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Wilson’s disease is an autosomal recessive inherited chronic disease that occurs as a result of the deposition of copper in organs and tissues with impaired biliary excretion. With this case report, we aimed to share our experience in cesarean anesthesia in a pregnant woman with Wilson disease who had irregular medical follow-up and underwent chelation therapy. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aims to demonstrate whether using scoring systems effects postoperative complications of patients in the recovery room as well as its contribution to patients’ safety Method: We examined files of patients operated in our Hospital between 2010 and 2017. In the recovery room after anesthesia, complications developed in the recovery room and in the early period were recorded in patients who were followed up by the Modified Aldrete Scoring System (MASS) (MASG) and without using the scoring system (CG). We used Statistica 13.3 program for statistical analyses. Results: The duration of stay in the recovery room was longer in MASG than CG. The minor complication rate was close in both groups. In the control group , one patient had a cardiac arrest, as a major complication, which responded to cardiopulmonary resuscitation. Conclusions: We determined that more serious complication developed in patients for whom the scoring system was not used in the recovery room than patients followed up with the scoring system. Safety of patients during their transfer to the service depends on having an advanced infrastructure in anesthesia recovery rooms, employing trained health personnel and using algorithms such as MASS. [ABSTRACT FROM AUTHOR]

Objective: Central venous catheterization (CVC) is an invasive procedure used in intensive care units with various indications. Malposition of the catheter has been reported in the literature ranging from 3.6-14% in practice. In this study, we aimed to determine the preference of catheter placement and malposition rates in CVC applications performed by specialist physicians in our intensive care units without using ultrasonography. Method: After the approval of the ethics committee, medical files of 1710 patients who were applied to the Mersin City Training and Research Hospital in 2017-2019 were reviewed. Permanent port catheter, dialysis catheter and catheters placed in pediatric patients under 18 years of age were excluded from the study. All catheterization procedures were performed by a specialist physician using 7 F catheters with Seldinger technique without the use of ultrasound. Results: Of the 1463 patients included in the study, the catheters were inserted intointernal jugular vein in 842, subclavian vein in 467,and femoral vein in 154 patients. When femoral catheterization was excluded from assessments, malposition was found in 1309 patients with a rate of 1.68%. There were 14 malpositioned catheters in the right internal jugular vein, 6 in the right subclavian vein and 2 in the left subclavian vein. Conclusion: In conclusion, it has been reported that ultrasound-guided catheter placement may prevent malposition and reduced complication rate when performed by experienced clinicians. However,when the ultrasound is not available, we believe that performing the procedure by experienced clinicians and confirming the accuracy of the catheter position with lung x-ray after the procedure may reduce malposition rates. [ABSTRACT FROM AUTHOR]

Substance abuse is a social problem and may increase morbidity with additional risks to the administration of anesthesia in patients requiring surgery. When it comes to cesarean section, the choice and management of a good anesthetic technique is mandatory for both the baby and the mother. A 30-year-old multiparous patient weighing 50 kg, in her 34 gestational week with a history of cesarean section but without routine follow-up presented with a sudden onset of active cervical hemorrhage and preterm labour. The patient’s vital signs were stable, laboratory values were within normal limits. It was learnt that she used heroin 4 hours previously, and she was not hungry. She underwent caesarean section under emergency conditions. A baby weighing 1500 g was delivered under general anesthesia. The infant was diagnosed with newborn withdrawal syndrome and phenobarbital treatment was performed in the neonatal intensive care unit. Maternal withdrawal syndrome and other complications did not occur. On the postoperative 5th day, the mother and baby were discharged. [ABSTRACT FROM AUTHOR]

Transfusion-related acute lung injury (TRALI) is the second leading cause of transfusion-associated mortality in high-risk patients undergoing major surgery. TRALI presenting with acute hypoxia and non-cardiac edema is a vital clinical entity which must be considered in the differential diagnosis in transfusion-associated patients. Fresh frozen plasma, erythrocyte suspension and thrombocyte suspension transfusion were performed during perioperative and postoperative periods to the patient undergoing supracoronary graft interposition due to ascending aortic aneurysm. Respiratory support treatment with positive pressure mechanical ventilation was initiated for acute hypoxia and bilateral pulmonary edema developed immediately after the procedure. The patient thought to have delayed TRALI was extubated on postoperative 5. day. Noninvasive mechanical respiratory support treatment was maintained. On postoperative 10. day the patient did not need any oxygen and ventilatory support. TRALI should be considered in patients with acute onset of hypoxia, ARDS especially in cases undergoing major surgery and transfusion of large amounts of ES, FFP, platelet suspension. Noninvasive mechanical ventilation should be considered as a treatment option. [ABSTRACT FROM AUTHOR]

Objective: One of the most frequently studied parameters in terms of outcome estimation in cardiac surgery is HbA1c. Several studies in literature suggest that high HbA1c value increases mortality and morbidity, but there is no relation between them. The primary aim of the present study is to investigate whether HbA1c value in diabetic patients undergoing coronary bypass graft surgery is an independent predictor for post-operative mortality and morbidity, and our secondary goal was to determine independent risk factors that cause mortality and morbidity in the same patient population. Methods: 380 diabetic patients diagnosed with diabetes who underwent coronary surgery with cardiopulmonary bypass in Mersin State hospital between July 2014 to December 2016 after the approval of the Mersin University Faculty of medicine ethics committee were included in this retrospective, observational, and cross-sectional study. Patient demographic and perioperative information were obtained from the electronic information operating system and from anesthesia-intensive care follow-up forms. The HbA1c threshold was accepted as 7%, which was reported to be more appropriate for evaluating high-risk groups. Results: Three hundred and fifty-four patients with complete access to the data were included in the study. The mean age of the patients was 60.8±9.4 years. 37% of the patients (131 patients) were female. The number of patients with HbA1c=7 was 194 (54,8%) in the entire patient population. In this study, high HbA1c (=7) values in diabetic patients undergoing isolated coronary bypass graft surgery were not found to be independent predictors of post-operative mortality and morbidity. Mortality was seen in 28 patients (7.9%). ejection fraction (EF) was found to be an independent predictor factor for pre-operative factors in logistic regression models constructed according to mortality predictors (OR:0.94; 95% CI: 0.90-0.99; p=0.016). Complications were seen in 50 patients (14.1%). In the models formed from the point of view of the complication predicators, only EF was found to be independent predictor (OR:0.95; 95% CI: 0.92-0.98; p=0.004). It was found that HbA1c was not predictive in all models for mortality and complication (p>0.05). Conclusion: There are reports in the literature that mortality increases 4-fold when HbA1c value is higher than 8.6% in coronary surgery. However, there is a view that HbA1c alone cannot predict mortality in coronary surgery if diabetes associated factors are excluded. In this study, high HbA1c (=7) values in diabetic patients undergoing isolated coronary bypass graft surgery were not found to be independent predictors of post-operative mortality and morbidity. Pre-operative low ejection fraction was found as an independent risk factor for post-operative mortality and morbidity in the general patient population. [ABSTRACT FROM AUTHOR]