GÝRÝÞ ve AMAÇ: Torakotomi sonrasý aðrýda, cerrahi sýrasýnda direk görülerek takýlan paravertebral kateterin, Lomber epidural morfin uygulamasýna üstünlüðünün olup olmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2013 – Ocak 2014 tarihleri arasýnda torakotomi uygulanan ve çalýþmaya dahil etme kriterlerine uyan 34 lomber epidural kateter ve 32 paravertebral kateter uygulanan toplam 66 hastanýn dosyalarý geriye dönük olarak tarandý. Hastalarýn dosyalarýndan hem istirahat hem de öksürük sýrasýndaki postoperatif 0, 1, 4, 12 ve 24. saat aðrý düzeyleri (Verbal Rating Scale) kaydedildi. Ayrýca postoperatif ayný saatlerdeki kalp hýzlarý, kan basýnçlarý, solunum sayýsý, parmak ucu saturasyonlarý, toraks dren çekilme zamanlarý ve postoperatif komplikasyonlar kaydedildi.
BULGULAR: Her iki gruptaki hastalarýn demografik ve operatif verileri benzerdi. Postoperatif aðrý açýsýndan, bütün ölçüm zamanlarýnda, Verbal Rating Scale her iki grupta benzer olarak bulundu. Her iki grup arasýnda postoperatif komplikasyonlar açýsýndan da istatistiksel anlamlý bir farklýlýk saptanmadý.
TARTIÞMA ve SONUÇ: Torakotomi sýrasýnda direk görülerek takýlan paravertebral kateter, lomber epidural kateterden uygulanan morfin ile ayný düzeyde analjezi saðlamýþtýr. Daha güvenilir bir þekilde uygulanabilmesi ve etkin analjezi saðlanmasý nedeni ile paravertebral kateterin, epidural uygulamasýna alternatif bir yöntem olabileceði kanýsýndayýz.

INTRODUCTION: To investigate if paravertebral catheter which is placed under direct vision during surgery is superior to lumbar epidural morphine application.
METHODS: The records of 66 patients who underwent thoracotomy between January 2013 and January 2014, who had 34 lumbar epidural catheters and 32 paravertebral catheters and who are meeting the inclusion criteria were evaluated retrospectively. From the patients’ files pain scores (Verbal Rating Scale) at postoperative 0, 1, 4, 12 and 24 hour were recorded during both resting and coughing. In addition, heart rate, blood pressures, respiratory rate, saturation, thoracic drain withdrawal times and postoperative complications were recorded at the same postoperative hours.
RESULTS: Demographic and operative data of patients in both groups were similar. In terms of postoperative pain, Verbal Rating Scale was similar in both groups at all measurement times. There was no statistically significant difference between the two groups in terms of postoperative complications.
DISCUSSION AND CONCLUSION: The paravertebral catheter which is placed under direct vision during thoracotomy provided the same level of analgesia as the lumbar epidural morphine administration. We believe that the paravertebral catheter may be an alternative method to epidural due to its effective analgesia and safely application.

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GÝRÝÞ ve AMAÇ: Koroner arter baypas (KABG) operasyonlarýnda, özellikle deðiþik teknikler kullanýldýðýnda optimal miyokardiyal koruma halen tartýþmalýdýr. Bu prospektif çalýþmada, fibrilasyonda aralýklý aortic kros-klempleme (IAC) tekniði veya kardiyoplejik kardiyak arest (CCA) tekniði ile yapýlan elektif KABG vakalarýný, miyokardiyal metabolizma ve transmural biopside apopitoz varlýðý açýsýndan karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Etik komite onayý ile aradarda gelen elektif KABG operasyonu geçirecek normal ventrikül fonksiyonlu, regüle hipertansiyon ve/veya tip II DM dýþýnda baþka komorbid hastalýðý olmayan IAC grubunda 13 hasta, CCA grubunda 8 hasta ile çalýþma yapýldý. Hemodinamik veriler, aralýklý CK-MB deðerleri ve ECG deðiþiklikleri postoperatif 24 saate kadar kaydedildi. Miyokardiyal oksijen ekstraksiyonu ve laktat üretimi, radiyal arter ve koroner sinüse yerleþtirilen retrograde kanülden; kardiyopulmoner baypas (CPB) dan hemen önce, kross-klemp sýrasýnda ve kross-klemp kaldýrýlmasýný takiben 5-10dk. içindeki dönemlerde alýnan kan örneklerinden hesaplandý. Sol ventrikül ön duvarýndan CPB öncesi ve sonrasý alýnan biopsiler apopitoz açýsýndan incelendi.
BULGULAR: Demografik ve intraoperatif hemodinamik veriler gruplar arasý benzerdi. Her iki grupta da iskemi öncesi ve iskemi sonrasý miyokardiyal oksijen ekstraksiyonu ve laktat üretimi benzerdi. IAC grubunda yedi hastada ve CCA grubunda bir hastada erken postoperatif dönemde düþük doz inotrop ihtiyacý oldu. Her iki grupta apopitozu gösterir bir kanýt bulunamadý.
TARTIÞMA ve SONUÇ: Bu çalýþma bize düþük risk grubundaki KABG operasyonlarýnda kullanýlan IAC ve CCA metodunun miyordiyal koruma ve apopitoz varlýðý açýsýndan birbirlerine üstünlükleri olmadýðýný gösterdi.

INTRODUCTION: Optimal myocardial protection during CABG operations is still controversial. In this study we compared hemodynamic data, myocardial oxygen extraction, lactate production and apoptosis in transmural biopsy specimens in operations done either with intermittent aortic cross-clamping with fibrillation (IAC) or with cardioplegic cardiac arrest (CCA) method.
METHODS: Following Ethics Committee approval, consecutive patients with normal ventricular function and no comorbid disease other than regulated hypertension and/or type-2 DM were included in the study (IAC group n=13, CCA group n=8). Hemodynamic data, serial CK-MB values and ECG changes were recorded till postoperative 24 hours. Myocardial oxygen extraction and lactate production were calculated from the blood samples withdrawn from the aortic root and the coronary sinus cannula during following periods; before total CPB, during cross-clamp and following cross-clamp removal. Transmural biopsy specimens obtained before total CPB and before cessation of CPB were analyzed for apoptosis.
RESULTS: Demographic and hemodynamic variables were similar. Preischemic and postischemic myocardial oxygen extraction and lactate production values showed no significant differences. Seven patients in IAC and one patient in CCA group needed low dose inotropic support during early postoperative period. Biopsies revealed no evidence of apopitosis in both groups.
DISCUSSION AND CONCLUSION: This study shows that for low risk CABG procedures, IAC and CCA methods were no superior to each other in protecting the myocardium from ischemic injury with respect to myocardial oxygen extraction, lactate production and presence of apoptosis.

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GÝRÝÞ ve AMAÇ: Koroner arter baypas greft (KABG) cerrahisi sonrasý görülen en sýk ritm bozukluðu olan Atriyal Fibrilasyonda(AF), risk faktörlerini belirlemek ve C-Reaktif Protein (CRP) ile AF arasýnda bir korelasyon olup olmadýðýný göstermektir.
YÖNTEM ve GEREÇLER: Koroner arter cerrahisi yapýlacak 250 hasta prospektif olarak çalýþmaya alýndý. Tüm hastalarýn demografik verileri, peroperatif ve postoperatif deðiþkenleri ve postoperatif 6.güne dek günlük CRP ve AF takipleri ile, AF olanlarýn tedavi protokolleri kaydedildi.
BULGULAR: Takip edilen hastalarýn 43’ünde (%17.2) AF tespit edildi. Multivariate analizde, ileri yaþ, hipertansiyon (HT) ve preoperatif kalsiyum kanal blokeri kullanma ile AF arasýnda anlamlý bir iliþki olduðu saptandý(p<0.05). CRP deðerleri postoperatif 2. günde en yüksek deðere ulaþtý. AF bu dönemde 14 hastada görülmüþ (%5,6) olmakla birlikte, CRP yüksekliði ile AF geliþimi arasýnda bir iliþki tespit edilemedi(p>0.05). AF geliþen hastalarýn yoðun bakým ve hastanede kalýþ sürelerinin istatistiksel olarak anlamlý uzun olduðu gözlendi(p<0.05).
TARTIÞMA ve SONUÇ: KABG operasyonu geçiren ileri yaþtaki, hipertansif, preoperatif kalsiyum kanal blokeri kullanan hastalarda, AF geliþme riskinin daha fazla olduðu ve AF tespit edilen hastalarýn yoðun bakým ve hastanede kalýþ sürelerinin daha uzun olduðu tespit edilmiþ ve AF ile CRP arasýnda bir korelasyon bulunamamýþtýr

INTRODUCTION: The aim of this study was to determine the risk factors in Atrial Fibrillation (AF), which is the most common rhythm disorder observed after coronary artery bypass graft (CABG) surgery, and to show whether there is a correlation between C-Reactive Protein (CRP) and AF.
METHODS: 250 patients who underwent coronary artery surgery were prospectively included in the study. Demographic data, peroperative and postoperative variables of all patients, daily CRP and AF follow-ups until the 6th postoperative day and treatment protocols of AF patients were recorded.
RESULTS: AF was detected in 43 (17.2%) of the patients who were followed up. It was found that there was a statistically significant relationship in the multivariate analysis between advanced age, hypertension (HT) and use of preoperative calcium channel blocker and AF(p<0.05). CRP values reached the highest value on the 2nd postoperative day. Although AF was seen in 14 patients (5.6%) in this period, no relation was found between the height of CRP and the development of AF(p>0.05). It was observed that the duration of intensive care and hospital stay of patients with AF was statistically significantly longer (p <0.05).
DISCUSSION AND CONCLUSION: It was found that patients with advanced age, hypertensive, preoperative calcium channel blocker usage had a higher risk of developing AF. Duration of ICU and hospital stay was longer, and no correlation was found between AF and CRP.

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GÝRÝÞ ve AMAÇ: Koroner arter baypas graft (KABG) cerrahisi sonrasý yoðun bakým kalýþ sürelerinin uzamasý morbidite, mortalite ve hastane maliyetlerinin artmasý ile iliþkilidir. Bu çalýþmanýn amacý KABG operasyonlarý sonrasý postoperatif yoðun bakým kalýþ süresinin (YBKS) uzamasýyla iliþkili risk faktörlerini analiz etmektir.
YÖNTEM ve GEREÇLER: Elektif olarak KABG operasyonu geçirecek 199 hasta çalýþmaya alýndý. Uzamýþ yoðun bakým kalýþ süresi 48 saat olarak belirlendi. Hastalarýn preoperatif demografik verileri, kros-klemp ve pompa süreleri, inotrop kullanýmlarý, 2>ünite kan transfüzyonu, hipotermi, entübasyon süresi, aritmi, alveolo-arteriyel oksijen gradienti (PAO2-PaO2) ve parsiyel arteriyel oksijen/ fraksiyone inspire oksijen (PaO2/FiO2) oranlarý kaydedildi. Yoðun bakýmda kalýþ süresine göre hastalar iki gruba ayrýldý. Grup 1: Yoðun bakým kalýþ süresi 48 saatten kýsa olan hastalar, Grup 2: Yoðun bakýmda kalýþ süresi 48 saatten uzun olan hastalar. Ýstatik yöntemi olarak Mann Whitney U testi ve eþli olmayan t testi kullanýldý. Lineer regresyon analizi ile uzamýþ yoðun bakýmla iliþkili faktörler araþtýrýldý.
BULGULAR: Yoðun bakýmda kalýþ süresi Grup 1‘de 26.4±9.1 iken, Grup 2 hastalarýnda 137.8±72.3 saat olarak bulundu. Ventilasyon süresi ise grup 1’de 11.1±4.1 saat, Grup 2’de 74.5±81.0 olarak hesaplandý. Lineer regresyon analizine göre entübasyon süresi, kronik obstrüktif akciðer hastalýðý (KOAH), yaþ >60, kreatinin > 1.3 mg/dl ve ejeksiyon fraksiyonu (EF) < %45 uzamýþ yoðun bakýmda kalýþ süresi ile iliþkili faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Tespit edilen risk faktörlerinin varlýðýnda uygun tedavi seçenekleri ile hastalarýn desteklenerek operasyon zamanlamasýnýn iyi belirlenmesi, yoðun bakým kalýþ süresi azaltacaktýr.

INTRODUCTION: Prolonged ICU stay after coronary artery bypass surgery(CABG) is associated with increased morbidity, mortality and hospital costs.
The aim of this study is to analyze the risk factors associated with the prolongation of postoperative intensive care stay(ICUS) after CABG operations.

METHODS: 199 patients who would electively undergo CABG operation were included in the study. Prolonged ICU stay was determined as 48 hours. Preoperative demographic data, cross-clamp and pump times, inotropic uses, 2> unit blood transfusion, hypothermia, intubation time, arrhythmia, alveolo-arterial oxygen gradient (PAO2-PaO2) and partial arterial oxygen / fractional inspired oxygen (PaO2 / FiO2) ratios were recorded. Patients were divided into two groups according to the length of stay in the intensive care unit. Group1: Patients with ICU stay shorter than 48 hours, Group2: Patients with ICU stay longer than 48 hours. Mann Whitney U test and unpaired t test were used as statistical method. The factors associated with prolonged intensive care were investigated by linear regression analysis.
RESULTS: Duration of stay in intensive care unit was 26. ±9.1 in Group1, it was 137.8±72.3 hours in Group2 patients. Ventilation time was calculated as 11.1±4.1 hours in group 1 and 74.5±81.0 in group 2. According to the linear regression analysis, intubation time, chronic obstructive pulmonary disease (COPD), age>60, creatinine>1.3 mg/dl and ejection fraction (EF)<45% were found to be factors associated with prolonged ICU stay.
DISCUSSION AND CONCLUSION: In the presence of identified risk factors, the appropriate timing of the operation will be supported by supporting the patients with appropriate treatment options and determining the timing of the operation

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GÝRÝÞ ve AMAÇ: Çalýþmada, karotis arter darlýðý olan ve olmayan hastalarýn serebral oksijen satürasyonu (rSO2) takip ederek NIRS'ýn KABG ameliyatlarýnda rutin olarak kullanýlabilirliliðini araþtýrýldý.
YÖNTEM ve GEREÇLER: KABG uygulanacak olan 80 hasta iki gruba ayrýldý. Preoperatif yapýlan renkli doppler ultrasonografi ile internal karotis arterlerinde darlýk olan yada stabil plaðý olan hastalar Grup I (n=40), internal karotis arterde darlýk tespit edilmeyen hastalar Grup II'yi (n=40) oluþturdu. Her iki grupta; nabýz, sistolik ve diyastolik kan basýncý, ortalama arteriyel kan basýncý, nazofarengeal ýsý, hematokrit, PaO2, PaCO2, SPO2, BÝS, sað ve sol rSO2 deðerleri ve rSO2 yüzde deðiþim oranlarý karþýlaþtýrýldý.
BULGULAR: Her iki grupta da erkek/kadýn oraný 27/13 þeklindeydi. Hastalarýn ortalama yaþý grup I’de 60.82±9.63 (39-79) yýl, grup II’de 59.95±9.54 (41-80) yýl idi. Gruplar arasýnda demografik veriler, preoperatif labaratuar ve BÝS deðerleri, ameliyat ve pompa süresi açýsýndan bir fark izlenmedi. Arteriyal kan gazý deðerleri, sað ve sol rSO2 deðerlerinde tüm ölçüm zamanlarýnda gruplar arasýnda fark bulunmadý (sýrasýyla p=0,309, p=0,114). Her iki grupta tüm ölçüm zamanlarýnda rSO2 deðerlerinde %20'ten fazla azalma izlenmedi. Ancak grup I'de rSO2 yüzde deðiþim oranlarý grup II'ye göre istatistiksel olarak anlamlý bulundu (sað p=0,031, sol p<0,001). Postoperatif dönemde her iki grupta da inme izlenmedi.
TARTIÞMA ve SONUÇ: KABG uygulanan hastalarda kalp akciðer pompasýna geçildiðinde beyin perfüzyonunda düþme olmaktadýr ve NIRS ile peroperatif serebral perfüzyonun takibi önemlidir. rSO2'deki yüzde deðiþim oranlarý karotis arterde darlýk olan hastalarda daha fazla olmaktadýr.

INTRODUCTION: In the study, the regional cerebral oxygen saturation (rSO2) of patients with and without carotid artery stenosis was monitored to see whether or not NIRS can be used routinely in CABG operations.
METHODS: Eighty patients undergoing CABG were divided into two groups. Following the preoperative colour Doppler ultrasonography, the patients with internal carotid artery stenosis or with stable plaque were included in Group I (n=40), while the patients having no internal carotid artery stenosis were included in Group II (n=40). Pulse rates, systolic and diastolic blood pressures, mean arterial blood pressures, nasopharyngeal temperatures, haematocrit, PaO2, PaCO2, SpO2, BIS, right, and left rSO2 values, and relative changes in rSO2 from baseline of the two groups were compared.
RESULTS: The male/female ratios in both groups were 27/13. The mean age was 60.82±9.63 (39–79) years in Group I and 59.95±9.54 (41–80) years in Group II. No differences were observed in terms of demographic data, preoperative laboratory and bispectral index (BIS) values, and time of operation and CPB. In addition, no differences were observed between the arterial blood gas values or the right and left rSO2 values of the groups at all measurement time points (p=0.309 and p=0.114, respectively). In both groups, the decrease in rSO2 values was not higher than 20% at all measurement time points. However, the relative changes in rSO2 from baseline in Group I were statistically different compared to those in Group II (right p=0.031, left p<0.001). No stroke occurred in the groups postoperatively.
DISCUSSION AND CONCLUSION: In patients undergoing CABG, brain perfusion reduces when a CPB pump is put into operation, and the monitoring of intraoperative cerebral perfusion with NIRS is crucial. In patients with carotid artery stenosis, relative changes in rSO2 from baseline are higher.

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GÝRÝÞ ve AMAÇ: Santral venöz kateterizasyon(SVK) çeþitli endikasyonlarla yoðun bakýmlarda kullanýlan invaziv bir iþlemdir. Literatürde, uygulamada % 3,6-14 arasýnda deðiþen oranlarda malpozisyon bildirilmiþtir. Bu çalýþmayla yoðun bakýmlarýmýzda uzman hekimler tarafýndan ultrasonografi kullanmadan yapýlan SVK uygulamasýnda kateter yerleþtirme yeri tercihi ve malpozisyon oranlarýmýzý belirlemeyi amaçladýk.


YÖNTEM ve GEREÇLER: Etik kurul onayý sonrasý Mersin Þehir Eðitim ve Araþtýrma Hastanesinde 2017-2019 yýllarýnda SVK iþlemi uygulanan 1710 hasta dosyasý hastane bilgi yönetim sisteminden tarandý. Kalýcý port kateter, diyaliz kateteri ve 18 yaþ altý pediatrik hastalarda yerleþtirilen kateterler çalýþma dýþý býrakýldý. Tüm kateterizasyon iþlemleri uzman hekim tarafýndan ultrasonografi kullanmaksýzýn Seldinger tekniðiyle 7 F kateterler kullanýlarak yapýlmýþtý.


BULGULAR: Çalýþmaya dahil edilen 1463 hastadan kateter yerleþim yeri olarak, en çok olmak üzere 842 hastada internal juguler ven, 467 hastada subklavian ven ve 154 hastada femoral ven kullanýldýðý tespit edildi. Femoral katetrizasyon deðerlendirme dýþý býrakýldýðýnda 1309 hastada %1.68 oranýnda malpozisyon saptanmýþtýr. Sað internal juguler venden yapýlan kateteterizasyonlarda 14 adet, sað subklavian ven kateterizasyonunda 6 adet ve sol subklavian ven kateterizasyonunda 2 adet malpozisyon geliþmiþtir.
TARTIÞMA ve SONUÇ: Sonuç olarak ultrason rehberliðinde kateter yerleþtirilmesi tecrübeli klinisyenler tarafýndan uygulandýðýnda malpozisyon geliþimini önleyebildiði ve daha az komplikasyona neden olabileceði bildirilse de ultrasonun olmadýðý uygulamalarda iþlemin deneyimli kiþilerce yapýlmasýnýn ve iþlem sonrasýnda kateter yerinin doðruluðunun teyit edilmesinin malpozisyon oranlarýný azaltabileceðini düþünmekteyiz"

INTRODUCTION: Central venous catheterization (CVC) is an invasive procedure used in intensive care units with various indications. Malposition has been reported in the literature ranging from 3.6-14% in practice. In this study, we aimed to determine the preference of catheter placement and malposition rates in SVC application performed by specialist physicians in our intensive care units without using ultrasonography.
METHODS: After the approval of the ethics committee, 1710 patient files were applied to the Mersin City Training and Research Hospital in 2017-2019. Permanent port catheter, dialysis catheter and catheters placed in pediatric patients under 18 years of age were excluded from the study. All catheterization procedures were performed by a specialist physician using 7 F catheters with Seldinger technique without the use of ultrasound.
RESULTS: Of the 1463 patients included in the study, 842 patients had internal jugular vein, 467 patients had subclavian vein and 154 patients had femoral vein. When femoral catheterization was excluded, malposition was found in 1309 patients with a rate of 1.68%. There were 14 malposition catheters in the right internal jugular vein, 6 in the right subclavian vein and 2 in the left subclavian vein catheterization.
DISCUSSION AND CONCLUSION: In conclusion,it has been reported that ultrasound-guided catheter placement may prevent malposition and reduced complication rate when performed by experienced clinicians. However,when the ultrasound is not available, we believe that performing the procedure by experienced clinicians and confirming the accuracy of the catheter position with lung x-ray after the procedure may reduce malposition rates

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Kardiyotorasik cerrahide Erector Spinae Plane (ESP) bloðu, postoperatif analjezide perioperatif opioid kullanýmýna veya torasik epidural analjeziye iyi bir alternatif olabilir. Bu yazýda redo triküspit kapak replasmaný ameliyatýnda etkili ESP blok deneyimimizi sunduk. Hastaya torakotomi ile redo triküspit kapak replasmaný (TVR) ameliyatý planlandý. Hastaya 1994 yýlýnda aort kapak replasmaný, 2005 yýlýnda mitral kommissurotomi ve 2008 yýlýnda TVR uygulanmýþtý. ESP için T5 seviyesinde % 0.5 bupivakain: salin 1: 1 karýþýmý, her bir tarafa 20 ml olacak þekilde bilateral tek enjeksiyon bloðu uygulandý. Postoperatif 1. ve 2. gün VAS 1-2 idi ve ek analjezik gerekmedi. Tek enjeksiyonlu blok postoperatif aðrýyý hafifletmede oldukça etkiliydi, hasta hemodinamik olarak stabildi ve minimum perioperatif opioid gereksinimi ümit vericiydi. ESP bloðu, yüksek opioid dozlarýnýn neden olduðu sorunlarý önlemek için çok avantajlýdýr. Önemli bir nokta, redo ameliyatlarda daha fazla doku rezeksiyonu gerekir ve bu daha fazla aðrýya neden olur, ancak olgumuzda tek enjeksiyonlu ESP ile yeterli analjezi saðlanmýþtýr.

Erector Spinae Plane(ESP) block in cardiothoracic surgery may be a good alternative to perioperative opioid use or thoracic epidural analgesia in the treatment of postoperative analgesia. We presented to effective ESP block experience for a patient redo tricuspid valve replacement. A patient underwent surgery for redo tricuspid valve replacement(TVR) with thoracotomy. The patient underwent aortic valve replacement in 1994, mitral commissurotomy in 2005 and TVR in 2008. Single injection block was performed at the level of the T5 for ESP with 0.5% bupivacaine saline 1: 1 mixture was bilaterally administered in 20 ml each.On the 1.and 2. postoperative day, VAS was 1-2 and no additional analgesic was required. Single injection block was quite effective in relieving postoperative pain, the patient was hemodynamically stable and minimum perioperative opioid requirement was promising. ESP block is very advantageous in order to avoid problems caused by high opioid doses. An important point is that more tissue resection is required in redo surgeries, causing more pain, however, adequate analgesia was achieved with single injection ESP in our case.

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Beklenen zor entubasyon olgularýnda uyanýk fiberoptik entübasyon ve tüp deðiþtirici kateter kullanýlmaktadýr. Bu uygulamalar hayat kurtarýcý olmasýnýn yanýnda bazý komplikasyonlara neden olabilir. Bu olguda retromolar kitleye baðlý aðýz açýklýðý 0.2 mm olan hastaya, biyopsi amaçlý uyanýk nazal fiberoptik entubasyon yapýldý. Ekstubasyonda tüp deðiþtirici kateter kulanýldý. Ekstubasyon sonrasý Pnömotoraks gözlendi. Bu olguda nazal uyanýk fiberoptik entübasyon, tüp deðiþtirici kateterle yapýlan ekstubasyon ve sonrasýnda geliþen pnömotoraks ile ilgili deneyimimizi sunduk.

In the expected difficult intubation, Awake Fiber–Optic Nasotracheal Intubation and tube-changing catheter are used. These practices can be life-saving as well as cause some complications. In this case report, a patient with a mouth opening of 0.2 mm due to retromolar mass was subjected to Awake Fiber–Optic Nasotracheal Intubation for biopsy. A tube changer catheter was used on the extubation. Pneumothorax was observed after extubation. In this case, we present our experience with Awake Fiber–Optic Nasotracheal Intubation, extubation with airway exchange catheter and developing pneumothorax.

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