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    Effect of coagulation status and co-morbidity on flap success and complications in patients with reconstructed free flap [Serbest flep ile rekonstrüksiyon uygulanan hastalarda koagülasyon durumu ve komorbiditelerin flep başarısına ve komplikasyonlara etkileri]
    (AVES, 2019) Ekin Y.; Günüşen İ.; Yakut Özdemir Ö.; Tiftikçioğlu Y.Ö.
    Objective: Free flap surgeries constitute the basis of reconstruction surgery in patients with major defects. Prediction of complications that cause flap loss in such patients is important in terms of reducing the length of hospital stay and expenses. We aimed to retrospectively investigate the effect of co-morbidities and the coagulation status on flap loss and complications in patients with reconstructed free flap. Methods: Demographic data, smoking, alcohol habits, co-morbidities, coagulation tests and thromboelastogram results from preoperative, intraoperative and postoperative anaesthesia and surgical records of patients undergoing free flap surgeries between January 2015 and June 2017 were retrospectively screened. Results: Flap success rate was found to be 96.1% in total 77 patients with free flap. Coagulation related complication rate, such as thrombosis, haematoma and partial necrosis, were 22.1%. There was a significant relationship between age, chronic obstructive pulmonary disease and hypercholesterolaemia and flap loss (p=0.006, p=0.025 ve p=0.025, respectively). Flap complications were more frequent in patients with chronic obstructive pulmonary disease and hypertension. Laboratory test results revealed no statistical correlation between flap complications and flap loss with preoperative and postoperative TEG. Conclusion: Advanced age, co-morbidities such as hypertension and chronic obstructive pulmonary disease are associated with complications and flap loss in free flap surgery. However, there were no clinically significant association of complications and flap loss with laboratory tests showing coagulation. We believe that standardised protocols should be established in terms of preparation, intraoperative management and postoperative follow-ups because the time between taking the coagulation tests and postoperative anticoagulant administration should be standardised in such surgeries. © 2019 by Turkish Anaesthesiology and Intensive Care Society.
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    The evaluation of applied anaesthetic techniques for caesarean in parturients with cardiac diseases: Retrospective analysis [Kalp hastalığı olan gebelerde sezaryende uygulanan anestezi yöntemlerinin retrospektif değerlendirilmesi]
    (AVES Ibrahim Kara, 2014) Yıldırım Ö.İ.; Günüşen İ.; Sargın A.; Fırat V.; Karaman S.
    Objective: In this study, the effects of anaesthetic technique on mother and newborn were investigated in a retrospective analysis of parturients with cardiac diseases undergoing Caesarean section between 2006-2012.Methods: Our hospital’s medical information system records were analyzed, and we found 107 parturients with cardiac disease and were undergoing Caesarean section, and their demographic data and obstetric, anaesthetic, and neonatal record forms were inspected.Results: Fifty-three (49.5%) pregnant women received general anaesthesia, and 54 (50.5%) received regional anaesthesia (34 spinal, 19 epidural and 1 combined-spinal-epidural (CSE) (p=0.05). Week of pregnancy was lower for the group of general anaesthesia (p=0.007). Among cardiac parturients, valvular lesion rates were higher (75.7%). The relationship between existing cardiac disease and anaesthetic management was not significant (p=0.28). However, we determined that parturients with higher NYHA (New York Heart Association) classifications had higher general anaesthesia rates. (p=0.001). A rate of 39% of 74 NYHA I patients were undergoing general anaesthesia; this rate was 64% for NYHA II and 100% for NYHA III. The patients with cardiac surgery or medical treatment history had higher general anaesthesia rates (p=0.009). Although the general anaesthesia group newborn weights were lower (p=0.03), there was no difference between groups for APGAR scores. With regard to postoperative complications and hospital stay, the groups were similar.Conclusion: We determined that general and epidural rates in parturients with cardiac diseases were similar, general anaesthesia was preferred for parturients who had higher NYHA classifications and surgical or medical treatment history. We considered that general anaesthesia criteria should reduce the anaesthesia management of parturients with cardiac disease; epidural or CSE anaesthesia applications should increase according to the patient’s physical state, haemodynamic parameters, and obstetric indications. © 2014 by Turkish Anaesthesiology and Intensive Care Society.