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BACKGROUND AND AIM Acute kidney injury occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases and associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. We aimed to investigate the factors affecting the progression of kidney disease during cardiac surgery in preoperative chronic kidney disease patients (CKD). METHODS The demographic data of patients and preoperatively studied parameters are: American Society of Anesthesiologists Classification, diabetes mellitus, hypertension, left ventricular ejection fractions, estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. The pre and postoperative parameters recorded were glucose, blood urea nitrogen (BUN), creatinine, hemoglobin, and eGFR. In the intensive care follow-up, discharge status, revision status and 30-day mortality rates and complications were analyzed. RESULTS One hundred and thirty-eight patients (87 males, 51 females; mean age 61.7 years) were included, the mean preoperative Euro score II value was 8.72 ± 7.09 (7.3 ± 6.2 in the survival group and 13.1 ± 7.9. 83 in the deceased group). The number of patients who underwent revision surgery due to postoperative bleeding were 36 (26.09%) and the 30-day surgical mortality was 24.64% (n = 34). CONCLUSION Age, complication, euro score, cross-clamp time, pulmonary artery pressure, postoperative BUN, creatine, and CKD-EPI-GFR were found to be significantly effective in predicting 30-day mortality of the patients.

Introduction: The mean platelet volume (MPV) is one of several indicators of platelet activity. Recent studies have shown that MPV is increased in myocardial infarction, unstable angina, and stroke. Peripheral artery disease (PAD) manifests with the narrowing or obstruction of the abdominal aorta and arteries distal to the aortic bifurcation due to progressive atherosclerosis. The objective of this study is to investigate the MPV and platelet count in patients with PAD. Patients and Methods: This study included 67 patients aged 40-80 years who underwent elective surgery for PAD in our hospital between January 2018 and June 2019, along with a control group comprising 67 patients without PAD. The MPV and platelet count values were obtained from a preoperatively performed hemogram analysis. Importantly, the groups were statistically compared in our study. Results: As compared to the control group, the patients with PAD had a significantly higher mean age (p= 0.02), prevalence of diabetes mellitus (p< 0.01), as well as frequency of antiaggregant use (p< 0.01) and smoking (p< 0.01). There were no statistically significant differences in the other clinical features between the groups (p> 0.05). The mean platelet count and MPV were also significantly higher in patients with PAD as compared to patients without PAD (p< 0.01). Conclusion: The use of inexpensive and widely used tests such as platelet count and MPV can facilitate an early diagnosis of the diseases with high morbidity and mortality, such as PAD.

Background and objectives To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. Methods A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5 minutes after intubation in the supine position); T2 (30 minutes after CO2 insufflation); T3 (120 minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. Results The mean IOP was 12.4 mmHg at T1, 20 mmHg at T2, 21.8 mmHg at T3, and 15.6 mmHg at T4. The mean ONSD was 4.87 mm at T1, 5.21 mm at T2, 5.30 mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. Conclusions A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.

Background: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl. Results: There were no significant differences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1- and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO2, PO2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was significantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was significantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Pain on injection was present in 55% of patients (n = 81), mild in 36% (n = 54), and severe in 18% (n = 27). Myoclonies occurred in 4% of patients (n = 7) and local rash in 6% of patients (n = 10). Differences between formulations did not reach statistical significance. Conclusion: None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of effects on the neonate.

Amaç: Yoğun bakım ünitesinde yatan kritik hastalarda, hipovoleminin değerlendirmesi için kullandığımız inferior vena kava kollapsibilite indeksi (İVCCİ), santral venöz basınç (CVP), pasif bacak kaldırma testi (PBKT), laktat ve veno-arterial karbondioksit farkı (ΔpCO2) parametrelerinin birbiriyle korelasyonu ve ΔpCO2’in bu amaçla kullanılabilirliğini saptamak.Gereç ve Yöntem: Hastalar supin-nötr pozisyondayken CVP ölçüldü. CVP’nin %45 değeri hipovolemi lehine değerlendirildi. Hastaya nabız basınç kontrollü PBKT uygulanıp sistolik tansiyonda >%12 artış pozitif olarak kabul edildi. Daha sonra hastalardan eş zamanlı santral venöz ve arteriel kan gazı çalışılarak ΔpCO2 ve arteriyel laktat düzeyine bakıldı.Bulgular: Çalışmamızda İVCCİ ve CVP arasında orta derecede negatif korelasyon (p=0.02), İVCCİ ile PBKT arasında orta derecede bir pozitif korelasyon (p, Aim: Determination the correlation between inferior vena cava collapsibility index (IVCCI), passive leg rising test (PLRT), central venous pressure (CVP), and lactate and veno-arterial carbon dioxide difference (ΔpCO2) parameters that are used for evaluating hypovolemia in critical patients in intensive care units and determining the disposability of ΔpCO2 for this reason.Materials and Methods: When patients were supine-neutral position, CVP was measured. CVP values less than 8 mmHg (CVP 45%) were evaluated as hypovolemia. The patients were applied blood pressure-controlled passive leg lifting test (PLLT), and >12% increase at systolic blood pressure was accepted as positive. After that, simultaneous central venous and arterial blood gas of patients were studied, and ΔpCO2 and arterial lactate levels were controlled.Results: As a result of our study, we have detected a medium level negative correlation (p=0.02) between IVCCI and CVP, and medium level positive correlation between IVCCI and PLLT. However, weak positive correlation (p=0.032) has been detected between IVCCI and lactate level. Any correlation detected between ΔpCO2 and other parameters.Conclusion: IVCCI can be used for volume evaluation of intravascular fluid since it is a noninvasive method and at the same time, it is statistically in correlation with CVP, PLLT and lactate.

This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy.Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase.The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p0.05).The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.

Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normalhastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yanetkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acilserviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olanhastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyetiile başvurdu. Hastada metformin ilişkili laktik asidoz (pH5 mmol/L vebikarbonat

Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery.Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated.Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001).To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

Introduction: Sedation is often needed for magnetic resonance imaging (MRI) in pediatric patients for diagnostic purposes. In this study, we aimed to present anesthesia techniques and complications that occurred during sedation in pediatric patients. Methods: A total of 337 pediatric patients, in whom MRI was performed with sedation between January 1, 2016 and December 31, 2016, were retrospectively reviewed. The procedure, anesthetic drugs used, complications, and the need for additional medications were recorded. The patients were divided into 3 groups. Group 1: MRI procedure lasted 15 minutes, group 2: MRI procedure lasted 15-30 minutes and group 3: MRI procedure lasted more than 30 minutes. Within the groups, subgroup evaluations were made according to the type of anesthetic drug used. Results: There was no statistically significant effect of drug types used on complication development (bradicardia, hypoxia) and additional drug requirements in binary comparisons among subgroups (p=0.655, p=0.655 and p=0.317). In comparison of the groups according to the duration of the MRI procedure, complication development and need for additional medication were found to increase with prolonged imaging time (p=0.008, p=0.012 and p=0.02). Conclusion: Combinations of anesthetic and sedative drugs used during MRI in the pediatric patient group have no effect on complication development (bradicardia, hypoxia) and additional drug need. However, as the duration of the imaging procedure increases, complications and need for additional medication increase.

We aimed to present the assessment of the Cushing reflex caused by intracranial haemorrhagia developing during mechanical thrombectomy in a case presenting with acute ischemic stroke. A 59-year old male patient was scanned by CT angio due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarction was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the anesthesiology team was warned and 1 mg IV atropine was administered for bradycardia. Acute infarction has to be removed because it is understood as mechanical thrombectomy has been performed to a patient with an infarction. Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed. As conclusion, anesthesia and operation team must be alert for vessel perforation when Cushing triad develops during navigation of the thromboaspiration catheter.

BackgroundThe co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches.MethodsIn total, 58 study patients were randomly assigned to receive either anterior (group A, n = 29) or posterior (group P,n = 29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018.ResultsThe time to initiation of sensory block was significantly shorter in group P than in group A (7.70 ± 2.05 min and 12.88 ± 4.87 min, respectively;p = 0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00 ± 00.00 min for group P and 4.05 ± 7.47 min for group A;p p = 0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51 ± 2.87 μg for group P and 147.75 ± 22.30 μg for group A). Patient satisfaction (p p = 0.006), and surgical quality (p = 0.047) were significantly higher in group P.ConclusionsAnterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

Background: The co-administration of sciatic nerve and femoral nerve blocks may provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to sciatic nerve block have been described, including anterior and posterior approaches. Methods: Our study included 58 patients, randomly assigned to receive either an anterior (Group A , n = 29) or posterior (Group P, n = 29) approach. After the blocks were performed, we determined sensory and motor block start and end times, first fentanyl requirement time after block and before operation starts, first fentanyl requirement time after the operation starts, the mean fentanyl dose administered per patient after block and before operation starts, the mean fentanyl dose administered per patient after the operation starts, the time to first diclofenac sodium administration, and the total dose of diclofenac sodium required. The date of trial registration was retrospectively registered in 11.07.2018 Results: Comparison of the two groups revealed that Group P exhibited significantly shorter times to starting the sensory block (12.88±4.87 min for Group A, 7.70±2.05 min for Goup P) p=0.01 and first fentanyl requirement time after block and before operation starts (00.00±00.00 min for Group A, 4.05±7.47 min for Group P) p=

BackgroundTigertriever (Rapid Medical, Yoqneam, Israel) is a new design of stent retriever.PurposeTo evaluate the feasibility, safety, and efficacy of the Tigertriever in patients with acute ischemic stroke who have undergone mechanical thrombectomy.Materials and methodsTwo different techniques—namely, standard unsheathing (SUT) and repetitive inflation-deflation (RID) techniques, were used. Modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b and 3 were considered as successful recanalization.ResultsA total of 61 thrombectomy procedures with Tigertriever were retrospectively evaluated. The mean age of patients was 60.7 years and their National Institutes of Health Stroke Scale score was 14.7. Overall, the percentage of patients with a mTICI score of 0, 2b, and 3 was 24.6, 26.2, and 49.2, respectively. Successful recanalization and first-pass success rates were 75.4% and 37.7%, respectively. There were no statistical differences between the results of the SUT and RID techniques. No vessel rupture, dissection, or device detachment was observed. The number of patients with a good clinical outcome (modified Rankin Scale score 0–2) was 17 (27.9%).ConclusionOur results showed that the Tigertriever device is safe and efficient for mechanical thrombectomy.

Objective: Despite the fact that obstetric cases constitute only a small portion of intensive care hospitalizations, maternal mortality still remains an important health problem in the world. In this study, we aimed to evaluate the frequency and reasons of admission of obstetric patients to the intensive care unit (ICU), as well as the ‘advanced’ treatments applied and the clinical outcomes. Materials and Methods: The medical records of 8800 obstetric patients who were admitted to the hospital between 2012-2017 were retrospectively reviewed. The demographic data, reasons for admission to the ICU, concomitant diseases, intensive care interventions (advanced monitoring, extracorporeal therapies, etc.) and clinical outcomes were evaluated. Results: Of the 8800 obstetric patients, 40 (0.45%) patients required intensive care. The mean age was 32.2±5 years. The mean duration of stay in the ICU was 4.3 days. The most common reasons for admission to the ICU were HELLP-Preeclampsia-Eclampsia in 16 (40%) patients and bleeding (due to disseminated intravascular coagulation, uterine perforation, uterine atonia) in 11 (27%) patients. Seventeen patients received invasive mechanical ventilation and 3 patients received non-invasive mechanical ventilation. Two patients received extracorporeal membrane oxygenation (ECMO), 4 patients received plasmapheresis and 5 patients received hemodiafiltration. Three patients died. One patient died of multiorgan failure secondary to HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Two patients died due to HELLP and intracerebral hemorrhage. Conclusion: Advanced intensive care settings where new-era technological equipment (ECMO, hemodiafiltration, advanced monitoring, etc.) is in-reach and employing a multidisciplinary approach in the ICU may decrease the maternal mortality and morbidity.

Can propofol injection pain be avoided? Objective: The main purpose of this study is to investigate the most effective and reliable method for prevention of propofol injection pain. Material and Methods: In this prospective, randomized, double-blind trail we gave one of the six drugs of penthotal, lidocaine, saline, ketamine, ondansetron and decort by using wrist tourniquet. Then we evaluated arm withdrawn, grimace, verbal rating scale (VRS) and postoperative recall the pain during propofol injection. Results: Evaluation of VRS data between six groups revealed that the lidocaine group was the most painless group (86%). These findings were followed respectively by ondansetron (82%), decort (72%), penthotal (52%), ketamine (46%) and saline (12%).

Comparison of the hemodynamic effects of crystalloids and colloids in patients undergoing coronary artery bypass grefting surgery with the minimally invasive cardiac output monitoring system (Flotrac-Vigileo) Objective: The aim of this prospective randomized clinical trial is comparison of crystalloids and colloids’s hemodynamic effects in patients undergoing elective coronary artery bypass grefting surgery with arterial pressure waveform analysis. Material and Methods: The thirty patients undergoing elective coronary arter bypass surgery were divided into two groups: crystalloid (0.9% isotonic) and 50% crystalloid (0.9% isotonic) + 50% colloid (HES 6%). FloTrac Sensor and Vigileo Monitor was attached to the arterial line. The hemodynamic parameters were recorded regarding systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), cardiac output (CO), stroke volume (SV), stroke volume variation (SVV). Results: There was no statistically significant difference between the two groups ragarding mean average of cardiac output and stroke volume before the induction, after the induction, after the skin incision, after the sternotomy, before the canulation, after the canulation, on-pump, after the cross clemp, after the bypass and after the chest closure (p>0.05). Only after the skin closure, the mean cardiac output and stroke volume increased in crystaloid-colloid groups compared to crystaloid group (p=0.01). Conclusion: There was no significant clinical difference between the two groups for the hemodynamic parameters in patients undergoing coronary artery bypass grefting surgery.