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    Anesthesia for living-donor liver transplantation: Comparison of 20 adult and 10 pediatric patients [Canli donörden karaciger transplantasyonu anestezisi sonuçlari: 20 yetişkin 10 pediyatrik hastanin karşilaştirilamsi]
    (2002) Ayanoglu H.O.; Ulukaya S.; Kocabaş S.; Çökmez A.Z.
    Twenty adult and ten pediatric patients undergoing Living-Donor Liver Transplantation were evaluated in terms of perioperative anesthetic courses. Recipients had an anesthesia consisting of tiopental Na, fentanyl citrate/remifentanil, oxygen/air with isoflurane or midazolam/propofol and vecuronium/cisatracurium. The duration of the anesthesia and anhepatic periods of the pediatric patients were shorter compared to the adult group (541±106 vs 649±149 minutes and 47±12 vs 89±54 minutes, p<0.05). During the anhepatic periods of the operations cardiac output decreased 30% in adults vs 14% in pediatric patients (p>0.05), while a 38% increase in SVR values of adult cases and 74% increase in pediatric cases was observed (p<0.05). Postreperfusion syndromes were seen in two pediatric (20%) and five (25%) adult patients necessitating ephedrine boluses. Perioperative blood and fresh frozen plasma needs of the adult and pediatric groups were similar (Blood, 0.10±0.08 vs 0.11± 0.07 U kg-1; TDP, 0.11±0.07 vs 0.12±0.07 U kg-1, respectively p>0.05). Calcium gluconate requirement in pediatric patients was greater than the adult group (1.20±1.23 vs 0.62±0.78 mEq kg-1, p<0.05). Survival rates of the two patient groups was 70% in adults vs 60% in pediatric patients. In conclusion, immediate replacement therapies according to the laboratory and hemodynamic measurement performed at certain appropriate operation period are important in maintaining a stable peroperative course in both patient groups. Pediatric cases of smaller ages can be managed without monitoring with a pulmonary artery catheter. Use of proper anesthetic agents and stable hemodynamics during the operations can lead to extubation of the selected patients in the operating room and earlier recovery.
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    Incidence of postdural puncture headache after saddle block with bupivacaine or bupivacaine plus fentanyl in patients undergoing perianal surgery [Saddle blokta lokal anesteziye eklenen fentanilin postspinal baş agrisina etkisi]
    (2003) Ayanoglu H.Ö.; Kocabas S.; Ulukaya S.; Aldemir Ö.; Çökmez A.Z.
    This study aimed to determine the incidence of postspinal headache after saddle block using bupivacaine 0.5 % with or without fentanyl in ninety patients undergoing perianal surgery. The patients had saddle block with 0.5 % bupivacaine (6 mg) in Group I and + 25 µg of fentanyl in Group II. Quincke 25 G needles were used for dural punctures with needle bevels parallel to the dural fibres. Patients who experienced multiple needle insertions were excluded from the study. Sensory blockade was assessed by pinprick test and motor function was assessed by Bromage's scale. Times to first analgesic requirement, urination, ambulation and complications were noted. Postspinal headache was planned to be treated conservatively and by epidural blood patch, when needed. Times to onset of sensory blockade, to urinate and to ambulate were similar between groups. Time to first analgesic requirement was longer in Group II (156 vs. 283 min). Two patients in Group I and one patient in Group II developed postspinal headache. Twenty-eight patients in Group II had pruritus. The addition of 25 µg fentanyl to 0.5 % bupivacaine spinal anesthesia prolonged the duration of analgesia, increased the incidence of pruritus but had no effect on the incidence of postspinal headache.