Coşkun Araz

Syringe pumps take too long to give occlusion alarm.

Background:  The aim of this study was to assess the time needed to trigger an occlusion alarm, and the influence of the type of infusion pump, type and size of the syringe, and the set infusion rate.

Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy: preliminary experience

Abstract Objective: To report the feasibility of laparoendoscopic single port surgical approach for the management of huge adnexal cysts and adnexal torsion during pregnancy. To discuss the optimal method of entry into the peritoneal cavity for pregnant patients. Design: Two case report. Method and patient(s): Two pregnant patients with adnexal mass. First patient, suffering from persistent and progressive abdominal distention and pain on her 12th week of pregnancy, was diagnosed with an ovarian cyst in 18 cm diameter on left ovary. The other patient had IVF twin pregnancy and presented with left adnexal torsion on the 25th week of pregnancy Intervention(s): Single-port laparoscopic ovarian cystectomy on the 12th week of pregnancy in patient one and single-port left adnexectomy in a twin pregnancy on the 25th week of pregnancy in patient two. Main outcome measure(s): Feasibility of single port laparoscopic intervention during pregnancy for adnexal mass. Result(s): Complete resolution of the symptoms for both pregnant women after the surgeries. No fetal and maternal complication was diagnosed during both pregnancies. Conclusion(s): Single port laparoscopy with open-entry technique is feasible and might be a better surgical option for the pregnant patients with adnexal pathology. However, further studies with larger sample size are needed to reach clear conclusion.

Early-Onset Posterior Reversible Encephalopathy Syndrome After Solid Organ Transplantation in Pediatric Patients: A Report of 2 Cases

Posterior reversible encephalopathy syndrome (PRES) is a neurological disturbance that occurs due to different reasons and presents with different clinical symptoms. It can be a devastating situation, but, timely treatment may lead to complete recovery. We report 2 cases of PRES, which developed and fully recovered in the early period after solid organ transplantation in pediatric patients.

The Evaluation of Hemodynamic Changes During the Reperfusion Phase in Adult Living Donor Liver Transplantations: The Role of Cardiovascular Problems

OBJECTIVE This study sought to evaluate the hemodynamic changes of and to analyze the effects of coronary artery disease (CAD) as well as its risk factors on hemodynamic parameters during the reperfusion phase (RP) in adult living donor liver transplantation (ALDLT). PATIENTS AND METHODS This single-center retrospective study evaluated 154 adult patients being assessed from January 2001 to December 2013 for orthotopic liver transplantation (OLT). The patients were divided into separate groups according to the presence or absence of CAD and its risk factors, including diabetes, hypertension, dyslipidemia, smoking, sex, and age. The hemodynamic parameters were noted during the RP with respect to the patient files. The comparison of the groups and the effects of cardiovascular problems on hemodynamic parameters were statistically analyzed. RESULTS A decrease of more than 20% in systolic arterial pressure was seen in 16 (16.7%), 7 (43.8%), and 17 (40.5%) patients without CAD, with CAD, and with its high risk factors (>2), respectively (P < .05). Moreover, diastolic hypotension was seen in 59 (38.3%) patients during RP; of those, 10 (62.5%) had CAD and 19 (45.2%) had CAD high-risk factors. The decline in both systolic and diastolic arterial pressure was significantly correlated with the increased number of risk factors (P < .05). CONCLUSIONS RP in ALDLT remains an issue not only for the surgeons but also for the anesthesiologists. Clinicians should be aware of CAD and its risk factors before OLT and successful management of such problems are mandatory for hemodynamic stability during this formidable process.

Anesthetic Management of Renal and Liver Transplantation Recipients During Cesarean Section

Introduction The aim of this study is to present our experience in renal transplantation recipients (RTR) and liver transplantation recipients (LTR) during cesarean section. Materials and Methods Retrospective data regarding renal transplantation recipients and liver transplantation recipients who underwent cesarean section at Baskent University Hospital in Ankara between January 1997 and January 2017 have been collected from hospital records. Results and Discussion Fourteen live births occurred from five LTRs and nine RTRs, all of them from C/S. The mean maternal age (28.4±4.1 years vs 29.2±4.1 years, p=.38), body weight before conception (57.4±8.8 kg vs 64.5±8.2 kg, p=.48) and the time from transplantation to conception (99.0±50.7 months vs 101.0±57.5 months, p=.46) were similar respectively for LTRs and RTRs. All recipients were maintained on cyclosporine, azathioprine, tacrolimus and corticosteroids before and during pregnancy for immunosuppression. Four C/Ss were performed under general anesthesia (1 LTR vs 3 RTRs, p>.05) whereas spinal anesthesia was used in 10 patients. Liver and renal function tests were stable in all of the patients and we did not observe any acute or subacute rejection. Only one mother with renal transplantation died in one year after delivery. The mean birth weight was similar (2502 ± 311 gr vs 2161±658 gr, p=.3). There were 3 premature vs 6 premature and low birth weight (<2500 gr) 2 vs 4 among 14 newborns. Infants small for gestational age were diagnosed in 9/14 (3 LTRs vs 6 RTRs, p=1). None of the neonates died. Conclusion General and regional anesthesia can be safely used during cesarean delivery of the LTRs and RTRs without increased risk of graft loses. Prematurity and low birth weight was mainly due to the cytotoxic drugs for immunosuppression. There are no differences in LTRs and RTRs for maternal and fetal complications due to in our data.

Anaesthesia Management of a Patient with Factor XI Deficiency

Factor XI deficiency is an extremely rare disease presenting no clinical symptoms, unless there is an inducing reason such as trauma or surgery. Normally, factor levels are in the range of 70-150 U dL-1 in healthy subjects. Although no clinical symptoms are seen, only high levels of aPTT can be found. Once a prolongation is detected in aPTT, factor XI deficiency should be suspected and factor levels should be analysed. With careful preoperative preparations in factor-deficient people, preoperative and postoperative complications can be decreased. In this case report, management of anaesthesia during total hip arthroplasty of a patient with factor XI deficiency is presented.

A Case of Compartment Syndrome in the Hand Secondary to Intravenous Fluid Application

Compartment syndrome of the extremities is a rare but potentially devastating condition. Anaesthetic and analgesic drugs used in the perioperative period may cause a delayed diagnosis by preventing the symptoms from appearing, and irreversible complications can occur. In this report, a case of compartment syndrome secondary to vascular access and its treatment in a morbidly obese patient who underwent abdominoplasty was presented.

Cerrahi Yoğun Bakım Ünitesinde Çok İlaca Dirençli Acinetobacter Baumannii Enfeksiyonunun Ön Belirleyicileri: Retrospektif Bir Analiz

Tel.: +90 312 212 68 68/1172-4 Faks: +90 312 212 15 83 E-pos ta: acamkiran@gmail.com Geliş Tarihi/Received: 24.02.2011 Kabul Tarihi/Accepted: 19.08.2011 Amaç: Günümüzde hastane kaynaklı enfeksiyonlarda sık rastlanan bir etken olan çok ilaca dirençli Acinetobacter baumannii (ÇİD-A. baumannii) artmış morbidite ve mortalite ile ilişkilidir. Bu çalışmada cerrahi yoğun bakım hastalarında ÇİD-A. baumannii enfeksiyonu için ön belirleyicilerin belirlenmesi amaçlandı. Materyal ve Metod: Ocak 2008 ile Ağustos 2010 tarihleri arasında cerrahi yoğun bakım ünitesinde izlenen hastaların verileri retrospektif olarak tarandı. Çok ilaca dirençli A. baumannii enfeksiyonu olan hastalar ve kontrol grubunu oluşturan aynı dönemde yoğun bakımda izlenen ancak ÇİD-A. baumannii enfeksiyonu olmayan hastaların yaş, cinsiyet, Acute Physiology and Chronic Health Evaluation II (APACHE II) skoru, Glasgow koma skoru, yandaş hastalıkları, yoğun bakım ünitesine yatış nedeni, ameliyat olanların ameliyat türleri, uygulanan invazif işlemler (entübasyon, arteriyel, santral venöz ve üriner kateterizasyonlar), renal replasman tedavi gereksinimi, üreme yeri, sistem yetmezlikleri, hospitalizasyon ve yoğun bakım ünitesinde kalış süresi, laktat seviyesi ve beyaz küre sayısı kaydedildi. Bulgular: Araştırılan dönem içerisinde 25 hastada ÇİD-A. baumannii enfeksiyonu saptandı. Çok ilaca dirençli A. baumannii enfeksiyonu olmayan eşleştirilmiş kontrol grubu (n=25) ile karşılaştırıldığında enfeksiyonu olan grupta ortalama APACHE II skoru daha yüksek (p=0,001) ve solunum sistemi hastalığı (p=0,03), açık yara bulunması (p=0,002), mekanik ventilasyon ihtiyacı (p=0,005) ve ÖZET SUMMARY