Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG). Aim. To compare total intravenous anaesthesia (TIVA) and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3–5 mcg/kg/h) was started in both groups. Patients were divided into two groups. The PD group (n = 25) received 1 minimum alveolar concentration (MAC) desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h), while P group (n = 25) received propofol infusion (5-6 mg/kg/h) only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0), after initiation of CPB but before cross-clamping the aorta (T1), after removal of the cross-clamp (T2), and at the 24th postoperative hour (T3). Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p ≤ 0.05). CK-MB showed a significant decrease in group P (p ≤ 0.05). When we compared both groups, cortisol levels were significantly higher in PD group than P group (p ≤ 0.05). Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG.

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SummaryObjectives: The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters. Methods: Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50. after intubation; in Group E, 0.1% bupivacaine and 2 µg/mL fentanyl were administered by an infusion rate at 0.15 ml/kg/h via the epidural catheter and Group C received epidural normal saline as same infusion rate. Results:In group E, intraoperative MAP values were significantly lower than those in group C (p<0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in group E than those in group C. Total anaesthetic drug consumption was significantly higher in group C than those in group E (p<0.05). Conclusion: Based on lower requirements for propofol and remifentanil as well as the favourable effects on clinical parameters; we conclude that bispectral index score guided combined epidural with total intravenous anaesthesia is superior to solely total intravenous anaesthesia in this type of surgery.

Abs tractPulmonary embolism (PE) is a rare complication that may result in death after lumbar spinal fusion surgery. Although pulmonary embolism mortality rates decreased with early diagnosis and treatment, delays in the diagnosis of pulmonary embolism is commonly seen even with advanced diagnostic methods. Even though it is rare, the risk of pulmonary embolism as well as thrombophlebitis and deep vein thrombosis are encountered in patients undergoing spinal surgery. In this case presentation, we discussed the case of pulmonary embolism determined in a young patient developing unconsciousness and then cardiopulmonary arrest following mobilization at the postoperative 12 th hour after a lumbar spinal fusion surgery and determined to have severe right ventricular enlargement, leftward deviation of the interatrial septum, severe tricuspid failure at the bedside echocardiography and who was discharged after thrombolytic therapy. ( GirişPulmoner emboli (PE) lomber spinal füzyon ameliyatından sonra nadir görülen ve ölüme neden olabilen bir komplikasyondur. Özellikle postoperatif hastalarda masif PE semptom ve bulgularından nefes darlığı, göğüs ağrısı, hipotansiyon ve senkop PE'nin diğer klinik tablolarla karışmasına ve böylelikle tanı ve tedavisinde gecikmelere sebep olabilmektedir. Ekokardiyografi (EKO) ayırıcı tanının yapılmasında ve tedavinin yönlendirilmesinde önemli bir yardımcı tanı aracıdır (1). Sağ kalp boşluklarında yatak başı EKO ile mobil trombüsün görülmesi, tanıya çok değerli ve yeterli bir durum kazandırmaktadır. Sıklıkla hakkında veriler farklı olsa da, pulmoner embolisi olan vakaların %4'ünde, sağ kalp boşluklarından trombüsün pulmoner artere geçişli yakalanabilmektedir (2,3). Lomber spinal füzyon ameliyatı sonrası masif pulmoner emboli gelişen ve trombolitik tedaviye cevap veren olgunun gelişme sürecini sunmayı amaçladık. OlguBeyin cerrahisi polikliniğine; bel ve her iki bacakta ağrı şikayeti ile başvuran 44 yaşındaki bayan hastanın yapılan lomber manyetik rezonans (MRI) tetkikinde L4-L5 ve L5-S1 düzeyinde stenoz ve L4-L5, L5-S1 bilateral santral herniasyon izlenmesi üzerine operasyona karar verildi. Preoperatif yapılan anestezi değerlendirmesinde hipertansiyon tanısı