Background: Bleeding during rhinoplasty leads to many undesirable effects, such as loss of vision in the surgery area, complications during the procedure, and postoperative complications. The most important effect that increases bleeding is hemodynamic changes during surgery. Considering that osteotomy is the most challenging process in rhinoplasty, this study aimed to examine the hemodynamic changes during osteotomy and changes in the depth of anesthesia. Methods: A total of 50 patients, aged 18 to 65 years with an ASA (American Society of Anesthesiology) score of 1 and 2, who underwent osteotomy during rhinoplasty under general anesthesia, were examined retrospectively. After routine monitoring, the patients underwent general anesthesia induction and endotracheal intubation. Before the surgery, they received remifentanil 1 μg/kg as an intravenous bolus followed by 0.5 μg/(kg·min) as intravenous infusion until the end of the surgery. The hemodynamic parameters and depth of anesthesia [bispectral index (BIS) values] of the patients were examined before anesthesia, 10 minutes before osteotomy, during osteotomy, and 10 minutes after osteotomy. Results: A significant difference was found in heart rate (beats/min), systolic and diastolic blood pressures (mm Hg), and BIS values of the patients measured before, during, and after osteotomy (P < 0.001). The heart rate, systolic and diastolic blood pressures, and BIS values were significantly higher during osteotomy. Until the 10th minute after osteotomy, all 4 parameters nearly reached the values measured before osteotomy. Conclusions: Osteotomy directly affects hemodynamic parameters and depth of anesthesia. Hence, it is of utmost importance that the analgesic need and depth of anesthesia are adequately monitored and adjusted during osteotomy. By suppressing hemodynamic stress responses, the amount of bleeding can be reduced, thus increasing the surgical success and the patient's comfort.
Background: Atherosclerotic cardiovascular diseases (ACVD) is the most common cause of mortality in hemodialysis (HD) patients and the annual mortality in this population is about 10%. Inflammation is one of the most important predictor of ACVD morbidity and mortality in these patients. Recent studies demonstrated that levels of inflammatory markers and ACVD mortality vary seasonally in healthy population and in high-cardiac-risk populations. In this retrospective analysis, we aimed to determine seasonal variation of inflammation and ACVD morbidity and mortality in HD patients. Material and methods: Data were retrieved retrospectively for 1 year. Patients with acute or chronic infections or inflammatory conditions were excluded from the analysis. Laboratory data and ACVD-related events were retrieved from patients' files and these data were classified into seasonal periods. Results: Sixty-two patients were included in the final analysis. During follow-up period, geometric means of serum hsCRP levels were similar in all of the seasonal periods (4.17, 4.17, 4.57, and 4.17 mg/L in winter, spring, summer, and autumn, respectively). Means of hsCRP values were significantly higher in patients with active-ACVD compared to patients with no-ACVD in winter (3.38 vs. 13.18 mg/L, p < 0.05) and in autumn (3.63 vs. 23.4 mg/L, p < 0.05). There were 5 mortality and 7 morbidity and 12 combined morbidity and mortality related to ACVD and the distribution of these events were similar in all of the seasonal periods. Conclusions: Our study demonstrates that hsCRP levels and ACVD events do not show seasonal variation in HD patients.
ÖZET ABSTRACTNazal septum deviasyonu sonrası burundan nefes alamama Kulak Burun Boğaz polikliniklerinde en sık rastlanılan şikâyetler arasındadır. Bu sebeple nazal septoplasti operasyonu da Kulak Burun Boğaz kliniklerinde sıklıkla yapılmaktadır.Geçici ya da kalıcı görme kayıpları septoplasti operasyonu sonrası çok ender görülebilen komplikasyonlar arasındadır. Biz de bu vakamızda septoplasti sonrası retinal arter dal oklüzyonuna bağlı görme kaybını sunmayı amaçladık.Otuz altı yaşında erkek hasta kliniğimize burun tıkanıklığı şikâyetiyle başvurdu. Anamnezde hastanın şikâyetlerinin uzun süredir olduğu ve çocukken burnuna darbe aldığı öğrenildi. Hasta sigara içmiyordu ve ek hastalığı da yoktu. Hastaya kliniğimizde septoplasti operasyonu yapıldı. Hastanın postop 1. saatte sol gözde görme azlığı tespit edildi. Hastanın Göz muayenesinde sol göz alt retinal dalcık trasesi ve alt perifer retinal arter trasesi bölgelerine uyan retinada ödem izlendi.Sıklıkla yapılan Septoplasti operasyonları hastaların burun tıkanıklığını dramatik olarak değiştirdiği için perioperatif dönemde hastalar iyi takip edilmeli ve değerlendirilmelidir. Medikal ve hukuki yaptırımlarla başa çıkabilmek için Göz hekimleri ve Kulak Burun Boğaz hekimleri bu gibi komplikasyonların oluşma ihtimali konusunda dikkatli olmalıdırlar.Difficulty to breath from nose after nasal septum deviation is one of the most common complaints in Ear Nose Throat policlinics. Therefore nasal septoplasti operation is performed commonly in Ear Nose Throat clinics.Temporary or permanent visual loss is a rare complication seen after septoplasty operation. In this case report, we aimed to introduce visual loss due to retinal artery branch occlusion after septoplasty.A 36-year old patient came to our clinic with complaint of difficulty to breath from nose. We learnt that he had this complains for a long time, and had a trauma to his nose in childhood. He was not a smoker and had no co-morbidity. Septoplasty operation was done in clinic. One hour later after surgery, patient had visual loss in his left eye. In ophthalmological examination there was retinal edema-related left inferior retinal branch block and inferior peripheral retinal artery occlusion.Septoplasty operations change nasal functions dramatically. Therefore patiens should be evaluated fastidiously during and after the surgery. Due to the medical and the legal responsibilities, Ear Nose Throat doctors and ophthalmologists should be aware of this kind of complications.Anahtar Kelimeler: Görme kaybı, septoplasti, retinal arter
Objective: In ranula etiology, trauma in submandibular and sublingual glands and trauma in secretory ducts have role. There are many different treatment strategies ranging from drainage to ekcision of sublingual gland with ranula. Aim of this study is evaluation of the effects of usage of surgicel in ranula surgery instead of marsupialization with gauze ped. Materials and methods: We included 26 patients to our study who had sublingual ranula surgery and fulfil study criteria Results: Significant differences were not determined according to age,sex, anesthesia type and ranula size. Infection signs were not seen in post-operative one week control of patients. In six months controls, oral base wound was healed totally and there were no relapse cases. Conclusions: In result of this study, We showed that using of surgicel with marsupialization is an effective therapeutic method and it decreases relaps rates in ranula patients.
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