Atriyal fibrilasyon en sýk görülen kardiyak aritmidir. Anestezistler preoperatif deðerlendirmenin yanýsýra, hastalarda intraoperatif ve postoperatif yeni baþlayan veya baþlangýç zamaný bilinmeyen AF ile karþý karþýya kalmaktadýr. AF’lu hastalarda, hemodinamik stabiliteyi korumak ve komplikasyonlarý önlemek deneyim gerektirir.
Bu derlemede, AF sýnýflandýrýlmasý, intraoperatif tedavisi ve AF nedeniyle antikoagülan kullanan hastalarda anestezi yönetimi sunulmuþtur.

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, in addition to preoperative evaluation of patients, anesthesiologists are faced with a new beginning or underlying unknown AF. To provide hemodynamic stability and to avoid complications in patients with AF is a very important skill for anesthesiologists.
This review presents anesthetic approach of AF classification and intraoperative management of patients taking anticoagulants due to AF.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Kardiyovasküler cerrahi sýrasýnda near infrared spektroskopi (NIRS) ile serebral oksijenasyon monitörizasyonu deðeri gittikçe artan bir metotdur. Çalýþmamýzda kardiyotomi yapýlan kapak hastalarýnda teorik olarak daha fazla olan embolik olaylarý NIRS monitorizasyonu yaparak saptayýp saptayamayacaðýmýzý, koroner hastalarýyla kýyaslayarak araþtýrmayý hedefledik.
YÖNTEM ve GEREÇLER: Kardiyopulmoner baypas (KPB) kullanýlarak elektif kapak operasyonu (grup 1) ve koroner arter baypas greftleme (grup 2) operasyonu planlanan 40 hasta çalýþmaya alýndý. Hastalarýn NIRS deðerleri, arteriyel kan basýnçlarý, kalp hýzý, oksijenasyon, hematokrit, laktat deðerleri; indüksiyon öncesi, indüksiyon sonrasý, kanülasyon sýrasýnda, KPB'a girildikten 5dk sonra, KPB’ta en düþük ýsýda, KPB’tan çýktýktan 5dk sonra ve operasyon sonunda olmak üzere 7 dönemde kaydedildi.
BULGULAR: Gruplar arasýnda hastalarýn demografik özellikleri, operasyon süreleri farklý saptanmadý. Grup l'de kros-klemp ve KPB sürelerinin uzun olduðu saptandý. Gruplarda hemodinamik veriler, sað-sol NIRS deðerleri farklý bulunmadý. Gruplarýn kendi içinde deðerlendirilen sað-sol NIRS deðerleri de benzerdi. Yoðun bakýmda inotropik ilaç desteði Grup 1’de anlamlý olarak yüksekti.Yoðun bakýmda kalýþ süreleri,ekstübasyon zamanlarý açýsýndan gruplar birbirine benzer bulundu. Hastalarýn post-operatif 24.saatteki nörolojik muayeneleri normaldi.
TARTIÞMA ve SONUÇ: Çalýþmamýzda kalp boþluklarý açýlan ve açýlmayan hasta gruplarý arasýnda belirlenen zaman aralýklarýnda takip ettiðimiz parametreler ve NIRS ölçümlerindeki deðiþimler açýsýndan anlamlý farklýlýk saptanmadý. NIRS monitörizasyonu ile emboli saptanmasý ancak çok büyük vasküler yataðýn etkilenmesiyle ortaya çýkacak perfüzyon bozukluklarýnda aþikar olarak görülebileceðinden, emboli varlýðýný daha ayrýntýlý olarak tespit edebilmek için transkranial doppler kullanýmý ve intrakardiyak havayý devamlý izlemek için transözofageal ekokardiyografi monitörizasyonunu da içeren ve daha fazla hastaya sahip çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Cerebral oxygen monitorisation with NIRS during cardiovascular surgery is a method with increasing value. In our study we aimed to detect the risk of embolus which is higher in patients who underwent cardiotomy using NIRS monitorisation in comparison to coronary patients.
METHODS: Fourty patients were enrolled to our study who underwent elective valvular surgery by cardiopulmonar bypass (group 1) and coronary artery bypass grafting (group 2). Patients’ NIRS values, arterial blood pressures, heart rates, oxygenation, hematocrite and lactate levels were recorded in 7 time periods as before and after anesthesia induction, during canulation, 5th min. of cardiopulmonar bypass, while nadir temperature is reached, 5th min.after cardiopulmonar bypass and at the end of the operation.
RESULTS: Between 2 groups there were no difference detected of demographic features of patients and operation times. In group 1 cross clemping and CPB times were detected longer. Between groups; hemodynamic datas, right and left NIRS values were not different. Right and left NIRS values which evaluated within groups were similar too. In group 1 inotropic support in ICU was significantly high. ICU stay and extubation times were similar between groups. 24th hour examination of patients postoperatively were normal.
DISCUSSION AND CONCLUSION: In our study no difference were detected about changes of NIRS measurements and observed parameters for patients. Hence embolus detection with NIRS is seen in perfusion disorders emerging from major vascular bed influence, to detect embolus events detailed studies including more patients are required with transcranial doppler use and monitorisation of intracardiac air regularly by transesophagial echocardiography.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Malignite tanýsý alan hastalarda tekrarlayan intravenöz (IV) yollara ulaþýmýn zorluðu sýk karþýlaþýlan bir sorundur. Çalýþmamýzýn amacý kemoterapi uygulanacak hastalardaki port kateter yerleþtirme iþlemlerimizi retrospektif olarak deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Mayýs 2012 ile Kasým 2014 tarihleri arasýnda kliniðimizde kemoterapi port kateterizasyonu uygulanan 98 hastanýn dosyalarý retrospektif olarak incelendi. Hastalarýn demografik verileri, primer tanýlarý, giriþimin lokalizasyonu, giriþim sayýsý, floroskopi ihtiyacý, hasta konforu (1kötü, 2 orta, 3 iyi ) kaydedildi. Hastalar giriþ venlerine göre sað internal juguler ven (Grup J) ve sað subklavyen ven (Grup S) olarak deðerlendirmeye alýndý.
BULGULAR: Hastalarýn 50’si (%51) erkek 48’i (%48.9) kadýndý. Hastalarýn yaþ aralýklarý 19-84, yaþ ortalamasý ise 49,55±14,57 olarak saptandý. Sað internal juguler venden takýlan portlardan 8' inde (%26.7), sað subklavyen venden takýlan portlardan ise 4'ünde (%5.9) komplikasyon geliþtiði görüldü. Geliþen komplikasyonlardan 9 tanesi yanlýþ yerleþim, 3 tanesi ise enfeksiyon nedeniyleydi. Gruplar hasta konforu açýsýndan karþýlaþtýrýldýðýnda J grubunda memnuniyet derecesi 1 puan (kötü) veren hasta sayýsý 7 (%23,3), S grubunda ise 3(%4,4) olarak saptandý.
TARTIÞMA ve SONUÇ: Sonuç olarak; uzun süreli kemoterapi planlanan hastalarda port kateteri takýlmasýnýn hasta konforunu artýran, komplikasyon oraný düþük bir uygulama olduðu kanýsýndayýz.

INTRODUCTION: The difficulty of accessing recurrent intravenous (IV) routes in patients with a diagnosis of malignancy is a frequent question. We retrospectively evaluate our port catheter placement procedures in patients who will undergo chemotherapy.
METHODS: We retrospectively reviewed the files of 98 patients who underwent chemotherapy port catheterization between May 2012 and November 2012 in our clinic. Patients' demographic data, primary diagnoses, localization of the procedure, number of interventions, fluoroscopy requirement, patient comfort (1, 2, moderate, 3 good) were recorded. Patients were evaluated as right internal jugular vein (Group J) and right subclavian vein (Group S) according to their entrance veins.
RESULTS: 50 (%51) of the patients were male and 48 (%48.9) were female. Their ages ranged from 19 to 84 and the mean age was 49.55 ± 14.57. Complications were seen in 8 (26.7%) of right internal jugular vein applications and 4 (5.9%) of right subclavian vein applications. The complications that occurred, 9 were due to misplacement and 3 were due to infection. When the groups were compared in terms of patient comfort, the number of patients giving satisfaction score 1 point (worse) in group J was 7 (23.3%) and in group S 3 (4.4%).
DISCUSSION AND CONCLUSION: As a result; We believe that implantation of port catheter in patients planned for long term chemotherapy improves patient comfort and has a low complication rate.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Pediyatrik kalp cerrahisi giriþimlerinde hastalarýn doku ve organ perfüzyonu önemlidir. Yetersiz perfüzyona baðlý hipoksemi ve iskemi sýklýkla gözlenmektedir. Çalýþmanýn amacý, kalp cerrahisi planlanan pediyatrik hastalarda serebral oksimetre monitörizasyonu uygulamasýnýn serebral oksijen dengesizliðini tanýmlama, gerekli düzeltici giriþimlerin belirlenmesidir.
YÖNTEM ve GEREÇLER: Hastane Eðitim Planlama ve Koordinasyon Kurulu izni ve ebeveyn onamý alýndýktan sonra konjenital kalp cerrahisi planlanan, 4 gün-10 yaþ arasý 40 hasta çalýþmaya alýndý. Hastalar 1 yaþ altý, 1 yaþ üstü ve bu gruplarda SaO2<92%: 2a ve SaO2>92%: 2b olarak alt gruplara ayrýldý. Hastalarýn özellikleri, kalp hýzý, arter ve santral ven basýncý, vücut ýsýsý, PaCO2, PaO2, FÝO2, SaO2, ScVO2, laktat, hematokrit ve bölgesel serebral O2 saturasyonu kaydedildi. Serebral O2 saturasyonunun hematokrit, ortalama arter basýncý ile korelasyonu deðerlendirildi.
BULGULAR: Gruplar arasýnda sað ve sol serebral O2 saturasyon deðerleri arasýnda fark yoktu. Olgularýn OAB ve hematokrit deðerleri ile serebral O2 saturasyonu arasýnda korelasyon olduðu görüldü.
TARTIÞMA ve SONUÇ: Konjenital kalp cerrahisinde intraoperatif süreçte perfüzyonun serebral oksimetre ile izlenmesi deðerli bir göstergedir. Çalýþmamýzda hipotansiyon, hemodilüsyon, hipovolemi, anemi, gibi doku O2’nin bozulduðu durumlarda sað ve sol serebral oksimetre deðerlerinin düþtüðünü bunlara yönelik önlemler alýndýðýnda deðerlerin düzeldiði görüldü.

INTRODUCTION: Patient tissue and organ perfusion is important in pediatric cardiac surgery procedures. Hypoxemia and ischemia due to inadequate perfusion are frequently observed. The aim of the study is to identify cerebral oxygen imbalance with cerebral oxymetry monitoring in pediatric patients planned for heart surgery, and to identify the necessary corrective interventions.
METHODS: After Hospital ethic comitee and parental consent 40 patients between ages of 4 days and 10 years scheduled for congenital cardiac surgery were taken into the study.
Patients were under 1 year of age and over 1 year of age and were subdivided into SaO2 <92%: 2a and SaO2> 92 %: 2b. Patient characteristics, heart rate, arterial and central venous pressure, body temperature, PaCO2, PaO2, FiO2, SaO2, ScVO2, lactate, hematocrit and regional cerebral O2 saturation were recorded. Correlation of cerebral O2 saturation with hematocrit and mean arterial pressure was evaluated.
RESULTS: There was no significant difference in the right and left cerebral oxygenation values between the groups. Hematocrit levels and mean arterial pressure correlated with cerebral O2 saturation values.
DISCUSSION AND CONCLUSION: Cerebral oximetry monitoring of perfusion is a valuable indicator during intraoperatively in congenital cardiac surgery. In our study, cerebral oximetry values decreased when tissue O2 was deteriorated, such as intraoperative hypotension, hemodilution, hypovolemia, anemia, and it was seen that the values improved when these measures were taken.

Makale Özeti | Tam Metin PDF

Transfüzyona baðlý akut akciðer hasarý (TRALI), major cerrahi geçiren yüksek riskli hasta grubunda tarnsfüzyona baðlý ölümlerin ikinci en sýk sebebidir. Akut hipoksi ve nonkardiyojenik pulmoner ödem tablosu ile ortaya çýkan TRALI, transfüzyon yapýlan hastalarda ayýrýcý tanýda düþünülmesi gereken önemli bir klinik tablodur. Asendan aort anevrizmalý suprakoroner greft interpozisyonu yapýlan hastaya perioperatif ve postoperatif TDP, ES ve trombosit transfüzyonu yapýldý. Sonrasýnda akut geliþen hipoksi ve bilateral akciðer ödemini takiben pozitif basýnçlý mekanik ventilasyon ile solunum destek tedavisi baþlandý. Gecikmiþ TRALI olarak düþünülen hasta postop 5.günde ekstübe edildi. Non invaziv mekanik solunum desteðine devam edildi. Onuncu günde oksijen ve solunum destek ihtiyacý tamamen ortadan kalktý. Özellikle major cerrahi geçiren, yüksek miktarda ES,TDP, trombosit süspansiyonu transfüse edilen hastalarda akut geliþen hipoksi, ARDS tablosunda TRALI akla gelmeli, tedavide noninvaziv mekanik ventilasyon seçeneði düþünülmelidir.
AnahtarKelimeler: kan elemanlarý transfüzyonu; Aort anevrizmasý

Transfusion-related acute lung injury (TRALI) is second important the leading cause of transfusion-associated mortality in high-risk patients undergoing major surgery. TRALI presented with acute hypoxia and non-cardiac edema is a vital clinical entity which must be considered in differential diagnosis in transfusion-associated patients. Fresh frozen plasma, erythrocyte suspension and thrombocyte suspension transfusion was performed perioperative and postoperative to the patient undergoing supracoronary graft interposition due to ascending aortic aneurysm. Respiratory support treatment with positive pressure mechanical ventilation was began for acute hypoxia and bilateral pulmonary edema developed immediately after. The patient thougth to be delayed TRALI was extubated postoperative day 5. Non-invasive mechanical respiratory support treatment was proceeded. The oxygen and ventilatory support need has been completely eliminated postoperative day 10. TRALI should be considered in patients with acute onset of hypoxia, ARDS especially undergoing major surgery and transfused large amounts of ES, FFP, trombocyte suspension. Noninvasive-mechanical ventilation option should be considered as a treatment.

Key words: Blood Component Transfusion; Aortic Aneurysm

Makale Özeti | Tam Metin PDF

Makale Özeti | Tam Metin PDF