Amaç: Kalp cerrahisi sonrasý erken dönemde hiperbilirubinemiye baðlý sarýlýk hastalarýn %10 ila %23’ünde geliþir. Çalýþmamýzýn amacý, sarýlýða neden olan hiperbilirubineminin risk faktörlerini ve klinik sonuçlarýný incelemektir.
Yöntem: Bu retrospektif çalýþmada, Þubat 2015-Mart 2021 tarihleri arasýnda kalp cerrahisi geçiren hastalar deðerlendirildi. Acil veya elek-tif cerrahi uygulanýp postoperatif dönemde sarýlýk geliþen ve total bilirubin konsantrasyonu >3 mg/dL olan hastalar çalýþmamýza dahil edildi. Temel demografik, ekokardiyografik, laboratuvar, ameliyat ve ameliyat sonrasý veriler kapsamlý bir þekilde toplandý. ROC analiziyle postoperatif total bilirubin cut-off deðeri hastane mortalitesine göre hesaplandý.
Bulgular: Toplam bilirubin konsantrasyonu 27 hastada >3 mg/dL olarak bulundu. Hastalarýn ortalama total bilirubin deðeri 9,56±6,427 mg/L, medyan toplam bilirubin deðeri 9,02 mg/L olarak bulundu. Hastalar maksimum bilirubin konsantrasyonuna ameliyat sonrasý 9,52±8,007 günde ulaþtý. Hastanede 17 (%63,0) hastada mortalite görüldü. Hastane içi mortaliteyi öngörmek amacýyla hesaplanan postoperatif total bilirubinin cut-off deðeri 9,24 mg/L olarak bulundu (duyarlýlýk= %70,6, özgül-lük= %90, olabilirlik oraný=7,05).
Sonuç: Kalp cerrahisi sonrasý dönemde hiperbilirubinemi geliþen hastalar düþük kalp debisi sendromu, sepsis veya akut karaciðer yetmezliði açýsýndan dikkatle izlenmelidir. Kalp debisi ve oksijen sunumu yeterli olduðunda düþük seviyeli hiperbilirubinemi çoðunlukla geri dönüþümlüdür. Ancak þiddetli persistan hiperbilirubinemi erkenden fark edilmesi ve önlem alýnmasý gereken bir durumdur.

Objectives: Jaundice due to hyperbilirubinemia develops in 10–23% of patients in the early period after cardiac surgery. The aim of our study is to examine the risk factors and clinical consequences of hyperbilirubinemia causing jaundice.
Methods: In this retrospective study, patients who underwent cardiac surgery in our clinic between February 2015 and March 2021 were evaluated. Patients who underwent routine or emergency surgery, who developed post-operative jaundice, and whose total bilirubin concentration was >3 mg/dL were included in our study. The baseline demo-graphic data, echocardiography data, laboratory data, operative data, and post-operative status were comprehensively collected. The cutoff value of post-operative total bilirubin was calculated according to hospital mortality in receiver operating characteristic analysis.
Results: Total bilirubin concentration was found to be >3 mg/dL in 27 patients. Mean total bilirubin (mg/L) was 9.56±6.427 and median total bilirubin score was 9.02 and the maximum bilirubin concentration was reached at 9.52±8.007 post-operative days. In-hospital mortality occurred in 17 (63.0%) patients. The cutoff for post-operative total bilirubin value was calculated as 9.24 by predicting in-hospital mortality (Sensitivity=70.6%, specificity=90%, and likelihood ratio: 7.05).
Conclusion: Patients who develop hyperbilirubinemia in the post-operative period of cardiac surgery should be carefully observed for low cardiac output syndrome, sepsis, or acute liver failure. Low-level hyperbilirubinemia is mostly reversible when cardiac output and oxygen delivery are adequate. However, severe persistent hyperbilirubinemia is a condition that needs to be recognized early and precautions should be taken.

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Amaç: Bu çalýþmada, kardiyak cerrahide çalýþan anestezistlerin kanýta dayalý geliþtirilen perioperatif Ameliyat Sonrasý Geliþmiþ Ýyileþme (Enhanced Recovery After Surgery [ERAS]) protokollerine iliþkin farkýndalýklarýnýn ve mevcut peroperatif yaklaþýmlarýnýn deðerlendirilmesi amaçlandý.
Yöntem: Kardiyak cerrahi uygulanan hastalarda, 2019 yýlýnda ERAS Kardiyak Derneði tarafýndan kanýta dayalý olarak bildirilen; preoperatif, intraoperatif ve postoperatif bakýmla ilgili önerilere iliþkin bilgi, tutum ve davranýþlarý deðerlendiren 30 sorudan oluþan anket, e-posta ve yüz yüze basýlý form aracýlýðýyla kardiyak cerrahide çalýþmakta olan anestezi hekimlerine yöneltildi.
Bulgular: Çalýþma örneklemini, kardiyak cerrahide çalýþan 90 anestezi hekimi oluþturdu. Katýlýmcýlarýn %31,1’inin ERAS protokolleri ile ilgili fikrinin olmadýðý görüldü. Rutin HbA1C düzeyi ölçümü yapanlarýn oraný %64,4, rutin albümin düzeyi ölçümü yapanlarýn oraný %60, karbonhidrat yüklemesi uygulayanlarýn oraný %8, topikal intranazal antimikrobiyal tedavi uygulayanlarýn oraný %9,1, rutin traneksamik asit veya epsilon aminokapronik asit uygulayanlarýn oraný %50 olarak saptandý. Ýntravenöz antibiyoterapi uygulama zamaný ile ilgili soruya katýlýmcýlarýn %54,4’ü indüksiyondan hemen sonra, %13,3’ü cerrahiden 30 dakika önce yanýtýný verdi. Akut böbrek hasarý saptanmasýna yönelik biyobelirteçlerin (metalloproteinaz-2 doku inhibitörü ve insülin benzeri büyüme faktörü baðlayýcý protein 7 gibi) ölçümünü yapan katýlýmcýlarýn oraný %2,2 olarak saptandý. Katýlýmcýlarýn %32,2’sinin analjezi amaçlý rejyonel anestezi tekniklerini kullandýklarý belirtildi.
Sonuç: Kardiyak cerrahide anestezistlerin perioperatif uygulamalarý ERAS kýlavuzuyla uyumluluk göstermektedir ancak katýlýmcýlarýn yaklaþýk üçte biri, bu protokole iliþkin fikir sahibi olmadýðýný belirtti. Her geçen gün önemi artan ERAS protokolüne olan farkýndalýðýn artýrýlmasýna yönelik çalýþmalar, kalp cerrahisinde hasta çýkýþ parametreleri açýsýndan son derece önemlidir.

Objectives: This study is aimed at evaluating awareness of the anesthe-siologists working in cardiac surgery related to the perioperative ERAS protocols developed based on evidence and their existing perioperative approaches.
Methods: A survey of 30 questions evaluating the knowledge, atti-tudes, and behaviors related to the suggestions regarding perioperative, intraoperative, and post-operative care in the patients with cardiac surgery notified based on evidence in 2019 by the ERAS cardiac association has been directed to anesthesiologists working in the cardiac surgery through E-mail and face-to-face printed forms.
Results: The research sample consists of 90 anesthesiologists working in cardiac surgery. It is observed that 31.1% of the participants do not have any idea regarding ERAS protocols. The rate of those routinely measuring HbA1C level is detected as 64.4%, the rate of those routinely measuring albumin level as60%, the rate of those loading carbohydrates as 8%, the rate of those carrying out topical intranasal antimicrobial treatment as 9.1%, and the rate of those routinely applying tranexamic acid or epsilon-aminocaproic acid as 50%. As for the question on the time for IV anti-biotherapy application, 54.4% of the participants have given the answer as immediately after the induction, and 13.3%, the answer as 30 min after the surgery. The rate of the participants measuring the bioindicators toward detection of acute kidney injury has been detected as 2.2%. About 32.2% of them have stated that they use regional anesthesia techniques for analgesia purposes.
Conclusion: The perioperative applications of the an esthesiologists in cardiac surgery show compliance with the ERAS guideline; however, approximately one-third of the participants have stated that they do not have any idea related to this protocol. Works relating to increasing the awareness on ERAS protocol becoming more important with each pass-ing day are extremely significant in terms of patient discharge parameters in cardiac surgery.

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Amaç: Calýþmamýzda, kalp kapak cerrahisi sýrasýnda hastalarda, yakýn infrared spektroskopisi kullanýmýyla deðerlendirilen serebral oksimetrideki deðiþikliklerin postoperatif norokognitif disfonksiyonu onlemede guvenilir bir takip yontemi olup olmadýðýnýn araþtýrýlmasý amaclandý.
Yöntem: Mart 2014-Mart 2015 tarihleri arasýnda kalp kapak cerrahisi gecirecek, calýþmayý kabul eden en az ilkokul mezunu 43 hasta (20 erkek, 23 kadýn; yaþ daðýlýmý 18-75 yaþ) calýþmaya dahil edildi. Tum hastalara induksiyon oncesinde ve operasyon suresince yakýn infrared spektroskopisi ile serebral oksimetri takibi yapýldý. En duþuk ve ortalama rSO2 (rejyo-nel hemoglobin oksijen saturasyonu) deðerleri kaydedildi. Yakýn infrared spektroskopisi takibinde rSO2 deðerinde %20 ve uzerinde duþme olup mudahalede bulunan gruba A grubu (n=18), %20’den daha az duþme olan gruba B grubu (n=25) þeklinde isim verildi. Kardiyopulmoner baypas yonetimi ve cerrahi protokolu tum hastalarda ayný þekilde uygulandý. Norokognitif deðerlendirme operasyondan en az iki gun once, operasyondan bir hafta sonra yapýldý. Bu amacla minimental test, gorsel mekansal iþlevler testi ve saat cizim testi uygulandý. Sonuclar istatistiksel olarak deðerlendirildi.
Bulgular: A ve B grubundaki hastalar karþýlaþtýrýlmýþ benzer bulunmuþtur. Gruplar arasýnda ameliyattan bir hafta sonra yapýlan minimental test, gorsel mekansal iþlevler testi ve saat cizim test deðerleri arasýnda anlamý bir farklýlýk bulunmamýþtýr. Bu iki grup icin yoðun bakýmda ve hastanede kalýþ acýsýndan da anlamlý bir fark bulunamamýþtýr.
Sonuç: Kalp kapak cerrahisinde serebral perfuzyon bircok nedenle bozulabilir. Bu durumun yakýn infrared spektroskopisi ile takibi ve gereðinde intraoperatif mudahale postoperatif norokognitif fonksiyonlarý onlemede onemli olabilir duþuncesindeyiz.

Objectives: Our study aims to investigate whether changes in cerebral oximetry as assessed by the use of near infrared spectroscopy are a reliable monitoring method in preventing post-operative neurocognitive dysfunction in patients undergoing cardiac valvular surgery.
Methods: The study included 43 patients who were to undertake valvular cardiac surgery between March 2014 and March 2015 and agreed to take part in the study. All patients received cerebral oximetry monitoring by near-infrared spectroscopy before induction and during the operation. The group of patients who demonstrated a ≥20% decrease in cerebral oximetry and received intervention were called Group A (n=18), and the group of patients with a <20% reduction in cerebral oximetry was called Group B (n=25). Neurocognitive assessments were performed 2 days before and 1 week after surgery. The minimental test, visual-spatial functions test, and clock-drawing test were utilized for this purpose.
Results: Patients in groups A and B were compared in terms of age, gender, educational status, and additional disease status, and the groups were found to be similar. There was no difference between the two groups in terms of peroperative cardiopulmonary bypass times and cross-clamp times. There was no significant difference between the groups in the minimental test, visual-spatial functions test and clock drawing test values performed one week after the surgery. No significant difference was found in terms of intensive care and hospital stay for these two groups.
Conclusion: We believe that near-infrared spectroscopy monitoring against such a decrease and immediate intraoperative intervention as necessary based on near-infrared spectroscopy monitoring may be important in preventing post-operative neurocognitive dysfunctions.

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Amaç: Büyük arterlerin transpozisyonu yenidoðanlarda siyanotik kalp hastalýðýnýn önemli nedenlerinden biridir ve yaþamýn ilk dönemlerinde cerrahi olarak tedavi edilmelidir. Son dönemlerde nötrofil/lenfosit oraný konjenital kalp hastalarýnda mortalite ve morbidite öngörüsü þeklinde yeni bir belirteç olarak kullanýlmaktadýr. Bu çalýþmada, arteryel switch operasyonu yapýlan büyük arterlerin transpozisyonu tanýlý olgularda nötrofil/lenfosit oraný deðiþikliklerinin yoðun bakýmda kalýþ süresine etkisi araþtýrýldý.
Yöntem: Çalýþma 1 Ocak 2021-31 Aralýk 2021 tarihleri arasýnda pediatrik kardiyak yoðun bakým ünitesinde izlenen ve arteryel switch operasyonu gerçekleþtirilen büyük arterlerin transpozisyonu tanýlý yenidoðanlar üzerinde yapýldý. Operasyon öncesi ve sonrasý (birinci, ikinci, üçüncü gün) nötrofil/lenfosit oraný deðiþiklikleri kaydedildi. Primer sonlaným noktasý uzun yoðun bakým ünitesi süresi (pediatrik kardiyak yoðun bakým ünitesinde kalýþ süresi, süre olarak en uzun yüzde 25’lik dilimde olmasý) olarak kaydedildi. Nötrofil/lenfosit oraný deðiþikliklerinin pediatrik kardiyak yoðun bakým ünitesinde kalýþ süresi üzerine etkileri incelendi.
Bulgular: Çalýþma döneminde 45 olgu mevcuttu. Medyan yaþ 3 gün (IQR 2-7 gün) ve medyan operasyon aðýrlýðý 3000 gram (IQR 2800-3100) idi. Olgularýn %51’i erkek, %49’u kýzdý. Medyan mekanik ventilatörde kalýþ süresi, yoðun bakýmda kalýþ süresi ve hastanede kalýþ süreleri sýrasýyla 48 saat (IQR 24-96 saat), 6 gün (IQR 5-12) ve 12 gün (IQR 10-16) idi. Pediatrik kardiyak yoðun bakým ünitesinde kalýþ süresi >8 gün olarak saptandý. Dört (%8,8) hasta erken dönemde kaybedildi. Preoperatif nötrofil/lenfosit oraný deðerinin >1,5 olmasý ve postoperatif üçüncü gün nötrofil/lenfosit oraný >2,1 olmasý pediatrik kardiyak yoðun bakým ünitesinde kalýþ süresini tahmin etmede güçlü belirteçlerdi.
Sonuç: Arteryel switch operasyonu yapýlan büyük arterlerin transpozisyonu tanýlý olgularda ameliyat öncesi ve postoperatif erken dönemdeki yüksek nötrofil/lenfosit oraný uzun yoðun bakým sürecinin deðerlendirilmesinde iyi bir belirteçtir.

Objectives: In this context, the objective of this study is to investigate the effect of variations in the neutrophil/lymphocyte ratio on the length of post-operative intensive care unit (ICU) stay in cases that were diagnosed with transposition of the great arteries (TGA) and who subsequently underwent arterial switch operation (ASO).
Methods: This study was conducted with newborns that were diagnosed with TGA, followed up in the pediatric cardiac ICU, and who underwent ASO between January 1, 2021 and December 31, 2021. Variations in neutrophil-lymphocyte ratio (NLR) were recorded before and after the operation (day 1, 2, and 3). The primary endpoint was deemed as the prolonged post-operative ICU stay. For the purposes of this study, a prolonged post-operative ICU stay (PCILOS) was defined as a post-operative ICU stay that falls within the 25th percentile of the lengths of stay with the most extended durations.
Results: The patient group comprised 45 patients. The median age of the patients was 3 (interquartile range [IQR] 2-7) days, and the median operation weight was 3000 (IQR 2800-3100) grams. Of the patients included in the study, 51% were male, and 49% were female. Median duration on a mechanical ventilator, the median length of ICU stay, and median length of hospital stay were 48 (IQR 24-96) hours, 6 (IQR 5-12) days, and 12 (IQR 10-16) days, respectively. PCILOS duration was determined as >8 days. Four (8.8%) patients died in the early period. Pre-operative NLR values of >1.5 and post-operative day-3 NLR values of >2.1 were found to be strong predictors of PCILOS.
Conclusion: The findings of this study suggest that high NLR values in the pre-operative and early post-operative period in patients that were diagnosed with TGA and who underwent ASO were good predictors of prolonged ICU stays.

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Amaç: Çalýþmada, konjenital kalp hastalýðý nedeniyle kalp cerrahisi geçiren çocuklarda del Nido ve soðuk kan kardiyoplejisinin böbrek fonksiyonlarýna etkisinin deðerlendirilmesi amaçlandý.
Yöntem: Bu çalýþma, prospektif olarak gerçekleþtirildi. “Risk Adjustment for Congenital Heart Surgery (RACHS)” skoru 3’ün altýnda olan 119 pediatrik hasta, gruplandýrma yazýlýmý kullanýlarak kardiyopleji solüsyonunun tipine göre rastgele iki gruba (soðuk kan ve del Nido kardiyoplejisi) ayrýldý. Kardiyoplejiden önce ve sonra üre, kreatinin, tahmini glomerüler filtrasyon hýzý ve renal yakýn kýzýlötesi spektroskopi deðerlerinin deðiþimi bu çalýþmanýn birincil sonuç ölçütleriydi.
Bulgular: Del Nido grubunda kardiyopulmoner baypas süresi (p<0,001), aort kros klemp süresi (p<0,001) ve ekstübasyon süresi (p=0,032) daha uzun, VIS-48. saat (p=0,048) deðeri daha fazlaydý. Preoperatif deðerlere göre 48. saatte üre artýþý del Nido grubunda daha yüksekti (p=0,028). Kardiyopulmoner baypas süresindeki artýþýn üre (p=0,009) ve kreatinin (p=0,004) artýþýný, daha genç yaþta olmanýn ise üre artýþý (p=0,014) ve tahmini glomerüler filtrasyon hýzýndaki düþüþü (p=0,044) öngördüðü belirlendi.
Sonuç: Del Nido kardiyopleji uygulanan olgularda kardiyopulmoner baypas süresi, aort kros klemp süresi ve ekstübasyon süresi daha uzun olmasýna raðmen, del Nido kardiyopleji yoðun bakým ünitesinde yatýþ süresi, mortalite oranlarý, VIS-baþlangýç ve VIS-24. saat deðerleri ve cerrahi sýrasýnda renal yakýn kýzýlötesi spektroskopi, kreatinin, tahmini glomerüler filtrasyon hýzý ve üre deðerlerinin deðiþimi açýsýndan kan kardiyoplejisi kadar güvenlidir. Del Nido kardiyoplejisinin konjenital kalp hastalýðý cerrahisinde kullanýmý konusunda daha kapsamlý araþtýrmalara ihtiyaç vardýr.

Objectives: We aimed to evaluate the effect of del Nido (DN) and cold blood (CB) cardioplegia on renal functions in children undergoing cardiac surgery for congenital heart disease (CHD).
Methods: This study was conducted prospectively. One hundred and nineteen pediatric patients with Risk Adjustment for Congenital Heart Surgery (RACHS) scores below 3 were randomly assigned using allocation software to two groups (CB and DN cardioplegia) according to the type of cardioplegia solution used. The change of urea, creatinine, estimated glomerular filtration rate (eGFR), and renal near-infrared spectroscopy (NIRS) values before and after cardioplegia were the primary outcome measures of this study.
Results: Cardiopulmonary bypass (CPB) duration (p<0.001), ACC duration (p<0.001), and extubation time (p=0.032) were longer and the VIS-48th h (p=0.048) value was higher in the DN group. The pre-operative versus 48th h increase in urea were higher in the DN group (p=0.028). The increase in CPB duration was predictive for the increase in urea (p=0.009) and creatinine (p=0.004), and younger age was a predictor for the increase in urea (p=0.014) and decrease in eGFR (p=0.044).
Conclusion: Although CPB duration, aortic cross-clamp times, and extubation times are longer in DN cardioplegia recipients, it is as safe as blood cardioplegia in terms of ICU LOS, mortality rates, VIS-initial and VIS-24th h values, and changing renal NIRS, creatinine, eGFR, and urea values during surgery. There is a need for more extensive research on the use of DN cardioplegia in CHD surgery.

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Amaç: Bu çalýþmanýn amacý, bilinçli sedasyon (BS) ile genel anestezi (GA) altýnda uygulanan endobronþiyal ultrason eþliðinde transbronþiyal iðne aspirasyonunda (EBUS-TBÝA) iþlem özellikleri ve komplikasyon oranlarýný karþýlaþtýrmaktýr. Ýkincil amaç ise genel anestezi için kullanýlan hava yolu araçlarýný deðerlendirmektir.
Yöntem: Bu çalýþmada, tersiyer bir hastanenin bronkoskopi merkezinde, Ocak 2017 ile Aralýk 2021 tarihleri arasýnda EBUS-TBÝA yapýlan hastalar retrospektif analiz edildi. On sekiz yaþ ve üstünde olup týbbi verilerinde eksiklik olmayan tüm hastalar çalýþmaya dahil edildi. Hastalar, BS ve GA olmak üzere iki gruba ayrýldý. Gruplar yaþ, cinsiyet, “American Society of Anesthesiologist (ASA)” fiziksel statü, EBUS-TBÝA, hasta baþýna düþen aspire lenf nodu iþlem sayýsý ortalamasý ve iþlem sýrasýndaki komplikasyonlar açýsýndan karþýlaþtýrýldý.
Bulgular: Çalýþmadaki 773 hastanýn 454’ü (%58,7) BS grubunda, 319’u (%41,3) GA grubundaydý. GA grubunda en sýk klasik laringeal mask airway (LMA) (%92,1); LMA içinde de en sýk 4 numara LMA (%71,7) kullanýldý. BS grubunda 308 (%68) hastaya midazolam, 146 (%32) hastaya midazolam+fentanil kombinasyonu uygulandý. EBUS-TBÝA’da hasta baþýna düþen aspire edilen lenf nodu iþlem sayýsý ortalamasý; GA grubunda BS grubuna göre daha yüksek bulundu (1,63’e karþý 1,32). BS grubunda, GA grubuna göre (%9,7’ye karþý %4,4) daha sýk komplikasyon görüldü.
Sonuç: EBUS-TBÝA’da GA'nýn; hasta baþýna düþen lenf nodu sayýsý ve komplikasyon oranlarý açýsýndan, BS'ye göre daha etkili ve güvenli; klasik LMA’nýn da uygun bir hava yolu aracý olduðu gösterildi.

Objectives: : The main objective of this study was to evaluate the procedure characteristics and complication rates of ultrasound-guided endobronchial transbronchial needle aspiration (EBUS-TBNA) performed under conscious sedation (CS) versus general anesthesia (GA). The airway devices used for GA were being evaluated as a secondary aim.
Methods: Patients who had EBUS-TBNA at our tertiary hospital’s between January 2017 and December 2021 were retrospectively studied. The study included all participants who were 18 years or older and had no missing medical data. The patients were divided into two groups: Those who had CS and those who had GA. Age, gender, ASA physical status, EBUS-TBNA mean number of lymph node (LN) per patient, and complications during the procedure were compared between groups.
Results: There were 454 patients (58.7%) in the CS group and 319 patients (41.3%) in the GA group in our sample of 773 patients. Classical laryngeal mask airway (LMA) (92.1%) was the most common in the GA group, whereas number 4 LMA (71.7%) was the most preferred in LMA. In EBUS-TBNA, the average number of aspirated LN procedures per patient was greater in the GA group than in the CS group (1.63 vs.1.32). Complications were more common in the CS group than in the GA group (9.7% vs. 4.4%).
Conclusion: The GA approach in EBUS-TBNA was shown to be more successful and safer than the CS approach in terms of number of LNs per patient and complication rates. We also determined that the classic LMA is an appropriate airway device in EBUS-TBNA.

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Amaç: Erektor spina plan bloku torasik, abdominal ve lomber cerrahiler sonrasý postoperatif analjezi amacýyla kullanýlabilmektedir. Ayrýca servikal veya torasik bölgelerdeki bazý cerrahi iþlemlerde intraoperatif anestezi saðlayabileceði de bildirilmiþtir. Bu olgu serisinde, karotis endarterektomisi yapýlan hastalarda erektor spina plan bloku uygulamasý rapor edilmektedir.
Yöntem: Toplam 12 hastanýn verileri analiz edildi. Demografik veriler, karotis klemp süreleri, ameliyat süreleri, intraoperatif ek lokal anestezik gereksinimi olan hasta sayýsý, intraoperatif ek lokal anestezik miktarý, opioid gereksinimi, postoperatif ilk analjezik gereksinim zamaný, postoperatif aðrý skorlarý, postoperatif analjezik tüketimi ve hastanede kalýþ süreleri kaydedildi.
Bulgular: Verileri analiz edilen 12 hastanýn 9'unda (%75) intraoperatif ek lokal anestezik ihtiyacý oldu. Ýntraoperatif ek lokal anestezik medyan [IQR [min-max)] deðeri 6 (5-9 [3-12]) mL olarak tespit edildi. Toplam 10 (%83,3) hastada postoperatif analjezi gerekti. Postoperatif ilk analjezik gereksinimi medyan (IQR [min-max]) süresi 8 (5-10,5 [1-12]) saat olarak tespit edildi. Ortalama hastanede kalýþ süresi 3,1±0,6 gündü.
Sonuç: Karotis endarterektomisinde erektor spina plan bloku tek baþýna intraoperatif dönemde tam bir cerrahi anestezi saðlayamasa da postoperatif analjeziye katkýsýnýn yaný sýra nispeten düþük doz lokal anestezik takviyesi ile kombinasyon halinde diðer bölgesel anestezi tekniklerine bir alternatif olarak kullanýlabilir.

Objectives: Erector spinae plane (ESP) block can be used for post-operative analgesia following thoracic, abdominal, and lumbar surgeries. Furthermore, it can provide complete surgical anesthesia in some procedures at cervical or thoracic regions. The case series describes use of ESP block in 12 patients who underwent carotid endarterectomy (CEA).
Methods: Data were analyzed from 12 patients. Patient characteristics, carotid clamping time, duration of surgery, number of patients requiring intraoperative supplemental local anesthetic, amount of additional local anesthetic administered by the surgeon, opioid requirements during the surgery, time to first requirement for analgesia in intensive care unit, pain scores, post-operative analgesic consumption, and hospital stay were recorded from the patients’ medical chart.
Results: Nine of 12 patients required intraoperative supplemental 2% lidocaine. The median (interquartile range [IQR] [range]) volume of lidocaine used for supplemental infiltration was 6 (5-9 [3-12]) ml. A total of 10 (83.3%) patients requested analgesia in the first 24 h postoperatively. The median (IQR [range]) time of first analgesic requirement postoperatively was 8 (5-10.5 [1-12]) h. Mean hospital stay was 3.1±0.6 days. Conclusion: Although erector spina plane block alone cannot provide complete surgical anesthesia in CEA, it can be used as an alternative to other regional anesthesia techniques in combination with relatively low-dose local anesthetic supplementation, as well as contributing to post-operative analgesia.

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Amaç: Perkütan dilatasyonel trakeostomi, yoðun bakým ünitelerinde yaygýn olarak kullanýlmakta olan giriþimsel bir iþlemdir. Komplikasyon oranlarý düþük olan bu uygulama hasta konforunu artýrýr ve hava yolu yönetimini kolaylaþtýrýr. Ancak iþlem sýrasýnda ve sonrasýnda erken ve geç dönem komplikasyonlar görülebilmektedir. Çalýþmanýn amacý, 10 yýllýk süre içinde yoðun bakým ünitesinde uygulanan perkütan dilatasyonel trakeostomi giriþimlerinin klinik deðerlendirmesinin yapýlmasýdýr.
Yöntem: Çalýþmamýza 2010-2020 yýllarý arasýnda cerrahi yoðun bakým ünitesinde ve anestezi yoðun bakým ünitesinde yatan ve perkütan dilatasyonel trakeostomi açýlmýþ 18 yaþ üstü 275 hasta dahil edildi. Hastalarýn yaþý, cinsiyeti, yatýþ tanýlarý, komorbid hastalýklarý, APACHE-II ve Glasgow koma skoru puanlarý, yatýþ ve taburculuk tarihleri, trakeostomi açýlma tarihleri, iþlem sýrasýnda ve sonrasýnda karþýlaþýlan erken ve geç dönem komplikasyonlar, dekanülasyon, nakil ve mortalite durumlarý retrospektif olarak tarandý.
Bulgular: Hastalarýn yaþ ortalamasý 71,6±14,6 yýl olarak tespit edildi. Yoðun bakým ünitesi yatýþ günlerine ait APACHE-II puanlarý 23,3±7,6 ve Glasgow koma skoru puanlarý 7,5±3,5 idi. En yüksek mortalite (%22) iskemik veya hemorajik serebral hasar grubunda idi. Yoðun bakým ünitesinde mekanik ventilasyonda geçirilen süre 34,2±19,4; yoðun bakým ünitesinde geçirilen süre 37,2±20,5 gün olarak belirlendi. Trakeostomi açýlma zamaný 16,3±7,7 gün olarak bulundu. Hastalarýn %33’üne erken (≤10 gün), %67’sine geç (>10 gün) dönemde perkütan dilatasyonel trakeostomi açýldý. Ýki yüz yetmiþ beþ hastanýn 27’sinde (%9,8) komplikasyon geliþti. En sýk görülen komplikasyonu kanama oluþturdu (%4,4). Sonuç: Perkütan dilatasyonel trakeostomi düþük komplikasyon oranlarý nedeniyle güvenli bir uygulamadýr. Ancak yoðun bakým ünitelerinde farklý uygulamalarda sýklýkla kullanýlan fiberoptik bronkoskopi ve ultrasonografinin perkütan dilatasyonel trakeostomi uygulamalarýnda da komplikasyonlarý azaltmada etkili olabileceðini düþünmekteyiz.

Objectives: Percutaneous dilatational tracheostomy (PDT) is an interventional procedure that is widely used in intensive care units (ICUs). This application, which has low complication rates, increases patient comfort and facilitates airway management. However, early and late complications can be seen during and after the procedure. The objective of this study was to perform the clinical evaluation of PDT interventions applied in the ICU over a 10-year period.
Methods: A total of 275 patients over the age of 18 who were hospitalized in the Surgical ICU and Anesthesia ICU and underwent PDT between 2010 and 2020 were included in the study. Patients’ age, gender, diagnosis of hospitalization, comorbid diseases, APACHE-II and Glasgow Coma Scale (GCS) scores, hospitalization and discharge dates, time to open tracheostomy, early and late complications encountered during and after the procedure, decannulation, transplantation, and mortality were retrospectively reviewed.
Results: The mean age of the patients was 71.6±14.6 years. During ICU admission, APACHE II scores were 23.3±7.6 and GCS scores were 7.5±3.5. The highest mortality (22%) was in the ischemic or hemorrhagic cerebral injury group. The duration of mechanical ventilation in the ICU was 34.2±19.4 days, and the length of stay in the ICU was 37.2±20.5 days. Time to open a tracheostomy was found as 16.3±7.7 days. PDT was performed in the early (≤10 days) period in 33% of the patients, and in the late (>10 days) period in 67% of the patients. Twenty-seven (9.8%) of the 275 patients develop complications with bleeding being the most commonly seen complication by 4.4%.
Conclusion: PDT is a safe procedure due to its low complication rates. However, we think that fiber optic bronchoscopy and ultrasonography, which are frequently used in different applications in ICUs, may also be effective in reducing complications in PDT applications.

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Amaç: Çalýþmanýn amacý, üçüncü basamak yoðun bakým ünitesinde koronavirüs hastalýðý 2019 (COVID-19) tanýsý ile yatýrýlan ve pnömotoraks geliþen hastalarýn laboratuvar bulgularýnýn klinik özellikleri ve tedavileri ile birlikte incelenmesi, pnömotoraks epidemiyolojisi ve risklerinin belirlenmesidir.
Yöntem: Çalýþma; 1 Nisan 2020 ile 1 Ocak 2021 tarihleri arasýnda üç adet üçüncü basamak yoðun bakým ünitesinde (her biri 24 yataklý) takip edilen 681 COVID-19 hastasýnýn elektronik kayýtlarý geriye dönük olarak incelenerek gerçekleþtirildi. Hastalarýn demografik ve klinik özellikleri, laboratuvar bulgularý, mekanik ventilatör parametreleri ve akciðer görüntülemeleri geriye dönük olarak deðerlendirildi.
Bulgular: COVID-19 geçiren 681 hastanýn 22'sinde (%3,2) pnömotoraks ve 481'inde (%70,6) akut respiratuar distres sendromu (ARDS) tespit edildi. Tüm çalýþma hastalarý ARDS taný kriterlerini karþýladý. Mortalite oranlarý tüm hastalarda %43.4 (296/681), ARDS'li hastalarda %52.8 (254/481), pnömotorakslý hastalarda ise %86,3 (19/22) idi. Hastalarda ortalama 17,4±4,8 gün içinde pnömotoraks geliþti. Semptomlarýn baþladýðý 1. haftada hastalarýn bilgisayarlý tomografilerinde yaygýn buzlu cam opa-siteleri, yama infiltratlarý ile heterojenik daðýlým, alveolar eksüdalar, interstisyel kalýnlaþma gözlendi.
Sonuç: ARDS'li COVID-19 hastalarýnda pnömotoraksýn mortaliteyi önemli ölçüde artýrdýðýný gözlemledik. Pnömotoraksýn özelliklerinin anlaþýlmasýnýn ve önlenmesinin mortalitenin azaltýlmasýna önemli katký saðlayacaðýna inanýyoruz.

Objectives: Objective of the study was to examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of coronavirus disease 2019 (COVID-19) and developed pneumothorax and to determine epidemiology and risks of pneumothorax.
Methods: The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary intensive care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were evaluated retrospectively.
Results: Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients was detected and acute respiratory distress syndrome (ARDS) in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4±4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their symptom onset.
Conclusion: We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.

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Amaç: Sitomegalovirüs reaktivasyonu, kritik hastalarda önemli bir morbidite ve mortalite nedeni olarak karþýmýza çýkmaktadýr. Reaktivasyon için en önemli faktörlerden biri yeni geliþmiþ veya var olan immünsüpresyondur. Akut solunum sýkýntýsý sendromu olan koronavirüs hastalýðý-19 (COVID-19) hastalarý, immünsüpresyona neden olan çeþitli koþullardan etkilenebilir. Sitomegalovirüs reaktivasyonunun ve özellikle tahmin edici özelliklerinin netleþtirilmesi, özellikle pandemi döneminde önem kazandý.
Yöntem: Bu çalýþma, retrospektif ve gözlemsel bir kohort çalýþmasýdýr. 11 Mart 2020 ile 11 Mart 2021 tarihleri arasýnda yoðun bakým ünitesine kabul edilen COVID-19 hastalarý deðerlendirildi. Tüm hasta bilgileri hastanenin elektronik kayýtlarýndan elde edildi. Trakeal örneklerde CMV DNA’nýn ≥ 1000 kopya/mL olarak saptanmasý sitomegalovirüs reaktivasyonu olarak tanýmlandý. Hastalar sitomegalovirüs reaktivasyonu olan ve olmayan hastalar olarak iki grupta deðerlendirildi.
Bulgular: Çalýþma süresi boyunca, tüm COVID-19 akut solunum sýkýntýsý sendromu hastalarýndan sadece 99'u çalýþmaya dahil edilme kriterlerini karþýladý ve 55 hastada (%55,6) sitomegalovirüs reaktivasyonu tespit edildi. Sitomegalovirüs reaktivasyonu saptanan hastalarda, yaþ, beden kitle indeksi, APACHE-II skoru, hipertansiyon, kronik solunum yolu hastalýðý, interlökin bloker kullanýmý, steroid kullaným süresi, prokalsitonin ve T hücre düzeyi (CD-8) sitomegalovirüs reaktivasyonu olmayan hastalardan önemli ölçüde farklýydý. Ayrýca, sitomegalovirüs reaktivasyon grubundaki hastala-rýn daha uzun yoðun bakým ve mekanik ventilasyon süresi ve daha yüksek mortaliteye sahip olduklarý gözlemlendi.
Sonuç: COVID-19 iliþkili akut solunum sýkýntýsý sendromu hastalarýnda sitomegalovirüs reaktivasyonu görülebilir ve bu durumun daha kötü sonuçlarla iliþkili olduðu tespit edilmiþtir. Ýnterlökin veya 12 günden fazla steroid kullanýmý, obezite, yüksek prokalsitonin ve düþük CD-8 T lenfosit düzeyleri reaktivasyon için risk faktörleridir. Yoðun bakýmda COVID-19 hastalarý immünsüpresyon ve sitomegalovirüs reaktivasyonu açýsýndan yakýn izlenmelidir.

Objectives: Cytomegalovirus (CMV) reactivation is a significant cause of morbidity and mortality in critically ill patients. Existing or newly developed immunosuppression appears to be the main factor for reactivation. COVID-19 patients with acute respiratory distress syndrome can be affected by a variety of conditions that cause immunosuppression. Clarifying CMV reactivation and notably its predictive features became important during the epidemic.
Methods: This is a retrospective, observational, and cohort study. All COVID-19 patients admitted to the ICU between March 11, 2020 and March 11, 2021 were analyzed. All of the information was gathered from the hospital’s electronic records. CMV reactivation was defined as CMV DNA ≥1000 copies/ml in tracheal samples. The patient population was analyzed in two groups, namely, patients with CMV reactivation and patients without reactivation.
Results: During the study period, 99 of all COVID-19 ARDS patients fulfilled the inclusion criteria, and CMV reactivation was detected in 55 (55.6%) of them. Age, BMI, APACHE-II score, hypertension, chronic respiratory disease, the usage of interleukin blockers, the duration of steroid usage, procalcitonin (PCT), and CD-8 T-cell levels differed significantly from the patients without CMV reactivation. Furthermore, the reactivation group had longer ICU stays, longer durations of mechanical ventilation, and higher mortality.
Conclusion: CMV can be reactivated in critically ill COVID-19 ARDS patients, which appears to correlate with worse outcomes. Obesity, the usage of IL-blockers and steroids >12 days, high PCT, and low CD-8 T-cell levels appear to be risk factors. Critically ill COVID-19 patients should be closely monitored with regard to immunosuppression and CMV status.

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Amaç: Bu çalýþmada, koronavirüs hastalýðý-19 (COVID-19) pnömonisi nedeniyle üçüncü basamak yoðun bakým ünitesine baþvuran hastalarda geliþen pnömotoraks ve pnömomediastinum sýklýðýnýn ve klinik özelliklerinin incelenmesi amaçlandý.
Yöntem: Yoðun bakým ünitesinde, 11 Mart 2020 ile 11 Ocak 2022 tarihleri arasýnda yatan COVID-19 hastalarý geriye dönük olarak incelendi, pnömotoraks ve pnömomediastinum tanýlarý alan hastalar belirlendi. Pnömotoraks ve pnömomediastinum sýklýðý ile klinik özellikleri araþtýrýldý. Bulgular: Yoðun bakým ünitesinde 11 Mart 2020 ile 11 Ocak 2022 tarihleri arasýnda yatan 720 hasta tarandý. Yirmi dört hastanýn pnömotoraks veya pnömomediastinum olduðu izlendi (%3,3). On yedi (%70) hastada pnömotoraks, 14 (%58) hastada ise pnömomediastinum izlendi. Pnömomediastinum ve pnömotoraksýn birlikte geliþtiði hasta sayýsý 7 (%29) idi. COVID-19 ile iliþkili pnömotoraks tek taraflý (n=16) ve sað taraflý olma (n=11) eðiliminde idi. Hastalarýn 18’i (%75) pnömotoraks veya pnömomediastinum geliþimi sýrasýnda invaziv mekanik ventilasyon, 5’ine (%20,8) noninvaziv mekanik ventilasyon uygulanmaktaydý. Bir hastada mekanik ventilasyon uygulanmýyorken pnömotoraks geliþti. COVID-19 hastalýðý ile yoðun bakýma yatan, pnömotoraks veya pnömomediastinum geliþen hastalarda 60. günde ölüm oraný %75 (n=18) idi.
Sonuç: Pnömotoraks ve pnömomediastinum COVID-19’a baðlý pnömoni hastalarýnda geliþebilen mortalitesi yüksek komplikasyonlardýr.

Objectives: This study aimed to examine the frequency, and clinical features of pneumothorax and pneumomediastinum cases in patients admitted to the intensive care unit due to coronavirus disease-19 (CO-VID-19) pneumonia.
Methods: We retrospectively screened the COVID-19 cases hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022. Patients diagnosed as pneumothorax or pneumomediastinum were determined. The frequency and clinical features of pneumothorax and pneumomediastinum were investigated.
Results: Seven hundred and twenty patients hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022 were screened. Twenty-four (3.3%) patients had pneumothorax or pneumomediastinum. Pneumothorax occurred 17 patients (70%), and pneumomediastinum in 14 patients (58%). The number of patients who developed pneumomediastinum and pneumothorax together was 7 (29%). COVID-19-associated pneumothorax tended to be unilateral (n=16) and right-sided (n=11). In 18 (75%) patients, pneumothorax or pneumomediastinum developed during invasive mechanical ventilation, 5 (20.8%) patients during non-invasive mechanical ventilation. One patient developed pneumothorax when mechanical ventilation was not applied. The mortality rate at 60 days was 75% (n=18) in patients who were admitted to the intensive care unit with CO-VID-19 and developed pneumomediastinum or pneumothorax.
Conclusion: Pneumothorax and pneumomediastinum are complications of COVID-19 pneumonia with high mortality rates.

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Amaç: Kardiyopulmoner resüsitasyon sonrasý spontan kan dolaþýmý geri dönen hastalarda yaþam kalitesinin yeniden kazanýlmasýnda terapötik hipotermi uygulanmaktadýr. Çalýþmamýzda kardiyopulmoner resüsitasyon sonrasý terapötik hipoterminin etkilerini araþtýrdýk.
Yöntem: Bu retrospektif çalýþmada terapötik hipotermi yapýlan hastalarýn (Grup 1, n=32) bulgularý normotermik hastalarýn (Grup 2, n=37) bulgularý ile karþýlaþtýrýldý. Kaydedilen veriler; demografik veriler, komorbid hastalýklar, kardiyak arrest nedenleri, kardiyak arrest ritimleri, spontan dolaþým dönüþ süreleri, Glasgow koma skalasý, derin tendon refleksi ve beyin sapý refleksi, ekstübasyon süreleri, yoðun bakýmda kalýþ süreleri ve komplikasyonlardýr.
Bulgular: Ekstübasyon süresi Grup 1’de (4,74±2,80 gün) Grup 2’den (9,55±10,16 gün) daha kýsaydý. Yoðun bakýmda kalýþ süresi Grup 1’de (7,96±5,10 gün) Grup 2’ye (13,40±11,40 gün) göre daha kýsaydý. Epileptik nöbet aktivitesinin insidansý Grup 1’de (%16,2) Grup 2’ye (%46,9) göre daha düþüktü. Grup 1’de taburculukta deðerlendirilen Glasgow koma skalasý skoru daha yüksek olmasýna raðmen bu fark istatistiksel olarak anlamlý deðildi (p>0,05).
Sonuç: Kardiyak arrest sonrasý kardiyopulmoner resüsitasyon iþlemi ile spontan kan dolaþýmý düzelen hastalarda terapötik hipotermi kullanýmýnýn yaþam kalitesinin düzelmesi üzerinde önemli ve olumlu etkileri olduðunu düþünüyoruz.

Objectives: Therapeutic hypothermia (TH) is applied to regain the quality of life in patients whose spontaneous blood circulation returns after cardiopulmonary resuscitation (CPR). In our study, we investigated the effects of TH after CPR.
Methods: The findings of patients who underwent TH (Group 1, n=32) were compared with those of normothermic patients (Group 2, n=37) in this retrospective study. Recorded data were demographic data, comorbid diseases, causes of cardiac arrest, cardiac arrest rhythms, return times of spontaneous circulation, Glasgow coma scale, deep tendon reflex and brainstem reflex, extubation times, durations of intensive care unit (ICU) stay, and complications.
Results: Extubation time in Group 1 (4.74±2.80 days) was shorter than in Group 2 (9.55±10.16 days). The length of stay in the ICU was shorter in Group 1 (7.96±5.10 days) compared to in Group 2 (13.40±11.40 days). Incidence of epileptic seizure activity was lower in Group 1 (16.2%) than in Group 2 (46.9%). Although Glasgow coma scale score evaluated at discharge was higher in Group 1, this difference was not statistically significant (p>0.05).
Conclusion: We consider that the use of TH in patients whose spontaneous blood circulation was restored by CPR procedure after cardiac arrest has significant and positive effects on recovering the quality of life.

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Günümüzde yaþlý nüfus arttýkça, akciðer kanseri teþhisi konulan ve eþ zamanlý cerrahi müdahale gerektiren kalp hastalýðý olan hasta sayýsý da artmaktadýr. Bu hastalarýn bir kýsmýnda preoperatif deðerlendirmeler sýrasýnda eþ zamanlý akciðer kanseri veya koroner arter, kalp kapak hastalýðýna rastlanýlmaktadýr. Her iki durumda da hastanýn anestezik yönetimi zordur. Biz de bu olguda eþ zamanlý off-pump koroner arter baypas greftleme ve sol akciðer üst lobektomi uygulanan bir hastadaki anestezi deneyimimizi sunmayý amaçladýk.

At present, as the elderly population increases, the number of patients with either heart disease or lung cancer also increases. Some of these patients are diagnosed to have concurrent lung cancer or coronary artery, heart valve disease during pre-operative evaluations. In both cases, the anesthetic management of these patients is challenging. In this case, we aimed to present our anesthesia experience in a patient who underwent concurrent off-pump coronary artery bypass grafting and left lung upper lobectomy.

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Konjenital komplet atriyoventriküler blok nadir görülmesine raðmen gebelik ve doðum sýrasýnda deðiþen kardiyovasküler fizyoloji ile mortal olabilmesi sebebiyle gebelerde oldukça önemli bir komorbiditeyi oluþturmaktadýr. Konjenital komplet atriyoventriküler blok tanýlý gebelerin sezaryenle doðumlarý için uygulanacak anestezi yöntemi konusunda tam bir uzlaþý bulunmamaktadýr. Bu olgu sunumunda konjenital komplet atriyoventriküler bloklu gebenin nöroaksiyel anestezi altýnda planlanan sezaryenle doðumu sýrasýnda baþarýsýz spinal anesteziye yaklaþýmýmýzý literatür eþliðinde tartýþmayý amaçladýk.

Although congenital complete atrioventricular block (AVB) is rare, it constitutes a very important comorbidity in pregnant women, because it can be mortal due to the cardiovascular physiological changes during pregnancy and delivery. There is no consensus for anesthetic management of cesarean delivery of pregnant women with congenital complete AVB. In this case report, we aimed to discuss our approach to failed spinal anesthesia for a parturient with congenital AVB scheduled to undergo cesarean section under neuraxial anesthesia in the light of the literature.

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