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Objective: In this study, our aim was to investigate the efficacy and sufficiency of bispectral indeks (BIS) guided remifentanil-desflurane anaesthesia on intraoperative haemodynamic stability in both normotensive and hypertensive patients undergoing off-pump coronary artery bypass surgery., Methods: Thirty adult, ASA I-III patients undergoing elective off-pump coronary surgery were included in the study. According to the presence of essential hypertension preoperatively, patients were divided into two groups. Haemodynamic parameters were recorded at 11 time points during the operation., Results: There were no differences in the demographic data, heart rate and intraoperative and postoperative parameters between the groups. Arterial blood pressure and additional requirement of remifentanil were found to be significantly higher in the hypertensive group intraoperatively., Conclusion: In patients undergoing off-pump coronary revascularisation surgery, intraoperative haemodynamic stabilisation with remifentanil-desflurane anaesthesia under BIS guidance was safely provided, but higher remifentanil doses were required in hypertensive patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Two days before surgery in a 70-year-old man with renal cell carcinoma, transthoracic echocardiography showed a dense mass in the inferior vena cava, lying proximally, but no mass was observed in the right atrium. Intraoperative transesophageal echocardiography revealed unexpected tumor thrombi in the right atrium, and the surgical plan was changed. This case highlights the importance of intraoperative transesophageal echocardiography in patients with renal cell carcinoma.

Near-infrared spectroscopy (NIRS) is a noninvasive continuous monitoring method for measuring the oxyhemoglobin saturation of the brain tissue. NIRS monitoring can suggest neuronal hypoxia in the frontal-brain before irreversible impairment of cellular metabolism. We report two cases of Type B aortic dissection surgery in which spinal regional perfusion monitoring was performed by placing two NIRS sensors on the back-skin through T6-T8 and T9-T11 vertebraes., (© 2013 Wiley Periodicals, Inc.)

Purpose: We investigated the distribution of early clinical outcomes among normal, obese, and morbidly obese patients undergoing open heart surgery., Methods: Medical records of 1,000 patients undergoing open heart surgery since February 2011 at our hospital were investigated retrospectively after permission was obtained from the Council of Education Planning of the hospital. The comorbidities and perioperative and discharge data were analyzed for 279 patients with a body mass index (BMI) score between 18 and <30 [non-obese reference group (NRG, n = 279)]; 166 patients with BMI between 30 and <35 [obese group (OG, n = 166); and 192 seriously obese patients with BMI ≥35 [extreme obese group (EOG, n = 192)]. Distribution of the patients according to BMI scores was found to represent the BMI distribution of the Turkish population., Results: Pulmonary and infective complications were significantly higher in EOG patients compared to NRG based on crude confidence interval. Based on adjusted multiple logistic regression analysis, by adjusting the effects of age, sex, comorbidities (diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease), and smoking, the incidence of pulmonary and gastrointestinal complications in EOG was higher compared to NRG. Discharge with morbidity was significantly higher in OG and EOG compared to NRG., Conclusions: We found that obesity does not increase short-term mortality for open heart surgery; however, it increases the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity.

We describe a 45-yr-old woman with an intermediate type atrioventricular septal defect associated with a double-orifice left atrioventricular valve (DOLAV). We diagnosed this exceptional anomaly by intraoperative transesophageal echocardiography (TEE) during surgery that was scheduled for only a primum type atrial septal defect (ASD) repair. Preoperative transthoracic echocardiography and angiography revealed the ASD but could not demonstrate the DOLAV. We were able to repair this rare and challenging abnormality successfully under the guidance of TEE imaging during the operation. TEE provides valuable information about both anatomy and functional aspect of the valvular structures. Besides its proven role in cardiac surgery, intraoperative use of TEE also serves as a useful tool for diagnosis of such unexpected and potentially missed abnormalities.