Hamide Ayben Korkmaz

Effect of Duration of Pre-Procedure Fasting on Clinical Outcomes in Intensive Care Patients Undergoing Percutaneous Tracheostomy - Article abstract #950128

Background: Although patient positioning in neurosurgical procedures is essential for optimal surgical exposure, it may adversely affect venous drainage, airway management, hemodynamic stability, and peripheral neurovascular structures. The aim of this study was to prospectively evaluate perioperative complications related to surgical positioning and head fixation methods in neurosurgical procedures. Material and Methods: This prospective, single-center observational study included 61 adult patients scheduled for neurosurgical procedures under general anesthesia. Patients were divided into two groups according to the occurrence of position-related perioperative complications. The primary outcome was the development of position-related perioperative complications, while secondary outcomes included hemodynamic changes and perioperative time variables. Results: During the perioperative period, a total of 12 position-related complications were identified in 10 patients (16.4%). The most frequently observed complications were bilateral orbital edema and diffuse facial edema. Anesthesia duration was significantly longer in the complication group compared with the uncomplicated group (p = 0.021). No significant differences were observed between the groups with respect to surgical duration, intraoperative fluid administration, or blood product transfusion. There was no statistically significant association between surgical position and the development of complications. Mean arterial pressure and heart rate values measured at different perioperative time points were comparable between the groups (all p>0.05). Position-related complications were most commonly observed in the prone position and predominantly involved the facial and upper airway soft tissues. Conclusion: Position-related perioperative complications occur at a non-negligible frequency in neurosurgical procedures. Appropriate patient positioning, standardized padding, and meticulous intraoperative management are of critical importance in ensuring patient safety.

Purpose: Families play a key role in the decision to donate the organs of people with brain death. However, studies on the factors affecting the decisions of families who are expected to make donation decision in a short time after their loss and possible emotional difficulties they experience afterwards are insufficient. In our study, we aimed to investigate the psychological experiences of donor families during and after the donation consent process and the factors affecting them. Methods: Relatives of donors who had brain death at least 6 months ago and gave their consent to be donors were included in the study. Demographic data form, Prolonged Grief Scale (PG-13), Grief and Meaning Reconstruction Inventory (GMRI), and Beck Depression Inventory (BDI) were administered to the participants. Results: In our study, it was found that male gender decreased the risk of depression (OR=0.08, p

Background: Contrast-enhanced imaging studies are widely used to diagnose and follow up acute cerebrovascular diseases. Exposure to contrast media may lead to nephropathy. This study investigated the incidence of contrast-induced acute kidney injury during intensive care follow-up of patients who underwent aneurysmal subarachnoid haemorrhage surgery and the impact of this condition on patient outcomes. Material and Methods: Patients >18 years of age with no known renal injury and admitted to the intensive care unit after Fisher Grade IV aneurysmal subarachnoid haemorrhage and surgery between January 2017 and June 2022 were retrospectively analysed. Renal injury was defined as a renal injury occurring within 48 hours of exposure to contrast media in line with the Kidney Disease Improving Global Outcomes criteria. Results: Among the 85 patients with subarachnoid haemorrhage who received at least one contrast medium, the mean age was 55, and 40% were female. 11.8% of the patients were found to have early acute kidney injury and were non-oliguric. At 48 hours, six, three, and one patients had Stage 1, 2, and 3 injuries, respectively. None of the patients required renal replacement therapy. Patients received a mean of 2 mL/kg/h saline infusion after contrast media administration and had a mean arterial pressure of 93.6 mmHg. There was no association between acute kidney injury and comorbidities, Glasgow coma scale, or APACHE II scores. Conclusions: The study found that the incidence of contrast-induced acute kidney injury was low and transient in patients followed at the ICU after aneurysmal subarachnoid haemorrhage (Fisher Grade IV) surgery. Adequate hydration and hemodynamic stability were found to be effective in reducing acute kidney injury in these patients.

Objective: To investigate the effect of vasoactive drugs use in brain-dead organ donors in renal recipient graft function. Material and Methods: Clinical data from 30 brain-dead organ donors, and 30 recipients in our center were analyzed retrospectively between July 2017 and November 2021. Results: Norepinephrine infusion was used in all 30 cadaveric donors, where 11 donors had inotropic combinations. Norepinephrine was infused at a median dose of 0.2mcg/kg/min. There was no relationship between duration and doses of norepinephrine in donors and graft rejection, graft loss, and dialysis requirement in renal recipients. Conclusion: Intravenous norepinephrine infusion below 0.2mcg/kg/min had no effect on graft function in the renal recipient, where fluid restitution was sufficient in the cadaveric donor. Keywords: brain dead, organ donors, vasoactive drugs, graft survival

Objective: The risk for adverse outcomes in COVID-19 patients necessitates further scrutiny in Covid 19 patients in providing appropriate surgical indications and perioperative surgical safety precautions. In this study, we aimed to contribute to elective surgery resumption about infection with early and late postoperative complications and mortality in patients with RT-PCR (+) and clinically suspicious COVID-19 who underwent emergency surgery in our hospital. Methods: A total of 86 patients who have been operated on in our institution for emergency surgery over the age of 18 who were diagnosed with SARS-CoV-2 infection seven days before or 30 days after surgery were enrolled in the study. In this retrospective study, the primary outcome has been established as mortality factors and survival within postoperative 30 days. Results: Regarding the primary outcome as 30-day survival, every 1-year increase in age increased the risk of death by two folds. Patients with one or more comorbidities have an increased risk of death 13 times and those with two or more have an increased risk of death 23 times. Patients in intensive care units increase the risk of death by 8.5 times compared to those who are not hospitalized. On the contrary, an increase in hemoglobin level was shown to reduce the risk of death by 0.8 times. Conclusion: The need for intensive care and mortality is high, especially after emergency surgery, in patients with COVID19 symptoms and more than one comorbidity. Surgical indications of such patients should be well investigated.

The incidence of anemia and its association with postoperative complications in pediatric patients undergoing elective minor surgery are unknown. This study aims to determine the prevalence of anemia and its impact on postoperative complications in children undergoing elective minor surgery under general anesthesia. The preoperative complete blood count data of ASA I-II patients aged 1-18 years, for whom the pediatric surgery department planned an elective minor surgery under general anesthesia between January 1, 2019 and December 31, 2019, were evaluated retrospectively. The frequency of patients with abnormal hemoglobin values, the influence on preoperative treatment, the perioperative blood requirement and the complications were evaluated. Based on the specified inclusion interval, 851 of 3142 patients (784 Turks, 67 immigrants) met the inclusion criteria. It was observed that 24.38% of these patients had varying degrees of anemia (1.72% was rated as severe anemia). In addition, it was found that the operations of patients with anemia were not postponed and no additional assessment was required from the patients. It was found that the prevalence of anemia between Turkish patients and immigrant patients is similar. No complications were observed in the patients during the perioperative period. We found that the preoperative complete blood count test has limited value in patient management in children undergoing elective minor surgery and the prevalence of anemia in our area is quite high. Instead of routine laboratory tests, a careful medical history and physical examination are sufficient to determine the preoperative suitability of the pediatric patient before elective minor surgery.

COVID-19 enfeksiyonunda akut böbrek hasarı (ABH), özellikle ağır seyreden vakalarda ve yoğun bakım hastalarında mortaliteyi önemli ölçüde artıran yaygın bir komplikasyondur. Bu hasarın gelişiminde hipovolemi, akut solunum sıkıntısı sendromu (ARDS) ile ilişkili hemodinamik değişiklikler ve yüksek PEEP uygulamaları, sitokin fırtınası sendromunun tetiklediği hiperinflamatuar süreçler ve virüsün ACE-2 reseptörü aracılığıyla böbrek tübüler epitel hücrelerine doğrudan viral invazyonu olmak üzere dört temel patofizyolojik mekanizma rol oynamaktadır. Hastalığın yönetiminde, idrar tahlili yoluyla hematüri ve proteinürinin erken dönemde taranması riskli hastaların tespiti açısından kritik bir öneme sahipken; tedavi sürecinde övoleminin sağlanması, izotonik salin yerine dengeli kristaloidlerin tercih edildiği kontrollü sıvı yönetimi ve endike durumlarda sürekli renal replasman tedavisinin (CRRT) zamanında başlatılması önerilmektedir. Genel popülasyona kıyasla daha yüksek ABH insidansı ve mortalite oranına sahip olan böbrek nakli alıcılarında ise erken hacim resüsitasyonunun yanı sıra immünosupresif tedavilerin hastanın klinik durumuna göre titizlikle yeniden düzenlenmesi hayati bir önem taşımaktadır. In patients with COVID-19 infection, acute kidney injury (AKI) is a common complication that significantly increases mortality, particularly in severe cases and intensive care patients. Four primary pathophysiological mechanisms play a role in the development of this injury: hypovolemia, hemodynamic alterations and high PEEP applications associated with acute respiratory distress syndrome (ARDS), hyperinflammatory processes triggered by cytokine storm syndrome, and direct viral invasion of renal tubular epithelial cells by the virus via the ACE-2 receptor. In the management of the disease, early screening of hematuria and proteinuria through urinalysis is critical for identifying high-risk patients, while the treatment process recommends maintaining euvolemia, employing controlled fluid management with balanced crystalloids instead of isotonic saline, and initiating continuous renal replacement therapy (CRRT) timely when indicated. For kidney transplant recipients, who present with higher AKI incidence and mortality rates compared to the general population, prompt fluid resuscitation and the meticulous adjustment of immunosuppressive therapies according to the patient's clinical status are of vital importance.

Aim: Kyphoplasty is a much less invasive technique than conventional methods to strengthen vertebral body fractures. This study aimed to demonstrate a safe and effective anesthesia method by retrospectively investigating the clinical conditions, perioperative pain experiences, and anesthesia methods of patients who underwent kyphoplasty in our institution. Material and Method: A total of 76 patients who had kyphoplasty operations performed under elective conditions between January 2018 and March 2021 have been enrolled in this research. Demographic data of patients, injury mechanisms, anesthesia method, duration of surgery, severe perioperative complications (heart attack, lung disease, delirium, etc.), duration of postoperative stay in intensive care, pre and postoperative pain degrees with visual analogue scale (VAS) has been interpreted. Results: There was a statistically significant difference between the groups in terms of duration of operation, duration of anesthesia, postoperative discharge time, postoperative 24-hour VAS score, intraoperative hemodynamic status, and presence in the post-anesthesia care unit (PACU) (p<0.05). The operation time, anesthesia time, postoperative discharge time, and the postoperative 24-hour VAS score of individuals with general anesthesia were higher than those under local anesthesia and sedation. Regarding intraoperative hemodynamic status, 37.5% of those under general anesthesia were stable, while 73.5% of individuals under local anesthesia and sedation were stable. While 37.5% of those under general anesthesia were in the post-anesthesia care unit, this rate was 7.4% in those under local anesthesia and sedation. Conclusion: The most appropriate anesthesia type should be determined according to the patient’s individual health status. Each method has its advantages, such as no need for a stable position in general anesthesia and availability of motor functioning evaluation and verbal communication in local anesthesia; hence local anesthesia and sedoanalgesia were together. This seems to be more advantageous with the appropriate sedation.

- OBJECTIVE: There has been an in-crease in intensive care applications due to respirator y failure of COVID-19 infection. Management of respiratory failure includes a range of additional interventions, including high-flow nasal oxygen, noninvasive and invasive ventilation and prone position. These interventions contain risk factors for the development of ocular complications. This study aimed to elucidate the ocular pathologies that occurred in COVID-19 pa-tients hospitalized in the intensive care unit. PATIENTS AND METHODS: Patients who com-pleted 24 hours in the intensive care unit were in-cluded in the study. Age, gender, duration of hos-pitalization before intensive care unit, comorbid diseases and APACHE 2 scores of COVID-19 patients admitted to intensive care unit were recorded. SOFA scores, presence of sedation and muscle relaxant, oxygen therapy (conventional oxygen therapy, high flow nasal oxygen therapy, noninvasive ventilation, invasive ventilation) and presence of prone position were recorded. All patients were evaluated daily for ocular findings. Routine eye care protocol was applied to all patients. RESULTS: Seventy patients were followed for a total of 596 days in the intensive care unit. Patho-logical ocular findings were observed during hospitalization in 59 of the patients followed. The incidence of chemosis in patients who underwent IMV was significantly higher compared to other methods (p<0.001). CONCLUSIONS: In this study, we observed that despite our routine eye care protocols, invasive mechanical ventilation applications predispose corneal surface damage in patients followed up in the intensive care unit with COVID-19 infection.