GÝRÝÞ ve AMAÇ: Açýk kalp cerrahisi geçiren hastalarda düþük kardiyak debi sendromu geliþebilmektedir. Kardiyak performansý arttýrmak amacýyla inotropik ilaç tedavisine baþlanmaktadýr, ancak bu ilaçlarýn da önemli yan etkileri mevcuttur. Bu çalýþmanýn primer amacý inotropik ilaç kullanýmý ile 30 günlük mortalite arasýndaki iliþkinin belirlenmesi, sekonder amacý ise mortaliteyi baðýmsýz predikte eden faktörlerin belirlenmesidir.
YÖNTEM ve GEREÇLER: Retrospektif gözlemsel çalýþmamýza kardiyopulmoner baypas ile kardiyak cerrahi geçiren 1002 hasta dahil edildi. Hastalarýn demografik ve intraoperatif özellikleri, inotropik ajan kullanýmlarý, postoperatif 30 günlük mortalite bilgileri anestezi kayýtlarýndan, postoperatif yoðun bakým kayýtlarýndan ve epikrizlerinden elde edildi.
BULGULAR: Hastalarýn 274’sýna (%27. 3) dopamin, 110’una (%11) dobutamin ve 63’üne (%6,3) adrenalin kullanýldýðý gözlendi. Univariate analizde inotropik ilaç kullanýmýnýn mortaliteyi etkilediði saptansa da çoklu regresyon analizi sonucunda inotropik ilaç kullanýmýnýn mortalite için tek baþýna baðýmsýz bir risk faktörü olmadýðý görüldü. Mortalite için baðýmsýz risk faktörlerinin ileri yaþ, hipertansiyon, kalp yetmezliði, ejeksiyon fraksiyonu düþüklüðü ve preoperatif anemi olduðu tespit edildi.
TARTIÞMA ve SONUÇ: Bulgularýmýz, perioperatif dönemde inotropik kullanýmýnýn 30 günlük mortalite için baðýmsýz prediktör olmadýðýný gösterdi. Bu sonuç küçük örneklemli çalýþmalarla uyumlu olmasa da, büyük hasta sayýlý çalýþmalarla koreledir. Otuz günlük mortalite için baðýmsýz risk faktörleri ileri yaþ, hipertansiyon, kalp yetmezliði, düþük ejeksiyon fraksiyonu ve peroperatif hemoglobin düþüklüðü olarak bulundu. Bulgularýmýz çalýþmalarda sýk görülen risk faktörleri ile uyumludur. Bu alanda daha fazla ilerlemeye ihtiyaç vardýr.

INTRODUCTION: Low cardiac output syndrome can develop in patients who have undergone open heart surgery. Inotropic drug therapy is being initiated to improve cardiac performance, but these drugs also have significant side effects. The primary aim of this study is to determine the relationship between the use of inotropic drugs and 30-day mortality, secondary aim is to determine the independent mortality predicting factors.
METHODS: Retrospective observational study included 1002 patients undergoing cardiac surgery with cardiopulmonary by-pass. Demographic and intraoperative characteristics of patients, use of inotropic agents, postoperative 30-day mortality data were obtained from anesthesia records, postoperative intensive care records and epicrisis.
RESULTS: 274 of the patients (27. 3%) was dopamine, 110 (11%) was dobutamine and 63 (6. 3%) adrenaline was used. In the univariate analysis, inotropic drug use was associated with mortality, but multiple regression analysis showed that inotropic drug use was not an independent risk factor for 30-days mortality alone. Independent risk factors for mortality were found to be advanced age, hypertension, heart failure, low ejection fractions and peroperative anemia.
DISCUSSION AND CONCLUSION: Our findings showed that inotropic use in the perioperative period was not an independent predictor of 30-days mortality. Although this result is not compatible with small sample studies, it is correlated with large patient studies. Independent risk factors for 30-days mortality were advanced age, hypertension, heart failure, low ejection fraction, and peroperative anemia. Our findings are often common risk factors in research. More progress is needed in this regard.

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GÝRÝÞ ve AMAÇ: Endovasküler aort onarýmý hýzlý derlenme ve kýsa hastanede kalýþ süresi gibi avantajlarýyla sýk uygulanan güvenilir bir yöntemdir. Çalýþmanýn amacý anestezi tipinin yoðun bakým ve hastanede kalýþ süreleri ve perioperatif komplikasyonlar üzerine etkilerinin araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Retrospektif çalýþmamýza 2004-2014 yýllarý arasýnda endovasküler aort onarýmý yapýlan hastalar dahil edildi. Genel anestezi (GGA), rejyonal anestezi (spinal veya epidural) (GSE) ve lokal anestezi (GLA) olmak üzere üç grup oluþturuldu. Hastalarýn yoðun bakým ve hastanede kalýþ süreleri ile hastalarda geliþen postoperatif komplikasyonlar takip edildi.
BULGULAR: Çalýþmaya alýnan 86 hastanýn 25’i GGA, 37’si GSE ve 24’ü GLA grubundadýr. Altmýþ beþ hastaya abdominal 21 hastaya torasik anevrizma onarýmý yapýlmýþtýr. GLA grubundaki hastalarýn yaþlarý diðer gruplarla karþýlaþtýrýldýðýnda belirgin yüksektir. (p: 0.025) Operasyon süresi GGA grubunda diðer gruplara kýyasla anlamlý yüksek bulundu. (p: 0.0147) Yoðun bakýmda kalýþ süresi de GGA grubunda GSE ve GLA grubuna kýyasla daha uzundu.(GGA 3,08±3 gün, GSE 1,05±0,4 gün, GLA 1,08±0,4 gün; p<0.001) Hastanede kalýþ süreleri de benzer þekildeydi. Uzamýþ hastanede kalýþ (>10 gün) 16 hastada görüldü. Lojistik regresyon analizinde preoperatif kronik böbrek yetersizliði (KBY) uzamýþ hastanede kalýþ ile iliþkili bulundu.
TARTIÞMA ve SONUÇ: Endovasküler aort anevrizma onarýmlarýnda rejyonal ve lokal anestezi tekniklerinin her ikisi de kýsa yoðun bakýmda kalýþ gerektirdiðinden endovasküler aort anevrizma onarýmlarýnda tercih edilebilir. Ancak hastanede kalýþ süresi üzerine anestezi tekniðinin etkisi yoktur. Lokal anestezi iþlem sýrasýnda hemodinamik stabilite saðlanmasý açýsýnda daha güvenlidir. Postoperatif dönemdeki sistemik komplikasyonlar tüm gruplarda benzerdir. KBY uzamýþ hastanede kalýþ ile büyük ölçüde iliþkilidir. Endovasküler iþlemlerde daha hýzlý derlenme saðlamalarý nedeniyle rejyonal ve lokal anestezi teknikleri ön planda deðerlendirilebilir.

INTRODUCTION: Endovascular aortic repair (EVAR) is widely used as a safe method with reduced hospital stay and faster recovery. The aim of this study is to investigate effects of type of anesthesia on patients’ outcome with ICU and hospital stays and perioperative complications.
METHODS: Patients undergoing EVAR were included in this retrospective study (2004-14). Study groups were enrolled as general anesthesia (GGA), regional anesthesia (spinal or epidural) (GSE) and local (GLA). Patient outcomes were evaluated with ICU or hospital stay with postoperative complications.
RESULTS: Eighty-six patients were enrolled for this study with 25 patients in GGA, 37 in GSE and 24 in GLA. Sixty-five had abdominal aneurysm whereas 21 had thoracic. Patients in GLA were significantly older compared to other groups (p: 0.025). Operation time was significantly longer than in GGA compared to GSE and GLA (p: 0.0147). ICU stay was longer in GGA compared to GSE and GLA (GGA 3,08±3days, GSE 1,05±0,4 day, GLA 1,08±0,4 day; p<0.001). Hospital stay was similar. Prolonged hospital stay (>10 days) was seen in sixteen patients. Preoperative chronic renal failure (CRF) was found to be associated with prolonged hospital stay in logistic regression.
DISCUSSION AND CONCLUSION: Both regional and local anesthesia techniques were preferable for reduced ICU stay; whereas hospital stay was not affected by the type of anesthesia. Local anesthesia seemed safer in terms of hemodynamic stability during surgery. Postoperative systemic complications were similar between groups. CRF was significantly associated with prolonged hospitalization. Regional or local anesthesia techniques might be initially considered in endovascular procedures to ensure faster recovery.

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GÝRÝÞ ve AMAÇ: Açýk kalp cerrahisinde kanama nedenli reoperasyon mortalite ve morbiditeyi arttýran ciddi bir risk faktörüdür. Bu çalýþmadaki amacýmýz, kanama nedeni ile reoperasyona alýnan hastalarda, cerrahi ve koagülopati kanamasý için olabilecek preoperatif ve intraoperatif risk faktörlerini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Hastalarýn verileri, hastane elektronik sisteminden ve hastalarýn dosyalarýndan elde edildi. Kalp yetmezliði ameliyatlarý haricinde, kardiyopulmoner baypas (KPB) kullanýlan tüm yetiþkin açýk kalp ameliyatý vakalarý çalýþmamýza dahil edildi. 2017 yýlýnda 1200 hasta arasýnda postoperatif kanama nedeniyle 24 saat içinde en az bir operasyon geçiren 77 hasta incelendi. Kanamalarý cerrahi ve koagülopatik olarak sýnýflandýrýldý. Revizyon sýrasýnda devam eden aktif kanama ve/veya sýzma olmaksýzýn hematom varlýðý koagülopatik kanama olarak tanýmlandý. Cerrahi kanama ise sütür veya klips gerektiren spesifik kanamalar olarak tanýmlandý.
BULGULAR: Postoperatif kanama nedeniyle 24 saat içinde en az bir operasyon geçiren 77 (% 6,4) hastanýn 71 tanesinin tam verilerine ulaþýlabildi. 28(%39,5) hastada cerrahi kanama ve 43(%60.5) hastada koagülopatik kanama tespit edildi. Preoperatif ve intraoperatif dönemde kanama tipi açýsýndan risk faktörü olabilecek deðiþkenler analiz edildi ancak iliþkili faktör bulunmadý.
TARTIÞMA ve SONUÇ: Hastalarýn% 39,5'inde cerrahi kanama tespit edildi. Literatürde diðer serilerde % 56.4 oranýnda cerrahi kanama oraný saptandý. Deneyimi yüksek olan kalp merkezimizde cerrahi kanama oraný, koagülopati kanamasýna göre daha düþük saptandý, az hasta sayýsý nedeniyle risk faktörlerini ayýrt etmek mümkün olmadý.

INTRODUCTION: Reoperation is a risk factor that increases the postoperative mortality and morbidity of cardiac surgery patients. Our aim in this study is to investigate the rates of bleeding-induced reoperation, preoperative and intraoperative risk factors for surgical or coagulopathy bleeding.
METHODS: Perioperative patient data were collected from hospital electronic system and patient’s files.We included all cases of adult open heart surgery using cardiopulmonary bypass,except for cases of heart failure surgeries. 1200 patients found, 77 patient have undergone at least one operation within 24 h due to postoperative bleeding(%6,4).We classified the bleeding as surgical and coagulopathic. Haematoma without ongoing bleeding and/or oozing was defined as coagulopathic bleeding, and spesific bleeding requiring suture or clips was defined as surgical bleeding.
RESULTS: 71 were available in the data of patients. 28(39.5%) patients had surgical bleeding, and 43(60.5%) patients had coagulopathic bleeding. When the variables that might be a risk factor in terms of type of bleeding in preoperative and intraoperative period were examined, no related factors were found.
DISCUSSION AND CONCLUSION: Surgical bleeding was detected in 39.5% of the patients. Surgical bleeding rate was 56.4% in other series in the literature. At our heart center with high experience, surgical bleeding rate was lower than coagulopathy bleeding and it was not possible to distinguish the risk factors because of the small number of patients.

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GÝRÝÞ ve AMAÇ: Yoðun bakýmda mortaliteyi tahmin etmede son zamanlarda çeþitli hemogram parametreleri kullanýlmaktadýr. Bu parametrelerin hýzlý bir þekilde kritik hastalarda karar verme, uygun tedaviye baþlama gibi avantajlarý bulunmaktadýr. Bu çalýþmada; 1 Ocak 2014 ile 30 Nisan 2018 yýllarý arasýnda Cumhuriyet Üniversitesi Týp Fakültesi Araþtýrma Uygulama Hastanesi Merkezi Yoðun Bakým Ünitesinde yatan hastalarýn dosyalarý ve hastane otomasyon programý yardýmýyla retrospektif olarak inceleyip ölen hastalar ile sað kalanlar arasýnda hemogram parametrelerinin mortaliteyi tahmin etmede iliþkisini ortaya koymayý amaçladýk.
YÖNTEM ve GEREÇLER: Cumhuriyet Üniversitesi Giriþimsel olmayan Klinik Uygulamalar Etik Kurulu ve hastalarýn onayý alýndýktan sonra çalýþmaya dahil etme kriterlerimize uyan 254 hasta çalýþmaya alýndý. Tüm hastalarýn Demografik verileri ilk yatýþtaki SOFA (Sequential Organ Failure Assessment), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation) skorlarý, CRP (C-Reaktif Protein), MPV (Ortalama Trombosit hacmi), RDW (Eritrosit daðýlým geniþliði), NLO (nötrofil lenfosit oraný), PLO (Trombosit lenfosit oraný) deðerleri kaydedildi.
BULGULAR: Çalýþmaya alýnan gruplarýn hemogram deðerleri, SOFA, CRP, APACHE Ⅱ skorlarý karþýlaþtýrýldýðýnda ölen ve sað kalan gruplar arasýnda farklýlýk anlamlý bulundu. Kesim noktasý için AUROC analizi sonucu MPV için %90.3 duyarlýlýk %95.8 özgüllük ile 9.75 femtolitre; NLO için %82.8 duyarlýlýk %88.3 özgüllük ile 13.55; PLO için %97 duyarlýlýk %98.3 özgüllük ile 301.5; RDW için %92.5 duyarlýlýk %96.7 özgüllük ile 15.15; SOFA için %90.3 duyarlýlýk %30 özgüllük ile 7.5 deðeri bulundu.
TARTIÞMA ve SONUÇ: Bu çalýþmada; hemogram parametrelerinin mortaliteyi ayýrt edicilik gücünün SOFA, CRP, APACHE Ⅱ’den daha yüksek olduðunu gözlemledik.

INTRODUCTION: Various hemogram parameters have recently been used to predict mortality in intensive care unit. These parameters have advantages such as making quick decision in critical illnesses and starting appropriate treatment. In this study; We aimed to investigate the relationship predicting the mortality of the hemogram parameters between death and survivor patients whose hospitalized between January 1, 2014 and April 30, 2018 in Cumhuriyet University Medical Faculty Research Hospital Center Intensive Care Unit with the files of patients and the hospital automation program.
METHODS: After being approved by the Ethics Committee of the Non-Interventional Clinical Practices of Cumhuriyet University; 254 patients taken to work. Demographic data of all patients were recorded admission SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation) scores, CRP (C-Reactive Protein), MPV (Mean platelet volume), RDW (Red cell distrubition width), NLR (Neutrophil lymphocyte ratio), PLR (Platelet lymphocyte ratio).
RESULTS: When the values of hemogram, SOFA, CRP, APACHE II scores of the study groups were compared, there was a significant difference between the death and survivor groups. The AUROC analysis result the cut-off point for MPV was 90.3% sensitivity and 95.8% specificity 9.75 femtolitre; for NLR was 82.8% sensitivity and 88.3% specificity was 13.55; for PLR was 97% sensitivity and 98.3% specificity 301.5; for RDW was 92.5% sensitivity and 96.7% specificity 15.15; for SOFA was Sensitivity of 90.3% and 30% specificity 7.5.
DISCUSSION AND CONCLUSION: In this study; we conclude that the mortality of hemogram parameters is higher than the discriminatory power of SOFA, CRP, APACHE II.

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GÝRÝÞ ve AMAÇ: Yoðun bakýmda enfeksiyon çok sýk karþýmýza çýkan bir sorundur. Sefoperazon/sulbaktam, yoðun bakýmda solunum yolu enfeksiyonlarýnda sýklýkla tercih edilen antibiyotiklerdendir. Çalýþmamýzda, 3. basamak dahili yoðun bakýmda, sefaperazon –sulbaktam tedavisi baþlanan hastalarýmýzýn koagülasyon parametrelerinde oluþan deðiþiklikleri retrospektif olarak deðerlendirdik ve bu geliþen komplikasyonun mortalite üzerine etkilerini inceledik.

YÖNTEM ve GEREÇLER: Çalýþmamýza 3. basamak yoðun bakýmda tedavi gören, sefoperazon/sulbaktam tedavisi alan, kronik obstrüktif
akciðer hastalýðý (KOAH) ve pnömoni tanýlý, 18 yaþýndan büyük, 39 hasta dahil edilmiþtir. Hastalarýn tanýlarý, demografik verileri ve takip parametreleri retrospektif olarak incelenip mortalite ile iliþkisi deðerlendirildi.
BULGULAR: Çalýþmamýz 29 erkek,10 kadýn olmak üzere toplam 39 hastadan oluþmaktadýr. 66 yaþ ve altý 12, 66-76 yaþ arasý 13, 76
yaþ ve üzeri 14 hasta vardý. APACHEII ölçümleri hayati duruma göre karþýlaþtýrýlarak incelenmiþtir. Elde edilen
sonuçlar Tablo 2’te yer almaktadýr. Tablo 2’e göre, APACHEII ölçüm hayati duruma göre anlamlý bir þekilde
farklýlaþmaktadýr (p<0,05). Buna göre, exitus olan hastalarýn APACHEII ölçümleri exitus olmayan hastalarýnkinden
anlamlý olarak daha yüksektir.
TARTIÞMA ve SONUÇ: Hastalarýmýzýn mortalitesi yüksek APACHE II deðerleri ile uyumlu olarak bulundu. Sefaperazon/sulbaktam kullanan
hastalarýmýzda gözlenen koagülasyon bozukluklarý mortaliteyi arttýrmaktadýr. Belirlenen bu komplikasyon kullanýlan
dozdan baðýmsýzdýr.

INTRODUCTION: In intensive care, infection is a very common problem. Cefoperazone / sulbactam are frequently preferred antibiotics in respiratory tract infections in intensive care unit. In our study, we retrospectively evaluated the changes in coagulation parameters of our patients who were treated with cefaperazon and sulbacetam in the 3rd stage internal ICU, and examined the effects of this developing complication on mortality.
METHODS: Patients who received treatment in the third stage intensive care unit, who received cefoperazon / sulbactam treatment, chronic obstructive 39 patients with lung disease (COPD) and pneumonia, aged over 18 years were included.
Patients' diagnoses, demographic data and follow-up parameters were evaluated retrospectively and mortality was assessed.
RESULTS: Our study consisted of 39 patients (29 male, 10 female). 66 years and below 12, 66-76 years 13, 76
age and over there were 14 patients. APACHEII measurements were compared by comparison with the vital situation. Obtained
The results are given in Table 2. According to Table 2, the APACHE II measurement is significantly
(p <0.05). According to this, APACHE II measurements of patients with exitus
it is significantly higher.
DISCUSSION AND CONCLUSION: The mortality of our patients was found to be consistent with high APACHE II values. Using Cefaperazon / Sulbactam
Coagulation disorders observed in our patients increase mortality. Using this specified complication
it is dose independent.

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Perikardiyal tamponad yaþamý tehdit eden bir durum olduðu için hýzlý taný konulmalý ve acilen tedavi edilmelidir. Perikardiyosentez, kardiyak tamponad varlýðýnda etkili bir yöntemdir ve hayat kurtarýcý olabilir.
80 yaþýnda kadýn hastaya, kardiyak tamponad nedeniyle acil kateter ile perkütan drenaj giriþiminde bulunulmuþ, iþlem sonrasý kateterden fibrine kan gelmesi üzerine yapýlan ekokardiyografik incelemede yerleþtirilen kateterin ucunun sað ventrikül içerisinde olduðunun saptanmasý üzerine hasta acil olarak operasyona alýndý. Bu olgu sunumunda, cerrahi olarak kateterin çýkarýlmasý ve anestezik yönetimi sunulmuþtur.

Because the pericardial tamponade is a life-threatening situation, it must be diagnosed quickly and treated immediately. Pericardiocentesis is an effective method in case of cardiac tamponade presence and can be life-saving. A percutaneous drainage intervention with catheter was performed urgently on an 80-year-old female patient due to cardiac tamponade, and the patient was urgently taken into operation when it was determined that the placed catheter tip was inside the right ventricle in the echocardiographic examination, which was applied after blood with fibrin came from the catheter following the procedure. In this case presentation, surgical removal of the catheter and anesthetic method are presented.

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Santral venöz kateterler (SVK); çoðunlukla yoðun bakým ünitelerinde ve ameliyathanelerde infüzyon terapisi, nutrisyonel destek, hemodinamik monitörizasyon, geçici transvenöz kalp pili, plazmaferez veya hemodiyaliz gerektiren hastalarda güvenli yöntem olduðundan yaygýn olarak kullanýlýrlar. Sað median cerebral arter enfarktüsü nedeni ile takip etmekte olduðumuz 73 yaþýndaki bayan hastanýn sað subklavian vendeki santral kateterin deðiþimi esnasýnda kateterin büyük bir kýsmýnýn koparak hastanýn venöz yapýlarý içinde embolize olduðu olguyu literatür ýþýðýnda tartýþmak istedik.

Central venous catheters (CVC) are commonly used for infusion therapies, nutritional support, hemodynamic monitorisation, temporary transvenous pace makers, plasmapheresis or hemodialysis, mostly in intensive care units and operating rooms. In this case of a 73 year old female patient who was monitorised for right median cerebral artery infarct, a large portion of the catheter was broken and embolized in patient’s venous structures while changing the central catheter in right subclavian vein.

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Takotsubo sendromu koroner arterlerin normal olmasýna raðmen sol ventrikül fonksiyon bozukluðu ve sol ventrikül anevrizmasý ile seyreden nadir görülen bir patolojidir. Bu patoloji genellikle yaþlý, postmenapozal kadýnlarda fiziksel veya duygusal stres altýnda çýkmaktadýr. Bu nedenle kýrýk kalp sendromu, stresle iliþkili kardiyomyopati ve geçici sol ventrikül anevrizmasý diðer tanýmlarýdýr Amerikan Kalp Cemiyeti tarafýndan kardiyomiyopatiler içerisinde sýnýflandýrýlmaktadýr. Bu yazýmýzda emosyonel stres sonrasý geliþen ve kendini akut koroner sendrom ile gösteren Takotsubo sendromu tanýsý sonrasý periferik embolisi olan 34 yaþýnda bir kadýn hasta sunulacaktýr.

Takotsubo syndrome is a rare pathology with left ventricular dysfunction and left ventricular aneurysm despite normal coronary arteries. This pathology is usually manifested by physical or emotional stress in older, postmenopausal women. Therefore, other definitions of fracture heart syndrome, stress-related cardiomyopathy and transient left ventricular aneurysm are classified by the American Heart Association into cardiomyopathies. We present a 34-year-old female patient with peripheral embolism after the diagnosis of Takotsubo syndrome that develops after emotional stress and shows itself as acute coronary syndrome.

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Amiodaron tedavisinin en önemli komplikasyonlarýndan biri akut pulmoner toksisitedir (APT). Koroner Arter Baypas Cerrahisi (KABC) sonrasýnda hastalar amiodaron kaynaklý toksisiteye eðilimi gösterirler. Bu nedenle bu ölümcül komplikasyonun tedavisine öncelik verilmelidir. Amiodarona baðlý akut pulmoner toksisite, erken taný konulmasý durumunda tedavi edilebilir bir fenomendir, bu nedenle titiz takip ve þüphe çok önemlidir. Dört damar koroner arter baypas ameliyatý yapýlan 72 yaþýndaki bir erkek hastada, amiodaron infüzyon tedavisinden hemen sonra, amiodaron nedeniyle geliþen pulmoner toksisitenin tedavisini sunduk.

One of the major complications of amiodarone therapy is acute pulmonary toxicity (APT). Patients tend to have amiodarone-induced toxicity after Coronary Artery Bypass Surgery (CABG). For this reason, priority should be given to the treatment of this fatal complication. Acute pulmonary toxicity due to amiodarone is a treatable phenomenon if diagnosed early, for this reason, meticulous follow-up and suspicion are of great importance. We describe the treatment of a 72-year-old male with amiodarone-induced pulmonary toxicity immediately after amiodarone infusion who underwent 4-vessel coronary artery bypass grafting surgery.

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