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Introduction: The Blue Code practice provides increase in survival rates and decrease in the rate of permanent sequelae after cardiac arrest. There are issues that healthcare workers should pay attention to in the Code Blue practice. Aim The primary purpose of this survey study is to determine the knowledge levels of physicians and nurses about the Code Blue and cardiopulmonary resuscitation in 6 centres. The secondary aim is to determine the solutions that can be made to eliminate these deficiencies. Methods After the approval of the Faculty Ethics Committee, Mersin University Faculty of Medicine, Adana Baskent Turgut Noyan Training and Research Hospital, Dokuz Eylül Univ. Faculty of Medicine, Hacettepe University Faculty of Medicine, Gulhane Training and Research Hospital, Manisa Celal Bayar Univ. Faculty of Medicine, except for the doctors and technicians of the Department of Anaesthesiology and Reanimation and the healthcare professionals working in the intensive care units, the doctors and nurses working in other departments were asked to answer the questions in the questionnaire via the internet with the questionnaire form stated in Appendix 1. Results A total of 415 participants responded the survey. Of them, 45.8% were nurses, 24.8% residents, 23.3% faculty members, 5.4% specialist doctors and 0.7% general practitioners. Totally 86.6% of the participants knew the Code Blue number. To the question "What is the Code Blue?", 92.7% of the participants gave the correct answer to his question. "Do you hesitate to intervene when you encounter a patient requiring emergency intervention?" 25.9% of the participants answered "Yes" to the question. "Is there a form about Code Blue in your clinic?" 41% answered "No" to the question. Conclusion According to the results of the survey we conducted, we are of the opinion that healthcare workers have insufficient knowledge about the Code Blue. In order to solve these problems, it would be appropriate to direct healthcare professionals to both in-hospital and external training programs.

Cardiopulmonary resuscitation (CPR) includes all treatment procedures during cardiac arrest. Resuscitation of patients with diagnosed or suspected of COVID-19 is particularly important in terms of protection and reducing the risk of transmission. In this review, the basic and advanced life support recommendations of Turkish Resuscitation Council for adult patients with a definite or probable diagnosis of COVID-19 are explained within the algorithm framework.

Amaç: Bu retrospektif çalışmada hastanemizde laparaskopik bariatrikcerrahi uygulanan hastalardaki anestezi deneyimimizin aktarılması veperioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç veYöntem: Obezite cerrahisi geçiren ASA risksınıflaması II-III olan 62 hasta retrospektif olarak değerlendirilmiştir.Hastaların demografik özellikleri, cerrahinin süresi, peroperatif dönemdegörülen komplikasyonlar, hastanede kalış süresi kaydedilmiştir.Bulgular: Hastaların yaş aralığı 19 ile 59 arasında değiştiği ve %72.6’sının kadınolduğu tespit edildi. Ortalama operasyonsüresi 167 dakika, hastanede kalış süresi 5 gündür. İntroperatif dönemdegörülen komplikasyonlar arasında taşikardi, hipertansiyon ve aritmi yeralmaktadır. Takiplerde 6 (%9.7) hastanın tekrar operasyona alındığı, hastalarıntamamının sağlıklı şekilde hastaneden taburcu edildiği tespit edildi.Sonuç:Laparaskopik obezite cerrahisinde oluşabilecekkomplikasyonların önlenmesinde donanımlı bir ekip ve takım çalışması ilebirlikte iyi bir preoperatif hazırlık, tromboemboli proflaksisi, sıkıhemodinami ve kan gazı takibi güvenli bir anestezi için gereklidir., Purpose: The aim of this study was topresent our experience in patients who underwent laparoscopic bariatric surgery and to discuss the current literature on theperioperative management.Material andMethods: Sixty two patients with ASA riskclassification II-III were evaluated retrospectively who underwent obesity surgery inour hospital. Demographiccharacteristics of the patients, surgical time, complications that seen in theperioperative period and the length of hospital stay were recorded.Results: The age of thepatients ranged from 19 to 59 years and 75.9% of them were female. Meanoperation time was 167 minutes and the length of hospital stay was 5 days. Complications seen during intraoperative period were tachycardia,hypertension and arrhythmia. In the following days, 6 (9.7%) patients were re-operated and there was no mortality.Conclusion: The prevention of complications that may occur inlaparoscopic obesity surgery is required with a equipped team and teamwork, agood preoperative preparation, thromboembolism prophylaxis, tight hemodynamicsand blood gas monitoring for safe anesthesia.

Objective Globally, previously determined teams activated by 'code blue' calls target rapid and organised responses to medical emergency situations. This study aimed to evaluate the cardiopulmonary resuscitation (CPR) conditions in Turkey. Methods A web-based survey was sent to anaesthesiologists in Turkey via email. The survey included 36 questions about demographic features and 'code blue' practices and procedures. Results A total of 180 participants were included. The mean working duration was 16.1±7.5 years. Of the anaesthesiologists who participated, 35% worked in university, 26.1% in education and research, 1.7% in city hospitals, 18.9% in state hospitals and 18.3% in private hospitals; 68.3% had CPR certification. There were code blue systems in 97.6% of the organisations. For code blue calls, 71.9% were activated by calling '2222'. There were 41.5% organisations with code blue teams of 3-4 people, whereas 26.7% had 2-member teams. Among call responders, 68.5% were anaesthesia technicians/paramedics, 60.7% were anaesthesiologists and 42.7% were anaesthesia assistants. In organisations, 66.3% regularly conducted code blue training. In total, 63.3% of the participants stated that the time to reach the location was nearly 2-4 minutes. During CPR, the use of capnography was 18.3%. Of the participants, 73.8% chose endotracheal intubation as priority airway device during CPR. Conclusion Today, code blue practice is an important quality criterion for hospitals. This study shows the current status of 'code blue' according to the results of respondent data completing the survey. To prevent in-hospital cardiac arrest, a chain of preventive measures should be established, including personnel training, monitoring of patients, recognition of patient deterioration, the presence of a call for help system and effective intervention.

Background and purpose In patients with aneurysmal subarachnoid hemorrhage, deciding the optimal treatment strategy is challenging in the presence of severe and symptomatic vasospasm and the existing literature is limited. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment of intracranial aneurysms and the feasibility of stent-assisted coiling during severe and symptomatic vasospasm. Materials and methods Fifteen consecutive patients with 18 aneurysms who underwent endovascular treatment during severe and symptomatic vasospasm were included in the study. Patient and aneurysm characteristics, treatment technique, and clinical and angiographic outcomes were retrospectively evaluated. Results Aneurysms were treated by the following techniques: single catheter coiling in 9, stent-assisted coiling in 8 (3 aneurysms with Y-configuration double stents), and balloon-assisted coiling in 1. All patients showed angiographic improvement of vasospasm after treatment including a noticeable dilation of the spastic parent arteries following deployment of the stents. According to the immediate post-treatment angiography results, 14 aneurysms (77.8%) had class I occlusion and 4 (22.2%) had class II occlusion. Three patients died during the course of subarachnoid hemorrhage. Mortality was related to the poor grade (Hunt and Hess grade V) and cardiovascular complications in two and refractory vasospasm one patient. The remaining patients had favorable clinical outcomes at follow-up (modified Rankin Scale 0–2). Conclusions Endovascular treatment of intracranial aneurysms during severe and symptomatic vasospasm is safe and effective. Stent-assisted coiling in the presence of severe vasospasm is also feasible in wide-necked aneurysms with the additional benefits of mechanical vasodilation.

ResumoJustificativa e objetivoA sedação em paciente dependente de diálise com doença renal em estágio terminal (DRET) requer cautela como resultado da administração de altas doses de sedativos e suas complicações. Os regimes de sedação com múltiplas drogas podem ser superiores e vantajosos em relação ao consumo menor de drogas e aos eventos adversos que ocorrem facilmente em pacientes com DEET. Avaliamos os efeitos da pré‐medicação com dexmedetomidina sobre o consumo de propofol, os níveis de sedação com os escores da Observer's Assessment of Alertness and Sedation (OAA/S) e do índice bispectral (BIS), as alterações hemodinâmicas e os potenciais efeitos colaterais em pacientes geriátricos com DRET submetidos à cirurgia para fratura de quadril sob raquianestesia.MétodoNeste estudo randômico, controlado e duplo‐cego, 60 pacientes idosos (idade≥65 anos), com DRET e fratura de quadril, agendados para fixação intramedular de haste femoral anterógrada foram designados para grupos para receberam infusão intravenosa de solução salina (Grupo C) ou pré‐medicação com infusão de 0,5mg kg/10min de dexmedetomidina (DEX) (Grupo D). Todos os pacientes receberam infusão de propofol após a indução da raquianestesia.ResultadosO consumo total de propofol, a dose de propofol necessária para os níveis‐alvo de sedação de acordo com os escores da OAA/S, os valores do BIS e os tempos de recuperação foram significativamente menores no Grupo D (p

Objective: Plasma interleukin-18 (IL-18) has been reported to be associated with homeostasis model assessment of insulin resistance (HOMAIR). It also has been described as one of the factors that, in addition to insulin resistance, may also contribute to atherosclerosis. Parameters of systemic inflammation are also significantly associated with circulating IL-18. Our objective was to investigate whether IL-18 is associated with insulin resistance and atherosclerosis in patients with rheumatoid arthritis (RA) in which accelerated atherogenesis develops.Material and Methods: Fifty-one female RA patients and 30 female controls were enrolled in the study; 31 of them were without diseasemodifying antirheumatic drug (DMARD) treatment and had a relatively short disease duration. Disease activity was assessed by Disease Activity Score (DAS) 28 index. HOMA-IR method was used to detect insulin resistance. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fasting plasma glucose (FPG), insulin, tumor necrosis factor alpha (TNF-?), and IL-18 levels were evaluated. Also, carotid intima-media thickness (cIMT) was measured.Results: There were no differences between patients and the control group according to age, sex, and body mass index. ESR, CRP, insulin, FPG, HOMA-IR, TNF-?, IL-18 levels, and cIMT measurements were significantly high in the patient group. HOMA-IR and cIMT measurements were similar and high in both the DMARD and non-DMARD patient groups. HOMA-IR correlated with TNF-? (r0.308, p0.028), but no correlation was found between IL-18 and HOMA-IR. However, IL-18 was correlated positively with cIMT (r 0.318, p0.028) and negatively with BMI (r-0.360, p0.01).Conclusion: IL-18 is associated with atherosclerosis in RA patients. However, no significant relation was found with insulin resistance. IL-18 may be a marker for early evaluation of atherosclerosis in RA patients

Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Background and purpose Multiple aneurysms have a high reported incidence, but the optimal treatment strategy is not clear. The aim of this study was to evaluate the safety and effectiveness of single-stage endovascular treatment of multiple aneurysms with a combination of various endovascular techniques. Materials and methods Fifty-three consecutive patients with multiple intracranial aneurysms who underwent single-stage endovascular treatment for ≥2 aneurysms from June 2011 to May 2016 were included in the study. Patient and aneurysm characteristics, treatment technique, complications, clinical and angiographic outcomes were retrospectively evaluated. Results 125 of 128 aneurysms (97.6%) were treated by the following endovascular techniques: simple coiling in 19, balloon-assisted coiling in 27, stent-assisted coiling in 33, flow diverters in 43, intrasaccular flow modifiers in 2, and a neck-bridging device in 1. Overall mortality and mortality directly related to the single-stage treatment was 15% (8/53) and 3.7% (2/53), respectively. Clinical and angiographic follow-up was available in 44 (83%) patients for 104 (83.2%) aneurysms for a mean duration of 16.2 months (range 3–51 months). According to the last angiographic follow-up, overall occlusion rates were complete in 85 (81.7%), near complete in 8 (7.6%), and incomplete in 11 (10.5%) aneurysms. Conclusions Single-stage endovascular treatment of multiple aneurysms with combined endovascular techniques is technically feasible and increases the treatment possibility of all detected aneurysms. However, the safety of the procedure is controversial due to relatively high complication rates. In particular, in patients with bilateral internal carotid artery aneurysms, staged therapy may be used instead of simultaneous treatment with flow diverters to avoid thromboembolic events.

Dear Editor, Edwards’ syndrome is the most common autosomal trisomy after Down syndrome (1). It is a syndrome in which multiple malformations such as structural heart defects, microcephaly, micrognathia, low-set ears, limbs, gastrointestinal and genitourinary system defects are observed (1). Death often occurs in the first year of life because of reasons such as severe heart defects, central apnoea, aspiration, respiratory failure and upper airway obstruction, found in more than 90% of patients (1, 2). Both serious heart problems and the possibility of a difficult airway due to micrognatia makes anaesthetic management special for patients to undergo surgery. There are few reports in the literature regarding the anaesthetic management of these patients. A 2-month-old baby boy weighing 3030 g was evaluated for intervention because of a right inguinal hernia. It was found out that he had perimembraneous outlet ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tricuspid valve malformation, pulmonary hypertension, horseshoe kidney and, in the cranial system, ventriculomegaly and mega cisterna magna. Physical examination revealed that the baby with microphthalmia, micrognathia, short neck and ‘club foot’ deformity in lower extremities was low-weighted and apathetic (Figure 1). Findings of laboratory tests were normal. It was decided to place a laryngeal mask without using muscle relaxant in the patient in whom routine monitoring was conducted. Number 1 laryngeal mask was placed on the patient, who received 3 mg kg−1 thiopental sodium and 2%–3% concentration of sevoflurane intravenously in the induction. In the anaesthesia maintenance, 50%/50% oxygen/nitrogen mixture was applied with 1%–2% concentration of sevoflurane. In the patient who remained haemodynamically stable, the intervention was completed smoothly, and no perioperative complications developed. Figure 1 Appearance of the baby with Edwards’ syndrome Edwards’ syndrome is a complex syndrome for anaesthesiologists, with many aspects. In these patients, in whom cardiac malformations are at the forefront, it is important to prepare an anaesthesia plan that will not affect the haemodynamics. Because Edwards’ syndrome may cause muscle rigidity, it is stated that succinylcholine should be avoided in cases where the use of muscle relaxants is required (3). Considering the possibility of difficult intubation that may occur because of micrognathia, we believe that it would be appropriate to use the supraglottic airway tools that require the use of lower doses of anaesthetic drugs in appropriate cases and cause less haemodynamic response.

Introduction: Sudden cardiac arrest (SCA) may also affect people making regularly sports with no known heart disease. Coronary atherosclerosis is the most common cause of sudden death in individuals older than 35 years, whereas inherited and structural heart disease predominates in younger athletes. Immediate cardiopulmonary resuscitation and early defibrillation is the treatment of choice for SCA. High success rates can be achieved if this is initiated promptly. The purpose of this study is to determine the awareness and attitudes of football players regarding cardiopulmonary resuscitation (CPR). Method: In the 2014-2015 football seasons, football players of professional league in the Aegean region in Turkey were enrolled. A 16-question survey was given to 259 football players. Topics such as previous CPR training and concerns related to CPR were questioned. Results: Fully completed forms of 259 footballers were evaluated. There were 7.7% who stated they had received training in CPR with certificate. 5.9% of them had CPR training within 5 years. The rate who stated they wished to receive this training was 46.3%. The rate who had witnessed SCA during a game was 3.5% and during workout was 3.1%. About one percent of football players (1.2%) stated that they had to perform CPR once. Of participants 17% had never heard of an AED. While 10.4% stated there was a written medical action plan (MAP) for emergency situations in their home stadium, 62.9% were not aware of a plan. Conclusion: Training in CPR and automated external defibrillators among football players is lacking. However, footballers as first responders can be helpful on the field as well as anywhere in the community. The majority of participants stated they were willing to correct and develop their knowledge related to CPR. These results should give warning to authorities to develop a strategy to improve CPR knowledge of football players.

Objective: The aim of this study was to determine the effectiveness of fo cused assessment with sonography in blunt trauma (FAST) patients as an initial diagnostic and observational tool. Material and Methods: This descriptive prospective study was performed by collecting data from patients with blunt trauma who presented to our tertiary university hospital emergency department (ED) between October 2008 and December 2008 and who were evaluated with ultrasound by the treating emergency medicine physician (GE Proseries Logic 200 machine with a 3.5 MHz large curved array probe). Demographic, clinical, laboratory, and imaging data were collected prospectively and ISS, RTS, TRISS, and Glasgow scores were calculated. Results: During the study period, 28 patients presented with blunt trauma and they were evaluated with a bedside ultrasound within 10 minutes. Only one patient had splenic trauma and two had pleural fluid on FAST exam. The FAST results correlated positively with the decrease in hematocrit (Htc) values, ISS, TRISS, and duration of admission (p=0.006, 0.01, 0.034, 0.009). 96.4% (n=27) of the patients were discharged, and 3.6% (n=1) died. Conclusion: FAST was the first and an observational clue for trauma before Htc, or even physical examination. (JAEM 2011; 10: 119-22)

Objective: Tracheostomy is one of the most frequent interventions for ICU patients. The current trend in performing a tracheostomy is a percutaneous approach because of its popularity and significant advantages. In this study, certain indications of surgical tracheostomy (ST) are suggested and furthermore, ST is compared with percutaneous tracheostomy (PT).Patient and Methods: We performed a U-shaped ST in 121 patients and PT in 85 patients between March 2003 and December 2006. All of the STs were opened U-shaped in the operating room. In this technique; instead of removing the tracheal ring, it was used to create a flap. The tracheal flap was hung with a suture from middle of the 2nd or the 3rd cartilage rings, as a guide. Also, the PT procedure “Griggs dilatation technique” was performed in the ICU.Results: PT and ST had similar complication rates: 4.1% for ST [bleeding in 2 patients, stenosis in 2, and stomal infection in 1] versus 3.6% for PT [bleeding in 2 patients, and pneomothorax in 1] (p = 0.08). No significant difference was found regarding mean operation time between ST [12 min (9–18)] and PT [8 min (6–16)] (p = 0.09) Conclusions: Staff utilization and cost seem like the major advantages of PT. However, our surgical technique has similar complication rates with PT and moreover, using ST still remains favorable for select patients with thyroid hyperplasia, short neck, tracheaomalacia, obesity, neck operation history and for children.

We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia.A total of 82 patients were studied in two groups. Group 1 (n = 45) consisted of the patients who underwent general anesthesia, and group 2 (n = 37) comprised those who received combined spinal-epidural anesthesia.The mean ages of patients in groups 1 and 2 were 45 +/- 15 and 44 +/- 15 years, respectively. The mean areas of the stones in groups 1 and 2 were 734 +/- 386 mm(2) and 731 +/- 394 mm(2), respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operative time, irrigation fluids, fluoroscopy time, delta hemoglobin, and hospitalization time (P = 0.439). At the end of the surgery, stone-free rates were 76% in group 1 and 81% in group 2; clinically insignificant residue fragments rates were 24% in group 1 and 19% in group 2. The difference was statistically insignificant between the groups (P = 0.543).We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.

in this study we controlled the efficiency and safety of using remifentanil combined with two different supplementary background infusions for labor analgesia in nulliparous patients.60 subjects were allocated to two groups. After programming the patient-controlled analgesia device to deliver a fixed load and demand doses of intravenous remifentanil for all subjects, group r (n = 30) received a background infusion of remifentanil 0.1 microg/kg/min and group R (n = 30) received a supplementary infusion of remifentanil 0.15 microg/kg/min. Visual analogue scale for analgesia, hemodynamic parameters, sedation scales and fetal heart rates were recorded at the 5th, 10th, 20th and 30th min of the study and measurements continued every 15 min during 90 min of labor and delivery. Side effects, Apgar and satisfaction scores were obtained for every subject.visual analogue scale scores of group R were significantly lower than those of group r throughout labor and delivery (p0.05). Hemodynamic parameters and fetal heart rates of the two groups were not different (p0.05). Most subjects were awake and only nausea was obtained (p0.05). The increase in the Apgar and satisfaction scores was not statistically significant (p0.05).it was determined that remifentanil with a 15-mug demand dose and 0.15 mug/kg/min supplementary continuous infusion is an effective choice for patient-controlled analgesia during labor in nulliparous subjects.

The purpose of the paper was to assess and to compare the effectiveness and safety of patient controlled epidural analgesia using tramadol or morphine for postoperative analgesia after major urological surgeries. For patient-controlled epidural analgesia; in group I (n = 30) a loading dose of 20 mg tramadol 0.1% with a continuous infusion of 1 mg/ml at a rate of 8 ml/h was administered preemptly and in group II (n = 30) a loading dose of 2 mg morphine in 20 ml normal saline was administered and a supplemental infusion of 0.2 mg/h morphine was begun at a rate of 2 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 minutes and a background infusion of 8 ml/h in tramadol 0.1% group and 2 ml/h in morphine 0.01% group were administered. VAS for pain intensity, vital signs, sedation scale and side effects were monitored at 0, 15, 30 minutes and 1, 2, 3, 4, 8, 12, 24 hours during the postoperative period. Adequate analgesia was provided in all patients. VAS values were significantly lower in group II than in group I after the fourth hour measurement (p < 0.05). The incidence of nausea, vomiting and pruritius was lower in the tramadol group (p < 0.05). In conclusion we decided that, after major urologic surgery, patient-controlled epidural administration of tramadol with a continuous background infusion might provide a safe and effective analgesia with limited side effects, even though there is increased drug consumption.

Purpose:Renal transplantation significantly improves quality of life compared to hemodialysis in patients with end-stage renal failure. In end-stage renal failure anesthetic technique should be planned carefully, due to changes in volume distribution, drug metabolism, excretion. Results of total intravenous anesthesia, inhalation anesthesia, regional techniques are being investigated. Aim of this study was to present our experience in total intravenous anesthesia in 77 patients, who underwent live and cadaveric donor renal transplantation at Baskent University Faculty of Medicine Adana Teaching and Research Center. Material and Methods:Induction of anesthesia was performed with propofol(2mg/kg) and fentanyl(1μg/kg), and rocuronium bromide(0.4-0.5mg/kg) was given before intubation. Anesthesia was maintained with total intravenous anesthesia(propofol,50 mcg/kg/min; remifentanil,0.25 mcg/kg/min infusion). Intraoperative fluid, urine volumes were recorded. For preemptive multimodal analgesia, pre-incisional intravenous paracetamol(15mg/kg), intramuscular morphine(0.1mg/kg) were given. Postoperative analgesia was maintained with intravenous patient-controlled analgesia(meperidine 10 mg bolus, with a lockout time of 20 minutes). Postoperative pain was recorded using Visual Analogue Scale, level of sedation was assessed by Ramsey Sedation Scale. Results:Study included 64(83.1%) live donor transplantations and 13(16.9%) cadaveric donor transplantations. Mean total fluid administration was similar between live and cadaveric donor kidney transplantation patients however mean intraoperative urine output was significantly higher in live donor kidney transplantation patients(p, Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Background and objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid “codeine” to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. Methods: Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. Results: The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p 0.05). Conclusions: The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects. Resumo: Justificativa e objetivos: Os anti-inflamatórios não esteróides (AINEs) são frequentemente usados para controlar a dor após artroscopia. A adição de um opiáceo oral eficaz (codeína) aos AINEs pode ser mais efetiva e diminuir o consumo de opiáceo parenteral no pós-operatório. O objetivo deste estudo foi comparar a eficácia e os efeitos colaterais de naproxeno sódico e uma nova preparação, naproxeno sódico-fosfato de codeína, quando administrados preventivamente para meniscectomia artroscópica. Métodos: Sessenta e um pacientes foram randomicamente divididos em dois grupos para receber naproxeno sódico por via oral (Grupo N) ou naproxeno sódico-fosfato de codeína (Grupo NC) antes da cirurgia. A cirurgia foi realizada sob anestesia geral. Meperidina intravenosa foi iniciada por meio de analgesia controlada pelo paciente (ACP) para todos os pacientes. O desfecho primário foi o escore de dor na primeira hora de pós-operatório, avaliada com a Escala Visual Analógica (EVA). A sedação foi avaliada usando a Escala de Sedação de Ramsey. A primeira demanda de ACP, o consumo de meperidina no pós-operatório, os efeitos colaterais e os dados hemodinâmicos também foram registrados. Resultados: Os grupos foram demograficamente comparáveis. As medianas dos escores EVA tanto em repouso quanto em movimento foram significativamente menores no Grupo NC comparado ao Grupo N; exceto para movimento na avaliação de18 horas (p 0,05). Conclusões: A combinação de naproxeno sódico-fosfato de codeína forneceu analgesia mais efetiva que naproxeno sódico, sem aumentar os efeitos colaterais. Keywords: Arthroscopy, Postoperative analgesia, Naproxen sodium, Codeine phosphate, Palavras-chave: Artroscopia, Analgesia pós-operatória, Naproxeno sódico, Fosfato de codeína

A 15 years old child with Lyme borreliosis was treated with meperidine via a patient controlled analgesia (PCA) pump for pain management. He had no history of seizure and had normal hepatic and renal functions. At the 7th hour of meperidine PCA delivery, generalized tonic-clonic seizure was developed and successfully suppressed with antiepileptics and no neurologic sequel was occurred. The total meperidine consumption in the patient was quite lower than the recommended doses with PCA. Although Lyme disease might also cause seizure activities, the timing of the seizures was related with the accumulation of normeperidine which is the main metabolite of meperidine with central nervous system stimulant effect. The meperidine pain management on patients with Lyme syndrome should be reconsidered to avoid undesired effects.Keywords.

Aim: Doppler Ultrasonography (DUS) has become an important diagnostic technique in the hepatic vasculature evaluation. Fatty infiltration of the liver can also change the Doppler findings -like cirrhosis- of hepatic veins. Diffuse fatty liver (DFL) is the most common finding in liver with the method of ultrasonography. Most literature reports mention the effect of chronic liver disease with a small-size liver on the waveform alterations. The objective of the study was to evaluate the hepatic vein (HV) Doppler waveforms in cases with hepatomegaly and diffuse fatty infiltration of the liver. Material and Method: Steatosis was present in all cases (Grade I: 35 (19.3%); Grade II: 129 (71.3%); and Grade III: 17 (9.4%)). Steatosis was accompanied by hepatomegaly in 107 (59.1%) cases. However, steatosis was accompanied by nonhepatomegaly in 74 (40.9%) cases. Results: Of the cases that were detected to have hepatomegaly, 35 (33%) were male and 72 (67%) were female. Their ages ranged from 27 to 83 years (mean: 53.5 ± 11.1). Hepatic vein waveforms were examined in all cases. HV waveforms were divided into 3 groups, namely regular triphasic form, biphasic form, and monophasic form. Etiologic factors were diabetes, hypertriglyceridemia, and hypercholesterolemia. An abnormal HV Doppler waveform was present in 119 (65%) of 181 cases. A correlation was detected between DFL grade and HV Doppler waveforms (p=0.03), whereas no correlation was detected between DFL grade and hepatomegaly (p=0.5). It is known that there is an association between the grade of steatosis and a change in the hepatic vein waveform. Discussion: Nevertheless, hepatomegaly that is observed with steatosis does not cause any significant change in HV flow, which can be detected with a Doppler apparatus.