Moyamoya disease (MMD) is a rare non-inflammatory cerebral vasculopathy characterized by progressive stenosis of the internal carotid arteries, often bilaterally, and the formation of abnormal collateral vascular structures at the cranial base. A patient who underwent elective cesarean section (C/S) twice under spinal anesthesia and was diagnosed with MMD as a result of recurrent intracranial hemorrhage in the postpartum periods is presented. A 41-year-old female patient without any systemic comorbidity, gravida 2, parity 2, had her second cesarean section (C/S) operation under spinal anesthesia and was discharged on the third postoperative day without any problems. The patient had a mild headache that started from the occipital region and spread to the entire cranium on the same day. After applying to the emergency department at different times, she was discharged with conservative treatment. The patient had a severe headache and was admitted to the emergency room on the ninth postoperative day. The patient, who was diagnosed with intracranial hemorrhage after cranial imaging, was referred. Cranial angiography revealed advanced bilateral internal carotid artery symmetric occlusion and the basilar artery was preserved. According to the angiographic image, the patient was diagnosed with moyamoya disease and was followed up in the intensive care unit. The muscle strength of the patient, who had no cranial nerve pathology or lateralization findings, was evaluated as normal. Conservative management was applied in the intensive care unit. The patient was discharged with recommendations for neurosurgery and cardiovascular surgery after 12 days. In the postpartum period, especially in cases of headache that persists for a long time after dural puncture and does not have a postdural feature, intracranial hemorrhage should be considered until proven otherwise, and moyamoya disease also be considered in the differential diagnosis of intracranial hemorrhage. The approach to the patient in the perioperative period should focus on providing normotension, normocapnia, normothermia, and effective analgesia.

Heparin, a naturally occurring polysaccharide belonging to the glycosaminoglycans (GAG) family, is ubiquitously found in mast cells. Unfractionated heparin is the least processed form of natural GAG, purified from animal tissue. In a 67-year-old female patient diagnosed with hypertension and asthma, who suffered a femoral fracture due to a fall, intravenous heparin sodium was administered for thromboembolic treatment in the postoperative period following closed reduction. Subsequently, respiratory distress, loss of consciousness, and cardiac arrest occured following profound hypotension. The patient, whose clinical findings were evaluated as anaphylaxis, was successfully resuscitated with prompt intervention. Despite immune-mediated reactions and Heparin-Induced Thrombocytopenia (HIT) being commonly encountered side effects in clinical practice, it is crucial for all healthcare professionals to recognize that widely used anticoagulant agents such as heparin sodium can lead to fatal complications.

Afet Durumlarında Rejyonel Anestezi Yönetimi Kıvanç ÖNCÜ Antikoagulan İlac Kullanan Hastalarda Noroaksiyel, Periferal ve Derin Sinir Blokları için Guvenli Aralık Sedat SAYLAN Ali AKDOĞAN Preeklampsili Hastada Anestezi Yönetimi Ali AKDOĞAN Engin ERTÜRK Postpartum Hemoraji ve Anestezi Yönetimi Özge ŞIKTAŞ Ortopedi Hastalarında Cerrahi Sonrası Hızlandırılmış İyileşme (ERAS) Protokolleri Demet LAFLI TUNAY Bolum 6 Malign Hipertermi ve Anestezi Yönetimi Murat TÜMER Rokuronyum İnfuzyonu İle Sağlanan Noromuskuler Bloğun Sugammadeks İle Geri Dondurulmesinin Desfluran veya Propofol Anestezisinde Karşılaştırmalı Değerlendirilmesi Necmiye ŞENGEL Gözde İNAN Mustafa ARSLAN

Objective: To evaluate the role of different pneumoperitoneum pressure ranges on cerebral oxygenation.Study design: Prospective, randomised controlled trial. Place and Duration of the Study: Karadeniz Technical University, Turkiye, from January to September 2020.Methodology: Seventy patients (aged 18-65 years, ASA I-IIII) scheduled for laparoscopic cholecystectomy were divided into two groups; low pressure (LP, 10-12 mmHg) and high pressure (HP, 13-15 mmHg). The heart rate, peripheral oxygen saturation, systolic, diastolic, and mean arterial pressure, BIS, end-tidal carbon dioxide, and left and right regional cerebral oxygen saturation (rSO2) were recorded during induction, at the beginning, and after 5, 10, 15, 30, 60, and 90th minutes of pneumoperitoneum, after the surgical and anaesthesia procedures.Results: The findings did not demonstrate a significant difference between the haemodynamic parameters of the groups. However, there were differences (fifth [p=0.022], fifteenth minutes [p=0.035], at the end [p=0038] of pneumoperitoneum in right rSO2, and similarly at the end [p=0.038] of pneumoperitoneum in left rSO2 between mean variation of rSO2 when compared to the baseline; cerebral oxygenation was better preserved in LP. While no patient had more than 20% rSO2 reduction in LP, a total of three patients had cerebral desaturation in HP.Conclusion: Although <15 mmHg pressure for pneumoperitoneum was usually well-tolerated by patients, it had been observed that cerebral oxygenation may be affected with this range. The pathophysiological effects of pneumoperitoneum and possible consequences of this situation should be considered while performing laparoscopy.

BACKGROUND Acute skeletal muscle wasting may predict clinical outcomes in critically ill patients. This study aimed to assess acute muscle loss, changes in anthropometric measurements, and the relationship between muscle loss and clinical outcomes in critically ill trauma and surgical patients. METHODS This single-center, prospective observational study was conducted in critically ill trauma and surgical patients who were expected to stay in the intensive care unit (ICU) for at least 7 days. Rectus femoris cross-sectional area muscle measurements were performed by bedside ultrasound, and anthropometric measurements were obtained at baseline and 7 days after the first assessment. Length of mechanical ventilation, ICU and hospital stay, and mortality were recorded. RESULTS Thirty-five patients with a mean age of 49.6 ± 18.6 years and 74.1% male were enrolled. The rectus femoris cross-sectional area, mid-arm circumference, and calf circumference were reduced at second assessment from baseline (P < 0.05). In univariate analysis, muscle loss and changes in anthropometric measurements were not associated with 90-day mortality (P > 0.05). CONCLUSION Muscle loss in critical trauma and surgical patients occurred rapidly during the first week of critical illness. Rectus femoris muscle cross-sectional area assessment can be used to detect skeletal muscle changes in critically ill patients. Further investigations on the skeletal muscle changes and clinical outcomes need to be conducted.

Transgender individuals are people whose gender identities differ from the gender they were assigned at birth. This case report aims to present the anesthesia management of HIV-positive transgender patient admitted to the plastic surgery clinic for mammoplasty and rhinoplasty operation. Transgender individuals may have difficulties in anesthesia management due to their clinical characteristics. Anatomical, pharmacological, and psychological aspects should be carefully examined in terms of anesthesia before the surgical procedure. In addition, a multidisciplinary approach will benefit both anesthesia management and postoperative care