Case Report / Olgu Sunumu Revision total hip arthroplasty (THA) is an orthopaedic surgery that is known to be associated with excessive bleeding. The rates of mortality and morbidity are high in patients with massive haemorrhage. The patient in this study was administered blood products with high fresh frozen plasma/red blood cell (RBC) suspension ratio and high platelet/RBC suspension ratio without waiting for haemostasis test results. This study suggests that this approach might prove beneficial in reducing the incidence of intra-and postoperative complications. this study presents our experience with a patient who underwent THA and required a transfusion that was three times her estimated total blood volume. The patient was successfully managed with close monitoring of haemorrhage and timely administration of blood and blood products before hypotension and loss of consciousness occurred.Keywords: Total hip arthroplasty, massive haemorrhage, massive transfusion, fresh frozen plasma, platelet suspension Total kalça protezi (TKP) revizyon ameliyatı, ortopedik cerrahinin kanama miktarı fazla olan girişimlerinden biridir. Masif kanayan hastalarda ise mortalite ve morbidite artmaktadır. Olgumuza total kalça revizyonu sırasında gelişen masif kanamada erken dö-nemde yani hemostaz testlerinin sonucu beklenmeden taze donmuş plazma (TDP)/eritrosit süspansiyonu (ES) ve Trombosit/ES oranı yüksek transfüzyon yaptık ve bunun intra ve post operatif komplikasyon oranlarını azaltmak açısından faydalı olabileceği kanısındayız. Burada kısa bir sürede tahmini total kan hacminin üç katı kadar transfüzyon yapılması gereken hastanın yakın kanama kontrol ve zamanında kan ve kan ürünleri ile replasmanını yaparak hipotansiyon ve şuur kaybı olmadan başarıyla yönettiğimiz TKP olgumuzdaki deneyimimizi paylaştık.Anahtar kelimeler: Total kalça protezi, masif kanama, masif kan transfüzyonu, taze donmuş plazma, trombosit süspansiyonu Abstract / Öz
Aim: Breast cancer is the most common cancer in women and is the second most cause of cancer associated death. After diagnosis is made, emotional distress, anxiety and depression occurs in 35-38% of women. High anxiety levels prior to operation increases the sensitivity and expectation of the patients towrads pain, influencing the severity of postoperative pain. The aim of the present study was to evaluate the effect of preoperative anxiety on postoperative pain expectation, postoperative pain and opioid consumption in patients undergoing modified radical mastectomy. Material and Method: 60 female patients between the ages of 18-65 were included in the present study. Preoperative anxiety was evaluated using State Trait Anxiety Inventory (STAI) and postoperative pain expectation using Visual Analog Scale (VAS). STAI1 test was administered at preoperative visit, preoperatively and postoperative 6th hour while STAI2 was administered at preoeprative visit. Demographic characteristics were questioned. Postoperative pain levels and overall morphine consumption were recorded. Results: Postoperative STAI1 values were significantly lower than preoperative visit and preoperative STAI1 values (p=0.002-p=0.004). Weak but statistically significant correlation was shown between preoperative visit STAI1 and STAI2 values. A statistically significant but weak positive relation was found betwen STAI1 preoperative and STAI1 postoperative 6th hour values and postoperative VAS (p=0.030; rho=0.280; p=0.003; rho=0.378). Median postperative pain expectation was found to be 6.0 (min=3.0; max=10.0). Conclusion: In the present study, it was demonstrated that high preoparetive anxiety scores are associated with increased postoperative pain level anxiety stimulations may potentiate pain, by exerting pain like effect via psychological system. It is our suggestion that, in special patient groups in which anxiety levels are high, such as breast cancer patients, planning postoeprative pain management after determining preoperative anxiety level and other risk factors will increase patient satsisfaction and the efficacy of analgesia.
Bu çalışmada atan kalpte koroner arter baypas greft (KABG) cerrahisinde fentanil ve remifentanilin hemodinamik stabilite, ameliyat sırası troponin-I salınımı ve erken ekstübasyona etkileri karşılaştırıldı. Ça lış ma pla nı: Atan kalpte elektif KABG cerrahisi planlanan 40 hasta randomize olarak iki gruba ayrıldı. Remifentanil grubuna indüksiyonda bir dakika boyunca 1 µg/kg-1 remifentanili takiben 0.1-1 µg/kg-1 dk.-1 sürekli infüzyon artı midazolam 0.1-0.15 mg/kg-1 idame dozu uygulandı. Fentanil grubuna indüksiyonda 10-15 µg/kg-1 fentanili takiben 0.1-1 µg/kg-1 dk.-1 sürekli infüzyon artı midazolam 0.1-0.15 mg/kg-1 idame dozu uygulandı. Trakeal entübasyonu kolaylaştırmak için rokuronyum bromür 0.6-0.8 mg/kg-1 verildi. İdame tedavisinde 0.4-1 µg/kg-1 dk.-1 midazolam infüzyonuna başlandı. Bul gu lar: Anestezi derinliği BIS 40-60 değerleri arasında olacak şekilde ayarlandı. Cilt insizyonu ve sternotomi sonrası sistolik arter basıncı remifentanil grubunda fentanil grubundan daha düşük bulundu (130±22 mmHg'ye kıyasla 115±14 mmHg, p<0.05; 135±19 mmHg'ye kıyasla 125±14 mmHg, p<0.05). Toplam midazolam dozu, remifentanil grubunda fentanil grubuna göre anlamlı olarak daha yüksekti (11.6±3.7 mg'ye kıyasla 13.9±3.7 mg, p<0.05). Ameliyat sırası beta bloker, nitrogliserin ve nitroprussid kullanımı her iki grupta benzerdi. Ortalama ekstübasyon zamanı ve yoğun bakımda kalış süresi, remifentanil grubunda daha kısaydı (10±3 saate kıyasa 6.5±3 saat, p<0.05; 20±6 saate kıyasla 14±6 saat, p<0.05). Ameliyat sonrası elektrokardiyografik değişiklik insidansı ve troponin-I ölçümleri iki grupta benzerdi. So nuç: Atan kalpte KABG cerrahisinde remifentanil uygulaması daha iyi ameliyat sırası hemodinamik stabilite ve ameliyat sonrası derlenme sağlamasına karşılık, her iki ajanın miyokardiyal hasar üzerine etkileri benzer bulundu. Anah tar söz cük ler: Anestezi; miyokardiyal koruma; atan kalpte cerrahi; remifentanil. Background: This study aims to compare the effects of fentanyl and remifentanil on hemodynamic stability, release of troponin-I and early extubation during off-pump coronary artery bypass graft (CABG) surgery. Methods: Forty patients who were scheduled for elective offpump CABG surgery were randomly assigned to two groups. The remifentanil group received 1 µg/kg-1 remifentanil over one minute for induction, followed by 0.1-1 µg/kg-1 min-1 continuous infusion plus midazolam 0.1-0.15 mg/kg-1 for maintenance dose. The fentanyl group received 10-15 µg/kg-1 fentanyl over one minute for induction and 0.1-1 µg/kg-1 min-1 continuous infusion plus midazolam 0.1-0.15 mg/kg-1 for maintenance dose. Rocuronium bromide at 0.6-0.8 mg/kg-1 was administered to facilitate tracheal intubation. Midazolam infusion at 0.4-1 µg/kg-1 min-1 was initiated for maintenance therapy. Results:The depth of anesthesia was adjusted to maintain a BIS value between 40-60. Following skin incision and sternotomy, systolic arterial pressure was lower in the remifentanil group compared to the fentanyl group (115±14 mmHg vs. 130±22 mmHg p<0.05; 125±14 mmHg vs. 135±19 mmHg...
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