Acute kidney injury (AKI) is a critical clinical condition characterized by a sudden loss of kidney function, accompanied by complex metabolic and structural changes. In this study, the early molecular and metabolic effects of AKI were investigated using an ischemia-reperfusion (IR) model. The study aims to evaluate the levels of total autofluorescent molecules, analyze diffuse reflectance spectroscopy (DRS) findings, and understand the roles of oxidative stress biomarkers and functional parameters in the kidney IR. The IR model was applied in rats, DRS data were measured in vivo from the kidney and from isolated mitochondria using a fiber optic probe. Additionally, NADH and FAD levels were assessed in serum and mitochondrial isolates using fluorescence spectrometer. Kidney function/injury parameters (creatinine, KIM-1, NGAL and L-FABP) and oxidative stress biomarkers (MDA, L-OOH, dityrosine, kynurenine, and AOPP) were analyzed. In the IR group, significant increases in NADH and FAD levels were observed in both serum and mitochondrial isolates. Oxidative stress biomarkers such as kynurenine, dityrosine, and lipid hydroperoxides also increased in the IR group. DRS analyses of mitochondrial isolates revealed a marked reduction in optical signals in the IR group, but no significant changes were detected in in vivo DRS analyses. Significant correlations were identified between functional and oxidative stress parameters in serum and mitochondria. Although not significant at the tissue, the alterations observed at the mitochondrial level demonstrate the efficacy of the DRS. This study highlights the importance of integrating optical and biochemical approaches to elucidate the effects of IR on mitochondrial-related metabolic processes.

Conventional endpoints may overlook pulmonary biological stress during abdominal mechanical loading and volume expansion. This controlled experimental study evaluated whether intra-abdominal hypertension (IAH), hypervolemia (HV), or their combination induces early pulmonary biochemical, permeability, oxidative-ischemic, inflammatory, and structural responses, with particular focus on surfactant protein A1 (SP-A1). Thirty-five male Wistar rats were randomized to Sham, HV, IAH, or IAH + HV groups. IAH was induced by CO2 pneumoperitoneum at 12-15 mmHg, and HV by 6% hydroxyethyl starch infusion until hematocrit decreased to approximately 25%; animals were followed for 120 min. Physiological variables, blood gases, wet-to-dry ratio, ATS-based histopathology, and biomarkers in plasma, bronchoalveolar lavage (BAL) fluid, and lung tissue were assessed. The dominant finding was a compartment-specific SP-A1 response: plasma SP-A1 was highest in the IAH group, whereas BAL fluid SP-A1 increased in both HV and IAH groups. These changes occurred without significant alterations in MAP, HR, SpO2, wet-to-dry ratio, or ATS lung injury score. Permeability index was higher in HV-containing groups, and sialic acid and oxidative-ischemic markers showed compartment-dependent changes, whereas TNF-α, IL-6, HA, and ANP did not differ significantly. These exploratory, hypothesis-generating findings suggest that SP-A1 may reveal early pulmonary epithelial/barrier stress before overt physiological or structural injury becomes apparent.

There is no consensus on the ideal sweep gas flow volume for achieving targeted blood partial gas pressures during cardiopulmonary bypass (CPB). The sweep gas flow rate is one of the oxygenator's main gas exchange variables. High sweep gas flow rates can lead to respiratory and hypocapnic cerebral alkalosis, which can cause neurological complications.This study included 84 patients aged > 18 years who were scheduled to undergo elective open-heart surgery with CPB. Before rewarming, the participants were randomly assigned to one of the three groups based on their sweep gas flow rates (Group 1, 1.35 L/m2/minute; Group 2, 1.2 L/m2/minute; and Group 3, 1 L/m2/minute). During the surgery, arterial blood gases were sampled at six different time points, and regional cerebral oxygen saturation (rSO2) levels were monitored bilaterally on the forehead.The study found that all groups experienced a decrease in partial pressure of arterial carbon dioxide (PaCO2) levels after the onset of hypothermia, which decreased to below the normal range at a moderate hypothermia level of 32°C. During both the baseline and hypothermic periods, the PaCO2 were similar between the groups; however, after rewarming, Group 3 had significantly higher PaCO2 than Groups 1 and 2 (P< 0.001). During the same period, Group 3 had significantly higher rSO2 levels than Groups 1 and 2 (P = 0.005). For all patients, there was a significant correlation between delta-PaCO2 and delta-rSO2 levels after rewarming (r = 0.45, P< 0.001).This study demonstrated that low sweep gas flow prevented alkalosis and preserved cerebral autoregulation.

Bakım Ortamı Fatma ETİ ASLAN Melike ÇAKIR Hemodinamik Parametreler ve İzlem – Mortalite ve Morbidite Ölçekleri - Yoğun Bakım Skorlama Sistemleri Halim ULUGÖL Fevzi TORAMAN Sıvı – Elektrolit Asit – Baz Dengesi Bozuklukları Özgen ILGAZ KOÇYİĞİT Yoğun Bakımda Malnutrisyon Yönetimi İlayda ÖZTÜRK ALTUNCEVAHİR Yoğun Bakımda Enfeksiyonun Önlenmesi Ferda AKYÜZ ÖZDEMİR İsmail TOYGAR Yoğun Bakım Rutinine Akılda Kalıcı Bir Yaklaşımla Yeniden Bakmak: Fast Hug Fadime ÇINAR Mehmet Aziz ÇAKMAK Yoğun Bakımda Etik Sorunlar Nadiye ÖZER Mozaiğe Seramik ve Camın Katılımı: Adıyaman Mozaikleri Üzerine Bir İnceleme Yaprak TANRIVERDİ Basınçlı Döküm Sistemi Yunis YILMAZER Yüksek Dereceli Odun Yakıtlı Fırınlarda Kül Sırının Dönüştürücü Etkisi ve Fırınlama Aşamaları Bahadır Cem ERDEM Yoğun Bakımda Şefkatli Dokunuş: Mizah ve Gülümseme Saliha KOÇ ASLAN Yoğun Bakımda Ekstrakorporeal Membran Oksijenasyonu Uygulaması ve Yönetimi Göknur PARLAK Fatma ETİ ASLAN Zor Hasta Yönetimi Ayla YAVA Aynur KOYUNCU Yoğun Bakımda Kardiyopulmoner Arrest ve İleri Yaşam Desteği Uygulamaları Göknur PARLAK Ali AKGÜN Fatma ETİ ASLAN Abdominal Distansiyon Sebahat ATEŞ Ağrı Yönetimi Sevim ÇELİK Sibel ALTINTAŞ Yoğun Bakımda Aritmi Tanı ve Yönetimi Zeynep KAPLAN AFACAN Fatma ETİ ASLAN Basınç Yaralanması Pakize ÖZYÜREK Meryem YAVUZ VAN GİERSBERGEN Çocuk Yoğun Bakım Ünitesinde Basınç Yaraları Alev SİVASLI Zerrin ÇİĞDEM Bulantı ve Kusma Dilek AYGİN Deliryum Fatma DEMİR KORKMAZ Fatma ETİ ASLAN Dispne Feride TAŞKIN YILMAZ Epileptik Nöbet Serap GÖKÇE ESKİN Sakine BOYRAZ ÖZKAVAK Hıçkırık Serap GÖKÇE ESKİN Sakine BOYRAZ ÖZKAVAK Hipertermi – Hipotermi Nurdan GEZER Halise ÇİNAR Hipoksi Özlem BİLİK Hipotansiyon - Hipertansiyon Sultan ÖZKAN Ezgi ARSLAN Hipoglisemi-Hiperglisemi Nermin OLGUN Selda GEDİK ÇELİK Kafa İçi Basıncı Artışı Nurhan BAYRAKTAR Dilek ÇİLİNGİR Konstipasyon - Diyare Besey ÖREN Nötropeni Gülbeyaz CAN Yoğun Bakım Ünitesinde Obezite Azime KARAKOÇ KUMSAR Oligüri – Anüri Neriman ZENGİN Oral Mukozitler Ayfer BAYINDIR ÇEVİK Ödem - Dehidratasyon Havva SERT Öksürük ve Balgam Çıkarma Ayşe ÇİL AKINCI Uykusuzluk Hayat YALIN Venöz Tromboembolizm Fatma DEMİR KORKMAZ Yorgunluk Zeynep ERDOĞAN Yutma Güçlüğü Hicran YILDIZ Yoğun Bakımda Sık Görülen Kas İskelet Sistemi Sorunları Hamdiye Banu KATRAN Yoğun Bakımda Solunum Problemlerinin Yönetimi Sena TEBER Yoğun Bakımda Hasta Yakınlarında Görülen Ruhsal Sorunlar Selda POLAT Sol Ventrikül Destek Cihazı Takılan Hastanın Fonksiyonel Sağlık Örüntüleri Modeline Göre Hemşirelik Yaklaşımı: Vaka İncelemesi Gamze ATAMAN YILDIZ Fatma ETİ ASLAN Kalp Kapak Cerrahisi Sonrası Myra Estrin Levine’in Koruma Kuramına Göre Hemşirelik Bakımı: Vaka İncelemesi Havvane KULAKSIZOĞLU Fatma ETİ ASLAN Fontan Dolaşıma Sahip Diyafragma Hernisi Tanılı Hastanın Faye Glenn Abdellah’ın 21 Hemşirelik Problemi Kuramına Göre Bakımı: Vaka İncelemesi Melis Merve ÇETİNKAYA Fatma ETİ ASLAN Robotik Mitral Kapak Replasmanı Sonrası Yoğun Bakımda Takip Edilen Hastanın King’in Amaca Ulaşma Kuramına Göre İncelenmesi: Vaka İncelemesi Özlem KIVANÇ Fatma ETİ ASLAN

Objectives: The impact of the tourniquet on cardiac efficiency remains unknown. This study aimed to assess the impact of the tourniquet on cardiac cycle efficiency (CCE) and to interpret how general anesthesia (GA) or combined spinal epidural anesthesia (CSEA) affects this during surgery using cardiac energy parameters. Methods: This prospective observational study included 43 patients undergoing elective unilateral total knee arthroplasty (TKA) with a tourniquet divided into GA (n = 22) and CSEA (n = 21) groups. Cardiac energy parameters were measured before anesthesia (T1), pre-tourniquet inflation (T2), during inflation (T3–T8), and post-deflation (T9). The estimated power of the study was 0.99 based on the differences and standard deviations in CCE at T2–T3 for all patients (effect size: 0.88, alpha error: 0.05). Results: CCE decreased significantly more at T3 in the GA group than in the CSEA group, whereas dP/dtmax and Ea increased more (p < 0.05, p < 0.001, and p < 0.01, respectively). At T9, CCE increased significantly in the GA group, whereas dP/dtmax and Ea decreased (p < 0.05, p < 0.001, and p < 0.001, respectively). Conclusions: The tourniquet reduces cardiac efficiency through compensatory responses, and CSEA may mitigate this effect.

Background: The use of wetting solutions (WSs) during high-volume liposuction is standard; however, the optimal amount of WS and its components and their effect on postoperative complications are unclear. We evaluated the effect of a WS and its components, calculated according to ideal body weight (IBW), on postoperative complications. Methods: High-volume liposuction with a WS containing 0.5 g of lidocaine and 0.5 mg of epinephrine in each liter was performed in 192 patients. Patients who received ≤90 mL/kg of WS were designated as group I and those who received >90 mL/kg of WS as group II. Postoperative complications and adverse events that occurred until discharge were recorded. Results: The mean total amount of epinephrine in the WS was significantly higher for group II (3.5 mg; range, 3.0–4.0 mg) than for group I (2.0 mg; range, 1.8–2.5 mg; p < 0.001), as was the mean total amount of lidocaine (3.5 g [range, 3.5–4.3 g] vs. 2.0 g [range, 1.8–2.5 g], respectively; p < 0.001). No major cardiac or pulmonary complications occurred in either group. Administration of >90 mL/kg of WS increased the median risk of postoperative nausea 5.3-fold (range, 1.8- to 15.6-fold), that of hypertension 4.9-fold (range, 1.1- to 17.7-fold), and that of hypothermia 4.2-fold (range, 1.1- to 18.5-fold). The two groups had similar postoperative pain scores and blood transfusion rates. Conclusions: The risks of postoperative nausea, vomiting, hypothermia, and hypertension may increase in patients who receive >90 mL/kg of WS calculated according to IBW during high-volume liposuction.

Background: Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using complex pharmacokinetic models, the use of TCI may provide a better hemodynamic profile during anesthesia induction. This study aimed to compare TCI versus manual induction and to determine the hemodynamic risk factors for post-induction hypotension. Methods: A total of 200 ASA grade 1–3 patients, aged 24 to 82 years, were recruited and randomly assigned to the TCI (n = 100) or manual induction groups (n = 100). Hemodynamic parameters were monitored with the pressure-recording analytic method. The propofol dosage was adjusted to keep the Bispectral Index between 40 and 60. Results: Post-induction hypotension was significantly higher in the manual induction group than in the TCI group (34% vs. 13%; p < 0.001, respectively). The propofol induction dose did not differ between the groups (TCI: 155 (135–180) mg; manual: 150 (120–200) mg; p = 0.719), but the induction time was significantly longer in the TCI group (47 (35–60) s vs. 150 (105–220) s; p < 0.001, respectively). In the multivariable Cox regression model, the presence of hypertension, stroke volume index (SVI), cardiac power output (CPO), and anesthesia induction method were found to predict post-induction hypotension (p = 0.032, p = 0.013, p = 0.024, and p = 0.015, respectively). Conclusion: TCI induction with propofol provided better hemodynamic stability than manual induction, and the presence of hypertension, a decrease in the pre-induction SVI, and the CPO could predict post-induction hypotension.

Objective: The laser speckle contrast imaging (LSCI) system is a method to evaluate microcirculation. The primary aim of our study is to evaluate the relationship between LSCI and perfusion markers in coronary artery bypass grafting (CABG). Our second aim is to investigate the relationship between LSCI and extubation time in the intensive care unit. Patients and Methods: Fifteen patients aged 43-80 years who will undergo on-pump CABG were included in the prospective study. Mean arterial pressure (mmHg), heart rate (min-1), PO2 (mmHg), PCO2 (mmHg) and lactate (mmol/L) levels were measured preinduction, post-induction, 10th minute of the extracorporeal circulation, post-crossclamp, and post-operatively. At the same time points, LSCI values from the skin were measured and recorded. The intubation times of the patients were also recorded. Results: There was no significant change in systemic tissue perfusion markers (P>0.05). LSCI perfusion values decreased significantly from induction and remained low until the end of surgery (P

Background:The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications.Methods:From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH.Results:Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support.Conclusions:Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors.Registration:Clinicaltrials.gov identifier: NCT05671783.

Objective This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. Design A prospective, observational study. Setting Single center. Participants Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. Measurements and main results All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Conclusion Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.

Objective:Red blood cell (RBC) transfusion in cardiac surgery is associated with increased morbidity and mortality. Even when using patient blood management methods, blood transfusions may still be needed in cardiac surgery. This study examined the risk factors for blood transfusion in isolated coronary artery bypass graft (CABG) surgery with a restrictive transfusion strategy, along with individualized patient blood management.Methods:We enrolled 198 patients (age, 61.8 ± 9.9 years; 28 females and 170 males) who underwent isolated CABG surgery in a single private hospital using a restrictive transfusion strategy between April 2015 and October 2020. Pre-, intra-, and postoperative parameters were compared between patients with and without RBC transfusions. The risk factors for transfusion and transfusion probability were analyzed.Results:Patients who received RBC transfusions had higher European System for Cardiac Operative Risk Evaluation values (13.60 ± 18.27%). Preoperative hematocrit (Hct) [odds ratio (OR)=0.752; 95% confidence interval (CI) 0.639-0.884; P=0.001] and female gender (OR=7.874; 95% CI 1.678-36.950; P=0.009) were significant independent risk factors for RBC transfusion in logistic regression analysis. When the preoperative Hct was 30%, the RBC transfusion probability was 61.08% in females and 16.6% in males. Patients who received RBC transfusions had longer intensive care unit (31.40 ± 25.42 hours) and hospital (11.18 ± 6.75 days) stays.Conclusion:Risk factors for RBC transfusion in isolated CABG surgery with a restrictive blood transfusion strategy were preoperative anemia and female gender.

Background: In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in surgeries that utilize the Trendelenburg position and pneumoperitoneum may increase the risk of postoperative AKI. We aimed to evaluate the effect of RFT duration on postoperative AKI. Methods: Forty-four patients who underwent RALP were included in this prospective observational study. Patients were divided into two groups according to the RFT duration (Group I, RFT duration ≤ 3 h, and Group II, RFT duration >3 h). AKI was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria (KDIGO) using patients’ serum creatinine levels after the first 24 h postoperatively. Hemodynamic parameters were monitored using the pressure recording analytical method. Results: The AKI incidence was significantly higher in Group II than in Group I (45.5% vs. 9.1%; p = 0.016). In both groups, all patients who developed AKI were KDIGO stage 1 and all recovered on the second postoperative day. At the end of the console period, the heart rate and arterial elastance were significantly higher, whereas the stroke volume index was significantly lower in Group II than in Group I (p = 0.041, p = 0.016, and p < 0.001, respectively). Although the amounts of fluid administered before and after the anastomosis were similar between the groups, the total amount of fluid administered was significantly different (p < 0.001). There was a significant negative correlation between RFT duration and the total amount of fluid administered (r2 = 0.43, p < 0.001). RFT duration of >3 h, total fluid administration of ≤3.3 mL/kg/h, and stroke volume index (SVI) at the end of the console period of ≤32 mL/m2 increased the risk of AKI by 12.0 times (1.7–85.2) (p = 0.013). Conclusion: RFT prolongation in RALP may increase the risk of developing AKI.

Background: Discussions continue on the ideal priming fluid in adult cardiac surgery. The purpose of this prospective study was to evaluate the effects of different types of priming fluids on extravascular lung water, cell integrity and oxidative stress status. Methods: Thirty elective coronary artery bypass surgery patients were randomised prospectively into two groups. The first group received colloid priming fluid, while the second group received crystalloid priming fluid. Extravascular lung water index, advanced oxidative protein products, total thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels were measured. Moreover, intra-operative and postoperative outcomes were reviewed. Results: There were no significant differences between the groups with regard to extravascular lung water index, oxidative stress parameters or cell integrity (p > 0.05). Similarly, no significant differences were observed between the patients with regard to intra-operative and postoperative outcomes (p > 0.05). Conclusions: The presumed superiority of colloidal priming for cardiopulmonary bypass could not be confirmed in our study.

Background: Hypotension is common after anesthesia induction and may have adverse outcomes. The aim of this study was to investigate whether arterial elastance (Ea) is a predictor of post-induction hypotension. Methods: Between January and June 2022, the hemodynamic parameters of 85 patients who underwent major surgery under general anesthesia were prospectively evaluated. The noncalibrated pulse contour device MostCare (Vytech, Vygon, Padua, Italy) was used to measure hemodynamic parameters before and after anesthesia induction. The duration of the measurements was determined from one minute before induction to 10 min after induction. Hypotension was defined as a greater than 30% decrease in mean arterial pressure from the pre-induction value and/or systolic arterial pressure of less than 90 mmHg. The patients were divided into post-induction hypotension (−) and (+) groups. For the likelihood of post-induction hypotension, a multivariate regression model was used by adding significantly different pre-induction parameters to the post-induction hypotension group. Results: The incidence of post-induction hypotension was 37.6%. The cut-off value of the pre-induction Ea for the prediction of post-induction hypotension was ≥1.08 mmHg m−2mL−1 (0.71 [0.59–0.82]). In the multivariate regression model, the likelihood of postinduction hypotension was 3.5-fold (1.4–9.1), increased by only an Ea ≥ 1.08 mmHg m−2mL−1. Conclusion: Pre-induction Ea showed excellent predictability of hypotension during anesthetic induction and identified patients at risk of general anesthesia induction-related hypotension.

Background:This study aims to compare the cerebral, hemodynamic, and metabolic effects of different prime solutions used in patients undergoing coronary artery bypass grafting.Methods:Between May 2013 and May 2014, a total of 30 patients (25 males, 5 females; mean age: 59.5±9 years; range, 42 to 78 years) who were schedule for elective isolated coronary artery bypass grafting were included in this prospective study. The patients were randomized into three groups: Group 1 (n=10) (ringer"s lactate [RL]), Group 2 (n=10) (6% hydroxyethyl starch [HES] 130/0.4), and Group 3 (n=10) (RL + 6% HES 130/0.4). Hemodynamic parameters, arterial blood gas analyses, hemoglobin, hematocrit, cerebral regional oxygen saturation, urine output and fluid balance were recorded preoperatively, before and after anesthesia, 10 min after the transition to extracorporeal circulation, while weaning from extracorporeal circulation, and at the end of surgery. Preoperatively and on postoperative Day 5, neuron-specific enolase enzyme and S-100 β protein were assessed. On Day 5 and Week 3 postoperatively, the Standardized Mini-Mental Test was administered to the patients.Results:The serum neuron-specific enolase enzyme and S-100 β protein levels of the patients were within physiological limits, and there were no clinical findings suggestive of cerebral damage, or changes in the Standardized Mini-Mental Test scores in any of the patients. There was a decrease of more than 20% of the baseline value of cerebral regional oxygen saturation in a total of four patients, one in Group 1 and three in Group 3. No significant difference was observed among the groups in terms of the other parameters.Conclusion:The prime solution content has no effect on the development of cerebral damage after cardiopulmonary bypass, and the main factor in preventing the development of cerebral damage was the preservation of cerebral perfusion, which can be achieved by monitoring cerebral perfusion in these patients.

Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5).Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01].Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.

Kandidemi, yüksek ölüm oranları ile dünya çapında sık görülen bir enfeksiyondur. Pandemi günlerinde, tüm dünyada yapılan kan bağışlarında ciddi bir azalma olmuştur. Yine 2019-2020 yılları karşılaştırıldığında bağış sayısının üçte bir oranında düştüğü görülmüştür. Türk Kızılayı verileri de pandeminin ilk günlerinde kan bağışının %90 oranında düştüğünü göstermektedir. Amerika’da yapılan bir çalışmada ise kan bağışı azalmasının yanında elektif cerrahiler ertelendiği için kan kullanımının da azaldığı görülmüştür. Bağış sırasında COVID-19’a yakalanma endişesi ve sokağa çıkma yasağı bağış sayısındaki azalmanın ana sebepleridi. Dünyada ve Türkiye’de de çözüm olarak öncelikle stoklar kullanılmış, sonrasında sosyal medya faaliyetleri ile bağışa özendirme kampanyaları yürütülerek ve daha önce bağış yapmış kişilere kısa mesaj gönderilerek kan bağışının artırılmasına çalışılmıştır. Derlememiz pandemi döneminde kan bankası rezervlerinin durumunu irdelemekte ve optimal yönetimi tartışmayı amaçlamaktadır.

Choosing whether or not to initiate neuraxial anesthesia in pregnant women with immune system defects may be challenging. Anesthesiologists have the responsibility of making the best decision in terms of anesthesia management for both mother and baby during the labor and delivery process. Whether neuraxial anesthesia is associated with an increased risk of central nervous system infection in immunocompromised compared with healthy patients is unknown. It is also unclear if maternal immune modulation required for fetal tolerance makes pregnant women susceptible to pathogens and causes an altered immune response. Infection-related complications of neuraxial anesthesia are rare but may be severe, especially in immunocompromised parturients. There are no guidelines regarding the indications and limitations of regional anesthesia procedures in these patients. Immunocompromised patients are now seen more commonly, and it is essential to adopt a multidisciplinary approach to their care while tailoring anesthetic plans to the individual. We present the case of a 37-year-old parturient who had a congenital immune deficiency and who developed aseptic meningitis after receiving spinal anesthesia for cesarean delivery.

Objectives Cardiac transplantation is an effective treatment for advanced heart disease and protection of the donor organ is directly associated with post-transplantation outcomes. Cardioplegic strategies intend to protect the donor heart against ischemic injury during transplantation procedures. In our study, the effects of three different cardioplegia solutions were evaluated in a rat heart donor model in terms of cellular base. Design. Cardioplegia solutions as St. Thomas, del Nido or Custodiol were administered to male Wistar albino rats until cardiac arrest. Arrested hearts were excised and incubated in cold cardioplegia solutions for 4 h. Organ bath experiments were performed using the right ventricular free wall strips of the heart tissues. ATP, sialic acid, TNF-alpha levels and MMP-9 activities were measured in heart tissues. Incubation media were also used to measure TNF-alpha and troponin-I levels following organ baths experiments. Results. Custodiol administration led to reduced myocardial contraction (p < .05), decreased ATP levels (p < .001) and increased both TNF-alpha levels (p < .05), and MMP-9 activity (p < .05). Additionally, troponin-I and TNF-alpha levels in media were significantly increased (p < .05), TNF-alpha levels were positively correlated with MMP-9 activities (r = .93, p = .007) and negatively correlated with ATP levels (r = -.91, p = .01) in the Custodiol group. Also, MMP-9 activities were negatively correlated with ATP levels (r = -.90, p = .01) Conclusion. Custodiol cardioplegia cannot prevent functional and cellular damage in donor heart tissue. St. Thomas or del Nido cardioplegia could result in superior functional and biochemical improvement during transplantation procedures. In this respect, these cardioplegic solutions may be more advantageous as cellular and functional.