and possible risk factors in patients undergoing open heart surgery.
AimsLithium is an effective mood stabiliser for the treatment of the bipolar disorder. Its utility is not restricted to acute mania and prophylactic treatment of the bipolar disorder. Another well-known indication for its use is the treatment of refractory depression. Lithium can cause several adverse effects, and typically the side effects are dose-related. Unlike antipsychotic medications, lithium is rarely associated with drug-induced Parkinsonism.MethodsWe present a case of 78 years old gentleman who was assessed due to complaints suggestive of cognitive impairment. His past psychiatric history revealed that he was admitted to a psychiatric inpatient unit with a diagnosis of treatment-resistant depression in 1991. Lithium therapy was commenced during this admission, and he remained on lithium for 27 years. The patient was clinically stable in terms of the symptoms of depression; however, he reported bilateral postural tremors 20 years after the initiation of lithium therapy. Initially, he was diagnosed with lithium-induced tremor; however, in the following months, his symptoms had worsened, and he developed new motor disturbances, although the serum levels of lithium were within the therapeutic range. On examination, he had classic parkinsonian signs of shuffling gait, muscle rigidity in all four limbs and freezing of gait. DaT-SPECT imaging clarified the diagnosis as drug-induced Parkinsonism. As the daily lithium dosage was stopped, the patient's motor symptoms improved significantly; nevertheless, some of the symptoms persisted.ResultsThe pathophysiological mechanism behind lithium-induced Parkinsonism is unclear. The condition may develop with or without frank lithium toxicity and have diverse presentations. Literature suggests that the risk factors for lithium-induced Parkinsonism appear to be the patients' age, duration of lithium therapy, and serum lithium levels. It has been suggested that older patients have a more permeable blood-brain barrier and decreased renal clearance; hence, serum lithium levels can appear therapeutic, but brain lithium levels may be much higher. Pharmacokinetic drug-drug interactions might also contribute; thus, careful monitoring is essential.Drug-induced Parkinsonism improves with discontinuation of the offending medication; however, 10% of patients will develop a persistent and progressive parkinsonian syndrome.ConclusionThis report aims to emphasise the need to consider lithium-induced Parkinsonism when Parkinson Disease symptoms appear in chronic lithium users and close monitoring of lithium levels in geriatric populations. It is essential to recognise the condition, avoid misdiagnosis and prevent inappropriate use of anti-dopaminergic medications.
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