Dilek Altun

An alternative treatment in hypertriglyceridemia-induced acute pancreatitis in pregnancy: Plasmapheresis

Hormonal influences during pregnancy can compromise otherwise controlled lipid levels in women with familial hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity in both mother and fetus. Both cholesterol and triglyceride levels in serum increase progressively during pregnancy. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications. Experiences with plasmapheresis are limited. We report two cases of hypertriglyceridemia-induced acute pancreatitis during pregnancy, which were successfully treated by plasmapheresis.

The effect of tramadol plus paracetamol on consumption of morphine after coronary artery bypass grafting

STUDY OF OBJECTIVE To compare the effects of oral tramadol+paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol. DESIGN A prospective, double-blind, randomized, clinical study. SETTING Single-institution, tertiary hospital. PATIENTS Fifty cardiac surgical patients undergoing primary CABG surgery. INTERVENTIONS After surgery, the patients were allocated to 1 of 2 groups. Both groups received morphine according to the PCA protocol after arrival to the coronary intensive care unit (bolus 1 mg, lockout time 15 minutes). In addition to morphine administration 2 hours before operation and postoperative 2nd, 6th, 12th, 18th, 24th, 30th, 36th, 42th, and 48th hours, group T received tramadol+paracetamol (Zaldiar; 325 mg paracetamol, 37.5 mg tramadol) and group P received placebo. Sedation levels were measured with the Ramsay Sedation Scale, whereas pain was assessed with the Pain Intensity Score during mechanical ventilation and with the Numeric Rating Scale after extubation. If the Numeric Rating Scale score was ≥3 and Pain Intensity Score was ≥3, 0.05 mg/kg morphine was administered additionally. MEASUREMENTS Preoperative patient characteristics, risk assessment, and intraoperative data were similar between the groups. MAIN RESULTS Cumulative morphine consumption, number of PCA demand, and boluses were higher in group P (P<.01). The amount of total morphine (in mg) used as a rescue analgesia was also higher in group P (5.06±1.0), compared with group T (2.37±0.52; P<.001). The patients who received rescue doses of morphine were 8 (32%) in group T and 18 (72%) in group P (P<.001). Duration of mechanical ventilation in group P was longer than group T (P<.01). CONCLUSION Tramadol+paracetamol combination along with PCA morphine improves analgesia and reduces morphine requirement up to 50% after CABG, compared with morphine PCA alone.

Successful anesthetic and airway management in Coffin-Siris syndrome with congenital heart disease: Case report

Abstract Introduction Coffin-Siris Syndrome (CSS) is a rare congenital malformation syndrome characterized with mild to severe developmental and cognitive delay, coarse facial features, fifth digit aplasia or hypoplasia associated with ectodermal, constitutional and organ-related (cardiac/neurological/gastrointestinal/genitourinary…) anomalies. Here, we have reported a successful anesthetic and airway management in a case of 5-year old boy with CSS who underwent congenital heart surgery. Case report A 5-year old male child weighing 14 kg, who was diagnosed as CSS underwent operation for the repair of partial atrioventricular septal defect and secundum atrial septal defect. This case report pertains to the successful anesthetic and airway management in the background of difficult airway and presence of various cardiac abnormalities. Although patient was anticipated to be difficult for intubation due to laryngomalacia, micrognathia, macroglossia, tracheal intubation was performed without any difficulty using fiber-optic laryngoscopy. At the end of the operation, the patient was transferred to the cardiovascular intensive care unit and was extubated when his spontaneous breathing was satisfactory 4 h later after the operation without any complication. Results and discussion CSS often requires surgery and anesthetic intervention. The abnormal facial and airway as well as mental related features may lead intubation difficult, potentially due to short neck, large tongue and lips, poor dentition and poor communication. Thinking that the practicing anesthetist needs to have appropriate knowledge for this entity and the equipment for managing difficult airway should readily be available. One of these patients which successfully managed without any complication was described in this brief report.

Yoğunbakım hastalarında renal fonksiyonların RIFLE ve AKIN Skorları ile takibinin mortalite ve morbidite üzerindeki etkilerinin karşılaştırılması

Monitoring of renal function in patients with RIFLE and AKIN scores to compare the effects on mortality and morbidity in ICU Objective: Acute kidney injury network (AKIN) in intesive care patients is a common clinical condition that adversely affect the clinical course. RIFLE and AKIN classification is used to determine the prognosis and mortality. We aimed to find out which of the two different classification is more efficient and reliable on to determine the prevalence of morbidity and mortality in intensive care patients. Materials and Methods: 190 patients followed up in our hospital’s intensive care unit and developed acute renal failure (ARF) were included in the study. AKIN and RIFLE scores were compared. Results: In our research RIFLE and AKIN rating was found compatible with a statistically significant difference . Conclusion: There is no significant differences between AKIN and RIFLE classification for the morbity and mortality of ARF.

Propofol Enjeksiyon Ağrisi Önlenebilir Mi

Can propofol injection pain be avoided? Objective: The main purpose of this study is to investigate the most effective and reliable method for prevention of propofol injection pain. Material and Methods: In this prospective, randomized, double-blind trail we gave one of the six drugs of penthotal, lidocaine, saline, ketamine, ondansetron and decort by using wrist tourniquet. Then we evaluated arm withdrawn, grimace, verbal rating scale (VRS) and postoperative recall the pain during propofol injection. Results: Evaluation of VRS data between six groups revealed that the lidocaine group was the most painless group (86%). These findings were followed respectively by ondansetron (82%), decort (72%), penthotal (52%), ketamine (46%) and saline (12%).

Acute isoniazid intoxication: case report -

Isoniazid is a bactericidal antituberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis with a high anion gap resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Pyridoxine, in a dose equivalent to the amount of isoniasid ingested, is the only effective antidote. Here, we reported a 14 years old female patient with the diagnosis of isoniasid intoxcication, successfully treated in our intensive care unit.

Therapeutic Plasma Exchange in an Uncommon Disease: Stiff-Person Syndrome: Case Report

Stiff-Person syndrome (SPS) is a rare and disabling disorder characterized by continuous motor unit activity causing severe rigidity and episodic spasms in axial and limb muscles. It deteriorates the quality of life and causes a serious burden in the patient’s life. It is frequently associated with other autoimmune diseases such as diabetes mellitus. Treatment with intravenous immunoglobulin, anti-anxiety drugs, muscle relaxants, anti-convulsants will improve symptoms, but will not cure the disorder. Therapeutic plasma exchange is an alternative treatment for the patients resistant to other treatment options. Here, we report a patient with SPS treated in intensive care unit and underwent therapeutic plasma exchange.

Koroner Arter Bypass Greftleme Cerrahisinde Kristaloid ve Kolloidlerin Hemodinami Üzerine Etkilerinin Minimal İnvaziv Kardiyak Output Monitörü (Flotrac-Vigileo) Kullanilarak Karşilaştirilmasi

Comparison of the hemodynamic effects of crystalloids and colloids in patients undergoing coronary artery bypass grefting surgery with the minimally invasive cardiac output monitoring system (Flotrac-Vigileo) Objective: The aim of this prospective randomized clinical trial is comparison of crystalloids and colloids’s hemodynamic effects in patients undergoing elective coronary artery bypass grefting surgery with arterial pressure waveform analysis. Material and Methods: The thirty patients undergoing elective coronary arter bypass surgery were divided into two groups: crystalloid (0.9% isotonic) and 50% crystalloid (0.9% isotonic) + 50% colloid (HES 6%). FloTrac Sensor and Vigileo Monitor was attached to the arterial line. The hemodynamic parameters were recorded regarding systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), cardiac output (CO), stroke volume (SV), stroke volume variation (SVV). Results: There was no statistically significant difference between the two groups ragarding mean average of cardiac output and stroke volume before the induction, after the induction, after the skin incision, after the sternotomy, before the canulation, after the canulation, on-pump, after the cross clemp, after the bypass and after the chest closure (p>0.05). Only after the skin closure, the mean cardiac output and stroke volume increased in crystaloid-colloid groups compared to crystaloid group (p=0.01). Conclusion: There was no significant clinical difference between the two groups for the hemodynamic parameters in patients undergoing coronary artery bypass grefting surgery.

Takayasu arteritli bir gebenin anestezik yönetimi / Anesthetic management of a pregnant with Takayasu arteritis

Takayasu’s arteritis (TA) is an idiopathic, rare vasculitis that affects the aorta and its primary branches. It is also known as ‘pulseless disease’ because of its presentation with absence of peripheral pulses. Women are more often affected than men. Anesthesia for patients with Takayasu’s arteritis is complicated by their severe uncontrolled hypertension, end-organ dysfunction resulting from hypertension, stenosis of major blood vessels affecting regional circulation, and difficulties encountered in monitoring arterial blood pressure. Anesthetic management of patients with this disease have been limited to isolated case reports in the anesthetic literature, mostly in women undergoing cesarean delivery. This case has been presented in order to review the details of the disease, since Takayasu’s arteritis has been observed very rarely, and to examine the patients in detail, in order to choose the optimal anesthetic management with the measures to prevent its possible perioperative complications.