We read the interesting article by Sert et al. (1) published in Turkish Journal Anaesthesiology and Reanimation, wherein the primary aim was to compare the patient outcomes, requirement for transfusion, and cost of transfusion between two different periods with and without patient blood management (PBM) protocol. The authors found that the transfusion of unnecessary blood and blood products was reduced and the cost decreased with PBM protocol, although blood product usage did not affect 30-day mortality.
First, all anaesthetic agents have some impact on the pulmonary system, and anaesthesia technique used per-se has minimal impact on the postoperative pulmonary morbidity (2), whereas the mechanical ventilation technique used, parameter settings and the addition of the amount of positive end-expiratory pressure, operative insult, and the patient’s ongoing pathophysiological insults have a significant impact on postoperative pulmonary functional adversities and ensuing increased morbidity (3). In addition to the amount and type of intravenous fluid used, overall fluid balance is a significant predictor (4). Elaboration and clarification of this information will help us better understand and interpret the results.
Injurious Ventilation and Post-Operative Residual Curarization : A Dangerous Combination Reply
Cerebral fat embolism syndrome is a rare, but potentially lethal, complication of long bone fractures. Neurological symptoms are variable, the clinical diagnosis is difficult and occurs in only 0.9-2.2% of these cases. A 19 yearold male with no head injury suffered 3 epileptic seizures 17 hours after left femoral shaft and left tibia fractures. He had hypoxia. Chest x-ray and thoracic computed tomography (CT) were normal. T2 and diffusion weighted magnetic resonance imaging (MRI) showed multiple hyperintesity within the bilateral basal ganglia. We thought that this indicated areas with multiple microemboli. He was intubated after clinical deteriotation. Heparin, acetylsalicylic acid, mannitol and corticosteroids were administered, he was operated on next morning for left femoral shaft and left tibia fractures and he showed neurological improvement after 24 hours. Diffusion weighted MRI of the brain should become the first step in the diagnostic algorithm of cerebral fat embolism and patients have neurological improvement with early diagnosis and appropriate management.
Main Points• Percutaneous tracheostomy is usually a beneficial and safe procedure.• Fractures and aspiration of the tracheostomy tubes are rare but possible complications.• Tubes can be manufactured as single rather than two connected pieces.• Mechanical stress associated with prone positioning may have facilitated the fracture of tracheostomy tubes.
Objective: During functional endoscopic sinus surgery (FESS), sufficient control of bleeding is essential in order to increase the visibility in the operative field and reduce the risk of injury to the optic nerve or internal carotid artery. However, choosing the ideal agent is still a controversial topic. The aim of this study is to compare the effects and possible side effects of remifentanil and dexmedetomidine for controlled hypotension in FESS.
Main Points• Percutaneous tracheostomy is usually a beneficial and safe procedure.• Fractures and aspiration of the tracheostomy tubes are rare but possible complications.• Tubes can be manufactured as single rather than two connected pieces.• Mechanical stress associated with prone positioning may have facilitated the fracture of tracheostomy tubes.
Main Points• Percutaneous tracheostomy is usually a beneficial and safe procedure.• Fractures and aspiration of the tracheostomy tubes are rare but possible complications.• Tubes can be manufactured as single rather than two connected pieces.• Mechanical stress associated with prone positioning may have facilitated the fracture of tracheostomy tubes.
Kartagener sendromu bronsektazi, sinuzit ve situs inversusla karakterize otozomal resesif gecisli bir hastaliktir. Bu yazida kombine genel ve torakal epidural anestezi altinda pulmoner rezeksiyon yapilan Kartagener send- romu ve bronsektazisi olan hastamiz sunuldu. Bu nadir hastalikta akciger izolasyon teknikleri; hastaya ve anesteziste gore degismektedir. Olgumuz- da; sol orta ve alt lobektomi icin sag ana bronsa, sol cift lumenli tupun bronsiyal lumeni sagda olacak sekilde yerlestirildi. Toraks cerrahisi geciren KGS'li hastada sevofluran ile kombine genel ve torakal epidural anestezi- nin avantajlari ve uygun anestezik yaklasimlar tartisildi.
Yöntemler: Etik kurul izni ile, ASA I-III 210 olgu çalışmaya alındı. Preoperatif anestezi viziti öncesi tüm hastaların Süreksiz Durumluluk/Sürekli Kaygı Envanteri (State Trait Anxiety Inventory-STAI) ile bazal anksiyete düzeyleri ölçüldü ve anestezi ile ilgili endişeleri sorgulandı. Hastalar görsel ve kontrol grubu olmak üzere 2 gruba ayrıldı. Görsel gruptaki hastalar; spinal anestezi yönteminin resimlerinden oluşan bir katalog ile, kontrol grubundaki hastalar ise standart yazılı bilgilendirme formu ile bilgilendirildi. Preoperatif ve postoperatif her iki gruba STAI tekrarlandı ve anestezi ile ilgili endişeler sorgulandı. Hastaların intraoperatif sedatif ilaç kullanımı, postoperatif ağrı skorları ve analjezik ihtiyaçları kayıt edildi.
Main Points• Percutaneous tracheostomy is usually a beneficial and safe procedure.• Fractures and aspiration of the tracheostomy tubes are rare but possible complications.• Tubes can be manufactured as single rather than two connected pieces.• Mechanical stress associated with prone positioning may have facilitated the fracture of tracheostomy tubes.
