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    Dopamine administration is a risk factor for delirium in patients undergoing coronary artery bypass surgery
    (Elsevier Ltd, 2016) Yılmaz, Seyhan; Aksoy, Eray; Diken, Adem İlkay; Yalçınkaya, Adnan; Erol, Mehmet Emir; Çağlı, Kerim
    Background: Delirium is an important morbidity following heart surgery. We sought to determine whether dopamine infusion is associated with increased risk of delirium in patients undergoing coronary artery bypass grafting. Methods: A total of 137 patients (mean age; 61.02±7.83, 105 males) were included in the study. Patients undergoing isolated coronary artery bypass grafting were considered eligible and those with preoperative neurological deficit or significant neurocognitive disorders, dementia or psychiatric disorders were excluded. Primary outcome measure was occurrence of delirium within 72 hours after operation. The diagnosis of delirium was made using confusion assessment method for the intensive care unit questionnaire. Both administration of dopamine as a dichotomised variable and the total amount of dopamine per kg body-weight were included in two different logistic regression models. Results: Delirium occurred in 18 (13.1%) patients. Age adjusted Mantel-Haenszel relative risk for delirium with receiving dopamine was 4.62. Relative risk was 2.37 (0.18 to 31.28, 95% CI, p=0.51) in total doses over 10 mg whereas it was 3.55 (1.16 to 10.89 95% CI, p=0.02) in total doses over 30 mg per kg body-weight. Older age (p=0.03), dopamine administration (OR: 9.227 95% CI, 2.688-32.022, p<0.001) and the amount of dopamine administered (OR: 1.072, 95% CI, 1.032-1.115, p<0.001) were independent predictors for delirium 72 hours after surgery. Conclusion: Along with older age, dopamine infusion - even in low doses but more probably in higher doses - emerged as an independent risk factor for delirium in patients undergoing CABG. Further study is needed to confirm the validity of results presented. © 2015.
  • Küçük Resim
    Öğe
    Koroner arter hastalığı ve sol plöroperikardiyal agenezi
    (Bilimsel Tıp Yayınevi, 2016) Erol, Mehmet Emir; Yalçınkaya, Adnan; Diken, Adem İlkay; Çağlı, Kerim
    Altmış üç yaşında erkek hasta üç damar koroner arter hastalığı tanısı ile departmanımıza yatırıldı. Preoperatif değerlendirilmesinde anormal bir bulguya rastlanmamıştır. Yapılan transtorasik ekokardiyografi (TTE)’de sol ventrikül EF’si %52 olarak hesaplanmış, kapak patolojisi ya da intrakardiyak defekt saptanmamıştır. Ayrıca TTE’de perikard hakkında patolojik bir bulgudan bahsedilmemiştir. Hastaya koroner arter baypas greftleme (CABG) operasyonu planlandı. CABG için hastaya genel anestezi altında mediyan sternotomi yapıldı. Sternotomi sonrasında hastanın kalbin sol tarafında perikardın ve akciğer plevrasının olmadığı, sol akciğerin kalp ile arada doku olmadan komşu olduğu fark edildi (Resim 1). Perikard sadece sağ ventrikül, aort ve pulmoner arter üzerinde normal şekilde devamlılık gösteriyordu (Resim 2). Hastaya üç baypas yapıldı. Hastaya perikard rekostrüksiyonu yapılmadı. Postoperatif dönemi sorunsuz geçen hasta postoperatif beşinci günde taburcu edildi.
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    Öğe
    Predictive value of STOP-BANG on osas-related complications following coronary artery bypass grafting
    (American Association for Respiratory Care, 2018) Erçen Diken, Özlem; Diken, Adem İlkay; Yalçınkaya, Adnan; Gülbay, Banu; Acıcan, Turan; Demir, Emre; Özyalçın, Sertan; Erol, Mehmet Emir
    BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavail-ability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations. © 2018 Daedalus Enterprises.
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    Öğe
    Proximal occlusion of a sequential vein graft after 20 years
    (2015) Yalçınkaya, Adnan; Diken, Adem İlkay; Erol, Mehmet Emir; Çiçek, Ömer Faruk
    A 67-year-old man presented with chest pain of three-month duration that occurred with moderate effort 20 years after coronary artery bypass graft surgery using the left internal mammarian artery (LIMA) to the left anterior descending artery and a sequential saphenous vein graft (SVG) to the diagonal branch and obtuse marginal artery.
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    Öğe
    Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis
    (SAGE Publications Ltd, 2018) Diken, Adem İlkay; Yalçınkaya, Adnan; Hanedan, Muhammet Onur; Erol, Mehmet Emir; Erçen Diken, Özlem
    Background: Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods: A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results: The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion: This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits. © The Author(s) 2017.