Search

Background Kartagener syndrome (KS) is a rare genetic disorder consisting of the triad of situs inversus, chronic sinusitis, and bronchiectasis. Although there are previous reports regarding the anaesthetic considerations in KS, none have included liver transplantation. Case presentation An 11-year-old boy with a diagnosis of KS underwent liver transplantation due to extrahepatic biliary atresia. Previous diagnostic imaging confirmed situs inversus and the absence of an inferior vena cava. The patient's peak airway pressure intermittently increased intraoperatively from 15 to 30 cm H2O due to increased pulmonary secretions, which required frequent suctioning of the endotracheal tube. Intraoperative volume resuscitation included 200 mL of 5% albumin, 5 units of erythrocyte suspension and 3 units of fresh frozen plasma. Intermittently, a norepinephrine infusion was required to maintain the MAP. Coagulation function was monitoring using the thromboelastogram to guide the use of blood products including fresh frozen plasma. At the end of the surgery, the patient was transferred to the intensive care unit. He was discharged from the intensive care unit on postoperative day 5, and from the hospital on postoperative day 28. He continues to do well with normal liver function 23 months after surgery. Conclusion Despite the risk of pulmonary related to airway secretions and exacerbation of hemodynamic instability related to anatomical variations in the inferior vena cava anatomy, KS patients can be safely anesthetized with careful planning and attention of the disease process, even for complex surgical procedures such as liver transplantation.

Introduction: Liver transplantation (LT) is the most effective treatment modality in patients with end-stage liver disease (ESLD). With the increased prevalence of diabetes and non-alcoholic fatty liver disease (NAFLD), coupled with a steady increase in the age of transplant population, liver transplant candidates are at increased risk for coronary artery disease (CAD). Improvements in anesthesia, surgical experiences, and increased effectiveness of drugs have facilitated concurrent surgical interventions in transplantation, allowing for orthotopic LT to be performed in elderly patients with a high incidence of coexisting diseases, especially those of the cardiovascular system. In this study, we present two cases of combined off-pump coronary artery bypass surgery and living donor liver transplantation. Case presentation: A 68-year-old male patient with ESLD due to chronic hepatitis C infection and multi-vessel CAD, and a 65-year-old female patient with NAFLD cirrhosis and multi-vessel CAD were referred to our institution for an LT evaluation. We performed combined living donor LT and off-pump coronary artery bypass surgery in both patients. Both the first and second patients were alive with good liver and cardiac function at the 25 and 15 months after surgery, respectively. Conclusion: Combined off-pump coronary artery bypass surgery and living donor LT are an alternative treatment for patients with severe CAD and ESLD. We consider that combined coronary artery bypass graft surgery and LT can be safely performed by experienced anesthesia and surgical teams in selected patients.

Akut karaciğer yetmezliği, ilerleyici karaciğer disfonksiyonudur. Karaciğer nakli, etkin bir tedavi seçeneğidir. Bu çalışmanın amacı akut karaciğer yetmezliği nedeniyle yapılan canlı vericili karaciğer nakillerini değerlendirmektir. Nisan 2014 ile Nisan 2019 tarihleri arasında, Medipol Üniversitesi Tıp Fakültesi Hastanesi Organ Nakli Bölümü’nde akut karaciğer yetmezliği nedeniyle canlı vericili karaciğer nakli yapılan 13 hasta retrospektif olarak değerlendirildi. Hastaların yaş ortalaması 21,1±20,9 yıldı. Hastaların dokuzu (%69,2) kadın ve yedisi (%53,8) çocukluk (< 18 yıl) yaş grubunda idi. En sık toksik hepatit nedeniyle (%38,5) karaciğer nakli yapıldı. Hastaların ortalama takip süresi 35,1±12,2 aydı. Hastaların beşinde (%38,5) komplikasyon gelişti. Hastalardan dördünde (%30,7) mortalite görüldü. Genel sağkalım oranı 1 ve 5 yıllık sırasıyla % 84,7 ve % 69,3 idi. Akut yetmezlikte yapılan canlı vericili karaciğer nakillerinin başarılı olduğu görünmektedir.

Background: BK virus is the most common infectious causes of nephropathy and graft loss after kidney transplantation. In our study, we investigated the factors that may affect positive BK virus in the blood in patients with kidney transplantation.

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative param- eters according to the donor type. In this study, we aimed to compare the intraoperative hemo- dynamic parameters in adult patients who un- derwent living-donor and deceased-donor kidney transplantation (KT). Material and Methods: The patients who underwent KT were divided into 2 groups ac- cording to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the liv- ing donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters. Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean op- erative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, periph- eral oxygen saturation and CVP values were all comparable between the two groups. Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intra- operative follow-up, and proper fluid management, similar intra- operative hemodynamic parameters are achieved in both types of donor recipients. Amaç: Böbrek nakli anestezisi ile ilgili çok sayıda çalışma yapılmıştır ancak verici tipine göre intraoperatif parametreler açısından literatürde yeterli veri bulunmamaktadır. Bu çalışmada canlı donör ve kadavra donör böbrek nakli (BN) yapı- lan erişkin hastalarda intraoperatif hemodinamik parametreleri karşılaştırmayı amaçladık. Gereç ve Yöntemler: BN yapılan hastalar verici böbrek tipine göre 2 gruba ayrıldı. Kadavra donör nakli yapılan alıcılar Grup 1 olarak çalış- maya dahil edildi. Canlı verici böbrek nakli ya- pılanlar arasında, Grup 1 ile benzer demografik verilere sahip aynı sayıda alıcı belirlendi ve Grup 2’ye dahil edildi. Her iki grup kaydedilen veriler ve intraoperatif hemodinamik parametreler açı- sından karşılaştırıldı. Bulgular: Çalışmaya 24 hasta dahil edildi. Ortalama diyaliz süreleri Grup 1 ve Grup 2 için sırasıyla 81,6 ± 64,8 ve 16,8 ± 17,4 aydı (p = 0,001). Ortalama soğuk iskemi süresi Grup 1›de Grup 2›den anlamlı olarak daha uzundu (p = 0,001). Grup 1 ve Grup 2 için operatif ortalama idrar çı- kışı sırasıyla 87.3 ± 149.6 ve 634.2 ± 534.5 idi (p = 0.002). Her iki grup ortalama arter basıncı, kalp hızı, periferik oksijen satürasyonu ve CVP değer- leri açısından benzerdi. Sonuç: Canlı donör nakline göre kadavra do- nör nakillerinde soğuk iskemi süresi daha uzun- dur ve operatif idrar hacmi daha düşüktür. İyi bir preoperatif hazırlık, yakın intraoperatif takip ve uygun sıvı yönetimi ile her iki tip donör alıcıda da benzer intraoperatif hemodinamik parametreler elde edilir.

Aim: Some parameters affecting intraoperative bleeding have been investigated, but there is not enough data on body mass index (BMI) and bleeding in liver transplantation (LT). We aimed to evaluate the relationship between the pretransplant BMI of recipients and blood loss, blood product transfusion, and fluid replacement during LT. Methods: In this retrospective cross-sectional study, patients aged >= 18 years who underwent LT between April 2014 and June 2020 were analyzed. Patients 30 in Group 4). Groups were compared according to operative hemodynamics, blood loss, blood transfusion, and fluid management-related parameters. Results: Two hundred and sixteen patients were included in the study. The mean blood loss was higher in obese patients than in others, but it was not statistically significant. The mean red blood cell, fresh frozen plasma, platelet, and cryoprecipitate transfusions were similar for the groups. The mean IV crystalloid fluid amount gradually shortened from underweight to obese patients but there was no significant difference. Preoperative mean international normalized ratio and prothrombin time were significantly higher in underweight patients than others (p=0.025). Conclusion: LT can be performed safely in patients with different BMI with similar blood loss and transfusion rates.

Background/aim: Pediatric kidney transplantation (PKT) anesthesia brings some different challenges than adult kidney transplantation (KT) anesthesia and there are still no studies analyzing the role of experience on PKT outcomes. In this study, we aimed to evaluate the anesthesia learning curve in pediatric kidney transplants performed in our institution and the effect of increasing experience on renal transplantation-related data. Materials and methods: Patients age 18 years were excluded. Patients were divided into 3 groups according to the date of transplant, as the first 10 patients in Group 1, the second 10 patients in Group 2, and the final 11 in Group 3. Groups were compared according to recorded data. Results: Thirty-one patients were included in the study. Age, sex, and body mass index were matched between the 3 groups. The mean durations of dialysis were 75.0 +/- 63.0, 22.4 +/- 27.9, and 5.7 +/- 4.5 months for Group 1, Group 2, and Group 3, respectively (p = 0.009). Blood loss, duration of postoperative mechanical ventilation, and length of stay in the intensive care unit (ICU) were comparable between the groups. The duration of anesthesia gradually shortened from Group 1 to Group 3 but there was no significant difference between the groups. The mean number of red blood cell (RBC) transfusion was 0.9 +/- 0.7 unit in group 1. It decreased to a mean of 0.6 +/- 0.7 unit for group 2, and afterward significant decrease occurred down to 0 for group 3 (p = 0.004). Conclusion: Our results demonstrate that considering the decrease in preoperative dialysis duration and operative RBC transfusion, 20 patients may be enough for anesthesia competency. Transplantation anesthesia experience before PKT, anesthesia technique, and patient characteristics may differ between institutions. Therefore, further prospective studies with established learning curve goals, larger patient volumes, and more variables are needed to validate our results.

BACKGROUND The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19. METHODS Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations. RESULTS Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025). CONCLUSION The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.

Aim: Hepatocellular carcinoma (HCC) is the most common primary solid tumor of the liver. Hepatitis B virus (HBV) infections, Hepatitis C virus (HCV) infections and at alcoholism can be seen. The aim of this study was to evaluate living donor liver transplantation in hepatocellular carcinoma.Methods: This is a retrospective cohort study. Between April 2014 and December 2017 at Medipol University Medical Faculty Hospital Organ Transplantation Department, 38 patients in living donor liver transplantation for HCC were evaluated.Results: The mean patient age was 58.0 (9.9) (20–74) years; 31 (81.6%) of the 38 were male. The mean MELD score was 14.2 (8–32). Outside Milan criteria (P=0.003), poorly differentiated and cholangiocarcinoma tumor component (P=0.003) appears to be worse in living donor liver transplantation in hepatocellular carcinoma.Conclusions: In this study, outside Milan criteria, poorly differentiated and cholangiocarcinoma tumor component appears to be worse in living donor liver transplantation in hepatocellular carcinoma., Amaç: Hepatosellür karsinom ( HCC ) karaciğerin en sık görülen primer solid tümörüdür. Hepatit B virus (HBV) enfeksiyonları, hepatit C virus ( HCV ) enfeksiyonları veya alkolizm zemininde de görülebilir. Bu çalışmanın amacı, HCC nedeniyle canlı vericili karaciğer nakli yapılan hastaların değerlendirilmesidir.Yöntemler: Retrospektif kohort çalışma planlandı. Nisan 2014 – Aralık 2017 tarihleri arasında Medipol Üniversitesi Tıp Fakültesi, Organ Nakli Merkezi'nde HCC nedeniyle canlı vericili karaciğer nakli yapılan 38 hasta değerlendirildi. Bulgular: Ortalama yaş 58,0 (9,9) (20-74) yıldı; 38 kişiden 31'i (%81,6) erkekti. Ortalama MELD skoru 14,2 (8–32) idi. Milan kriterleri dışında (P=0,003), kötü farklılaşmış ve kolanjiokarsinom tümör bileşeni (P=0,003), olan hepatosellüler karsinomda canlı vericili karaciğer naklinde daha kötü görünmektedir.Sonuçlar: Bu çalışmada Milan dışı, az differansiye ve kolanjiokarsinom komponenti olan tümörlerin daha kötü olduğu görünmektedir.