Son yýllarda, biyolojik yaþ kronolojik yaþ yerine, kalp cerrahisi sonrasý yaþlý hastalarda görülen sonuçlardaki heterojenliði açýklayabilecek ve yeni müdahale yöntemlerinden yararlanacak yaþlý hastalarý tanýmlamaya yardýmcý olabilecek bir kavram olarak ortaya çýkmaktadýr.
Bu derlemede, yaþlý hastalarda kardiyak cerrahide, frailite –kýrýlganlýk- kavramý ile postoperatif morbidite ve mortalite arasýndaki iliþki ve bu konudaki skorlama sistemleri ve bunlarýn klinik uygulamada postoperatif sonuçlarýn tahmin edilmesindeki faydasý tartýþýlmaktadýr.

In recent years, biological age has emerged instead of chronological age as a concept that could explain the heterogeneity in outcomes seen in older patients after cardiac surgery and help identify older patients who would benefit from new intervention methods.
This review discusses the relationship between fraility concept and postoperative morbidity and mortality in cardiac surgery in elderly patients and the scoring systems in this regard and their utility in predicting postoperative outcomes in clinical practice.

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GÝRÝÞ ve AMAÇ: Kan kullanýmýnýn azaltýlmasýna yönelik yöntemlere raðmen transfüzyon uygulamalarýnda halen kurumsal ve kiþisel farklýlýklar mevcuttur. Çalýþmamýzýn amacý, bir üniversite hastanesi olan kurumumuzdaki peroperatif transfüzyon uygulamalarýný etkileyen faktörleri ve transfüzyon sýklýðýný belirlemektir.
YÖNTEM ve GEREÇLER: Retrospektif yapýlan çalýþma, Ocak 2017- Haziran 2017 tarihleri arasýnda opere olan ve peroperatif kan transfüzyonu yapýlan 245 hastayla tamamlandý. Hastalarýn demografik özelliklerinin, peroperatif Hb deðerlerinin, cerrahi prosedürün-bölümün-sürenin, ASA skorunun, anestezi yönteminin, mevcut hematolojik patoloji varlýðýnýn, preoperatif antikoagülan kullanýmýnýn ve ek hastalýk sayýsýnýn peroperatif transfüzyon ihtiyacýný belirlemedeki etkinliði deðerlendirildi. Ýstatistiksel deðerlendirme sonucu p<0.05 anlamlý kabul edildi.
BULGULAR: Hastalarýn ortalama yaþý 58.09±16.11 yýl ve cerrahi süresi 226.17±125.59 dk olarak saptandý. Hastalarýmýzýn preoperatif muayenesinde %37.1 (n=91)’inin anemik olduðu, %50.6 (n=124)’sýnýn antikoagülan ilaç kullandýðý ve %78 (n=191)’inin de ek hastalýðý olduðu gözlendi. Anemisi olan hastalarýn transfüzyon ihtiyacýnýn olmayanlara göre daha fazla olduðu ve bu hastalarýn 40 (%43.9)’ýna preoperatif, 28 (%30.8)’ine intraoperatif ve 78 (%85.7)’ine de postoperatif dönemde transfüzyon yapýldýðý belirlendi. Toplamda transfüzyon sýklýðýmýz preoperatif %20.8, intraoperatif %41.6 ve postoperatif dönemde de %92.2 idi. Preoperatif transfüzyonlarýnýn preoperatif-Hb seviyesi ortalamasý 10.15± 1.86 gr/dl olan, kadýn cinsiyet, ASA 2-3 risk grubu, anemi tanýsý olan ve preoperatif-Hb deðeri 7.1-12.9 gr/dL olanlarda; intraoperatif transfüzyonlarýnýn intraoperatif-Hb seviyesi ortalamasý 12.23± 2.2 gr/dl olan, ileri yaþ, erkek cinsiyet, uzun süren cerrahiler, KVC ve ortopedi cerrahileri, ASA 3-4 risk grubu, genel anestezi uygulanan, anemi tanýsý olan, antikoagülan ilaç kullanýmý ve yandaþ hastalýðý olan ve intraoperatif-Hb deðeri 7.1-12.9 gr/dL olanlarda ve postoperatif transfüzyonlarýn ise elektif þartlarda, anemi tanýsý olan ve postoperatif-Hb deðeri 7.1-12.9 gr/dL olanlarda daha fazla yapýldýðý saptandý.
TARTIÞMA ve SONUÇ: Transfüzyon kararý birçok parametreyi deðerlendirerek alýnmasý gereken multidisipliner bir karardýr. Transfüzyon kararýnýn büyük oranda ilgili hekim tarafýndan verildiði, hastalarýn %20.8’ine preoperatif, %41.6’üne intraoperatif ve %92.2’sine postoperatif dönemlerde transfüzyon yapýldýðý izlendi. Transfüzyon protokollerinin tüm hekimler tarafýndan tekrar gözden geçirilmesinin önlenebilir transfüzyonlarýn azaltýlmasýnda önemli bir role sahip olabileceði ve transfüzyon uygulamasýnda davranýþ deðiþikliðinin gereksiz transfüzyonlardan kaçýnmamýza ve böylece hasta güvenliði açýsýndan da daha az risk almamýza neden olacaðý kanýsýndayýz.

INTRODUCTION: In spite of methods to reduce blood use, there are still institutional and personal differences in transfusion applications. The aim of this study was to determine the factors affecting the peroperative transfusion procedures and the frequency of transfusions in our institution, a university hospital.
METHODS: The retrospective study was completed with 245 patients who underwent peroperative blood transfusion between January 2017 and June 2017. The efficacy of the patients' demographic characteristics, peroperative Hb values, surgical procedure-part-time, ASA score, anesthesia method, presence of existing hematological pathology, preoperative anticoagulant use and number of additional diseases were evaluated in determining the need for peroperative transfusion. p <0.05 was considered statistically significant
RESULTS: The mean age of the patients was 58.09 ± 16.11 years and the duration of surgery was 226.17 ± 125.59 minutes. In the preoperative examination of our patients, 37.1% (n = 91) were anemic, 50.6% (n = 124) were using anticoagulant drugs and 78% (n = 191) had additional disease. It was determined that patients with anemia had more transfusion requirements than those without anemia and 40 (43.9%) of these patients had preoperative, 28 (30.8%) intraoperative and 78 (85.7%) postoperative transfusions. The overall frequency of transfusions was 20.8% preoperatively, 41.6% intraoperatively and 92.2% postoperatively. The mean preoperative Hb level of preoperative transfusions was 10.15 ± 1.86 gr / dl, female sex, ASA 2-3 risk group, diagnosed with anemia and preoperative Hb value 7.1-12.9 gr / dL; The intraoperative-Hb level of intraoperative transfusions was 12.23 ± 2.2 g / dl, advanced age, male sex, long-lasting surgeries, CVS and orthopedic surgeries, ASA 3-4 risk group, general anesthesia, anemia, anticoagulant drug use and comorbidity disease and intraoperative-Hb values ​​of 7.1-12.9 gr / dL and postoperative transfusions were performed in elective conditions, with anemia diagnosis and postoperative-Hb value of 7.1-12.9 gr / dL.
DISCUSSION AND CONCLUSION: Transfusion decision is a multidisciplinary decision that needs to be made by evaluating many parameters. It was observed that the transfusion decision was made mostly by the attending physician, 20.8% of the patients underwent preoperative, 41.6% intraoperative and 92.2% postoperatively. We believe that the review of transfusion protocols by all physicians may have an important role in reducing preventable transfusions, and that behavioral changes in transfusion practice will avoid unnecessary transfusions and thus lower risk for patient safety.

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GÝRÝÞ ve AMAÇ: Kalp cerrahisi sonrasý sývý replasmanýnda ilk tercih olarak kristalloidler önerilmekle birlikte, bazý özel durumlarda albümin ve sentetik kolloidler de kullanýlabilmektedir. Bu çalýþmada preoperatif albümin deðerinin postoperatif döneme etkisi ve bu hastalarda albümin kullanýmýnýn sonuca etkileri araþtýrýldý.
YÖNTEM ve GEREÇLER: Servisimizde 01.01.2014-31.12.2018 tarihleri arasýnda açýk kalp cerrahisi uygulanan hastalar retrospektif olarak incelendi. Hastalar preoperatif albümin deðerlerine göre 2 gruba ayrýldý. Preoperatif albümin deðeri 4 gr/dl olan hastalar Grup 1’i, albümin deðeri 4 gr/dl üzerinde olan hastalar Grup 2’yi oluþturdu. Hastalarda preoperatif albümin deðerinin postoperatif erken dönem morbidite ve mortaliteye etkileri ve kullanýlan sývý replasmaný ile iliþkisi deðerlendirildi.
BULGULAR: Preoperatif albümin deðeri düþük olan hastalarda postoperatif dönemde de hipoalbüminemi devam etti. Takiplerde 13 hastada minör komplikasyon geliþirken bunun 12’si Grup 1’de olup, on hastaya albümin replasmaný uygulanmýþtý. Postoperatif dönemde 9’u Grup 1’de olmak üzere 10 mortali geliþti. Kaybedilen hastalarýn 7’sine postoperatif dönemde albümin replasmaný yapýlmasýna raðmen hastalar kaybedilmiþti. Preoperatif albümin deðerinin 4 g/dl altýnda olmasýnýn postoperatif komplikasyon riskini 14 kat arttýrdýðý ve bu hastalarda albümin replasmaný uygulanmasýnýn sonuca beklenen katkýyý saðlamadýðý görüldü.
TARTIÞMA ve SONUÇ: Preoperatif albümin deðerinün düþüklüðü postoperatif dönemde artmýþ morbidite ve mortalite ile iliþkili olmakla birlikte, albümin replasmaný sonuca olumlu katký saðlamamaktadýr. Güncel kýlavuzlarýn önerisi doðrultusunda kalp cerrahisi sonrasý sývý replasmanýnda kan replasmaný gerekmeyen durumlarda, kristalloid solüsyonunun ilk tercih olarak düþünülmesi doðru olacaktýr.

INTRODUCTION: Crystalloid sollutions are recommended as first choice for fluid replacement after cardiac surgery. Albumin and synthetic colloids are used in special condition. In this study, the effects of preoperative albumin level on postoperative period and the effects of albumin were investigated.
METHODS: Patients who underwent cardaic surgery between 01.01.2014 and 31.12.2018 were evaluated retrospectively. Patients were divided into two groups according to preoperative albumin levels. Patients with preoperative albumin level < 4 g / dl are in Group 1 and ≥ 4 g / dl in Group 2. Effects of preoperative albumin levels on early postoperative morbidity and mortality and its relationship with fluid replacement were evaluated.
RESULTS: Hypoalbuminemia persisted in postoperative period in patients with low preoperative albumin levels. During follow-up, 13 patients developed minor complications, of which 12 were in Group 1, and ten had albumin replacement. There were 10 mortality, (9 in Group 1, 1 in Group 2); although 7 of them underwent albumin replacement. It was seen that preoperative albumin value under 4 g / dl increased the risk of postoperative complications 14 times and the application of albumin replacement in these patients did not provide the expected contribution to the outcome.
DISCUSSION AND CONCLUSION: Low preoperative albumin value is associated with increased morbidity and mortality in the postoperative period, however, albumin replacement does not contribute positively to the outcome. In accordance with the recommendations of current guidelines, it would be appropriate to consider crystalloid solution as the first choice in cases where blood replacement is not required after cardiac surgery.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada tek akciðer ventilasyonu (TAV) gereken hastalarda kullanýlan sol çift lümenli tüplerin (ÇLT) pozisyonunun doðrulanmasýnda toraks USG yöntemini hýzlý klinik deðerlendirme (HKD) yöntemi ile karþýlaþtýrarak, USG’nin ÇLT pozisyonunun doðrulanmasýnda katkýsý olup olmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: TAV gereken ve sol ÇLT ile entübe edilen 113 hasta çalýþmaya dahil edildi. Fiberoptik bronkoskop (FOB) kullanmadan, kör entübasyon sonrasý HKD ve USG yöntemleri ile elde edilen doðruluk tahminleri sonrasýnda; hasta supin pozisyonda iken konvansiyonel klinik deðerlendirmeler yapýlarak; TAV sýrasýnda SpO2 > %90, peak havayolu basýncý < 35 cmH2O, plato havayolu basýncý ise < 25 cmH2O olmasý ile ÇLT pozisyonunun optimum olduðuna karar verildi. HKD yönteminde toraksýn inspeksiyonu ve oskültasyonu yapýlýrken, USG yönteminde lung sliding ve lung pulse deðerlendirildi. Toraks USG; HKD sonrasý, ÇLT pozisyonu deðiþtirilmeden bütün hastalara uygulandý. ÇLT pozisyonunu tahmin etmede her iki yöntem sonuçlarý karþýlaþtýrýldý.
BULGULAR: USG yöntemiyle doðru ya da yanlýþ ÇLT pozisyonunu tahmin baþarýsý %83,2 iken, HKD yöntemiyle %77,9 idi (p<0.05). USG’nin sensitivite ve negatif prediktif deðeri; HKD’ye göre daha yüksekti. ÇLT’nin %71,7 oranýnda doðru pozisyonda ve %28,3 malpozisyon olduðu saptandý. Malpozisyon düþünüldüðünde ÇLT’ye yeniden pozisyon verildi.
Tek manipülasyonla malpozisyonu düzeltilen 14 (%43,7) hasta iken birden fazla manipülasyon gereken hasta sayýsý 18 (%56,3) idi. ÇLT’ye yeniden pozisyon verme iþlemlerinde baþarý saðlanamadýðý durumlarda ise, ÇLT yerleþimi yanlýþ kabul edilerek hasta supin pozisyonda iken, 6 (%5,3) hastada FOB yardýmýyla ÇLT optimum pozisyona yerleþtirildi.

TARTIÞMA ve SONUÇ: Hýzla yapýlabilen ve noninvaziv bir iþlem olan toraks USG yöntemi, ÇLT pozisyonunu deðerlendirmede klinik olarak karar vermeye katký saðlayabilir.

INTRODUCTION: Hýzla yapýlabilen ve noninvaziv bir iþlem olan toraks USG yöntemi, ÇLT pozisyonunu deðerlendirmede klinik olarak karar vermeye katký saðlayabilir.
METHODS: One hundred thirteen patients who required OLV provided by left sided DLT, enrolled in the study. After blind intubation without fiberoptic bronchoscopy (FOB) estimations of RCA and USG methods for accuracy of DLT position were recorded. The conventional evaluation and verification of DLT position was performed in the supine position by using clinical parameters including SpO2> %90, peak airway pressure < 35 cmH2O and plateau airway pressure < 25 cmH2O. While the RCA method was performed by using inspection and auscultation of thorax, the USG method was achieved by evaluating lung sliding and lung pulse. Thoracic USG was performed in all patients after RCA method, without changing DLT position. The predictions of these two methods were compared for the same DLT position.
RESULTS: The DLT position prediction of USG method was successful in the rate of 83.2% while it was 77.9 % in RCA method. The sensitivity and negative predictive value (NPV) of USG was higher than RCA’s values. The rate of correct DLT position was found 71.7%, while malposition rate was 28.3%. When malposition was considered, DLT was repositioned. While malposition was corrected with a single manipulation in 14 (43.7%) patients, multiple manipulations were needed in 18 (56.3%) patients. If repositioning of DLT was not successful, the placement of DLT was considered as “false”, and DLT position was corrected with the aid of FOB in 6 (%5.3) patients with supine position.
DISCUSSION AND CONCLUSION: Thorax USG method, which is performed rapidly and noninvasively, might aid decision making in confirmation of the DLT position.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada alt ekstremite vasküler cerrahi geçirecek eriþkin hastalarda intratekal yolla uygulanan levobupivakainin ile bupivakainin hemodinamik parametreler, sensoriyel ve motor blok süreleri ve yan etkileri bakýmýndan etkilerinin karþýlaþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Hastanemiz etik kurul izni ve hastalarýn onamý alýnarak, alt ekstremite vasküler cerrahi geçirecek, ASA I - III grubu, 25-75 yaþ arasý 30 hasta rastgele seçilerek çalýþmaya dahil edildi. Hastalar; Grup I (n=15) 17,5 mg (3,5 ml) izobarik % 0.5 bupivakain, Grup II (n=15) 17,5 mg (3,5 ml) izobarik % 0.5 levobupivakain spinal yolla uygulanan hastalar olarak randomize þekilde ikiye ayrýldý. Tüm hastalara 10 ml/kg Laktatlý Ringer infüzyonu verilip bazal deðerleri(T0) kaydedildikten sonra, spinal anestezi uygulamasý sonrasý 2.(T1), 4.(T2), 10.(T3), 20.(T4), 30.(T5), 60.(T6), ve 90. dakikalarda(T7) hemodinamik parametreleri kayýt edildi. Ayrýca bulantý, kusma, kaþýntý, solunum depresyonu, hipotansiyon, bradikardi, aritmi, konvülsiyon titreme gibi yan etkiler kaydedildi.
BULGULAR: Kalp atým hýzlarý(KAH), ortalama arter basýnçlarý(OAB)ve kardiyak indeks(KI)parametreleri açýsýndan gruplar karþýlaþtýrýldýðýnda anlamlý farklýlýk bulunmadý Gruplar sensoriyal blok baþlangýç süreleri ve sensöriyel bloðun dermotomlara ulaþma ve iki segment gerileme zamanlarý ve motor blok baþlangýç zamaný açýsýndan da benzerdi(p>0.05). Ancak motor blok gerileme ve motor blok kalkma süreleri Grup II’de istatiksel olarak anlamlý kýsa bulundu (p<0.05). Hiçbir hastada EKG deðiþikliði veya yan etki görülmedi. (p> 0.05).
TARTIÞMA ve SONUÇ: Levobupivakain, hemodinamiyi bupivakaine benzer þekilde etkilemekle, bu bulgularla kardiyovasküler hastalýk potansiyeli taþýyan hastalarda güvenle kullanýlabilecek bir lokal anestezik olduðu sonucuna varýlmýþtýr.

INTRODUCTION: The aim of the study was to compare the effects of intrathecal injection levobupivacaine with bupivacaine on hemodynamic parameters, sensorial and motor block duration and side effects in adult patients undergoing lower extremity vascular surgery.
METHODS: Our local ethics committee permission and the consent of the patients, the lower extremity vascular surgery will undergo, ASA I-III group, in the age of 25-75 years, 30 patients were randomly selected and included in the study. Patients; Group I (n=15) 17.5mg (3.5ml) isobaric 0.5% bupivacaine, Group II (n=15) 17.5mg (3.5ml) isobaric 0.5% levobupivacaine was randomized as intrathecal injection two groups. All patients were given 10 ml/kg Lactate Ringer infusion and basal values (T0) were recorded. Afterspinal anesthesia hemodynamic parameters were recorded of 2.(T1), 4.(T2), 10.(T3), 20.(T4), 30.(T5), 60.(T6) and 90.minute (T7). In addition, side effects such as nausea, vomiting, itching, respiratory depression, hypotension, bradycardia, arrhythmia, convulsion tremor were recorded.
RESULTS: No significant difference was found between groups in terms of heart rate (HR), mean arterial pressure(MAP), and cardiac index(KI) parameters. The goups were similar in terms of sensorial block onset times and sensory block Access to dermotomes and two-segment regressions times and motor block on time. However, motor block regression and motor block up times were found to be shorter in GroupII (p <0.05). None of the patients had ECG changes or side effects.(p>0.05).
DISCUSSION AND CONCLUSION: Levobupivacaine, affects hemodinamic in a similar way to bupicaine, it has been concluded that these findings may be used safely in patients with cardiovascular disease potential local anesthetic.

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GÝRÝÞ ve AMAÇ: Bu çalýþma ile bir eðitim ve araþtýrma hastanesinde 2009-2018 yýllarý arasýnda gerçekleþen beyin ölümü ve organ baðýþý olgularýnýn retrospektif olarak incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Vakalarýn beyin ölümü sayýlarý, organ baðýþlarý ve profillleri deðerlendirilmiþtir. Hastalarýn sayýlarý, yaþlarý, cinsiyetleri, milliyetleri, klinikleri, tanýlarý, baðýþ yapýlma durumu ve yapýlmadýysa sebebi incelenmiþtir. Çalýþmada arþiv kayýtlarýndan ve Saðlýk Bakanlýðý Transplantasyon, Diyaliz ve Ýzlem Sistemleri (TDIS) programýndan yararlanýlmýþtýr.
BULGULAR: 57 hastanýn beyin ölümünün tespit edildiði ve 19’unun (%33,3) organlarýnýn baðýþlandýðý bulundu. Olgularýn %89,4’ü (n=51) erkek, %40,3’ü (n=23) A kan grubu, %77,2’si (n=44) 20-60 yaþ aralýðýnda, tamamý Türkiye Cumhuriyeti vatandaþýdýr. Hastaneye yatýþ tanýlarý açýsýndan bakýldýðýnda travmalar %49,1 (n=28) ile ilk sýradadýr. Olgularýn %56,2’si (n=32) Anestezi ve Reanimasyon Kliniði yoðun bakým servisine yatmýþtýr. %39,4’ünün (n=15) dini sebeplerden dolayý organlarýnýn baðýþlanmadýðý bulunmuþtur.
TARTIÞMA ve SONUÇ: Beyin ölümü tespit sayýlarý ve organ baðýþ oranlarý istenilen düzeyde deðildir. Saðlýk personelinin ve toplumun farkýndalýðýný artýracak eðitim ve kampanyalar düzenlenmeli, kamu spotlarýndan daha çok faydalanýlmalýdýr. Dini açýdan sakýnca bulunmadýðýna dair Diyanet Ýþleri Baþkanlýðý ile daha yoðun faaliyetler yürütülmelidir.

INTRODUCTION: The objective of this study was to sought retrospectively the brain death and organ donation cases of a training and research hospital between 2009-2018.
METHODS: The profile of all cases, brain death numbers and organ donation were evaluated. The patients’ number, age, sex, nationality, their clinics, diagnosis, the status of donation and the reason of the donation failure, if any, were evaluated. Archives records and the Transplantation, Dialysis and Monitoring Systems of Health Ministry (TDIS) program were used for assestion.
RESULTS: We found that brain death of 57 patients was detected and organs of 19 cases (33.3%) were donated. 89.4% of patients (n= 51) were male, 40.3% (n = 23) A blood group, 77,2% (n = 44) in the 20-60 age range, and all cases were citizens of the Republic of Turkey. In terms of hospitalization diagnoses, traumas were the most common with 49.1% (n = 28). 56.2% (n = 32) of the cases were admitted to the intensive care unit of the Anesthesia and Reanimation Clinic. 39.4% (n = 15) found organ donation unacceptable because of religious beliefs.
DISCUSSION AND CONCLUSION: Brain death detection numbers and donation rates are not at the desired level. Education and campaigns should be implement to increase the awareness of the health personnel and the society, public spots should be utilized more. More intense activities should be carried out with the Presidency of Religious Affairs that there are no religious problems.

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GÝRÝÞ ve AMAÇ: Anksiyete perioperatif bir komplikasyondur ve birçok hasta bu durumla yüzyüze kalýr. Premedikasyon kullanýmý minimal kognitif bozulma ile anksiyeteyi azaltýr ve bu yüzden önemlidir. Bu çalýþmada epidural kateter takýlan ve elektif TUR-prostat ameliyatý olacak hastalarda preoperatif melatoninin intraoperatif vital bulgulara, postoperatif anksiyete ve kognitif fonksiyonlara etkisini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, 60 yaþ üstü 80 erkek olguda gerçekleþtirildi. Hastalar rastgele 40’ ar kiþilik iki gruba ayrýldý. Grup 1 ( n=40) ameliyattan 60 dakika önce melatonin 6 mg verildi. Grup 2 ( n=40) premedikasyon yapýlmadý.
TUR-Prostat hastalarýna epidural kateter yerleþtirildikten sonra, epidural kateterden 3 mL % 1’ lik lidokain test dozunu takiben, kateterin yeri doðrulandýktan sonra preoperatif 20 dakika önce epidural kateterden 12-18 mL % 0.5’ lik levobupivakain yapýldý.

BULGULAR: Gruplar karþýlaþtýrýldýðýnda postoperatif SAB, DAB, OAB ve KAH deðerleri arasýnda anlamlý fark saptanmadý. Gruplar periferik oksijen saturasyonu açýsýndan karþýlaþtýrýldýðýnda, Grup 1’in SpO2 deðerlerinin, Grup 2 deðerlerinden anlamlý derecede yüksek olduðu tespit edildi. Gruplar MMT açýsýndan karþýlaþtýrýldýðýnda Grup 1’ in postoperatif 1. saat MMT deðeri, Grup 2’ nin postop 1. saat MMT deðerinden anlamlý derece yüksek bulundu.
TARTIÞMA ve SONUÇ: Epidural blok öncesi hastalara melatonin verilmesinin kognitif fonksiyonlarý ve hemodinamik parametreleri olumlu etkilediði ancak anksiyete üzerine olumlu ya da olumsuz etkisinin bulunmadýðý kanaatine varýldý.

INTRODUCTION: Anxiety is a preoperative complication, which most patients encounter. The use of a premedication to reduce preoperative anxiety with minimal cognitive impairment is crucial. This study was conducted to compare the sedative effect of preoperative melatonin in patients with transurethral prostatectomy that performed on the cases decided to apply epidural anesthesia undergoing elective surgery.
METHODS: This study was performed on the cases decided to apply epidural anesthesia were selected from among the 80 male patients with transurethral prostatectomy over the age of 60. Patients were divided randomly into 2 groups as 40 people. 6mg melatonin were given to working group Group 1 for preoperative 60 minutes. Premedication was not used in control group Group 2
After applying the epidural catheter to patients, 3 mL 1% lidocain as test dosage was applied from epidural catheter than 12-18 mL 0.5% levobupivacain were applied before preoprative 20 minutes with confirming of the localisation of the catheter.


RESULTS: Meaningful difference were determineted between the postoperative HR, SAP, DAP, MAP values when the groups were compared. SpO2 values of Group 1 were determineted meaningfully higher than the group 2 values when groups were compared about peripheral oxygen saturation. The postoperative 1st hour MMT value of Group 1 were determineted meaningfully higher than the postoperative 1st hour MMT value of Group 2 when the groups were compared about MMT values.
DISCUSSION AND CONCLUSION: We established that useage of melatonin in patients before epidural block affects positively to cognitive functions and hemodinamic parameters but not any positive or negative effect on anxiety.

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GÝRÝÞ ve AMAÇ: Postoperatif akut böbrek hasarý (AKI) koroner arter baypas greft cerrahisinin (CABG) en önemli komplikasyonlardan bir tanesidir. Biz bu prospektif çalýþmada açýk kalp cerrahisinin aortik kros klemp (ACC) sýrasýndaki çýkan idrar miktarýnýn postoperatif AKI belirleme üzerine etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Bu çalýþma prospektif olarak Ocak 2016 ile Nisan 2017 tarihleri arasýnda izole koroner baypas operasyonu geçiren hastalar üzerinde yapýldý. Postoperatif üçüncü günde preoperatif kreatinin deðerlerinde 1,5 katýndan fazla artýþ olan hastalar RIFLE kriterlerine göre akut böbrek hasarý olarak kabul edildi. Hastalar AKI'nin varlýðýna göre i AKI (+) ve AKI (-) olmak üzere iki gruba ayrýldý.

BULGULAR: Çalýþmadaki 146 hastanýn 12'sinde akut böbrek hasarý geliþti. Gruplar arasýnda demografik veriler ve intraoperatif deðiþkenler birbirine benzerdi (p> 0.05). AKI (-) gruptaki ACC sýrasýndaki çýkan idrar miktarý (ml/kg/saat) AKI (+) gruba göre önemli derecede yüksek bulundu (p=0.045).
TARTIÞMA ve SONUÇ: Verilerimiz ACC ve kardiyopulmoner baypas sýrasýndaki çýkan idrar miktarýnýn AKI erken tanýsý için deðerli bir kriter olabileceðini gösterdi.
Biz ACC sýrasýnda idrar çýkýþý 3.345 ml/kg/saatin altýnda olan hastalarýn postoperatif AKI için yüksek risk taþýdýðý kanaatindeyiz.

INTRODUCTION: Postoperative acute kidney injury (AKI) is a common and serious complication of coronary artery bypass grafting surgery (CABG). In this prospective study, we investigated the efficacy of urinary volume during aortic cross-clamping (ACC) in cardiac surgery in determining postoperative AKI.
METHODS: This prospective study consisted of patients who underwent isolated coronary artery bypass surgery between January 2016 and April 2017. Patients with an increase of more than 1.5 times preoperative creatinine values on their third postoperative day were considered acute kidney injury according to RIFLE criteria. The patients were divided into two groups as AKI (+) and AKI (-), regarding presence of AKI, which were then compared.
RESULTS: Acute kidney damage developed in 12 patients out of 146 patients studied. The demographic variables, intraoperative variables were similar between the groups (p > 0.05). The urinary output during ACC (mL/kg/h) of the AKI (-) group was significantly higher than that of the AKI (+) group (p=0.045).
DISCUSSION AND CONCLUSION: Our data demonstrated that urinary output during ACC and cardiopulmonary bypass (CPB) periods may be a valuable criterion for early diagnosis of AKI. We suppose that, the patients with a urine output less than 3.345 ml/kg/h during the ACC period carry a high risk for postoperative AKI.

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ALCAPA (Anomalous origin of the left coronary artery from pulmonary artery) Sendromu (Bland – White - Garland Sendromu) anormal yerleþimli sol koroner arterin aorta yerine pulmoner arterden çýkýþý ile karakterize, nadir görülen bir konjenital koroner arter anomalisidir. Anestezi indüksiyonu ve idamesi pek çok nedenle özellik arz eder. Bu olgu sunumu ile sýk rastlanmayan bu sendromda anestezi yönetiminin tartýþýlmasý ve intraoperatif transözofageal ekokardiyografi bulgularýnýn paylaþýlmasý, kullanýmýnýn önemine dikkat çekilmesi amaçlanmýþtýr.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome (Bland-White-Garland syndrome) is a rare congenital coronary artery anomaly characterized by an abnormally located left coronary artery that arises from the pulmonary artery instead of the aorta. Anesthesia induction and maintenance have significance due to many reasons. In the present paper, we aimed to discuss the anesthesia management in this rare syndrome and present case, and to draw attention to share and use the findings of intraoperative transesophageal echocardiography.

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Toksik epidermal nekroliz (TEN) genellikle ilaçlara karþý geliþen, akut seyirli, deri ve mukozalarý tutan ve þiddetli döküntü ile seyreden bir hastalýktýr.Keratinositlerin yüzeylerinde gösterdikleri antijenler nedeniyle bu hücrelere karþý geliþen sitotoksik immün reaksiyon sonucunda hastalýk ortaya çýkar.Hastalýðýn þiddeti ve verilen saðlýk hizmetinin kalitesi hastalýðýn prognozunu ve doðal olarak da mortalite oranýný belirler. Tedavinin en önemli basamaklarý; erken taný ve þüpheli ilaç ya da ilaçlarýn hemen kesilmesidir.59 yaþýnda, TEN tanýlý, kadýn hastanýn tedavisi yoðun bakýmda baþarýyla yönetildi.

Toxic epidermal necrolysis (TEN) is a disease that usually develops against drugs, has an acute course, involves the skin and mucous membranes, and is accompanied by severe rash. It determines the prognosis of the disease and naturally the mortality rate. The most important steps of treatment; early diagnosis and immediate discontinuation of suspected drugs.59 years old female patient with TEN was managed successfully in the intensive care unit.

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Rainier hemoglobinopati, hemoglobinin düþük kan oksijen satürasyonuna yol açan armýþ oksijen afinitesi ile karakterize, oldukça nadir görülen hematolojik bir hastalýktýr. Güncel literatür, genel anestezi ile ameliyat edilen sadece 1 olguyu kapsamaktadýr.
Bu yazýda, genel anestezi ile nazal septoplasti yapýlan, Rainier hemoglobinopatisi olan 27 yaþýnda bir erkek hastayý sunduk.

Rainier hemoglobinopathy is an extremely rare hematologic disorder characterized with increased oxygen affinity of hemoglobin leading low blood oxygen saturation. Up to date literature includes only 1 case whom had been operated with general anesthesia.
In this report, we present a 27-year-old male patient with rainer hemoglobinopathy whom underwent nasal septoplasty with general anesthesia.

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