Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery.
Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded.
Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05).
Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

Objective: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU). VAP develops 10-20% of patients in 48 hours of mechanical ventilation. In this study, it was aimed to determine the effect of preoperative oral chlorhexidine rinse on VAP and mortality in patients undergoing open cardiac surgery.
Methods: 300 patients who were planned to undergo elective open cardiac surgery were included in this study. Patients were prospectively randomized into two groups by a computer software. Group 1: Patients brushing their teeth and then gargling with 0.12% chlorhexidine before bedtime at the last night before surgery and 15 minutes before going to the operating room. Group 2, It consisted of patients only brushing their teeth.
Results: VAP was seen in 3 patients (2.12%) in Group 1 and in 12 (8.10%) patients in Group 2 (p<0.02). Duration of intubation was 15±7.40 hours for Group 1 and 23 32.01 for Group 2. These differences were statistically significant (p <0.01). Although duration of ICU stay and hospital stay in Group 1 are shorter than in Group 2 but it was not statistically significant (p>0.05). There was no difference in mortality (p>0.05).
Conclusion: Consequently, chlorhexidine gluconate rinse before elective cardiac surgery reduced the VAP rate and duration of intubation but did not change the mortality rate and the length of ICU and hospital stay. On the other hand we think these results would be change in large multicentric studies.

Objective: Desflurane is used in cardiac anesthesia because it provides hemodynamic stability and rapid recovery. In this study, the effects of using different minimal alveolar concentrations (MAC) of desflurane on jugular venous oxygen saturation (SjvO2) and hemodynamic parameters in coronary artery bypass surgery (CABG) were investigated.
Methods: Sixty patients who were scheduled for CABG were divided into 3 groups after obtaining the hospital ethics committee and patient consent. Desflurane was used in these groups at 0.5, 1.0 and 1.5 MAC values, respectively. In addition to routine invasive catheterization, a retrograde jugular venous catheter was inserted. Hemodynamic data, SjvO2, other parameters and blood gas values were recorded before, during and after CPB.
Results: SjvO2 values in all groups were not within the desaturation limit. Glucose, lactate, partial arterial O2 saturation (PaO2) and partial jugular venous O2 saturation (PjvO2) values remained normal. In each group, a decrease was observed in arterial and jugular venous O2 content difference O2CT (a-jv) values due to hypothermia and hemodilution at admission to CPB (p<0.05).
Conclusion: SjvO2 reflects the balance between cerebral blood flow and cerebral oxygen metabolic rate and the adequacy of cerebral perfusion. In previous studies; The effects of isoflurane, sevoflurane and desflurane on SjvO2 at 0.5 MAC level during CABG were investigated. The effects of the three inhalation agents on SjvO2 were similar. It was determined that cerebral autoregulation was not impaired and SjvO2 values did not decrease in 3 different MAC values of desflurane used in our study. However, it was observed that 0.5 MAC dose, which was also reflected in the hemodynamic findings, did not suppress the stress response sufficiently, and higher MAC values provided hemodynamic stability, especially in hypertensive patients. 1.5 MAC causes hypotension in some patients and vasopressor drugs may be needed. Hemodynamic stability is provided at a MAC value of 1.0.

Objective: There is little data in the literature on the effects of COVID-19 in patients undergoing cardiac surgery. Our aim in this study is to describe the post-cardiac surgical effects of COVID-19, the basic characteristics of the patients and their laboratory findings; and also to discuss the mechanism underlying the poor diagnostic performance of rRT-PCR.
Methods: The data of 191 patients who were operated between 18 May 2020- 07 June 2021 were retrospectively analyzed. A total of 12 patients who were asymptomatic and rRT-PCR (-) preoperatively and rRT-PCR positive postoperatively were included. Patients who required emergency operation, did not perform rRT-PCR in the preoperative period or had rRT-PCR (+), had outpatient surgery were not included. The patients’ age, operation, length of stay in the ICU, intubation times, echocardiography, blood gas and biochemistry results and PCR results were recorded.
Results: In the study, postoperative rRT-PCR was studied from 87 patients and the result was (+) in 12 (13.8%) patients. Two of 12 (16.7%) patients died due to SARS-CoV-2 pneumonia. While the mean values of preoperative leukocytes (7.78 103/mcL), lymphocytes (1.52 103/mcL) and CRP (49.27mg/dL) were within the normal range, the mean values of ferritin (823 ng/ml) and D-Dimer (1138 ng/ml) were above the normal range.
Conclusion: We recommend that patients has to be isolated for at least 7 days before the operation. Also sputum samples from the tracheal tube should be studied simultaneously nasopharyngeal PCR samples in the preoperative and the early postoperative period in order to minimize false negative PCR results.

Objective: In this study, the effect of open heart surgery on triiodothyronine (T3) functions
was investigated in patients undergoing congenital cardiac surgery.
Methods: 30 patients who underwent elective congenital cardiac surgery were prospectively
enrolled in the study. Preoperatively (T0), during cardiopulmonary bypass (T1), postoperative
0th hour (T2), postoperative 1st day (T3), 2nd day (T4), 3rd day (T5) and 8 days (T6), free T3,
thyroxine (T4) and thyroid stimulating hormone (TSH) values, intubation time, intensive care
and hospital stay were recorded.
Results: According to T0 time T3 levels decreased statistically significantly in T2, T3, T4 and
T5 periods, TSH levels decreased in T2, T3 and T4 while T4 levels were found to be statistically
significantly lower at T2 and T3 periods than T1 time.(p <0.05). There was a negative
correlation between T3 levels and the duration of intubation and hospital stay at the change
in T5 time compared to T0 time.
Conclusion: It was found that T3 levels decreased after congenital cardiac surgery, and
triiodothyronine levels negatively affected the duration of intubation and hospital stay

Objective: The aim of the study is to compare the hemodynamic and sedation results of patients who underwent anesthesia for electrical cardioversion (EC) during a one-year period in the coronary intensive care unit, retrospectively.
Methods: 60 patients who were administered ketamine or fentanyl in addition to midazolam, which was administered EC for the correction of atrial fibrillation rhythm, were evaluated in terms of the study. According to the sedation applied to the patients, they were divided into two groups as Group F (midazolam-fentanyl) and Group K (midazolam-ketamine). The hemodynamic parameters of the groups before and after the procedure and the sedation data during and after the procedure were compared.
Results: The pre-intervention heart rate of the patients was found to be high in Group-F (p<0.05). There was no significant difference between the two groups in terms of systolic and diastolic blood pressures (p>0.05). While heart rate was observed to be statistically higher after the intervention in midazolam-fentanil applied patients, a statistically significant decrease was found in diastolic blood pressures (p<0.05). When Ramsay sedation scale was evaluated; There was no significant difference between the two groups at the 5th, 10th and 15th minutes (p>0.05).
Conclusion: It was determined that the combination of midazolam + fentanyl or midzolam + ketamine provided adequate sedation at standard doses and had no adverse effects on hemodynamic and sedation parameters. These results made us think that both protocols can be safely applied for electrical cardioversion sedation in intensive care units.

Objective: Our study aimed to examine retrospectively the anesthesia techniques and their results
applied to patients who underwent endovascular aortic repair due to aortic pathology.
Methods: This retrospective and observational study included patients who underwent EVAR or
TEVAR for abdominal and/or thoracic aortic aneurysm between 2015-2021. Patients’ demographic
data, type of surgery and anesthesia, duration of surgery and anesthesia, amount of blood
transfusion, lengths of stay in ICU and of hospital were recorded.
Results: The data of 206 patients who underwent EVAR and TEVAR for abdominal and/or thoracic
aortic aneurysm were obtained. TEVAR was applied to 63 patients and EVAR was applied to 143
patients. The procedure was performed under general anesthesia (GA) in all 63 patients who
underwent TEVAR, while 15 patients who underwent EVAR were operated under GA and 128
patients under regional anesthesia (RA). The mean anesthesia and surgery times were found
136.1±72.0 min. and 112.2±71.3 min. in GA patients and it was 112.2±71.3 min. and 96.5±32.1
min. in RA patients. The mean length of ICU and hospital stays were determined as 1.6±2.1 days
and 3.1±2.7 days in GA patients, and 1.2±0.6 days and 3.1±2.5 days in RA patients.
Conclusion: GA or RA methods are preferred as anesthesia techniques in patients undergoing EVAR
due to aortic aneurysm. Although RA has advantages compared to GA, such as shorting the lenght
of hospital and ICU stays, reducing the blood product requirements, shorting both anesthesia and
surgery times, patient characteristics should also be considered in the selection of anesthesia
techniques.

Objective: Objective of this study is to analyze the results of patients who underwent embolization treatment with n-butyl cyanoacrylate in vena saphena magna due to chronic venous insufficiency (CVi).
Methods: 241 patients who underwent saphena ablation due to venous stasis between January 2017 and 2020 at Bozok University Medical Faculty Hospital were included in the study. Cyanoacrylate embolization (CAE) was performed on 249 extremities in 241 patients with vena saphena magna (VSM) diameter above 5.5 mm and saphena-femoral junction reflux duration longer than 0.5 s as measured by Color Doppler Ultrasonography (CDU). Patients were followed up with clinical examination at post-op Day 7 post-op and CDU scans at Months 1 and 6.
Results: Mean age was 42.7±12.35 years, and the average diameter of the saphenous vein was 8.21±2.5. The operation time was 15.27 minutes on average and the patients were discharged on the same day. Thrombophlebitis developed in 12 (4.81%) of our cases; cellulitis in 4 patients (1.60%); and erythema on the skin over the trace of the saphenous vein in 20 patients (8.03%) and improved with medical treatment. Partial recanalization was identified in 8 VSMs (3.21%) in CDU controls at Month 6. No patients developed deep vein thrombosis or neurological complications.
Conclusion: Shorter operation and discharge durations, high VSM obliteration, low complication rates are the outstanding properties of CAE. The fact that the technique is limited with patients with tortuous veins as is the case with all procedures requiring a catheter has not been able to completely exclude conventional surgery.

Objective: History and chest x-ray are the main diagnostic tools in children with foreign body aspiration (FBA). The study aims to evaluate clinical, radiological, and bronchoscopic findings associated with early and delayed diagnosis of FBA.
Methods: The records of 249 children having bronchoscopy for suspected FBA were analyzed in three groups as negative bronchoscopy for FBA (group I), early diagnosis (group II), and delayed diagnosis (group III).
Results: Choking episodes, coughing, and decreased breath sounds were determined significantly in FBA. The percentage of radiopaque FBs was 6.2%. Emphysema in groups II and III; atelectasis and pneumonia in group III were significantly higher on chest x-ray. Pneumonia and significant inflammation found during bronchoscopy were prominent in group III. FBs were mostly vegetable origin and the majority were found in the bronchus, more on the right side. FBs were successfully removed by rigid bronchoscopy except one having thoracotomy.
Conclusion: Review of the literature, our current (2010-2019) and previous (1994-2003) studies designed in the same group structure showed that choking episode associated with a radiopaque FB leads to bronchoscopy. Emphysema and atelectasis are also valuable for early diagnosis. Regardless of radiological findings, bronchoscopy should be considered in patients with a strong history.

It is necessary to open subcutaneous arteriovenous fistulas for patients with chronic renal failure for the future steps of dialysis. These surgical procedures are performed under sedation, local anesthesia, regional anesthesia, or general anesthesia. In this case report, we shared our anesthesia experience in a patient with comorbid diseases, high BMI, and difficult airway to undergo fistula surgery between the left brachial artery and the left axillary vein. We performed serratus anterior plane block and infraclavicular block which was successful, and the surgical procedure was performed comfortably without any complications. Infraclavicular block and upper-level serratus anterior plane block can be applied together for anesthesia of the T1-T2 dermatome.