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Cardiac arrest (CA) remains a critical global health issue with high rates of mortality and morbidity. Accurate prediction of neurological outcomes in post-CA patients is essential for optimizing management strategies. Optic nerve sheath diameter (ONSD) and near-infrared spectroscopy (NIRS) are emerging as promising tools for evaluating brain oxygenation and intracranial pressure. However, the potential benefits of combining these methods for improved prognostic accuracy have not been thoroughly explored. This study investigates whether the combined use of ultrasonographic ONSD and NIRS measurements enhances the prediction of neurological outcomes after CA. In this prospective study, ONSD measurements were obtained three times at 24-hour intervals, while regional hemoglobin oxygen saturation (rSO2) using NIRS was recorded twice. Neurological outcomes were assessed using the Full Outline of Unresponsiveness (FOUR) and Cerebral Performance Categories (CPC) scores for both early and late evaluations. Results indicated that 47.5% of patients had poor outcomes and 52.5% had good outcomes based on the FOUR score, while 65% had poor outcomes and 35% had good outcomes according to the CPC score. The combination of ONSD and NIRS measurements showed superior prognostic performance compared to either method alone. While standalone NIRS measurements taken after 24 hours exhibited limited predictive value, combining ONSD and NIRS provided a more reliable approach for neurological assessment in the short term following CA. This integrated method may improve prognostic accuracy and support better clinical decision-making.

Purpose: A dynamic thiol/disulfide balance is pivotal in organizing anti-oxidant defense, detoxification, apoptosis, and enzyme activities, as well as transcription and cellular signal-transfer mechanisms. The connection between urolithiasis and oxidant/antioxidant status, which can be assessed through thiol-disulfide homeostasis (TDH), has not yet been examined. In this study, we evaluated the effects of TDH on the formation, size, and location of stones by examining the associations between TDH parameters and urolithiasis. Materials and Methods: Patients with urolithiasis and healthy controls were recruited. The patients were divided into subgroups in terms of stone size (>15 mm or ≤15 mm) and stone location (nephrolithiasis or ureterolithiasis). TDH parameters were measured using a novel automatic and spectrophotometric method and compared statistically. Results: TDH parameters were different between the urolithiasis and control groups. TDH tended towards the disulfide side in the urolithiasis group. Stone size increased an average 0.14 mm with a 1 µmol/L increase in disulfide level and decreased an average 0.058 mm with a 1 µmol/L increase in native thiol level. Disulfide and native thiol levels were found to be different across patients with stone size >15 mm, ≤15 mm, and controls (p

Ultrasonography-guided regional anesthesia (UGRA) applications are important in the practice of anesthesiology in the world. Despite the positive effect on patient care, there is concern that ultrasound (US) probes may be used repeatedly and assume a vector role in pathogen transport. There is no consensus on how to preserve US probes and use of gels against probing surface damage with pre-UGRA probe disinfection, agents used, and is still a research topic. Methods: Five different disinfection methods were compared via image quality by experienced anesthesiologists. Evaluators has been wanted to score the image that was recorded with using a defined disinfection method. Evaluators were blind while scoring the image. As a mean of 4,65 (US probe non-sterile stretch film coating and antiseptic spray(10% povidone-iodine) on the stretch film) Method 3 has been the most preferred one. The use of proven disinfection methods in UGRA interventions will be beneficial in terms of cost-effectiveness. According to study results, Method 3 (US probe non-sterile stretch film coating and antiseptic spray(10% povidone-iodine) on the stretch film) was observed to provide best image quality and cause the least cost for long-term use. [Med-Science 2019; 8(2.000): 422-5]

Informed consent forms are printed forms prepared to assist patients in the treatment process by explaining the indications, benefits and possible risks of medical practices. Readability describes understanding difficulty and is calculated by mathematical formulas. The study aimed to assess the readability level of Informed Consent Forms used in intensive care units. The informed consent forms from 45 hospitals in our country have been gathered. In each average form number of words, the average number of syllables and the average number of words with 4 or more syllables were manually calculated using the Microsoft Office Excel 2016® program. Their readability levels have been assessed with Atesman and Bezirci-Yilmaz readability formulas. The readability level of forms was difficult according to the Atesman readability formula and at undergraduate level according to the Bezirci-Yilmaz readability formula. The readability level of forms used in private hospitals was found to be significantly lower than that used in state and university hospitals (p=0.019, p=0.012). The average number of words and the average number of words with 4 or more syllables in forms were found to be significantly higher in private hospitals compared to state and university hospitals (p=0.004, p=0.01). It has been determined that the readability level of informed consent forms was at academic literacy level. To protect patient rights and to regulate patient-physician relationships by taking into account individuals rights, informed consent forms should be reviewed and that their readability levels should be adjusted to cover the overall educational level of individuals in the general population. [Med-Science 2019; 8(2.000): 277-81]

The effect of intraoperative recruitment maneuver on ischemia-modified albumin (IMA) and oxidative stress in performed laparoscopic cholecystectomy with intra-abdominal 12 mmHg pressure was investigated. Fifty patients undergoing laparoscopic cholecystectomy were included in the study by separating the two groups. Basal ventilator settings in both groups were set as tidal volume: 6-8 ml / kg, respiratory rate: 12 breaths / min, I: E = 1: 2, flow: 4 l / min. In group R, after intubation, 5 cm H2O PEEP was adjusted in addition to basal ventilator settings. Five minutes after CO2 insufflation and exsufflation, PEEP was step by step raised to 10-15-20 cm H2O, and patients were ventilated for 10 breaths. Venous blood samples were taken from the patients for three times in perioperative periods to measure IMA and oxidative stress.There was no difference between the groups in terms of demographic data, surgery and insufflation times. Significant differences in IMA,TOS,TAS and OSI levels within the group were observed but no difference was between groups. The recruitment maneuver that we used in laparoscopic cholecystectomies was found to have no effect reducing tissue ischemia and oxidative stress response in the intraoperative period. [Med-Science 2019; 8(2.000): 325-9]

Healthcare providers who encounter different ethnic groups have been faced with serious communication problems with immigrant and refugee (I/R) patients. The perioperative period is very important for both anesthesiologists and patients. In this study, it was aimed to reveal anesthesiologists problems related to I/R patients and to propose solutions for determined problems. An online survey questionnaire about the quantity and quality of communication problems that anesthesiologists come across in the perioperative period was developed. 120 of the anesthesiologists (49.0%) were trying to communicate by using body language or dictionary. 65 (26.5%) of the anesthesiologists could not communicate with these patients at all. During the process of taking Informed Consent Form before the anesthesia practice, 125 of the anesthesiologists (51.2%) stated that used a form written in physicians own language which was not understood by I/R patients. 76 anesthesiologists (31%) stated that they preferred general anesthesia instead of regional anesthesia because of language barriers. As a conclusion, the present study reveals that there are serious problems in the providing health care services regarding anesthesia to I/R patients especially due to the language barriers. [Med-Science 2019; 8(2.000): 375-80]

Introduction:The Google search engineis a widely used resource for accessing health-related patient education texts.Therefore accessible information in the texts should be accurate, up-to-dateand appropriate to the general public health literacy level. In this research,we aimed to analyze the readability of patient education texts prepared forbreast cancer presented on internet and to evaluate the content of texts.Methods:A total of 200 web sitesat Google search engine were evaluated using the terms “breast cancer and breast mass”. The averagereadability level was analyzed using Ateşman and Bezirci-Yilmaz readability formulas.The texts were also evaluated in terms of the risk factors identified in thedevelopment of breast cancer, the presence of examination and screening methodsthat could be used in early diagnosis.Results:A total 64 internet sitesthat are in compliance with the research criteria were evaluated. The overallmean reading level of the texts was found moderate, using the Ateşman formulaand college level according to Bezirci. 18 Web sites had both the risk factorsidentified in the development of breast cancer and the methods of screenings.Conclusions:Atotal 64 internet sites that are in compliance with the research criteria wereevaluated. The overall mean reading level of the texts was found moderate,using the Ateşman formula and college level according to Bezirci. 18 Web siteshad both the risk factors identified in the development of breast cancer andthe methods of screenings.

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) isan otologic emergency that can lead to loss of function in one of the mostimportant human senses. Recently, hyperbaric oxygen therapy (HBOT) has gainedpopularity with pharmacotherapy in ISSNHL. This study aimed to determinechanges induced in thiol/disulfide homeostasis (TDH, a new biomarker ofsystemic oxidative stress) by pharmacotherapy and HBOT in patients with ISSNHL.Methods: This prospectivestudy analyzed the albumin, total thiol, native thiol, and disulfide levels anddisulfide-native thiol, disulfide-total thiol, and native thiol-total thiolratios before and after HBOT with standardizing pharmacotherapy using a newcolorimetric method in patientswith ISSNHL.Results: 41 patients withISSNHL including 14 (34.1%) women and 27 (65.9%) men participated in the study.The mean age of the patients was 48.02 ± 13.10 years. Of them, 24 (58.5%) hadhearing loss in the right ear and 17 (41.5%) had hearing loss in the left ear.There was a statistically significant decrease in the albumin (p lt;0.001),total thiol (p lt;0.001), native thiol (p lt;0.001), and disulfide (p lt;0.001)levels after treatment compared to baseline. There was no statisticallysignificant difference in the disulfide-native thiol (p=0.148), disulfide-totalthiol (p=0.172), and native thiol-total thiol (p=0.169) ratios after treatmentcompared to baseline.Conclusion: Consequently,this study demonstrated that the thiol-disulphide balance tended to shifttowards the oxidative side after HBOT and pharmacotherapy compared to baseline in patients with ISSNHL andthat patients with high oxidation level after treatment had better treatmentresponse.

The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. However respiratory, airway, cardiovascular and genitourinary systems complications can occur with age progressing. Restricted range of motion of cervical spine may lead to difficulty with airway management. In addition, degenerative changes and stiffness of lumbar spine due to ochronosis would make neuraxial blockade challenging. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for management of potential challenging problems. This report highlights special care and precautions that need to be taken during anesthetic management. Resumo: Este relato descreve o manejo anestésico em dois casos de ocronose alcaptonúrica. Alcaptonúria é uma doença genética rara do metabolismo de tirosina caracterizada por acúmulo de ácido homogentísico em cartilagem e tecidos conjuntivos. Os pacientes geralmente recorrem à cirurgia ortopédica devido à artropatia progressiva que, muitas vezes, pode ser diagnosticada incorretamente. No entanto, complicações das vias respiratórias, cardiovasculares e geniturinárias podem ocorrer com o avanço da idade. A restrição de mobilidade da coluna cervical pode levar ao manejo difícil das vias aéreas. Além disso, as alterações degenerativas e a rigidez da coluna lombar devido à ocronose podem tornar o bloqueio neuroaxial um desafio. Embora essa condição hereditária seja extremamente rara, os anestesiologistas devem estar cientes de sua existência e se prepararem para o manejo de potenciais problemas desafiadores. Este relato destaca os cuidados e precauções especiais que devem ser tomadas durante o manejo anestésico. Keywords: Alkaptonuria, Ochronosis, Anesthesia, Palavras-chave: Alcaptonúria, Ocronose, Anestesia

Background and objectives: Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. Methods: 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4 h in the first 24 h. Adverse effects were questioned every 4 h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. Results: There was no difference in acute pain scores and analgesic consumption through the 24 h period, Visual Analog Scale at 24 h was 1.5 ± 1.5 cm for follicular group 1.4 ± 1.7 cm for luteal group (p = 0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6 ± 0.7 cm and 1.8 ± 0.8 cm for follicular group and 2.7 ± 1.3 cm and 2.9 ± 1.7 cm in the luteal group (p = 0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p = 0.01) and oral feeding time was shorter in follicular phase (5.9 ± 0.9 h) than in luteal phase (6.8 ± 1.9 h, p = 0.02). Conclusions: Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle. Resumo: Justificativa e objetivos: As flutuações dos hormônios sexuais femininos durante o ciclo menstrual influenciam a percepção da dor. A inibição endógena da dor é prejudicada na fase folicular do ciclo menstrual. Testamos a hipótese primária de que cirurgias em mulheres durante a fase folicular têm mais dor aguda e precisam de mais opioide que aquelas na fase lútea e a hipótese secundária testada foi que as cirurgias em mulheres durante a fase folicular têm mais dor incisional aos três meses de pós-operatório. Métodos: No total, 127 mulheres adultas submetidas à colecistectomia laparoscópica foram randomizadas para serem operadas durante a fase lútea ou folicular de seus ciclos menstruais. Um regime padronizado para anestesia e tratamento da dor foi administrado a todas as pacientes. A dor e o consumo de analgésico foram avaliados na sala de recuperação pós-anestésica e a cada quatro horas nas primeiras 24 horas. Efeitos adversos foram avaliados a cada quatro horas. Os tempo para ingestão oral e deambulação foram registrados. Dor pós-cirúrgica, ansiedade hospitalar, escala de depressão e questionário SF-12 foram avaliados em visitas feitas no primeiro e terceiro meses. Resultados: Não houve diferença nos escores de dor aguda e no consumo de analgésicos durante o período de 24 horas, Escala Visual Analógica em 24 horas foi de 1,5 ± 1,5 cm para o grupo folicular e 1,4 ± 1,7 cm para o grupo lúteo (p = 0,57). A dor persistente no pós-operatório foi significativamente mais prevalente no primeiro e terceiro mês, com incidência de 33% e 32% nas pacientes em fase folicular versus 16% e 12% na fase lútea, respectivamente. A Escala Visual Analógica no primeiro e terceiro mês foram 1,6 ± 0,7 cm e 1,8 ± 0,8 cm no grupo folicular e 2,7 ± 1,3 cm e 2,9 ± 1,7 cm no grupo lúteo (p = 0,02), respectivamente. Não houve diferença significativa entre os grupos em relação à ansiedade e à depressão, escore SF-12 em ambos os tempos. Náusea foi mais comum no grupo na fase folicular (p = 0,01) e o tempo para alimentação oral foi menor na fase folicular (5,9 ± 0,9 horas) que na fase lútea (6,8 ± 1,9 horas, p = 0,02). Conclusões: Embora a dor persistente no pós-operatório tenha sido significativamente mais prevalente no primeiro e no terceiro mês após a cirurgia, a magnitude da dor foi baixa. Nossos resultados não apoiam o agendamento de cirurgias tendo como alvo fases específicas do ciclo menstrual. Keywords: Menstrual cycle, Acute pain, Chronic pain, Cholecystectomy, Laparoscopy, Postoperative pain, Palavras-chave: Ciclo menstrual, Dor aguda, Dor crônica, Colecistectomia, Laparoscopia, Dor pós-operatória

Background: This study was conducted to compare the efficacy and effects of dexmedetomidine and midazolam in preoperative sedation. Materials and Methods: A total of 125 patients in American Society of Anaesthesiologists (ASA) I-II were divided into three groups: Group I (n = 40) for controls, Group II (n = 40) for Dexmedetomidine (1 μg/kg), and group III was the midazolam group (n = 45). Group III was further divided into three subgroups according to the doses of midazolam: Group IIIA (n = 15) received 0.02 mg/kg, group IIIB (n = 15) received 0.04 mg/kg, and group IIIC (n = 15) received 0.06 mg/kg of midazolam. Drugs were infused over a 10-minute period with appropriate monitoring. Ramsay and visual analog scores, for sedation and anxiety, respectively, and mean arterial pressure, heart rate, and SpO 2 measurement, including respiratory rates were recorded, every 5 minutes for 30 minutes following infusion. Results: There was marked sedation and a decrease in anxiety in groups II and IIIC (P < 0.01). Mean arterial pressure (MAP) and heart rate (HR) decreased significantly in group II (P < 0.01 and P < 0.05, respectively), but there was no associated hypotension (MAP 0.05); however, decrease in SpO 2 was significant in group IIIC (P < 0.01). Conclusions: Dexmedetomidine was as effective as higher doses of midazolam in sedation. The hemodynamic and respiratory effects were minimal. Although dexmedetomidine caused significant decrease in the blood pressure and heart rate, it probably just normalized increased levels caused by preoperative stress.

Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period.

ABSTRACT Objective: Surgical procedures are critical components of healthcare services; however, they are usually neglected during public health interventions due to misperceived high costs and limited benefits. Estimating surgical needs for refugee individuals in the host country would help humanitarian aid planning and strategical development of national surgery capacity for resource allocation. The present research aimed to analyze the surgical procedures of refugees. Methods: 2703 of 15725 hospitalized refugee patients, underwent a surgical procedure during February 2015 and December 2018. Demographic data of the patients such as age and gender, risk classification according to the American Society of Anesthesiologists (ASA), the anesthesia type, type of the surgical procedures, intraoperative blood transfusion rates, admission incidence to intensive care unit (ICU), and mortality rates were recorded. The surgical procedures divided into groups according to the surgical branches and analyzed. Results: Distribution of two-thirds of the surgical procedures among medical branches was obstetrics and gynecology, orthopedics and traumatology, general surgery and plastic, reconstructive, and aesthetic surgery. The most common surgical procedures were C-section, appendectomy, disorders of bone integrity, and wrist injuries. Conclusion: Approximately one sixth of the refugee patients treated in our hospital underwent various surgical procedures. Our results should be taken into account by governments in planning humanitarian assistance, budgeting sources, and improving surgical capacity for the rapidly growing number of refugees worldwide.

Amaç: Bu çalışmanın amacı, elektif ürolojik cerrahi uygulamalar ve acil tıp kliniklerinde uygulanan prosedürlere ait aydınlatılmış hasta onam formlarının okunabilirliklerinin, okunabilirlik formülleri aracılığı ile karşılaştırılarak değerlendirilmesidir.Gereç ve Yöntem: Acil tıbbı prosedürler için toplam 32 adet, ürolojik cerrahi uygulamalar için toplam 61 adet onam formu değerlendirmeye alındı. Ortalama kelime sayısı, hece sayısı ve hece sayısı 4 ve üzeri olan kelimeler hesaplandı. Onam formlarının okunabilirlik düzeyinin hesaplanmasında, Türkçe metinlerin okunabilirlik düzeyinin belirlenmesi için tanımlanmış olan Ateşman ve Bezirci-Yılmaz formülleri ve genel okunabilirlik düzeyini ölçen Gunning fog, Flesch kincaid formülleri kullanıldı. Bulgular: Elektif ürolojik onam formlarının okunabilirliği Ateşman, Gunning fog, Flesch kincaid formüllerine göre anlamlı düzeyde daha zor okunabilir olarak bulundu p=0.001, p

Amaç: Bu çalışmanın amacı akut romatizmal ateşle ilişkili internet tabanlı hasta eğitim materyallerinin okunabilirliğini değerlendirmektir.Gereç ve Yöntem: Herbir anahtar kelime (“akut romatizmal ateş”, “akut eklem romatizması”, “romatizmal ateş”, “akut romatizmal kardit '',“ romatizmal kardit '') için Google arama motorunda (www.google.com) 50 site olmak üzere toplam 250 web sitesi değerlendirildi. On cümleden daha az bilgi içeren siteler, sohbet, forum ve ticari blog siteleri çalışma dışı bırakıldı. Ortalama kelime sayısı, ortalama hece sayısı ve ortalama hece sayısı 4 ve üzerinde olan kelimeler hesaplanmıştır. Ortalama okunabilirlik seviyesi Ateşman ve Bezirci-Yılmaz okunabilirlik formülleri kullanılarak analiz edilmiştir.Bulgular: Hariç tutma ölçütleri uygulandıktan sonra 250 web sitesinin toplam 50'si araştırma için uygun bulundu. İncelenen sitelerden 33'ü sağlık uzmanları ve 17'si sağlık personeli olmayan kişiler tarafından oluşturulmuştur. Ateşman formülüne göre web sitelerinin okunabilirliği orta derecede zor, Bezirci-Yılmaz formülüne göre lisans düzeyinde insanlar tarafından anlaşılabilir bulunmuştur.Sonuç: Web sitelerindeki akut romatizmal ateş alanıyla ilgili hasta eğitimi metinlerinin okunabilirlik seviyesinin akademik okuryazarlık düzeyinde olduğu belirlenmiş ve bu bilgilerin Türkiye'deki ortalama eğitim düzeyi ile anlaşılması güç olacağı düşünülmektedir.

Amaç: Bu gözlemsel, prospektif, vaka kontrol çalışmasında erişkin hastalarda serum dinamik Tiyol-Disülfir Homeostazisi (TDH) ile sepsis arasındaki ilişkiyi araştırmayı amaçladık.Gereç ve Yöntem: Sepsis tanısı ile alan 44 hasta, yaş ve cinsiyet uyumlu 44 sağlıklı kontrol ile karşılaştırıldı. Hastalar yoğun bakım ünitesi yatışından sonraki 28. günde sağ-kalan ve hayatını kaybedenler olarak 2 gruba ayrıldı. TDH parametreleri yeni, otomatik ve spektrofotometrik bir yöntem kullanılarak ölçüldü ve sonuçlar istatistiksel olarak karşılaştırıldı.Bulgular: Sepsisli hastalarda, nativ tiyol, total tiyol ve disülfit seviyeleri kontrol grubuna göre daha düşük olarak bulundu ve bu fark istatistiksel olarak anlamlı idi. Başlangıç TDH parametreleri sağ-kalan ve hayatını kaybeden hastalar arasındaki benzer bulundu. Ancak sağ kalan ve ex olan hastaların 3 ve 7. günde tekrarlanan TDH ölçümleri (nativ ve toplam tiyol seviyeleri) arasında anlamlı farklar bulundu.Sonuç: Bu çalışma, erişkin sepsis hastalarında dinamik TDH'deki bozulmanın negatif sonuçlara ilişkili olabileceğini göstermiştir.

2Kadınhanı Refik Saime Koyuncu Devlet Hastanesi, Kadınhanı, Konya. Kraniyofasiyal iskelet ile üst ekstremitenin embriyolojik dönemde gelişim zamanlarının örtüşmesi ve belirli gen mutasyonlarının her iki sistemin gelişiminde de etkili olması sebebiyle bir çok ekstremite defekti, konjenital kraniyofasiyal anomaliler ile birlikte seyreden bir sendromun parçası olabilir. Apert, Saethre-Chotzen, Pfeiffer, and Carpenter sendromları üst ekstremite defektleri ile birliktelik gösteren en sık kraniyofasiyal sendromlardır. Bu sendromlar, hava yolu yönetimi, intravenöz damar yolu açılması ve hemodinamik kontrol açısından gerçek bir sorun olabilir. Başarının anahtarı etkin hazırlık, zor pediatrik havayolu yönetimi ve intravenöz kanü- lasyonda uzmanlığa sahip personel varlığı, düzenli eğitim ve takım çalışmasıdır. Bu derlemede kraniyofasiyal ve ekstremite gelişim anomalileri içeren çocuk hastalarda güncel bilgiler ve uygulamalar ışığında anestezik yaklaşım sunulmuştur

Amaç: İnternal jugular ven İJV kanülasyonu bazı klinik durumlarda baş nötral pozisyonda tutularak yapılmalıdır. Ancak bu pozisyonda hangi anatomik işaretleme noktasının kullanılması gerektiği açık değildir. Bu çalışmanın amacı baş nötral pozisyonda iken karotis arter KA palpasyonu kullanılarak yapılan sağ İJV kanülasyonunun başarı oranlarını araştırmaktır. Gereç ve yöntem: Bu prospektif randomize çalışma iki aşamada dizayn edildi. Birinci aşama: Birbirini takip eden 30 servikal bilgisayarlı tomografi görüntüsü çalışma öncesi sağ İJV ve KA arasındaki ilişkiyi belirlemek için incelendi. İkinci aşama: Sağ İJV kanülasyonu yapılması planlanan toplam 150 hasta çalışmaya alındı. Hastaların başı nötral pozisyonda tutuldu. Genel anestezi altında trendelenburg pozisyonu ve soluk sonu pozitif basınç uygulandı. Sağ İJV kanülasyonu 10 farklı klinisyen tarafından KA palpasyonu işaret noktası alınarak, iğneye medial yada laterale açı verilmeksizin uygulandı. Öncelikli hedefimiz iğne ile ilk üç girişimde sağ İJV ulaşabilme başarı oranlarının belirlenmesi idi. Bulgular: İğnenin toplam üç girişimde sağ İJV’ye ulaşma oranı %96,7 idi. Klinisyenler arasında başarı oranları açısından istatistiksel fark yoktu. Hastaların hiçbirinde KA delinmedi. Sonuç: Başın nötral pozisyonda tutulduğu hastalarda sağ İJV kanülasyonu için yüksek başarı oranlarından dolayı KA işaret noktası olarak etkili bir şekilde kullanılabilir

We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment. Resumo: Relatamos um caso de embolia gasosa durante miomectomia abdominal. Embora a incidência exata de embolia gasosa não seja conhecida, a maioria dos casos relatados na literatura se refere à posição sentada em craniotomias. Muitos casos são subclínicos e os métodos diagnósticos têm diferentes graus de sensibilidade e especificidade. No momento da suspeita, a prevenção de qualquer êmbolo de ar subsequente é a chave fundamental do tratamento. Keywords: Venous air embolism, Myomectomy, Anesthesia, Palavras-chave: Embolia aérea, Miomectomia, Anestesia