Zeki Ertug

The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation

BACKGROUND: This study aimed to quantify changes in acid-base balance, potassium and lactate levels as a function of administration of different crystalloid solutions during kidney transplantation, and to determine the ideal fluid for such patients. METHODS: In this double-blind study, patients were randomized to three groups (n = 30 each) to receive either normal saline, lactated Ringers, or Plasmalyte, all at 20–30 mL · kg−1 · h−1. Arterial blood analyses were performed before induction of anesthesia, and at 30-min intervals during surgery, and total IV fluids recorded. Urine volume, serum creatinine and BUN, and creatinine clearance were recorded on postoperative days 1, 2, 3, and 7. RESULTS: There was a statistically significant decrease in pH (7.44 ± 0.50 vs 7.36 ± 0.05), base excess (0.4 ± 3.1 vs –4.3 ± 2.1), and a significant increase in serum chloride (104 ± 2 vs 125 ± 3 mM/L) in patients receiving saline during surgery. Lactate levels increased significantly in patients who received Ringers lactate (0.48 ± 0.29 vs 1.95 ± 0.48). No significant changes in acid-base measures or lactate levels occurred in patients who received Plasmalyte. Potassium levels were not significantly changed in any group. CONCLUSIONS: All three crystalloid solutions can be safely used during uncomplicated, short-duration renal transplants; however, the best metabolic profile is maintained in patients who receive Plasmalyte.

Deformability and oxidant stress in red blood cells under the influence of halothane and isoflurane anesthesia

1. The effects of halothane and isoflurane anesthesia on red blood cell (RBC) deformability, lipid peroxidation and antioxidant enzymes were tested in rabbits. 2. RBC transit time was significantly increased to 2.12 +/- 0.07 msec after 1-hr halothane anesthesia preceded by 6 mg/kg pentobarbital injections from 1.98 +/- 0.07 msec preanesthesia value (p < 0.05). Thiobarbituric acid-reactive substances also were increased significantly, being 23.35 +/- 2.75 nmol/gHb and 33.11 +/- 5.34 nmol/gHb before and after anesthesia, respectively (p < 0.05). 3. Under halothane anesthesia without prior pentobarbital injection or under isoflurane anesthesia with or without pentobarbital injection, no significant alterations were observed in these parameters. 4. RBC superoxide dismutase activity was decreased in the group anesthetized with the pentobarbital-halothane combination. The impaired RBC deformability and increased oxidant damage might be related to the free radical formation during the metabolism of halothane. Pentobarbital can potentiate this effect either by inducing cytochrome P-450 or by altering antioxidant defense. 5. Alterations in RBC mechanical properties may contribute to the tissue perfusion problems that develop after surgery under general anesthesia.

Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique

Background:u2002 Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery.

Surgical correction of vesico-ureteric reflux for recurrent febrile urinary tract infections after kidney transplantation.

To evaluate the outcome of anti‐reflux revision surgery in patients diagnosed with at least a grade 3 reflux at voiding cysto‐urethrography in patients with recurrent urinary tract infection (UTI) after renal transplantation.

Pancreas survival in simultaneous pancreas-kidney and pancreas-after-kidney transplantations: A five-year follow-up report

BACKGROUNDnPancreas transplantation methods, such as simultaneous pancreas-kidney (SPK) transplantation and pancreas-after-kidney (PAK) transplantation, have become the most important treatments for patients with type-1 diabetes mellitus (DM)-related end-stage renal diseases (ESRD). The purpose of the study was to compare the clinical results of the pancreas graft in patients after SPK and PAK transplantations and to present the findings of our 5-year follow-up.nnnMATERIAL/METHODnA total of 55 patients who had kidney and pancreas transplantation between February 2003 and December 2010 were included in the study. The patients were divided into 2 groups based on the timing of the pancreas transplantation: SPK (n=21) and PAK (n=34).nnnRESULTnThe patients in the SPK group consisted of 13 males and 8 females, with a mean age of 33.6±6.8 years; whereas 25 males and 9 females formed the PAK group, with a mean age of 32.0±6.0 years. In the early postoperative period, the SPK group had 3 patients with vascular thrombosis (2 venous, 1 arterial) and the PAK group had 7 patients with thrombosis (4 venous, 3 arterial) (p=0.319). At the end of the 5-year follow-up, the patient, kidney and pancreas survival rates in the SPK group were 95.2%, 95.2%, and 61.9% respectively, and the corresponding values in the PAK group were 97%, 91.2%, 61.8% (p=0.382, p=0.504, p=0.927).nnnCONCLUSIONSnWe concluded that PAK is just as effective as SPK to prevent the destructive effects of DM when the waiting time for SPK is long and a potential live donor is present.

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children.

Background:u2002 We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2u2003mg·kg−1) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery.

Concurrent unilateral or bilateral native nephrectomy in kidney transplant recipients

BACKGROUNDnThe aim of this study is to present results of patients who have undergone renal transplantation concurrent with bilateral or unilateral native nephrectomy, with a special focus on polycystic kidney disease (PKD).nnnMATERIAL AND METHODSnWe presented the outcome of renal transplantation patients who have undergone native nephrectomy unilaterally (n=38) and bilaterally (n=125) and compared the results of patients with PKD and other nephrectomy indications.nnnRESULTSnOverall graft survival in the 1st, 3rd, and 5th years were 93%, 90%, and 89%, respectively, in transplantation with concomitant nephrectomy patients. Overall patient survival in the 1st, 3rd, and 5th years were 97%, 94%, and 94%, respectively. Overall surgical complications rate was 17.7% and medical complication rate was 19%. Patients with PKD had more frequent complications.nnnCONCLUSIONSnDespite additional surgery, the long-term results of patients with complications were not affected negatively by early diagnosis and treatment. We believe that native nephrectomy concurrent with transplantation can be successfully performed when indicated in selected patients at experienced centers.