No abstract

Introduction Maintenance of microcirculatory homeostasis is essential for the preservation of organ function [1]. Cardiac surgery is associated with an inflammatory reaction that may promote alterations in the microcirculatory level, in addition to the general impact on hemodynamic status [2]. The use of cardiopulmonary bypass (CPB) additionally causes a broad range of changes in microcirculatory perfusion and oxygenation [1]. Anemia and transfusion not only make patients more prone to the deleterious effects of CPB but also aggravate the inflammatory response, oxidative stress, and renal hypoxia [3,4]. An intraoperative transfusion of red blood cells (RBCs) increases the risk of mortality and several morbidities. These risks are substantial for even one unit in general surgery patients [5]. The aim of this study was to compare tissue oxygenation, which was evaluated by blood lactate concentration, central venous oxygen saturation (S cv O 2), and venoarterial carbon dioxide pressure difference (ΔpCO 2), between patients who had dilutional anemia resulting from CPB and could be treated with a minimal RBC transfusion (1-2 units) and the patients who did not. Our hypothesis was that a minimal transfusion would lead to normalized Background/aim: Cardiac surgery, especially in the presence of cardiopulmonary bypass (CPB), is associated with an inflammatory reaction that may promote microcirculatory alterations, in addition to the general impact on system hemodynamics. Anemia and transfusion make patients more susceptible to the deleterious effects of CPB. In this study, it was aimed to evaluate the effect of dilutional anemia, which is caused by CPB and can be treated with 1-2 units of red blood cell (RBC) transfusion, on global tissue oxygenation parameters in cardiac surgery patients. Materials and methods: This prospective observational study comprised 127 patients who had a relatively stable operation period without any major anesthetic or surgical complications (e.g., operation duration >5 h, bleeding or hemodilution requiring more than 1-2 units of RBCs, or unstable hemodynamics, requiring inotropic support of more than 5 µg/kg/min dopamine). Patients were observationally divided into two groups: minimally transfused (Group Tr) and nontransfused (Group NTr). Global tissue oxygenation parameters were evaluated after anesthesia induction (T 1) and at the end of the operation (T 3) and compared between the groups. Results: Group Tr consisted of patients who had significantly lower preoperative hemoglobin values than Group NTr patients. The dilutional anemia of all Group Tr patients could be corrected with 1 unit of RBCs. The lactate levels at T 3 , increment rates of lactate, and venoarterial carbon dioxide pressure difference (ΔpCO 2) levels [(T 3-T 1) : T 1 ] in Group Tr were significantly higher than those in Group NTr. Conclusion: Dilutional anemia as a result of CPB mostly occurs in patients with borderline preoperative hemoglobin concentrations and its correction with RBC transfusion does not normalize the de...

No abstract

No abstract

Perioperative management of bleeding in children can be challenging. Microvascular imaging techniques have allowed evaluating the effect of blood transfusion on the microcirculation, but little is known about these effects in children. We aimed to investigate the effects of blood management using macro-and micro-hemodynamic parameters measurement in children undergoing craniofacial surgery. This is a prospective observational repeated measurement study including fourteen children. The indications for blood transfusion were changes of hemoglobin/ hematocrit (Hct) levels, the presence of signs of altered tissue perfusion and impaired microcirculation images. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, Hct, lactate, mixed venous oxygen saturation, K þ , heart rate, mean arterial blood pressure) were evaluated baseline (T1), at the end of the surgical bleeding (T2) and end of the operation (T3). Four patients did not need a blood transfusion. In the other 10 patients who received a blood transfusion, capillary perfusion was higher at T3 (13[9 -16]) when compared with the values of at T2 (11[8 -12]) (P < 0.05) but only 6 patients reached their baseline values.Although blood transfusions increased Hct values (17 AE 2.4 [T2]-19 AE 2.8 [T3]) (P < 0.05), there was no correlation between microvascular changes and systemic hemodynamic parameters (P > 0.05). The sublingual microcirculation could change by blood transfusion but there was not any correlation between microcirculation changes, hemodynamic, and tissue perfusion parameters even with Hct values. The indication, guidance, and timing of fluid and blood therapy may be assessed by bedside microvascular analysis in combination with standard hemodynamic and biochemical monitoring for intraoperative bleeding in children.

No abstract

ÖZEndovasküler yöntemle aort anevrizma cerrahisi onarımı, anatomik olarak uygun torasik ve abdominal lezyonlarda sıklıkla yeğlenmektedir. Torako-abdominal anevrizmaların endovasküler tedavisinde eşzamanlı torakal ve abdominal endovasküler stent greft rekonstrüksiyonu (TEVAR+EVAR) ise oldukça ender yapılan uzun süreli bir işlemdir. Bu komplike işlem anestezik yönetim açısından yüksek risklidir.Bu makalede, torakal ve abdominal aort anevrizması, endovasküler olarak aynı seansta başarılı bir şekilde tedavi edilen hastamızın anestezi yönetiminde deksmedetomidin kullanımı sunulmuştur.Anahtar kelimeler: abdominal aort anevrizması, anestezi, deksmedetomidin, endovasküler prosedürler, torasik aort anevrizması ABSTRACT Dexmedetomidine Use in Application of Simultaneous Thoracic and Abdominal Endovascular Stent Graft ReconstructionEndovascular approach in aortic aneurysm repair is usually chosen for appropriate thoracal and abdominal lesions but simultaneous thoracal and abdominal endovascular stent graft reconstruction in the endovascular treatment of thoracoabdominal aneurysms (TEVAR+EVAR) is rarely performed long-lasting procedure. This is a high risk complex procedure for anesthetic management.In this report, the dexmedetomidine use in the anesthetic management of a patient during successful endovascular treatment of simultaneous thoracal and abdominal aortic aneurysms is described.

ALCAPA (Anomalous origin of the left coronary artery from pulmonary artery) Sendromu (Bland-White-Garland Sendromu) anormal yerleşimli sol koroner arterin aorta yerine pulmoner arterden çıkışı ile karakterize, ender görülen bir konjenital koroner arter anomalisidir. Anestezi indüksiyonu ve idamesi pek çok nedenle özellik gösterir. Bu olgu sunumu ile sık rastlanmayan bu sendromda anestezi yönetiminin tartışılması ve intraoperatif transözofageal ekokardiyografi bulgularının paylaşılması, kullanımının önemine dikkat çekilmesi amaçlanmıştır.