Suleyman Kucukay

Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study

Objective The aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA). Material and method 70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups. Results The total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584). Conclusion A high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.

Two-year experience with cell salvage in total hip arthroplasty

BACKGROUND AND OBJECTIVE The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril

BACKGROUND AND OBJECTIVE The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

Anesthetic Approach for a Patient with Jeune Syndrome.

Jeune syndrome (JS) is an autosomal recessive disease also known as asphyxiating thoracic dystrophy. A narrow bell-shaped thoracic wall and short extremities are the most typical features of the syndrome. Prognosis in JS depends on the severity of the pulmonary hypoplasia caused by the chest wall deformity. Most patient deaths are due to respiratory problems at early ages. Herein, we report a case of JS patient, who was scheduled for femoral extension under general anesthesia. The severity of respiratory problems in JS patients is thought to diminish with age. Our case supported this theory, and we managed the anesthetic process uneventfully.

Regional anaesthesia in a Duchenne muscular dystrophy patient for upper extremity amputation.

Duchenne muscular dystrophy (DMD) is the most common of the neuromuscular disorders. DMD is usually a challenge for the anaesthesiologist, with poor cardiac function, a high risk of developing rhabdomyolysis, and the probable life-threatening complications of general anaesthesia. To avoid possible morbidity associated with general anaesthesia, we applied a supraclavicular blockade. In this report, we present a 17-year-old DMD patient with a massive rhabdomyosarcoma, for whom a left arm amputation was indicated. In the post-operative period, a malignant hyperthermia-like reaction occurred, which resolved in a short time. We suggest a regional blockade as a safer alternative to general anaesthesia for the management of high risk DMD patients during orthopedic procedures.

Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade

Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.

SPİNAL ANESTEZİ SONRASI GÖRÜLEN KOMPLİKASYONLARIN DEMOGRAFİK DAĞILIMI VE HASTA MEMNUNİYETİ

Giris: Hasta memnuniyeti, gunumuzde, butun tip bilimleri icin buyuk onem ve oncelik tasiyan bir konudur. Spinal anestezi ile iliskili hasta memnuniyeti de anesteziyoloji icin onde gelen konulardan birisidir. Spinal anestezi sonrasi gorulen komplikasyonlarin demografik dagilimi, hasta memnuniyeti ve bu dusuncelerin hastalar tarafindan bize yansitilmasinin, hastalarimizin yasadigi cografi bolgelerle ile ilgili olarak farkliliklar gosterdigini gozlemlemekteyiz. Bu nedenle, spinal anestezi uygulanan vakalarda hasta memnuniyetini arastirmayi hedefledik. Gerec ve yontem: 236 hastayi kapsayan prospektif gozlemsel bir calisma gerceklestirildi. Spinal anestezi uygulanmis hastalar 7 cografi bolgeye gore siniflandirildi. Hasta memnuniyeti ve komplikasyonlar acisindan degerlendirildi. Operasyonu takiben 2., 6., 12., 24. saatlerde ve 7. gunde gelisen komplikasyonlari ve hasta memnuniyeti sorgulandi. Bulgular: Hastalarin en cok Marmara (%24,6) ve Karadeniz bolgesinden oldugu goruldu (%22,9). Spinal anestezi memnuniyeti anlamli olarak yuksek (n:171; %72,5) (p < 0.001) bulundu. Genel olarak en sik gorulen komplikasyonlar ise 63 hastada bulanti-kusma (%26,7) ve 52 hastada bel agrisi (% 20,1) olarak saptandi. Sonuc: Hastalarin spinal anestezi icin sorgulanan sikâyet veya memnuniyetlerinin ifadesinde cesitli faktorlerden etkilendigi tespit edildi. Bu nedenle spinal anestezi planlanan hastalara girisim oncesi, daha genis ve etkin bilgi verilmesi ve hastalarin operasyon surecine daha aktif katilimlarinin saglanmasinin hasta memnuniyetini arttiracagi kanisindayiz.