Yusuf Ziya Çolak

Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital.

ABSTRACT Purpose: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. Materials and Methods: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients. Results: Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005). Conclusion: DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.

Effect of Transversus Abdominis Plane Block in Combination with General Anesthesia on Perioperative Opioid Consumption, Hemodynamics and Recovery in Living Liver Donors : The prospective, double-blinded, randomized study.

Transversus abdominis plane (TAP) block provides effective postoperative analgesia after abdominal surgeries. It can be also a useful strategy to reduce perioperative opioid consumption, support intraoperative hemodynamic stability, and promote early recovery from anesthesia. The aim of this prospective randomized double‐blind study was to assess the effect of subcostal TAP blocks on perioperative opioid consumption, hemodynamic, and recovery time in living liver donors.

Anaesthesia Induction with Ketamine: Propofol Combination (Ketofol) in Caesarean Delivery

Sezaryen ameliyatlarında genel anestezi uygulaması, son on yılda azalmış ise de, maternal kanama, belirgin koagülopati, hayatı tehdit eden fetal distres veya hastanın rejyonal anesteziyi reddetmesi gibi durumlarda tercih edilmektedir (1). Genel anestezi uygulamalarında mevcut aspirasyon riskini azaltmak amacıyla, sıklıkla hızlı sıralı entübasyon uygulanmaktadır. Ancak hızlı sıralı anestezi indüksiyonu sonrası annede farkındalık, yetersiz analjezi ihtimalleri artmaktadır (2, 3). Bu nedenle, sezaryen ameliyatlarında anestezi indüksiyonu için seçilecek ajan ve dozu çok önemlidir (2, 4).

Determination of Absence of Right Internal Jugular Vein During Ultrasonographic Guided Central Venous Cannulation

Written informed consent was obtained from the patient for sharing his clinical condition in a scientific journal. The 53-year-old male patient (weight 78 kg) was going to undergo liver transplantation from a living donor because of end-stage liver failure. His history revealed that he had cirrhosis for 1 year and had thrombus in his portal vein. He was admitted into the operating room and underwent induction after standard monitoring. A cannula was inserted into the left radial artery, and invasive arterial pressure was monitored. A central catheter was planned to be inserted into the right IJV under USG guidance. The table was set in the Trendelenburg position and the patients head was slightly turned to the left side. The patient was covered in a sterile way and 9-L linear probe of USG (5.0–13.0 MHz, multi-frequency, boardband) was sterilised and placed in the right neck region, but the right IJV was not visible. While the right carotid artery could be clearly observed using colour Doppler, the right IJV was not detected (Figure 1). Although the right neck was thoroughly examined via USG, the right IJV was absent. The left IJV was evaluated through USG and it was easily viewed (Figure 2). A central venous catheter was inserted into the left IJV without any problem.

Intensive care admission in patients with hellp syndrome in a tertiary referral hospital

Every year, 500.000 mothers die from pregnancy-related complications, and 99% of these deaths occur in low- and middle-income countries [1]. These maternal deaths occur from complications associated with pre-eclampsia or eclampsia; hemolysis elevated liver enzymes, and low platelet (HELLP) syndrome, or other hypertensive disorder of pregnancy [2].