Mitral kapakta tromboz nedeniyle stuck kapak saptanan ve buna bağlı olarak akut kalp yetmezliği ve pulmoner ödem tablosunda acil ameliyata aldığımız 28 haftalık gebenin anestezi yönetimi sunulmuştur. Nefes darlığı yakınması ile başvuran 28 haftalık gebe, MVR (mitral valve replacement) stuck kapak saptanması üzerine acil ameliyat için hastanemize sevkedilmiştir. Transtorasik ekokardiyografisinde EF %55, protez mitral kapak disfonksiyene, açılımı kısıtlı, sağ boşlukları ileri derecede dilate, pulmoner arter basıncı 65 mmHg, 2.-3. derece aort yetmezliği, 2. derece triküspit yetmezliği mevcuttu. Ameliyat masasına alınan hastada, ekstremite uçlarında ve dudaklarda hafif siyanoz, takipne, ortopne ve hemoptizi mevcuttu. Batın ultrasonografide uterusta 28 haftalık canlı fetüs olduğu tespit edildi. Hastanın, isteği doğrultusunda trombolitik tedavi başlanmadı. Genel anestezi altında önce sezaryen ile bebek canlı olarak doğurtuldu ve ardından kardiyopulmoner baypass ile mitral kapak değişimi yapıldı. Nonfonksiyone mitral kapak nedeniyle ameliyata aldığımız gebede uygun bir anestezi ve cerrahi planlama yapılarak anne ve bebekte komplikasyon yaşanmadan operasyon tamamlandı.
Objectives: To assess the impact of low-flow, mid-flow, and high-flow sevoflurane anesthesia on the oxidative state by measuring thiol/disulfide levels in patients undergoing surgery. Methods:The study included 99 patients randomly assigned to 3 groups. In the low-flow anesthesia group, the fresh gas flow was diminished to 1 L.min -1 for anesthesia maintenance after 6 L.min -1 was administered for the first 10 minutes. In the mid-flow anesthesia group, fresh gas flow was applied as 2 L.min -1 . In the high-flow anesthesia group, the fresh gas flow was administered as 4 L.min -1 throughout the operation. Blood samples were obtained before induction, at the 60th minute after induction, and at 2 hours postoperatively. Native thiol, total thiol, disulfide analyzed and disulfide/ native thiol percentage, disulfide/total thiol percentage, and native thiol/total thiol percentage were calculated. Original ArticleResults: Disulfide values in mid-flow and low-flow anesthesia were significantly lower at the 60th minute after induction compared to the high-flow anesthesia group. In the group evaluations, intraoperative native thiol levels in the high-flow group were found to be substantialy lower than preoperative values. Conclusion:It was sighted that low-flow anesthesia with sevoflurane prohibited oxidative damage. It was concluded that low flow anesthesia can be utilized safely in this respect.
BackgroundNesfatin-1 is involved in cardiovascular regulation, stress-related responses. The objective of this study is to investigate the impact of volatile anesthetics on Nesfatin-1 levels.MethodFourty-two patients aged 30–65 years with the American Society Anesthesiology (ASA) Class I-II who were scheduled for laparoscopic cholecystectomy were included in the study Patients were randomized into two group; desflurane administered group (Group I, n = 21) and sevoflurane administered group (Group II, n = 21). For anesthesia maintenance, the patients received 6% desflurane or 2% sevoflurane in 40% O2 and 60% air. The patient’s heart rate (HR), mean, systolic and diastolic arterial pressures (MAP, SAP, DAP), peripheral O2 saturation (SpO2) were monitored and recorded before induction, after induction, after intubation, and during extubation. Blood samples were collected before induction (T1), and after extubation when aldrete score was 10 (T2).ResultsDemographic data were similar between the groups. The preoperative levels of nesfatin were similar in the two groups (p = 0.715). In desflurane group, post-operative nesfatin levels were similar compared to preoperative levels (p = 0.073). In sevoflurane group, post-operative nesfatin levels were similar (p = 0.131). The nesfatin levels (postoperative vs preoperative) were similar between the groups (p = 0.900).ConclusionIn conclusion, this study results suggest that nesfatin-1 levels are not affected by the use of sevoflurane or desflurane in patients undergoing laparoscopic cholecystectomy.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12617001023347, retrospectively registered on 17 July 2017.
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