REVIEW | |
1. | The evaluation of preoperative consultations, guidelines and risc scoring systems in geriatric patients Elvin Kesimci, Fevzi Toraman doi: 10.5222/GKDAD.2016.001 Pages 1 - 8 (1944 accesses) The incidence of geriatric patients undergoing surgical procedures has been increasing markedly as a result of increase in geriatric population. The anesthetic management of these patients should provide a better understanding of preoperative period and a better and smooth postoperative care, with a specific approach including physiological and psychological age -specific changes. We evaluated the consultations, guidelines and risc scoring systems in the geriatric population; required in the postoperative period. |
EXPERIMENTAL WORK | |
2. | Serum electrolyte and ph alteratıons durıng cardıopulmonary bypass: analysis by the stewart approach Alper Kararmaz, Beliz Bilgili, Seçil Ayhan Özcan, Ömer Ayanoğlu, Zuhal Aykaç doi: 10.5222/GKDAD.2016.009 Pages 9 - 15 (1618 accesses) INTRODUCTION: “Minimal Extracorporeal Circulation System”(MECC) has differences from conventional cardiopulmonary bypass(CCPB) system such as having a centrifugal pump,heparin-coated circuit and free of a reservoir. This study aims to distinguish the differences in blood gas changes analysed by the physicochemical approach between patients undergoing elective CABG surgery with MECC and CCBP. METHODS: Fifty-nine patients who undergone coronary artery bypass surgery were screened retrospectively. MECC circuit was primed with isotonic and hydroxyethyl starch solution, following the cannulation prime solution was removed from the circuit by otology priming. CCPB system was primed with 1650 ml standard priming solution. Arterial blood gas analyses were done before, during, after the pump. The duration of pump and cross-clamp, pH,pCO2,lactate, base excess(BE),hemoglobin,strong ion difference(SID) were recorded. RESULTS: The hemoglobin levels were low before and after the pump(p<0.001),SID,BE,pH were high during the pump in the CCPB group(n=30)compared to the MECC group(n=29)(p<0.0001). The high sodium consistency of the priming solution in the CCPB system yielded high SID and pH. Although SID and pH were stable during the pump,SID decreased as a result of Cl– increase after the pump,but this did not influence pH in the MECC group. The lactate levels were high(p<0.01),the duration of pump and cross-clamp were longer(p<0.01) in the CCPB group compared to the MECC group. DISCUSSION AND CONCLUSION: The hemoglobin levels and pH are more stable during the extracorporeal circulation when MECC is used compared to the CCPB. The priming solution with high SID and hemodilution are determined as the causes of metabolic alkalosis in the CBB group by the physicochemical analysis. |
3. | Etiological Factors Concerning The Early Complications That Occur Following Coronary Artery Bypass Graft Surgery İpek Mavili, Cengiz Şahutoğlu, Zeynep Pestilci, Seden Kocabaş, Fatma Zekiye Aşkar doi: 10.5222/GKDAD.2016.016 Pages 16 - 23 (2014 accesses) INTRODUCTION: As coronary artery bypass graft (CABG) surgeries are becoming more common along with the advancements in anesthesia and surgery and patient profiles are changing day by day, more complications are observed during the preoperative period. Due to these complications, mortality and morbidity rates are increasing and length of stay in the intensive care unit is extended. This study aimed to specify the etiological factors that cause the development of complications in CABG surgeries. METHODS: Files of 400 patients who were operated between January 2011 and December 2012 were reviewed retrospectively. Information concerning the patients’ ages, gender, weight, height, body mass index (BMI), ejection fraction, EuroSCORE (European system for cardiac operative risk evaluation score), presence of additional diseases, number of anastomoses carried out, the duration of cardiopulmonary bypass and aortic cross-clamping time, postoperative inotropic drug support, mechanical ventilation time, length of stay in the intensive care unit and in hospital, and the complications that occurred was noted. The relationship between the occurring complications and these variables was studied statistically. RESULTS: The mean age of the patients was 61,4± 9,4 years and 307 of them were males. Cardiac complication was the most frequently observed complication in patients with a rate of 29.8%. This was followed by renal dysfunction (21%) and respiratory complications (12.3%). 41.5% of the patients developed one complication alone while 19% of them developed two and more complications. In the multiple direction logistic regression analysis, male gender, high BMIs, high EuroSCOREs, use of inotropic agents, long CPB durations and the number of coronary anastomoses carried out were independent risk factors for complications. For the patients who developed complications, extubation, mechanical ventilation, length of stay in intensive care and hospital were found to have been extended significantly (p = 0,05). DISCUSSION AND CONCLUSION: It would be possible to decrease the rates of complications by preparing patients for the operation thoroughly in the preoperative period and giving optimal treatment, complying with the myocardial protections techniques and reducing operating times. |
4. | Postoperative Residual Curarization in Postanesthesia Care Unit: Relationship With Clinical Tests Gonca Oğuz, Süheyla Ünver, Gülşah Açıkgöz, Oruç Emre Solmaz, Yeliz İrem Tunçel doi: 10.5222/GKDAD.2016.028 Pages 24 - 28 (1240 accesses) INTRODUCTION: The residual effects of neuromuscular blocking agents may persist into early postoperative period. Although train-of-four stimulation is used to evaluate the degree of neuromuscular blockade, many anesthetists still prefer clinical tests. A train-of-four ratio of 0.9 is accepted as threshold for adequate respiratory function. In this study, the incidence of postoperative residual curarization in postanesthesia care unit and the relation of train-of-four ratios with clinical tests were evaluated. METHODS: 128 patients scheduled for surgical procedures under general anesthesia were enrolled. Residual curarization was assessed using train-of-four monitorization upon arrival in the postanesthesia care unit. At the same time, the ability of 5s head lift, eye opening, hand grip and tongue protrusion were evaluated. Additional neostigmine need, verbal or mechanical stimulation for respiration and reintubation were also noted. RESULTS: Eighteen percent of patients had a train-of-four ratio≤0.7, 32.8% between 0.7-0.9 and 49.2% ≥0.9. Train-of-four values showed weak-moderate positive correlation with head tilt and hand grip. The correlation coefficient was most significant with head tilt (0.318, p=0.000). The correlation was negative with American Society of Anesthesiologists classification (-0.289, p=0.001). Eleven of 23 patients with train-of-four ≤0.7 were able to sustain 5s head tilt, while the number increased to 56 of 63 when train-of-four ≥0.9. DISCUSSION AND CONCLUSION: Incomplete recovery from neuromuscular blocking agents is an important problem in postoperative care units. The clinical tests are not well correlated with postoperative residual paresis. Objective neuromuscular monitoring and optimal reversal must be performed to improve patient outcomes. |
5. | Evaluation of the scoring systems in trauma patients to predict intensive care mortality Fatma Yıldırım, İskender Kara, Hamit Küçük, Lale Karabıyık, İsmail Katı doi: 10.5222/GKDAD.2016.029 Pages 29 - 33 (2217 accesses) INTRODUCTION: In this study, we aimed to investigate the contribution of Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Glasgow Coma Score (GCS) and Revised Trauma Score (RTS) to predict the prognosis of trauma patients in ıntensive care unite (ICU). METHODS: Medical records of the trauma patients that were treated in the Anesthesiology ICU between January 2013-October 2013 were retrospectively viewed. Demographic characteristics, trauma etiologies, admission sites, duration of hospitalization, mortality and APACHE II, SOFA, GCS, and RTS scores of patients were recorded. The relationship between scores and ICU mortality was examined. RESULTS: Median age of the 31 patients (20 men, 11 women) was 43 [25-61], 19 (61.3) of them died, 12 (38.7) of them discharged from the ICU. There was no difference in terms of age, gender, etiology of trauma, admission sites, duration of hospitalization (p> 0.05) between died and discharged patients. APACHE II score of the exitus group was higher (median 15 vs 9, p = 0.035). According to the ROC curve analysis that was performed to determine the value of scoring systems to predict mortality, area under the curve for APACHE II, GCS, SOFA, RTS were 0.726 (p = 0.037), 0.393 (p = 0.320), 0.625 (p = 0.248), 0.412 (p = 0.417) respectively. Correlation coefficients were -0630, 0894, -0545 and 1.0 respectively. DISCUSSION AND CONCLUSION: APACHE II score seems more effective to predict mortality in trauma patients in ICU. |
CASE REPORT | |
6. | Anesthetic management of a pregnant patient who underwent surgery due to stuck valve Hülya Kaşıkara, Aslıhan Küçüker, Melahat Yıldırım, Cemile Altın, Gökçer Uğur, Şemsi Mustafa Aksoy, Abdulkadir But doi: 10.5222/GKDAD.2016.034 Pages 34 - 37 (1917 accesses) Introduction: We report anasthetic management of a prosthetic valve thrombosis on a 28th week pregnant women, with acute heart failure and pulmonary oedema. Case report: A twenty-eight-week pregnant patient who visited a hospital with a complaint of dyspnea was sent to our clinic to undergo an urgent surgical intervention after diagnosed with mitral valve replacement stuck valve. Transthoracic echocardiography revealed EF %55, dysfunctional prosthetic mitral valve, restricted leaflet opening, severe dilatation in right atrium, pulmonary artery pressure of 65mmhg, aorta insufficiency of 2-3.degree, tricuspid incompetence of 2. degree. The surgeons observed mild cyanosis in extremities and lips, tachypnea, orthopnea, hemoptysis while the patient was on the operating table. Thrombolytic treatment was refused by the patient. The patient's Mmitral valve was replaced with cardiopulmonary bypass procedure following the live delivery of the baby with c-section under general anesthesia. In conclusion the operation on the pregnant woman with nonfunctional mitral valve was successfully performed without any maternal and fetal complication following an appropriate anesthetic and surgical planning. |
7. | Preoperative Autologous Donation In A Pediatric Patient Undergoing Open Heart Surgery: Case Report Cengiz Şahutoğlu, Nursen Karaca, Seden Kocabaş, Fatma Zekiye Aşkar, Alev Atalay, Yüksel Atay doi: 10.5222/GKDAD.2016.038 Pages 38 - 40 (1369 accesses) Pediatric open heart surgery is a major procedure in which transfusion rates are moderately high and blood products are mandatorily used during cardiopulmonary by-pass. Insufficiency of cross-match compatible blood products are rarely seen and these circumstances may yield to the delaying of these operations. İnforcement of blood preservation methods like preoperative auotologous donation are necessary in these patients. In this article, we present the case of a patient who had undergone surgery for the repair of congenital mitral valve insufficiency, in which preoperative auotologous donation was performed as cross-match compatible blood products were inadequate. |
8. | A rare cause of acute respiratory distress syndrome: Chylothorax Beliz Bilgili, Fethi Gül, İsmail Cinel doi: 10.5222/GKDAD.2016.041 Pages 41 - 44 (1373 accesses) Chylothorax is the disruption or obstruction of thoracic duct as a result of trauma or neoplasms. It is a rare cause of pleural effusion characterized by high triglyceride and low cholesterol concentrations. Cyhlothorax related acute respiratory distress syndrome is an uncommon condition. Herein, we report and discuss a case that developed acute respiratory distress syndrome (ARDS) due to high flow chylothorax, which was treated by protective mechanical ventilation strategies, prolonged prone position and thoracic duct ligation. |