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    A case of hyponatremia and pulmonary oedema developed during operative hysteroscopy and treated intensive care unit [Operati·f hi·steroskopi· sirasinda geli·şen ve yogun bakimda tedavi· edi·len hi·ponatremi· ve akci·ger ödemi· olgusu]
    (2013) Sargin A.; Akdemir A.; Günüşen I.; Sertöz N.; Karaman S.
    Hysteroscopic procedures, due to ease of application properties has been widely used at diagnosis and treatment of gynecological cases. However, it should kept in mind that life-threatening complications such as hyponatremia and pulmonary oedema might occur during the operative hysteroscopic procedure. Such complications are usually treated in a short term period hut unfortunately some cases require mechanical ventilation therapy. In this case report, we aimed at presenting the treatment of a patient under histeroscopic procedure with severe hyponatremia accompanied by the phenomenon of pulmonary oedema requiring mechanical ventilation, and discuss the intensive care treatment approaches and management.
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    Preoperative, intraoperativeand postoperative predictors of postoperative respiratory system complications in patients undergoing open heart surgery [Açik kalp cerrahisinde postoperatif solunum sistemi komplikasyonlarinin preoperatif, intraoperatif ve postoperatif belirleyicileri]
    (2013) Sargin A.; Aşkar F.Z.; Kocabaş S.N.
    Objective: The increasing prevalence of risky cardiac operations and the changing patient profile, can cause more problems during intraoperative and postoperative periods. Problems related to the respiratory system in the postoperative period are also the most important causes of increased mortality and morbidity rates. The aim of the study was to determine the preoperative, intraoperative, and postoperative predictors of the respiratory complications of open-heart surgery patients. Material and Methods: 1401 patients undergoing open-heart surgery between 2000-2005 were evaluated retrospectively. Patients' age, sex, body mass index, preoperative laboratory tests, left ventricular ejection fractions (LVEF, %), comorbid dieases, use of ß-blockers ,smoking,type and duration of operation, cardiopulmonary bypass and anesthesia, transfusion of blood intraoperatively, time of extubation, amounts of mediastional drainage, length of stay in the 1CU and in the hospital were recorded. The relationship between these predictors and postoperative respiratory complications is investigated. Results: In our study, the prevalence rate of postoperative respiratory complications among patients undergoing open-heart surgery was found to be 39.2%. The most common complication was prolonged mechanical ventilation (36.1%), while the least frequent complication was pneumothorax (0.6%). The mortality rate due to respiratory complications was 3.3%. Rbk factors for respiratory complications included older age, female gender, smoking, hypertension, COPD, higher rates of concomitant operations, preoperative hematologic and biochemical abnormalities, prolonged duration of CPB, anesthesia, operative, and extubation times, length of ICU and hospital stay, extra need for intraoperative transfusion of blood products and increased mediastinal drainage. Conclusion: Detailed examination of the patients preoperatively, and optimal treatment, could decrease complications of anesthesia and mortality rates by preference for the appropriate fast-tract anesthesia method which shortens duration of surgery, anesthesia and CPB.
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    A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean ection: Prospective, double-blinded study
    (2011) Gunusen I.; Karaman S.; Sargin A.; Firat V.
    Purpose Levobupivacaine may produce a sensory and motor block different from that produced by bupivacaine, which is the most popular local anesthetic in parturients undergoing cesarean section. The aim of this study was to investigate the block characteristics, the clinical efficacy, surgeon and patient satisfaction, and hemodynamic effects of using different doses of intrathecal plain levobupivacaine combined with fentanyl. Methods One hundred twenty women undergoing elective cesarean section with a combined spinal-epidural technique were enrolled. The parturients were randomly assigned to receive one of the following: levobupivacaine 5 mg (group 5), 7.5 mg (group 7.5) or 10 mg (group 10), all combined with fentanyl 25, 15 or 10 µg, respectively. Results Anesthesia was effective in 60, 82.5 and 100% of the patients in the levobupivacaine 5, 7.5 and 10 mg groups, respectively. Levobupivacaine 10 mg provided longer durations of analgesia and motor block and greater patient and surgeon satisfaction, although the incidence of hypotension was lower in groups 5 and 7.5 than in group 10 (12.5, 17.5 and 42.5%, respectively). Intraoperative epidural supplementation was higher in group 5 than in group 7.5 (40 and 17.5%, respectively), whereas no patients in group 10 were given an epidural bolus dose. Conclusions The incidence of hypotension was higher in the levobupivacaine 10 mg group, even though this group presented more effective anesthesia and greater patient and surgeon satisfaction compared with the levobupivacaine 5 and 7.5 mg groups. As a result, we believe that levobupivacaine 7.5 mg combined with fentanyl 15 µg is suitable for combined spinal-epidural anesthesia in elective cesarean section. © 2011 Japanese Society of Anesthesiologists.
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    Ventricular fibrillation due to hypokalemia as a consequence of thallium scintigraphy: A case report [Talyum si·nti·grafi·si· sonrasi hi·pokalemi·ye bagli ventri·küler fi·bri·lasyon geli·şen bi·r olgu]
    (2013) Sertöz N.; Baş E.; Sargin A.; Karaman S.
    A 44 year old man who had kidney transplantation was hospitalized to orthopedia clinic for total hip prosthesis due to his coxarthrosis. In his preoperative evaluation, he had diarrhea for three days, and he had a chest pain that lasted less than 20 minutes which was not related with effort. According to cardiology consultation the patient was applied myocard perfussion scintigraphy with thallium. After the scintigraphy, a sudden cardiac arrest occured. He was monitorized after having orotracheal intubation. Since he was in ventricular fibrillation, he was defibrillated. According to the ERC criteria cardiac compressions were continued. Because of resistant ventricular fibrillation and hypokalemia at the 15th minute of cardiac resusitation, 20 mmol l-1 KCl and 12 mmol l-1 magnesium were administered within five minutes. After these applications sinus rythm was achieved and the patient was transfered to the cardiology service and he was followed up there. Hypokalemia exists in the electrolyte imbalances that cause ventricular dysrhythmias. Occurance of hypokalemia in patients with diarrhea and gastrointestinal disorders should be kept in mind during the anesthetic evaluation. In addition, hypokalemia can become deeper as a consequence of thallium scintigraphy that can result with resistant ventricular dysrhythmias.