Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, in addition to preoperative evaluation of patients, anesthesiologists are faced with a new beginning or underlying unknown AF. To provide hemodynamic stability and to avoid complications in patients with AF is a very important skill for anesthesiologists.
This review presents anesthetic approach of AF classification and intraoperative management of patients taking anticoagulants due to AF.

INTRODUCTION: Cerebral oxygen monitorisation with NIRS during cardiovascular surgery is a method with increasing value. In our study we aimed to detect the risk of embolus which is higher in patients who underwent cardiotomy using NIRS monitorisation in comparison to coronary patients.
METHODS: Fourty patients were enrolled to our study who underwent elective valvular surgery by cardiopulmonar bypass (group 1) and coronary artery bypass grafting (group 2). Patients’ NIRS values, arterial blood pressures, heart rates, oxygenation, hematocrite and lactate levels were recorded in 7 time periods as before and after anesthesia induction, during canulation, 5th min. of cardiopulmonar bypass, while nadir temperature is reached, 5th min.after cardiopulmonar bypass and at the end of the operation.
RESULTS: Between 2 groups there were no difference detected of demographic features of patients and operation times. In group 1 cross clemping and CPB times were detected longer. Between groups; hemodynamic datas, right and left NIRS values were not different. Right and left NIRS values which evaluated within groups were similar too. In group 1 inotropic support in ICU was significantly high. ICU stay and extubation times were similar between groups. 24th hour examination of patients postoperatively were normal.
DISCUSSION AND CONCLUSION: In our study no difference were detected about changes of NIRS measurements and observed parameters for patients. Hence embolus detection with NIRS is seen in perfusion disorders emerging from major vascular bed influence, to detect embolus events detailed studies including more patients are required with transcranial doppler use and monitorisation of intracardiac air regularly by transesophagial echocardiography.

INTRODUCTION: The difficulty of accessing recurrent intravenous (IV) routes in patients with a diagnosis of malignancy is a frequent question. We retrospectively evaluate our port catheter placement procedures in patients who will undergo chemotherapy.
METHODS: We retrospectively reviewed the files of 98 patients who underwent chemotherapy port catheterization between May 2012 and November 2012 in our clinic. Patients' demographic data, primary diagnoses, localization of the procedure, number of interventions, fluoroscopy requirement, patient comfort (1, 2, moderate, 3 good) were recorded. Patients were evaluated as right internal jugular vein (Group J) and right subclavian vein (Group S) according to their entrance veins.
RESULTS: 50 (%51) of the patients were male and 48 (%48.9) were female. Their ages ranged from 19 to 84 and the mean age was 49.55 ± 14.57. Complications were seen in 8 (26.7%) of right internal jugular vein applications and 4 (5.9%) of right subclavian vein applications. The complications that occurred, 9 were due to misplacement and 3 were due to infection. When the groups were compared in terms of patient comfort, the number of patients giving satisfaction score 1 point (worse) in group J was 7 (23.3%) and in group S 3 (4.4%).
DISCUSSION AND CONCLUSION: As a result; We believe that implantation of port catheter in patients planned for long term chemotherapy improves patient comfort and has a low complication rate.

INTRODUCTION: Patient tissue and organ perfusion is important in pediatric cardiac surgery procedures. Hypoxemia and ischemia due to inadequate perfusion are frequently observed. The aim of the study is to identify cerebral oxygen imbalance with cerebral oxymetry monitoring in pediatric patients planned for heart surgery, and to identify the necessary corrective interventions.
METHODS: After Hospital ethic comitee and parental consent 40 patients between ages of 4 days and 10 years scheduled for congenital cardiac surgery were taken into the study.
Patients were under 1 year of age and over 1 year of age and were subdivided into SaO2 <92%: 2a and SaO2> 92 %: 2b. Patient characteristics, heart rate, arterial and central venous pressure, body temperature, PaCO2, PaO2, FiO2, SaO2, ScVO2, lactate, hematocrit and regional cerebral O2 saturation were recorded. Correlation of cerebral O2 saturation with hematocrit and mean arterial pressure was evaluated.
RESULTS: There was no significant difference in the right and left cerebral oxygenation values between the groups. Hematocrit levels and mean arterial pressure correlated with cerebral O2 saturation values.
DISCUSSION AND CONCLUSION: Cerebral oximetry monitoring of perfusion is a valuable indicator during intraoperatively in congenital cardiac surgery. In our study, cerebral oximetry values decreased when tissue O2 was deteriorated, such as intraoperative hypotension, hemodilution, hypovolemia, anemia, and it was seen that the values improved when these measures were taken.

Transfusion-related acute lung injury (TRALI) is second important the leading cause of transfusion-associated mortality in high-risk patients undergoing major surgery. TRALI presented with acute hypoxia and non-cardiac edema is a vital clinical entity which must be considered in differential diagnosis in transfusion-associated patients. Fresh frozen plasma, erythrocyte suspension and thrombocyte suspension transfusion was performed perioperative and postoperative to the patient undergoing supracoronary graft interposition due to ascending aortic aneurysm. Respiratory support treatment with positive pressure mechanical ventilation was began for acute hypoxia and bilateral pulmonary edema developed immediately after. The patient thougth to be delayed TRALI was extubated postoperative day 5. Non-invasive mechanical respiratory support treatment was proceeded. The oxygen and ventilatory support need has been completely eliminated postoperative day 10. TRALI should be considered in patients with acute onset of hypoxia, ARDS especially undergoing major surgery and transfused large amounts of ES, FFP, trombocyte suspension. Noninvasive-mechanical ventilation option should be considered as a treatment.

Key words: Blood Component Transfusion; Aortic Aneurysm