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Kirbas A.,Cardiovascular Surgery Clinic | Yalcin Y.,Pediatric Cardiology Clinic | Tanrikulu N.,Anesthesiology and Reanimation Clinic | Gurer O.,Cardiovascular Surgery Clinic | Isik O.,Cardiovascular Surgery Clinic
Cardiology Journal

Background: Pulmonary arterial hypertension is of importance in congenital cardiac surgery as being a significant cause of morbidity and mortality. Although therapy options are limited, inhaled nitric oxide (NO) is used as a standard therapy. The present study aimed to compare inhaled NO and aerosolized iloprost in children with secondary pulmonary hypertension who underwent congenital cardiac surgery. Methods: Sixteen children included in the study were randomized into either inhaled NO or aerosolized iloprost group. For both groups, the observation period terminated at 72 h after cardiopulmonary bypass. Results: There was no significant difference between the groups in terms of mean age, weight, cross clamp time, pump time, and extubation time. No significant change was observed in the arterial tension and central venous pressure of both groups before the operation, 30 min after the pump, 45 min after the pump, and after extubation, whereas an increase was observed in the heart rate and cardiac output, and a decrease was observed in the pulmonary artery pressure. The mean values at the above-mentioned time points showed no difference between the groups. No serious adverse event and mortality was detected. Conclusions: Both inhaled NO and aerosolized iloprost were found to be effective and comparable in the management of pulmonary hypertension. © 2012 Via Medica. Source

Yazici H.,Ear Nose Throat Clinic | Yazici H.,Balikesir University | Daskaya H.,Anesthesiology and Reanimation Clinic | Dogan S.,Ear Nose Throat Clinic | And 2 more authors.
European Archives of Oto-Rhino-Laryngology

This study aimed at determining the limits of preoperative investigation and calculate estimated cost analysis in septoplasty with and without turbinate surgery. A retrospective chart review. The study was conducted at secondary referral center. A retrospective chart review of patients who have undergone septoplasty over a 1-year period was performed. The need for routine (battery testing) versus patient specific preoperative workup of 380 septoplasty patients was evaluated. Mean age of the patients was 31.5 ± 4.6. The patients were classified into three groups according to preoperative routine laboratory testing results: (1) normal group (2) abnormal group and (3) abnormal out of action limit group. Medical records were revaluated by an anesthesiologist and ear nose throat doctor according to preoperative American Society of Anesthesiologists guidelines to calculate estimated possible costs in case of patient specific preoperative workup. Three hundred seventy-seven patients were within ASA 1 group and three patients were within ASA 2. According to preoperative battery testing results, 5.8% of the patients (n = 22) were in group 1, 93.4% (n = 355) were in group 2, 0.8% (n = 3) were in group 3. Surgery was postponed due to concomitant pathologies for about 44 days (10-180 days) in four patients (1.1%). Preoperative routine laboratory testing costs were calculated as $41.08 ± 6.69 (40.25-128.78) per patient. When medical records were reevaluated retrospectively, estimated cost per patient would be $8.91 ± 10.40 (7.18-79.91) if patient specific preoperative workup were done. Individual preoperative testing would save $12,226.78 annually and total cost would decrease from $15,612.41 to $3,385.62. (p = 0.001). Patient-specific preoperative workup is more cost effective than routine battery testing in septoplasty with and without turbinate surgery. © Springer-Verlag 2013. Source

Sapmaz A.,Ankara University | Ulus A.T.,Cardiovascular Surgery Clinic | Ulus A.T.,Hacettepe University | Turan N.N.,Gazi University | And 5 more authors.

Objective: This study was designed to test the effects of different types of preconditioning and postconditioning methods on spinal cord protection following aortic clamping. Methods: The animals (rabbits) were divided into sham-operated, ischemic preconditioning, remote ischemic preconditioning, simultaneous aortic and ischemic remote preconditioning, and ischemic postconditioning groups. After neurological evaluations, ultrastructural analysis and immunohistochemical staining for caspase-3 were evaluated after 24 h following ischemia. Results: The neurological outcomes of the remote ischemic preconditioning (4.2 ± 0.4) and ischemic postconditioning (4.6 ± 0.8) groups were significantly improved when compared with the ischemia group (2.2 ± 04). The immunohistochemical analysis revealed that the lowest percentage of apoptosis was in-group ischemic preconditioning at 12.5 ± 30.6%. In the comparison of intracellular edema in an ultrastructural analysis, the ischemic preconditioning and ischemic postconditioning groups had significantly lower values than the ischemia group. Conclusion: The conditioning methods attenuate ischemia–reperfusion injury for spinal cord injury. Ischemic and remote preconditioning and also postconditioning methods are simple to perform and inexpensive. © 2015, © The Author(s) 2015. Source

Turkan H.,Anesthesiology and Reanimation Clinic | Aydin A.,Gulhane Military Medical Academy | Sayal A.,Gulhane Military Medical Academy | Karahalil B.,Gazi University
Toxicology and Industrial Health

The aim of our study was to evaluate the markers of oxidative status of erythrocyte during general anesthesia and compare the markers of oxidative status of erythrocyte in both sevoflurane and desflurane. Venous blood samples of patients were collected the following time intervals; initial time (IT) and first hour (1st h), first (1st day) and third days (3rd day) after anesthesia (sevoflurane and Desflurane). The levels of magnesium (Mg), zinc (Zn) as a cofactor of these enzymes, malondialdehyde (MDA) and the activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzymes were also determined. No significant changes were observed in these measurements when the patients were exposed to desflurane anesthesia. On the other hand, the levels of Zn on erythrocytes were significantly increased at 1st hour and 1st and 3rd days compared to initial time in sevoflurane group (p < 0.01, p < 0.01, and p < 0.05, respectively). The activity of GSH-Px was significantly increased (p = 0.05) while the activity of SOD was significantly decreased (p < 0.01) at 1st hour after administration of sevoflurane compared to the initial time. There were no changes on the levels of Mg and MDA. Our results showed that sevoflurane has more impacts on the antioxidant status of erythrocytes than desflurane. © The Author(s) 2011. Source

Kirbas A.,Cardiovascular Surgery Clinic | Yalcin Y.,Pediatric Cardiology Clinic | Tanrikulu N.,Anesthesiology and Reanimation Clinic | Isik O.,Cardiovascular Surgery Clinic
Journal of Clinical and Analytical Medicine

Aim: This study aims to reported the outcomes of the modified two patch technique in patients with complete atrioventricular septal defects (AVSD). Material and Method: Fifty patients (10 males, 40 females; mean age13.64±15.72 months) who were diagnosed with AVSD and underwent twopatch technigue with surgical repair between September 2005 and October 2011 in our clinic were retrospectively evaluated. Standard anesthetic, surgical, and CPB protocols were used in all patients.The demographic data, intraoperative and postoperative outcomes were recorded. Results: Rastelli type A in 46 patients (92%), Rastelli type B in 1 patient (2%), Rastelli type C in 3 patients (6%) were seen. Cardiopulmonary bypass and aortic clamp times were 115.42 ±39.1minutes and 84.44 ±31.1, respectively. Postoperative moderate-severe degree of left-sided atrioventricular valve insufficiency was observed in the echocardiographic evaluation of one patient (2%) and we performed the mitral annuloplasty. A moderate degree of left-sided atrioventricular valve insufficiency was observed in three patients. Left ventricular outflow tract obstruction was not detected in our patients. One patient (2%) developed complete atrioventricular blockage in the postoperative period and rhythm spontaneously improved. There were two (4%) deaths in the early postoperative period. Discussion: The modified two-patch technique can be performed with acceptable results in infants with complete AVSD. Source

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