Pheochromocytoma is a rare tumor that originates in the adrenal medulla and causes serious hemodynamic fluctuations due to excessive catecholamine secretion. In the preoperative period, patients’ blood pressure and cardiac functions were stabilized using alpha-blockers, beta-blockers, and fluid therapy. Hypertensive responses related to medications, laryngoscopy, and surgical stimulation were controlled during anesthesia induction through train-of-four and surgical pleth index monitoring, utilizing lidocaine, propofol, rocuronium, and remifentanil. Sevoflurane and remifentanil were used during the maintenance period. Intraoperative hemodynamic stabilization was achieved with continuous monitoring of dynamic parameters such as cardiac output, global end-diastolic index, systemic vascular resistance index, extravascular lung water index, global ejection fraction, stroke volume variation, and pulse pressure variation using the PiCCO (Pulse Contour Cardiac Output, Pulsion Medical Systems SE, Feldkirchen, Germany) monitoring method. Postoperatively, patients were extubated and followed closely in the intensive care unit under multimodal analgesia. The findings indicate that PiCCO is an effective tool in hemodynamic management and in the prevention of complications during pheochromocytoma surgery. These results emphasize the value of PiCCO in optimizing perioperative outcomes. Keywords: Pheochromocytoma, PiCCO, hypertension

Background/Aim: Liver transplantation surgery is one of the most common abdominal surgeries requiring blood transfusion. Coagulation parameters vary during the perioperative period because of the patient profile. Blood transfusion management should be carefully controlled to avoid causing dysfunction in the newly transplanted organ. Various laboratory parameters are used to achieve this. This study aimed to investigate the effect of transfusion managed by conventional coagulation tests or thromboelastogram (TEG) on blood product consumption and postoperative outcomes in the post-reperfusion period. Methods: The records of 90 recipients who underwent transplantation between January 1, 2012, and November 30, 2022, were retrospectively analyzed. Twenty patients who were administered blood transfusion under TEG guidance in the post-reperfusion period constituted the case group, while 20 patients non-consecutive randomly selected among other patients who were administered blood transfusion with conventional coagulation tests constituted the control group. In conclusion, 40 patients were included in this retrospective case-control study. We retrospectively analyzed demographic data, surgical data, perioperative laboratory parameters, intraoperative total and post-reperfusion blood and blood product transfusions, TEG parameters, and postoperative complications. Results: No difference was found between the groups regarding demographic data, etiological factors, surgical data, and preoperative laboratory parameters (P>0.05). There was a significant decrease in the amount of fresh frozen plasma (FFP) transfused in the case group compared to the control group in the intraoperative total and post-reperfusion period (P=0.011, P=0.003). There was no difference between the groups regarding other blood product transfusions and postoperative complications (P>0.05). Regarding the effects of intraoperative total and post-reperfusion blood and blood products on ventilator stay, intensive care unit stay, length of stay (LOS), hepatic artery thrombosis, graft rejection, postoperative kidney damage, and first 28-day mortality, only a weak negative correlation was found between intraoperative total and postreperfusion fibrinogen use and LOS (r=-0.325/P=0.041, r=-0.354/P=0.025). Conclusion: TEG-guided transfusion in the post-reperfusion period reduced total blood product consumption. Besides, the increase in the use of fibrin has led to a decrease in LOS. However, using TEG has no significant effect on postoperative mortality and morbidity. TEG and an objective assessment of patient clinical status may be an ideal guide for transfusion strategy.

ABSTRACT Background Hemorrhoidal disease is a common benign anorectal disease. Acute thrombosis that occurs during the course of hemorrhoidal disease is a painful complication. Factors affecting its etiopathogenesis are not known definitively. The aim of this study, therefore, was to assess predisposition to coagulation during the development of the disease. Method 30 patients with acute thrombosed hemorrhoidal disease and 30 other patients with hemorrhoidal disease but no thromboses were included in the study. Samples collected from these patients were analyzed with thromboelastography machines. The results were compared with patients’ demographic data. Results No statistically significant difference was found between the groups as per age, sex, diarrhea, history of a similar attack, history of surgical treatment, spicy food consumption, fibrous food consumption, and regular exercise. The results of our study revealed that the alpha angle was smaller in patients with acute thrombosed hemorrhoidal disease. Conclusion Hypercoagulability does not occur in patients with acute thrombosed hemorrhoidal disease

BACKGROUND:There is still a debate about what constitutes effective and safe postoperative analgesia in hepatectomy surgery. Erector spinae plane (ESP) block may be an important part of multimodal analgesia application in hepatectomy surgery.OBJECTIVES:To compare the effects of ultrasound-guided bilateral erector spinae plane block combined with intravenous (iv) patient-controlled analgesia (iv PCA), in comparison with iv PCA alone, in hepatectomy surgery.DESIGN AND SETTINGS:Randomized prospective single-blinded study in a tertiary university hospital.METHODS:Fifty patients scheduled for elective hepatectomy surgery were included in the study. Patients were randomized into the ESP group or the control group. In the ESP group, bilateral ESP block was performed preoperatively and iv PCA was used. In the control group, only iv PCA was used. Numerical rating scale (NRS) scores at rest and coughing, analgesic requirements and occurrences of nausea and vomiting were recorded.RESULTS:Intraoperative and postoperative opioid consumption, rescue analgesia requirement and resting and dynamic NRS scores were significantly lower in the ESP group (P < 0.05). There was no significant difference between two groups in terms of the presence of dynamic pain after the first postoperative hour. While all patients in the control group had nausea and vomiting, 24% of the patients in the ESP group did not have nausea and vomiting.CONCLUSION:This study showed that ESP block can be used as a part of multimodal analgesia, with the benefit of reducing opioid consumption and postoperative nausea and vomiting in hepatectomy surgery.CLINICAL TRIAL REGISTRATION:ACTRN12620000466943.

Background/Aim: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive techniques used for intracranial pressure (ICP) measurement. ICP changes have been evaluated based on ONSD measurements during many laparoscopic surgeries. However, such analyses in the obese patient populations are limited. This study aimed at investigating the effects of pneumoperitoneum and reverse Trendelenburg and head-up position on ICP based on ONSD measurements in obese patients undergoing laparoscopic cholecystectomy. Methods: This observational study included 60 female patients who were scheduled for laparoscopic cholecystectomy. Obese patients with a body mass index (BMI) of 30 and above were assigned to Group 1, while BMI < 30 patients were assigned to Group 2. The first ONSD measurement was performed just before insufflation (T1). The second measurement was taken 5 min after insufflation (T2), the third measurement 5 min after placing patients in the reverse Trendelenburg and head-up position (T3), and the last measurement 5 min after the deflation while the reverse Trendelenburg and head-up position was maintained (T4). Results: ONSD measurements at the T2 and T3 time points in Group 1 patients were higher than in Group 2 patients (P = 0.012 versus P = 0.020). Both measurement values were higher in obese patients. In Group 1 patients, T2 and T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P < 0.001). No significant difference between T2 and T3 and between T1 and T4 measurements were found. In Group 2 patients, T2 measurements were significantly higher than the T1, T3, and T4 measurements, while T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T3; P = 0.022, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P = 0.048). No significant difference between T1 and T4 measurements was noted. Conclusion: Laparoscopic cholecystectomy does not cause an increase in ICP of obese patients with limited pneumoperitoneum pressure, reverse Trendelenburg and head-up position, and controlled anesthesia.

Objective: Adequacy of anaesthesia provides information about electrical activity of the brain with entropy, and analgesic response of the body with surgical pleth index (SPI). In this study, we aimed to evaluate the effects of anesthetic management performed using adequacy of anaesthesia monitorization on intraoperative hemodynamics, postoperative recovery and the cost of anesthetic drugs. Design: Prospective, randomized and controlled study Setting: Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey Subjects: A total of 120 patients scheduled for thyroidectomy operation under general anesthesia were included in the study. Intervention: Patients divided into two equal groups as Group Adequacy of Anesthesia (Group AoA, n=60) and Group Control (Group C, n=60). For the induction, Group C was maintained with 1-2 mg/kg propofol and 1 mu g/kg remifentanil injection, while based on the entropy and SPI values during the induction, Group AoA was injected with propofol and remifentanil so as to provide state entropy and SPI values of 50 +/- 10. Main outcome measures: Hemodynamic data, times and recovery data were recorded and statistically analyzed. Results: Extubation and recovery times were significantly shorter in Group AoA (P=0.29, P<0,01, P << 0.01; respectively). The cost of anesthesia calculated based on the amount of drugs used was significantly lower in group AoA (P<0.01). Conclusion: In this study where we compared the use of adequacy of anesthesia with conventional anesthetic depth monitorization methods, we found that the use of adequacy of anesthesia provided positive contributions to the cost of anesthetic drugs and post-anesthetic recovery.

BACKGROUND:The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases.METHODS:The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I-II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed.RESULTS:R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year.CONCLUSION:When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.

Background and aim: A high D-dimer level may indicate the risk of coagulopathy and mortality in COVID-19 patients. Thromboelastography (TEG) is a test that evaluates clot formation and fibrinolysis in real-time, unlike routine coagulation tests. The study aimed to investigate the coagulation process with TEG in patients diagnosed with COVID-19. Materials and Methods: The study was performed at our university hospital, chest diseases outpatient clinic as a cross-section study. A total of 51 patients with 23 high D-dimer levels group (HDG) and 28 low D-dimers group (LDG) were included in the study. TEG analysis was performed at the pretreatment evaluation in these two groups. Results: D-dimer and fibrinogen levels of the HDG were higher than those of the LDG (550 vs. 90 ng/mL, p < 0.001; 521 vs. 269 mg/ dL, p < 0.001, respectively). In TEG analysis, HDG's R and K values were lower than LDG, and HDG's Angle, MA, and CI values were higher than LDG (p = 0.037; p < 0.001; p < 0.001; p < 0.001; p < 0.001, respectively). ROC curve analysis suggested that the optimum TEG parameters cut-off points for thrombosis risk were as below: for K was <_2.1 min, for R was <_6.1 min, for Angle was >62 degrees, MA was 60.4 mm. Conclusion: Our study showed that the risk of thrombosis might increase in COVID-19 patients who are not hospitalized in the intensive care unit. Thrombosis risk should be investigated with TEG analysis and laboratory tests in every patient diagnosed with COVID-19, and treatment should be started for risky patients.

Bilisim sistemleri gunumuz dunyasinda insanlarin arastirmalarini, calismalarini, sosyal iliskilerini ve hatta egitimlerini yaptiklari platformlar haline gelmistir. Bu sistemler ozellikle 2000li yillardan sonra hayatimizin her asamasina hizla girmistir. Bu hizli yayginlasma sonucu insanlarin ihtiyaclarini karsilayacak alt yapi sistemlerinde de buyuk gelismeler ve degisimler surekli yasanmaktadir. Bu calisma, Inonu Universitesi’nde gerceklestirilmis olan bilisim altyapi projesinin asamalarini, karsilasilan problemleri ve tercih edilen altyapi teknolojilerini anlatmayi amaclamaktadir. Bu sayede benzer calisma gerceklestirebilecek kurum ve kuruluslara fayda saglamasidir. Inonu Universitesi olarak bu anlamda, 2019 yilinin son ceyreginde gerceklestirilen bir proje ile sunucu-depolama ve ag sistemlerinin yenilenmesi, kapasitesinin arttirilmasi ve kablosuz erisim noktasin kapsama alaninin genisletilmesine gidilmistir. Bu sayede universite personeline yetersiz duruma gelen bilisim sistemlerinin ihtiyaclari karsilayacak hale getirilmesi amaclanmaktadir.

Aim: Postoperative sore throat after general anesthesia with laryngeal mask airway is a common and undesirable complication. There are many agents and methods to prevent this complication. However, there is no study comparing intravenous lidocaine and lidocaine-paracetamol combination in the literature. The objective of this study was to compare the effects of systemic lidocaine and systemic lidocaine-paracetamol combination on postoperative sore throat in patients who underwent general anesthesia with laryngeal mask airway. Methods: A total of 80 patients aged over 18 years with ASA I-III who underwent elective inguinal hernia surgery under general anesthesia with laryngeal mask airway were included in this cross-sectional study. Group LidoPara was administered 1 mg kg-1 lidocaine + 10 mg kg-1 paracetamol, and Group Lido, 1 mg kg-1 lidocaine. Resting and swallowing sore throat and hoarseness were evaluated with a 4-point scale at the postoperative 0th, 2nd, 4th, and 24th hours. Results: Demographic data of the patients were similar (P>0.05). There was no statistically significant difference between the two groups in terms of resting and swallowing sore throat at the postoperative 0th, 2nd, 4th, and 24th hours. No hoarseness was found in both groups at the postoperative 4th and 24th hours. Conclusion: Combined paracetamol and lidocaine was found to affect postoperative resting and swallowing sore throat similar to lidocaine alone.

Aim: Endoscopy under anesthesia creates stress and anxiety in children and their parents. In this study, we aimed to determine the preoperative anxiety levels of parents and patients who were routinely informed before endoscopy and examine the relationship between children and parents' state and trait anxiety levels. Methods: A cross-sectional study was planned in which pediatric patients and parents were included. The study comprised 104 ASA I-II patients, aged 6-14 years, who were scheduled for endoscopy under deep sedation, and their parents. Immediately after the child patient was taken to the treatment room, parents were asked to fill out the State-Trait Anxiety Inventory. The demographic characteristics of the patients were recorded. The children’s anxiety level immediately after separation from parents was evaluated with Modified Yale Preoperative Anxiety Scale (m-YPAS). The patients were divided into two groups according to anxiety levels. Those with m-YPAS >30 were considered the anxiety (+) group, m-YPAS ≤30 were defined as the anxiety (-) group. Results: The mean age of the patients was 11.8 (2.6) years (6-14). Twenty-nine patients had m-YPAS> 30, and 75 patients had m-YPAS ≤30. Parent anxiety levels were not significantly different between the two groups. There was a strong negative correlation (r=-0.589, P<0.001) between child’s anxiety and child age, a negative moderate correlation between child’s anxiety and parent age (r=-0.259, P=0.008), and weak positive correlation between child’s anxiety and complications (r=0.218, P=0.026). Young age was determined as an independent risk factor for increased child anxiety (OR: 0.501, P<0.001, 95% CI: 0.390-0.643). Conclusion: There is no relationship between preoperative anxiety in school-age children and parental anxiety. Young age is an independent risk factor for the development of anxiety in the child.

In this study, we aimed to evaluate the effects of different agents used for anesthesia maintenance on liver enzymes and lactate changes in patients undergoing laparoscopic cholecystectomy using CO2 pneumoperitoneum with constant pressure. Seventy-five patients planned to undergo laparoscopic cholecystectomy operation have been randomly divided into 3 groups. Liver function tests have been evaluated preoperatively and postoperatively in the 24th hour. Arterial blood samples for lactate level determination were obtained: (T_1) immediately before pneumoperitoneum, (T_2) 10 min after pneumoperitoneum, (T_3) 30 min after pneumoperitoneum, (T_4) 60 min after desufflation of CO2. Patients scheduled to undergo laparoscopic cholecystectomy operation. The possible effects of different agents used for anesthesia maintenance on liver enzymes and lactate changes in patients undergoing laparoscopic cholecystectomy. In comparison of lactate values, there were no differences between the three groups in T_1, T_2 and T_4 measurements (P=0.059, P=0.108, P=0.225). However, in the T_3 measurements, lactate values are lower in the Group P, compared to Group S and D (P=0.001, P=0.001). Postoperative AST and ALT values are lower in the Group P, compared to Group S and D (P [Med-Science 2019; 8(1.000): 180-5]

Background/aim Ultrasonographic measurements of inferior vena cava (IVC) diameters and right ventricle (RV) volumes are important tools for the evaluation of intravascular volume. The current study investigates the association of IVC diameters and RV volumes before colonoscopy in prediction of postanesthesia hypotension. Materials and methods Seventy patients scheduled for colonoscopy were included in the study. Preoperatively, expirium (dIVC max) and inspirium (dIVC min) IVC diameters were measured using M-mode ultrasonography and the collapsibility index (IVC-CI) was calculated. Ventricular volumes and areas were also measured using transthoracic echocardiography. Postanesthesia hypotension was defined as mean arterial blood pressure of <60 mmHg or a decrease of >30% in the mean arterial pressure after sedation. Results Minimum and maximum IVC diameters were significantly lower (P = 0.005 and P < 0.001, respectively) and IVC-CI was significantly higher (P < 0.001) in patients who developed hypotension. Similarly, right ventricular end-diastolic area (RV-EDA), right ventricular end-systolic area (RV-ESA), right ventricular end-diastolic volume (RV-EDV), right ventricular end-systolic volume (RV-ESV), and left ventricular end-systolic volume (LV-ESV) values were significantly lower in patients with hypotension (P < 0.05). Logistic regression analysis showed that dIVC min and RV-ESA were independent predictors of hypotension. Conclusion IVC diameters and RV-ESA, RV-EDA, RV-ESV, and RV-EDV are good indicators of preoperative volume status and can be used to predict the patients at risk of developing hypotension.

Purpose: In this study we aimed to evaluate effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following anesthesia induction, and in determining hypovolemia occurring in patients undergoing bowel preparation as secondary outcomes. Materials and Methods: The study included patients with American Society of Anesthesiologists physical status classification (ASA) I-II, aged between 18 and 65 years who were scheduled for gastrointestinal operation under general anesthesia. Fourty-two of the 84 patients included underwent bowel preparation. Patients’ maximum diameter of inferior vena cava (dIVCmax) and minimum diameter of inferior vena cava (dIVCmin), inferior vena cava collapsibility index (IVC-CI) and preinduction basal mean arterial pressure (MAP) was measured. Results: Thirty-nine (46.4%) of the 84 patients developed hypotension after general anesthesia induction. Cut-off for dIVCmax was found as 15.750 mm with ROC analysis. Specificity and sensitivity for the cut-off value of 15.750 mm were calculated as 55.6% and 71.8%, respectively. Cut-off for IVC-CI was found as 32.746 % with ROC analysis. Specificity and sensitivity for the cut-off value of 32.746 % mm were calculated as 83.3% and 74.4%, respectively. Conclusion: According to our data, IVC ultrasonography may be helpful in prediction of preoperative hypovolemia in patients. IVC-CI was higher and dIVCmax was lower and the incidence of hypotension was higher in patients who underwent bowel preparation compared to the patient who did not undergo.

Limb-girdle musküler distrofiler (LGMD), otozomal dominant veya resesif geçiş özelliği gösteren, pelvis ve omuz çevresi kaslarında ilerleyici zayıflık ve atrofi ile ortaya çıkan, heterojen

Ponte Academic JournalDec 2018, Volume 74, Issue 12 ACTIVATED CARBON USE IN PASSIVE WASTE GAS SYSTEM FOR OPERATING ROOMSAuthor(s): Ahmet Topal ,Resul Yilmaz, Mehmet SarginJ. Ponte - Dec 2018 - Volume 74 - Issue 12 doi: 10.21506/j.ponte.2018.12.1 Abstract:Introduction: The operating room atmosphere is constantly contaminated with the anesthetic gases from the leak valves of the anesthesia machines, due to the closure mechanisms of the vaporizers not being safe and even from the expiratory air of the patients. The main goal in designing this study was to create safer and healthier conditions by cleaning the operating theaters, the ongoing work areas of the anesthetists, of the inhaler pharmacological agents used. Methods: This work was based on the identification of circulating anesthetic agents in the flow circulation. For this reason, it is planned for this purpose to prepare a circuit consisting of two gas modules, the respiratory circuit which will measure the anesthetic agent, and an activated carbon filter. Results: The total elimination time for isoflurane was 71 hours, for sevoflurane 49 hours and for desflurane 23 hours. When the amounts of volatile agents in the incoming and outgoing streams were equalized, an increase of 370 gr for isoflurane, 312 gr for sevoflurane and 335 gr for desflurane was observed. Conclusion: We believe that active carbon containing filter which will be integrated into the waste gas system will make the operating room environment safer for anesthetic gases and that chronic exposure to exhaust gases can be reduced considerably by regular use. Furthermore, in hospitals with active waste gas systems, the using of activated carbon filter at the atmospheric release point of the waste gases, can be considered. Download full text:Check if you have access through your login credentials or your institution Username Password

OBJECTIVES:We aimed to retrospectively investigate the efficacy of ultrasound guided rectus sheath block (RSB) method in our study.METHODS:We scanned 235 patient files operated for abdominal pathology. Patients meeting the criteria were evaluated for intra-operative rectus sheath block and two different groups were formed. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from patient controlled analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated.RESULTS:Postoperative VAS values (Postoperative 1, 12 and 24 hours p<0.001), DEM values (Postoperative 1, 12 and 24 hours p<0.001) and total amount of morphine consumed (Postoperative 1, 12 and 24 hours p<0.001) were lower in patients with RSB. Also, in patients with RSB nausea (p=0.014) and vomiting was less seen postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with RSB and constipation was seen in 30 patients without RSB (p=0.00).CONCLUSION:Ultrasound guided rectus sheath block is an effective method for postoperative pain control.