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Aim: The purpose of this study was comparing the type of anesthesia in geriatric patients undergoing orthopedic surgery with cerebral tissue oxygen saturation values and Mini Mental Test (MMT) scores. The relationship between cerebral tissue oxygen saturation values and MMT scores was also evaluated. Material and methods: A total of 40 patients over the age of 65 and above who were scheduled for Proximal Femoral Nail Antirotation (PFN-A) operation were included in our study. Cases were divided into 2 groups as general anesthesia (Group I) and spinal anesthesia (Group II). Cerebral tissue oxygen saturation right and left values and hemodynamic data were measured at regular intervals in the preoperative period until the postoperative 48th hour. MMT scores at the preoperative and 48th postoperative hours were evaluated. The relationship between cerebral oxygen saturation values and MMT scores were evaluated. Results: Although there was decreased in the MMT scores performed at 48th postoperative hours compared with the preoperative period, no statistically significant difference was observed between the groups (p>0.05). When the cerebral tissue oxygen saturation right and left values in the perioperative period were compared, there was no statistically significant difference between the groups, although there was a decrease in the cerebral tissue oxygen saturation values (p>0.05). When the relationship between perioperative cerebral tissue oxygen saturation right and left values and the MMT scores were examined, no statistically significant relationship was found (CI%95:0.318-35.364) (p>0.05). Conclusion: In elderly patients who undergo minimally invasive orthopedic surgery, a decrease in cerebral tissue oxygen saturation values and MMT scores can be seen in the perioperative period in both spinal anesthesia and general anesthesia. However, there was no relationship between cerebral tissue oxygen saturation values and MMT scores., Amaç: Bu çalışmada birincil amacımız, ortopedik cerrahi uygulanan geriatrik hastalarda anestezi tipinin serebral oksijen satürasyonu değerleri ve Mini Mental Test (MMT) skorları ile karşılaştırılmasıdır. Bu çalışmadaki ikincil amacımız, serebral oksijen satürasyon değerleri ile MMT puanları arasındaki ilişkiyi değerlendirmekti. Gereç ve Yöntemler: Çalışmamıza Proksimal Femoral Çivi Antirotasyon (PFN-A) operasyonu planlanan 65 yaş üstü toplam 40 hasta dahil edildi. Olgular Genel Anestezi ve Spinal Anestezi olarak 2 gruba ayrıldı. Preoperatif dönemde postoperatif 48. saate kadar düzenli aralıklarla serebral doku oksijen satürasyonu sağ ve sol değerleri ve hemodinamik veriler ölçüldü. Ameliyat öncesi ve ameliyat sonrası 48. saatteki MMT skorları değerlendirildi. Tüm veriler grup I ve grup II arasında karşılaştırıldı. Serebral oksijen satürasyon değerleri ile MMT skorları arasındaki ilişki değerlendirildi. Bulgular: Ameliyat sonrası 48. saatte yapılan MMT skorlarında ameliyat öncesi döneme göre azalma olmasına rağmen, gruplar arasında istatistiksel olarak anlamlı fark gözlenmedi (p>0,05). Perioperatif dönemde serebral oksijen satürasyonu sağ ve sol değerleri karşılaştırıldığında, serebral oksijen satürasyonu değerlerinde azalma olmasına rağmen gruplar arasında istatistiksel olarak anlamlı fark yoktu(p>0,05). Perioperatif serebral oksijen satürasyonu sağ ve sol değerleri ile MMT skorları arasındaki ilişki incelendiğinde istatistiksel olarak anlamlı bir ilişki bulunamadı (CI% 95:0,318-35,364) (p>0,05). Sonuç: Minimal invaziv ortopedik cerrahi uygulanan geriatrik hastalarda hem spinal anestezide hem de genel anestezide perioperatif dönemde serebral doku oksijen satürasyon değerlerinde ve MMT skorlarında azalma görülebilmektedir. Ancak serebral doku oksijen satürasyon değerleri ile MMT skorları arasında ilişki yoktu. Bu konuda daha kapsamlı çalışmalara ihtiyaç vardır.

Intestinal transplantation is a complex procedure both in terms of anesthesia and surgery. In particular, pediatric anesthesia management during intestinal transplant surgery can become even more complicated. It has been stated that propofol, remifentanil, and sevoflurane reduce patient mortality by reducing the incidence of intestinal ischemia-reperfusion injury. Although studies of these agents continue to be conducted in vivo or in vitro, these anesthetics are currently used for specific procedures that have a high risk of incurring ischemia-reperfusion injury. Herein, we present the case of a male child, aged 20 months, who was dependent on total parenteral nutrition and was found to have intestinal failure associated with liver disease type 1. Hematologic tests showed findings of anemia and metabolic acidosis. Propofol was administered for induction of anesthesia. Anesthesia maintenance was achieved using sevoflurane with remifentanil infusion. We ensured safe and adequate vascular access in the patient and performed hematologic and biochemical tests with detailed system controls. Before the procedure, we prepared a leukocyte-poor erythrocyte suspension, leukocyte-poor random or apheresis platelets, and ABO- and Rh-compatible fresh frozen plasma. We monitored for signs of acidosis, hypotension, coagulation disorders, and hyperkalemia during the reperfusion period. We maintained patient normothermia. In this case report on the anesthetic management of a pediatric patient aged 20 months who received a small bowel transplant due to microvillous inclusion disease, we found that the selection of anesthetic agents may affect the prognosis of future surgical procedures.

Objective: Ensuring airway security carries the utmost importance in anesthesia. Specific predictive tests or findings for difficult airway are not defined for children under 3 years old. This study is aimed at finding out the value of anthropometric measurements in the prediction of difficult laryngoscopy and intubation in children by comparing them to direct laryngoscopic evaluation of Cormack-Lehane test and intubation evaluation of intubation Difficulty Scale.", Method: A total of 108 patients (aged 0-3 years), undergoing elective surgery were included in this study. Patients with known syndrome, facial anomaly, Anesthesiologists Physical Status Classification Class >2, and laryngeal mask airway were excluded from the study. Demographic data, head circumference, weight, height measurements, body mass index and percentile values were recorded by a pediatric surgeon in the preoperative period. During laryngoscopy and intubation evaluations were made using Cormack-Lehane Score and intubation Difficulty Scale and recorded by a blinded resient. All recorded parameters were compared with Cormack-Lehane and intubation Difficulty Scale scores., Results: When all parameters were compared with CL Grade I-II-III, IDS scores; a statistically significant difference was found between age and head circumference and CL Grade I, II (p, Conclusion: Anthropometric measurements are not predictive for difficult direct laryngoscopy and difficult intubation in pediatric patients. The potentiality of difficult direct laryngoscopy could be higher in boys than girls and in children with low weight percentile.

Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children.The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8).Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group.Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.

Background/aims Small bowel transplantation (SBTx) is a treatment option for patients with serious parenteral nutrition-related problems in intestinal failure. Izmir Tepecik Training Research Hospital Organ Transplantation Center is still the only pediatric intestinal transplant center in Turkey. Material and methods This study was approved by the local ethics committee. Patients' data were analyzed from the medical charts and the hospital digital database. Seven isolated SBTxs were performed in six children between 2010 and 2016. Results One jejunal segment and six partial jejuno-ileal segments were used for seven transplants. All grafts were retrieved from deceased donors (one child and six adult donors). The six recipients had a mean age of 8.8±6.9 years (9 months to 17 years; M: 4, F: 2). The mean follow-up period of patients was 727±848 (34 to 1950) days. Acute cellular rejection (ACR) rates were 57% (n: 4) in the first 2 months. Graft loss due to severe ACR was seen in one patient. Central line-associated fungal (n: 3, 42%) and bacterial infections (n: 3, 42%) were seen in the first 2 months. Two Epstein-Barr virus (EBV) infections were recorded between 3 and 8 months in two patients. Our 1-year patient and graft survival rates were 71% and 71%, respectively. Conclusion SBTx has become a treatment modality for patients with intestinal failures. Management of ACR and infections are still challenging problems in SBTx. Appropriate-sized cadaveric donors are very limited in Turkey for pediatric intestinal transplantation candidates. Although the number of SBTxs performed was small, this study shows promising results.