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Koronavirüs 2 (SARS-CoV-2)'nin neden olduğu kritik COVID-19 hastalarında hipoksi ve aşırı inflamasyon beraberinde sıklıkla koagülopatiye bağlı trombotik olaylar gelişir. Venöz , arteriyel ve mikrovasküler tromboz gelişimi ile karakterize koagülopati, prognozu ağırlaştırır. Yoğun bakımda izlenen COVID-19 hastalarının %16-64'ünde trombotik komplikasyonlar rapor edilmiştir. Başlangıçta artmış Ddimer ve fibrinojen beraberinde trombositopeni ve protrombin zamanında hafif uzama gelişebilir. Hastalığın ilerlemesi ile yaygın damar içi koagülasyon gelişir.Antikoagülan tedavi belirgin D-dimer artışı ve COVID-19 ilişkili koagülopati kriterleri gösteren hastalarda daha iyi prognoz açısından önemlidir.Bu hastalığın laboratuvar izleminde viral parametrelerden daha fazla koagülopati ile ilgili parametrelerin izlenmesi; antiviral tedavilerden çok koagülopati proflaksisi ve tedavisi ile ilgili girişimler prognoz ve mortalite açısından daha önemli görülmektedir., Critical COVID-19 patients caused by coronavirus 2 (SARS-CoV-2) is characterised by hypoxia, hyperinflamation besides coagulopathy and thrombosis. Venous, arterial and microvascular thrombosis are associated with poor prognosis. For the critical COVID-19 patients admittted to intensive care unit, the incidence of thrombotic complications were reported as 16-64%. Initial elevated Ddimer and fibrinogen levels are associated with thrombocytopenia and mild elevated prothrombin time. As the disease progress, disseminated intravasculary coagulopathy can develop in severe COVID-19 patients. Anticoagulant treatment with heparin is important for improving prognosis in COVID-19 patients who have high D-dimer levels and coagulopathy criterions. Monitoring of coagulopathy related parameters more than viral parameters and interventions related to coagulopathy prophylaxis and treatment managements are more important in terms of prognosis and mortality of COVID-19 patients than antiviral treatments.

Objective: Trigeminocardiac reflex is a reflex characterized by hypotension, bradycardia, gastric hypermotility or asystole that develops as a result of stimulation of the trigeminal nerve. In our retrospective study, in septorhinoplasty operations performed under general anesthesia, trigeminocardiac reflex development was investigated primarily during the periods where the reflex was surgically stimulated. Secondly, the effect of different inhalation anesthetic agents on the emergence of this reflex was investigated. Methods: Anesthesia notes and Datex Ohmeda icentral central monitor records of septorhinoplasty cases operated between 01 / January / 2016 - 30 / November / 2016 were retrospectively examined and detected through the Hospital Information Management System software. Induction, application of local anesthesia, surgical incision, initiation of incision suturing and 5 minutes after extubation were recorded from the records. It was determined that two different inhalation anesthetics were administered in 60 patients who met the criteria, and analyzes were performed in 2 separate groups as group sevoflurane and group desflurane, and the development of QT, QTc and Trigeminocardiac reflex was investigated. Results: Although there was no difference between the groups, when the basal values were compared with the other periods, it was found that the development of TKR and QT and QTc experts were mostly observed in the periods of local anesthesia, surgical incision and incision suturing. (p 0.001). Conclusions: We think that the inhalation anesthetic agents used mostly in the sevoflurane group play a facilitating role in the development of TKR, especially by creating a cumulative effect during periods when the trigeminal nerve is maximally stimulated, bradikardi, gastrik hipermotilite veya asistoli ile karakterize bir refleksdir. Genel ve lokal anestezi altında yapılan septorinoplasti operasyonları sırasında trigeminokardiyak refleks gelişebildiği gözlenmiştir. Retrospektif çalışmamızda genel anestezi altında yapılan septorinoplasti operasyonlarında birincil olarak cerrahi olarak refleksin uyarıldığı düşünülen periyodlarda trigeminokardiyak refleks gelişimi araştırılmıştır. İkincil olarak da farklı inhalasyon anestezik ajanların bu refleksin ortaya çıkışında etkisi araştırılmıştır. Gereç ve Yöntem: 01/ Ocak/2016- 30/Kasım/2016 tarihleri arasında opere edilmiş septorinoplasti vakalarının anestezi notları ve Datex Ohmeda icentral merkezi monitör kayıtları ve MİA-MED Hastane Bilgi Yönetim Sistemi yazılımı üzerinden retrospektif olarak incelenerek saptandı. İndüksiyon, sınırlı uyuşturma uygulaması, cerrahi insizyon, insizyon sütürasyonu başlangıcı ve ekstübasyondan 5 dakika sonra değerleri kayıtlardan saptandı. Kriterlere uyan 60 hastada 2 farklı inhalasyon anestezik madde uygulandığı tespit edilerek grup sevofluran ve grup desfluran olarak 2 ayrı grupta analizler yapıldı ve QT, QTc ve Trigeminokardiyak refleks gelişimi araştırıldı. Bulgular: Gruplar arasında fark olmamasına rağmen bazal değerler ile diğer periyodlar karşılaştırıldığında TKR gelişiminin ve QT, QTc uzmanlarının en fazla lokal anestezi uygulaması, cerrahi insizyon, insizyon sütürasyonu periyotlarında izlendiği saptandı. (p0,001). Sonuç: En fazla sevofluran grubunda olmak üzere kullanılan inhalasyon anestezik ajanların özellikle trigeminal sinirin maksimal uyarıldığı periyodlarda kümülatif etki yaratarak TKR gelişiminde kolaylaştırıcı bir rol oynadığını düşünmekteyiz.

Objective: Trigeminocardiac reflex is a reflex characterized by hypotension, bradycardia, gastric hypermotility or asystole that develops as a result of stimulation of the trigeminal nerve. In our retrospective study, in septorhinoplasty operations performed under general anesthesia, trigeminocardiac reflex development was investigated primarily during the periods where the reflex was surgically stimulated. Secondly, the effect of different inhalation anesthetic agents on the emergence of this reflex was investigated. Methods: Anesthesia notes and Datex Ohmeda icentral central monitor records of septorhinoplasty cases operated between 01 / January / 2016 - 30 / November / 2016 were retrospectively examined and detected through the Hospital Information Management System software. Induction, application of local anesthesia, surgical incision, initiation of incision suturing and 5 minutes after extubation were recorded from the records. It was determined that two different inhalation anesthetics were administered in 60 patients who met the criteria, and analyzes were performed in 2 separate groups as group sevoflurane and group desflurane, and the development of QT, QTc and Trigeminocardiac reflex was investigated. Results: Although there was no difference between the groups, when the basal values were compared with the other periods, it was found that the development of TKR and QT and QTc experts were mostly observed in the periods of local anesthesia, surgical incision and incision suturing. (p 0.001). Conclusions: We think that the inhalation anesthetic agents used mostly in the sevoflurane group play a facilitating role in the development of TKR, especially by creating a cumulative effect during periods when the trigeminal nerve is maximally stimulated, bradikardi, gastrik hipermotilite veya asistoli ile karakterize bir refleksdir. Genel ve lokal anestezi altında yapılan septorinoplasti operasyonları sırasında trigeminokardiyak refleks gelişebildiği gözlenmiştir. Retrospektif çalışmamızda genel anestezi altında yapılan septorinoplasti operasyonlarında birincil olarak cerrahi olarak refleksin uyarıldığı düşünülen periyodlarda trigeminokardiyak refleks gelişimi araştırılmıştır. İkincil olarak da farklı inhalasyon anestezik ajanların bu refleksin ortaya çıkışında etkisi araştırılmıştır. Gereç ve Yöntem: 01/ Ocak/2016- 30/Kasım/2016 tarihleri arasında opere edilmiş septorinoplasti vakalarının anestezi notları ve Datex Ohmeda icentral merkezi monitör kayıtları ve MİA-MED Hastane Bilgi Yönetim Sistemi yazılımı üzerinden retrospektif olarak incelenerek saptandı. İndüksiyon, sınırlı uyuşturma uygulaması, cerrahi insizyon, insizyon sütürasyonu başlangıcı ve ekstübasyondan 5 dakika sonra değerleri kayıtlardan saptandı. Kriterlere uyan 60 hastada 2 farklı inhalasyon anestezik madde uygulandığı tespit edilerek grup sevofluran ve grup desfluran olarak 2 ayrı grupta analizler yapıldı ve QT, QTc ve Trigeminokardiyak refleks gelişimi araştırıldı. Bulgular: Gruplar arasında fark olmamasına rağmen bazal değerler ile diğer periyodlar karşılaştırıldığında TKR gelişiminin ve QT, QTc uzmanlarının en fazla lokal anestezi uygulaması, cerrahi insizyon, insizyon sütürasyonu periyotlarında izlendiği saptandı. (p0,001). Sonuç: En fazla sevofluran grubunda olmak üzere kullanılan inhalasyon anestezik ajanların özellikle trigeminal sinirin maksimal uyarıldığı periyodlarda kümülatif etki yaratarak TKR gelişiminde kolaylaştırıcı bir rol oynadığını düşünmekteyiz.

review article, Fetal cerrahi anne ve fetal hastayı ilgilendirdiği için fetal-maternal cerrahi olarak adlandırılabilir. Fetusun tedavisi için fizyolojik özellikleri birbirinden farklı iki hastaya anestezi uygulanmaktadır. Fetal cerrahide anestezi uygulamaları doğum ve pediatrik anestezi eğitimi ile farklı disiplinlerin beraber çalışmasını gerektirir. Anestezik ajanların gelişen beyin dokusuna nörotoksik etkileri üzerine ileri araştırmalar devam etmektedir. Ağrılı uyaranlara bağlı olarak fetusun gelişen sinir sistemindeki değişikliklerin uzun dönem etkileri olduğu bilinmektedir. Fetal cerrahi işlemler midgestasyon intrapartum cerrahiler, minimal invaziv girişimler, ve ex utero intrapartum tedaviler (EXIT) olmak üzere üç grupta toplanır. Anestezi teknikleri, lokal anestezi ve sedasyondan, genel anestezi ve nöroaksiyel anesteziye kadar değişebilir. Cerrahi teknik, anne fetus için risk fayda dengesi, ve önceliklş gereksinimler optimal anestezi planının yapılmasında önemlidir. Bu derlemede; gebedeki fizyolojik değişikliler, fetusun anestezi açısından fizyolojik özellikleri, etik konular, anestezinin fetusa etkileri, cerrahi tekniklere göre anestezi ugulamaları gözden geçirilecektir., Fetal surgery is performed on pregnant patient and fetal patient and could be called maternal-fetal surgery. Surgery is on the pregnant women for fetal benefit and anesthesia is necessary for these two patients whose physilogic characteristics are extremly different. Providing anesthesia for fetal surgery necessitates integration of obstetric and pediatric anesthesia integration and many disciplines colloboration and cooperation. The researches are going on about the possibility of anesthetic drugs neurotoxicity on developing nervous system of fetus. The fetus reacts to painfull stimuli and these painfull interventions may cause long term effects . Fetal surgery issues are, minimally invazive interventions, open midgestation surgery and EXIT procedures. An anesthetic plan can range from local anesthetic infiltration to sedation to neuroaxial or general anesthesia. Surgical technique, risk and benefit ratio and potential need are important for optimal anesthetic plan. In this article, we reviewed the maternal physiology, fetal physiology, ethic issues, anesthetics effects on the fetus, anesthetic managements for different types of surgical techniques.

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Background/aim: This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. Material and methods: Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg/kg was administered to one group (Group sugammadex) and atropine and neostigmine was administered to the other group (Group neostigmine) intravenously. In the data analysis stage, the group was divided into two subgroups according to sugammadex and group neostigmine in itself, with vitamin D levels above and below 30 ng/mL. Statistical analysis was performed on these 4 groups (Group neostigmine and vitamin D 30 ng/mL), (Group neostigmine and vitamin D ? 30 ng/mL), (Group sugammadex and vitamin D 30 ng/mL), (Group sugammadex and vitamin D ? 30 ng/mL). When two responses to train of four (TOF) stimulation were taken, the following times were recorded until extubation phase. The time until TOF value 50%, 70%, 90%, and extubation were recorded. Results: There were statistically significant differences between Group sugammadex and vitamin D 30 ng/mL and Group sugammadex and vitamin D ? 30 ng/mL (P = 0.007) for extubation times and 50% TOF reach times (P = 0.015). However, there was no difference observed between Group neostigmine and vitamin D 30 ng/mL and Group neostigmine and vitamin D ? 30 ng/mL (P = 0.999). Conclusion: Vitamin D deficiency is important for anesthesiologists in terms of muscle strength and extubation time. Vitamin D deficiency seems to affect sugammadex reverse times but seems not to affect neostigmine reverse times. This conclusion needs further studies.

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Background/aim: This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. Material and methods: Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg/kg was administered to one group (Group sugammadex) and atropine and neostigmine was administered to the other group (Group neostigmine) intravenously. In the data analysis stage, the group was divided into two subgroups according to sugammadex and group neostigmine in itself, with vitamin D levels above and below 30 ng/mL. Statistical analysis was performed on these 4 groups (Group neostigmine and vitamin D 30 ng/mL), (Group neostigmine and vitamin D ? 30 ng/mL), (Group sugammadex and vitamin D 30 ng/mL), (Group sugammadex and vitamin D ? 30 ng/mL). When two responses to train of four (TOF) stimulation were taken, the following times were recorded until extubation phase. The time until TOF value 50%, 70%, 90%, and extubation were recorded. Results: There were statistically significant differences between Group sugammadex and vitamin D 30 ng/mL and Group sugammadex and vitamin D ? 30 ng/mL (P = 0.007) for extubation times and 50% TOF reach times (P = 0.015). However, there was no difference observed between Group neostigmine and vitamin D 30 ng/mL and Group neostigmine and vitamin D ? 30 ng/mL (P = 0.999). Conclusion: Vitamin D deficiency is important for anesthesiologists in terms of muscle strength and extubation time. Vitamin D deficiency seems to affect sugammadex reverse times but seems not to affect neostigmine reverse times. This conclusion needs further studies.

Objective: Rocuronium-linked injection pain often occurs. In this study, we aimed to compare the local heating of the injection site and the iv lidocaine administration in the prevention of injection pain with rocuronium. Method: In the ASA I-II risk group, scheduled for operation in the context of general anesthesia with ethics committee approval and written approval, 60 patients aged 18-65 years were included in the study in 3 randomly assigned groups. Tourniquets were applied to the front arm in all three groups. In group 1 (n = 20) 2 ml of saline was administered iv; thirty seconds later the turnstile opened; 1 ml (10 mg) of rocuronium was applied for 2 seconds. In group 2 (n = 20) the patient's arm was warmed externally with the patient's heating blanket adjusted to 43 °C; turnstile opened at 30th; external heating was applied for a total of 1 minute; followed by 1 ml (10 mg) of rocuronium for 2 seconds. In Group 3 (n = 20), 1ml (10 mg) rocuronium was administered for 2 seconds following 2 ml of 2% lidocaine iv. Following rocuronium injection in the intubation dose, the pain was assessed by a 4-point traction response score. Results: The groups were similar in terms of demographics. The 4 point verbal rating scales were significantly different in Group 1, compared to Group 2 and Group 3 (2,0+0,8 and 0,5+0,5 and 0,3+0,4, mean+SD). There was no statistically significant difference between Groups 2 and 3. The 4 point withdrawal response scores and the number of patients who had withdrawal response were found to be significantly higher in Group 2, and no statistical difference between Groups 1 and 3. Conclusion: Local heating or lidocaine applications may be used to prevent injection pain during priming of rocuronium. We believe that both administration of lidocaine can be preferred to local heating in the prevention of rocuronium-induced mild withdrawal response at the intubation dose, and that both treatments prevent severe response.

Uyanık kraniyotomi tekniği ilk olarak epilepsi cerrahisinde başlamışken günümüzde hassas beyin korteksine yakın beyin tümörlerinin rezeksiyonunda, stereotaktik beyin biyopsisi, ventrikülostomi, derin beyin stimülasyonu, supratentorial tümör rezeksiyonu işlemlerinde uygulanmaktadır. Ayrıca genel anestezi risklerini önlemek, hastanede kalış sürelerini azaltarak hastane kaynak kullanımında tasarruf sağlamak için tercih edilmektedir. Bu teknikte anestezistin hedefi ameliyatın güvenli ve etkin şartlarda yapılması bunun yanında, hastanın işlemin ağrılı bölümlerine ve uzamış immobilizasyona toleransını sağlamak, intradural testler sırasında kooperasyonunu devam ettirmektir. Anestezi uygulaması kafa cildi anestezisi ile beraber olmak zorundadır. Uzun etkili yüksek hacimde bupivakain ve levobupivakain tercih edilir. Sedasyon için sıklıkla propofol, deksmedetomidin ve remifentanil tercih edilir. Başarılı bir uyanık kraniotomi ekibin tecrübesi ve anestezi işleminin detaylı olarak planlanmasına bağlıdır. Bu derlemenin amacı, yazılı kaynaklara dayalı olarak uyanık kraniotomi uygulamalarında anestezi teknikleri hakkında bilgi paylaşımıdır., Awake craniotomy, which was initially used for the surgical treatment of epilepsy, is performed for the resection of tumours in the vicinity of some eloquent areas of the cerebral cortex which is essential for language and motor functions. It is also performed for stereotactic brain biopsy, ventriculostomy, and supratentorial tumour resections. In some institutions, avoiding risks of general anaesthesia, shortened hospitalization and reduced use of hospital resources may be the other indications for awake craniotomy. Anaesthesiologists aim to provide safe and effective surgical status, maintaining a comfortable and pain-free condition for the patient during surgical procedure and prolonged stationary position and maintaining patient cooperation during intradural interventions. Providing anaesthesia for awake craniotomy require scalp blockage, specific sedation protocols and airway management. Long-acting local anaesthetic agents like bupivacaine or levobupivacaine are preferred. More commonly, propofol, dexmedetomidine and remifentanyl are used as sedative agents. A successful anaesthesia for awake craniotomy depends on the personal experience and detailed planning of the anaesthetic procedure. The aim of this review was to present an anaesthetic technique for awake craniotomy under the light of the literature.

Objective: Rocuronium-linked injection pain often occurs. In this study, we aimed to compare the local heating of the injection site and the iv lidocaine administration in the prevention of injection pain with rocuronium. Method: In the ASA I-II risk group, scheduled for operation in the context of general anesthesia with ethics committee approval and written approval, 60 patients aged 18-65 years were included in the study in 3 randomly assigned groups. Tourniquets were applied to the front arm in all three groups. In group 1 (n = 20) 2 ml of saline was administered iv; thirty seconds later the turnstile opened; 1 ml (10 mg) of rocuronium was applied for 2 seconds. In group 2 (n = 20) the patient's arm was warmed externally with the patient's heating blanket adjusted to 43 °C; turnstile opened at 30th; external heating was applied for a total of 1 minute; followed by 1 ml (10 mg) of rocuronium for 2 seconds. In Group 3 (n = 20), 1ml (10 mg) rocuronium was administered for 2 seconds following 2 ml of 2% lidocaine iv. Following rocuronium injection in the intubation dose, the pain was assessed by a 4-point traction response score. Results: The groups were similar in terms of demographics. The 4 point verbal rating scales were significantly different in Group 1, compared to Group 2 and Group 3 (2,0+0,8 and 0,5+0,5 and 0,3+0,4, mean+SD). There was no statistically significant difference between Groups 2 and 3. The 4 point withdrawal response scores and the number of patients who had withdrawal response were found to be significantly higher in Group 2, and no statistical difference between Groups 1 and 3. Conclusion: Local heating or lidocaine applications may be used to prevent injection pain during priming of rocuronium. We believe that both administration of lidocaine can be preferred to local heating in the prevention of rocuronium-induced mild withdrawal response at the intubation dose, and that both treatments prevent severe response.