Effect of cell salvage on bleeding, transfusion of blood products, and bleeding parameters in patients undergoing liver transplantation with intraoperative massive blood transfusion

Background/aim: Autologous transfusion using a cell saver system has been used in liver transplantation with controversial outcomes. Its efficiency in patients with massive intraoperative transfusion has not been studied yet. This study aimed to evaluate effect of cell salvage (CS) on intraoperative bleeding and transfusion practices in liver transplantation with massive intraoperative transfusion. Materials and methods: Consecutive patients aged ≥18 years with intraoperative massive blood transfusion (≥ 6 units) between March 2014 and September 2020 were included. Patients subjected to CS were grouped as CS, whereas other patients were grouped as control. Number of transfused red blood cells was study’s primary outcome. Results: There were 38 and 32 patients in CS and control groups, respectively. Median blood loss was significantly lower in CS group than in control group (2500 mL vs. 4000 mL, p = 0.010). There were significantly more transfusions of red blood cells, fresh frozen plasma, platelets, and cryoprecipitates in CS group (p < 0.05). Postoperative median hemoglobin levels were determined as 4.8 g/dL and 8.2 g/dL in CS and control groups (p < 0.001). The decrease in postoperative hemoglobin levels compared to preoperative values was significantly higher in the CS group (p < 0.001). The mortality rate in postoperative first year was significantly higher in CS group than in control group (36.8% vs. 12.5%, p = 0.041). Conclusion: Use of CS in patients undergoing liver transplantation with massive intraoperative transfusion did not improve clinical and transfusion-related outcomes. In conclusion, its usage can be questionable given the absence of any clinical benefit and presence of poor outcomes

Erişkin canlı donör ve kadavra donör böbrek nakillerinde alıcıların intraoperatif hemodinamik parametrelerinin karşılaştırılması

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative param- eters according to the donor type. In this study, we aimed to compare the intraoperative hemo- dynamic parameters in adult patients who un- derwent living-donor and deceased-donor kidney transplantation (KT). Material and Methods: The patients who underwent KT were divided into 2 groups ac- cording to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the liv- ing donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters. Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean op- erative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, periph- eral oxygen saturation and CVP values were all comparable between the two groups. Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intra- operative follow-up, and proper fluid management, similar intra- operative hemodynamic parameters are achieved in both types of donor recipients.Amaç: Böbrek nakli anestezisi ile ilgili çok sayıda çalışma yapılmıştır ancak verici tipine göre intraoperatif parametreler açısından literatürde yeterli veri bulunmamaktadır. Bu çalışmada canlı donör ve kadavra donör böbrek nakli (BN) yapı- lan erişkin hastalarda intraoperatif hemodinamik parametreleri karşılaştırmayı amaçladık. Gereç ve Yöntemler: BN yapılan hastalar verici böbrek tipine göre 2 gruba ayrıldı. Kadavra donör nakli yapılan alıcılar Grup 1 olarak çalış- maya dahil edildi. Canlı verici böbrek nakli ya- pılanlar arasında, Grup 1 ile benzer demografik verilere sahip aynı sayıda alıcı belirlendi ve Grup 2’ye dahil edildi. Her iki grup kaydedilen veriler ve intraoperatif hemodinamik parametreler açı- sından karşılaştırıldı. Bulgular: Çalışmaya 24 hasta dahil edildi. Ortalama diyaliz süreleri Grup 1 ve Grup 2 için sırasıyla 81,6 ± 64,8 ve 16,8 ± 17,4 aydı (p = 0,001). Ortalama soğuk iskemi süresi Grup 1›de Grup 2›den anlamlı olarak daha uzundu (p = 0,001). Grup 1 ve Grup 2 için operatif ortalama idrar çı- kışı sırasıyla 87.3 ± 149.6 ve 634.2 ± 534.5 idi (p = 0.002). Her iki grup ortalama arter basıncı, kalp hızı, periferik oksijen satürasyonu ve CVP değer- leri açısından benzerdi. Sonuç: Canlı donör nakline göre kadavra do- nör nakillerinde soğuk iskemi süresi daha uzun- dur ve operatif idrar hacmi daha düşüktür. İyi bir preoperatif hazırlık, yakın intraoperatif takip ve uygun sıvı yönetimi ile her iki tip donör alıcıda da benzer intraoperatif hemodinamik parametreler elde edilir

Genel anestezinin işitsel beyinsapı cevap testine etkisi

Objective: The auditory brainstem response (ABR) test is usually applied during natural sleep, but it can also be conducted under anesthesia. This retrospective study aimed to compare the ABR findings of a general anesthesia group and a control group that underwent ABR test during natural sleep. Methods: The anesthesia group consisted of 42 (mean age 44.5±20.3 months) children, and the control group included 58 children (36.1±16.1 months). The results of the click ABR test of the two groups were compared in terms of amplitude, latency, interpeak latencies, and hearing thresholds. Results: The amplitudes of waves III and V were significantly decreased in the general anesthesia group compared with that in the control group. The ABR latencies of waves I and V and the interpeak latencies for I-V and III-V were prolonged in the anesthesia group compared with that in the control group. Moreover, the click threshold obtained in the anesthesia group was significantly higher than those of the control group. Conclusions: Clinicians and audiologists should advise families to know the effects of general anesthesia on ABR and be cautious in interpreting the results obtained in ABR test performed under anesthesia.Amaç: İşitsel beyinsapı cevap (ABR) testi genellikle doğal uyku sırasında uygulansa da anestezi altında da yapılabilir. Bu retrospektif çalışmanın amacı, genel anestezi grubu ile doğal uykuda ABR testi uygulanan kontrol grubunu ABR test bulguları açısından karşılaştırmaktır. Yöntemler: Anestezi grubu 42 (yaş ortalaması 44,5±20,3 ay) ve kontrol grubu 58 (yaş ortalaması 36,1±16,1 ay) çocuktan oluşmaktaydı. İki grubun klik ABR test sonuçları amplitüd, latans, dalgalar arası latans ve işitme eşikleri açısından karşılaştırıldı. Bulgular: Genel anestezi grubunda, III ve V. dalganın amplitüdü kontrol grubuna göre anlamlı olarak azaldı. Genel anestezi grubunda, I. ve V. dalgaların latansları, I-V ve III-V dalgalar arası latanslarında kontrol grubuna göre uzama gözlendi. Ayrıca genel anestezi grubunda elde edilen klik eşiği kontrol grubuna göre anlamlı olarak daha yüksek elde edildi. Sonuçlar: Klinisyenler ve odyologlar, ailelere genel anestezinin ABR üzerindeki etkilerini bilmesini tavsiye etmeli ve anestezi ABR ile elde edilen sonuçları yorumlarken dikkatli olmalıdır

Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?

WOS: 000371172200007PubMed ID: 26034194Background: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction

The impact of body mass index on intraoperative blood loss, blood transfusion and fluid management in patients undergoing liver transplantation: A retrospective analysis from a tertiary referral center

Aim: Some parameters affecting intraoperative bleeding have been investigated, but there is not enough data on body mass index (BMI) and bleeding in liver transplantation (LT). We aimed to evaluate the relationship between the pretransplant BMI of recipients and blood loss, blood product transfusion, and fluid replacement during LT. Methods: In this retrospective cross-sectional study, patients aged >= 18 years who underwent LT between April 2014 and June 2020 were analyzed. Patients 30 in Group 4). Groups were compared according to operative hemodynamics, blood loss, blood transfusion, and fluid management-related parameters. Results: Two hundred and sixteen patients were included in the study. The mean blood loss was higher in obese patients than in others, but it was not statistically significant. The mean red blood cell, fresh frozen plasma, platelet, and cryoprecipitate transfusions were similar for the groups. The mean IV crystalloid fluid amount gradually shortened from underweight to obese patients but there was no significant difference. Preoperative mean international normalized ratio and prothrombin time were significantly higher in underweight patients than others (p=0.025). Conclusion: LT can be performed safely in patients with different BMI with similar blood loss and transfusion rates

Evaluation of the learning curve of pediatric kidney transplantation anesthesia

Background/aim: Pediatric kidney transplantation (PKT) anesthesia brings some different challenges than adult kidney transplantation (KT) anesthesia and there are still no studies analyzing the role of experience on PKT outcomes. In this study, we aimed to evaluate the anesthesia learning curve in pediatric kidney transplants performed in our institution and the effect of increasing experience on renal transplantation-related data. Materials and methods: Patients age 18 years were excluded. Patients were divided into 3 groups according to the date of transplant, as the first 10 patients in Group 1, the second 10 patients in Group 2, and the final 11 in Group 3. Groups were compared according to recorded data. Results: Thirty-one patients were included in the study. Age, sex, and body mass index were matched between the 3 groups. The mean durations of dialysis were 75.0 +/- 63.0, 22.4 +/- 27.9, and 5.7 +/- 4.5 months for Group 1, Group 2, and Group 3, respectively (p = 0.009). Blood loss, duration of postoperative mechanical ventilation, and length of stay in the intensive care unit (ICU) were comparable between the groups. The duration of anesthesia gradually shortened from Group 1 to Group 3 but there was no significant difference between the groups. The mean number of red blood cell (RBC) transfusion was 0.9 +/- 0.7 unit in group 1. It decreased to a mean of 0.6 +/- 0.7 unit for group 2, and afterward significant decrease occurred down to 0 for group 3 (p = 0.004). Conclusion: Our results demonstrate that considering the decrease in preoperative dialysis duration and operative RBC transfusion, 20 patients may be enough for anesthesia competency. Transplantation anesthesia experience before PKT, anesthesia technique, and patient characteristics may differ between institutions. Therefore, further prospective studies with established learning curve goals, larger patient volumes, and more variables are needed to validate our results

Obstetrik hastalarda bölgesel anestezi tercihini etkileyen faktörler: Anket çalışması

Objective: Most patients in Turkey still prefer general anaesthesia (GA) and are somehow afraid of regional blocks. Receiving adequate information is likely to increase patients' awareness about regional anaesthesia (RA). We aimed to determine the current preferences of parturients, the reasons for refusal of RA techniques, and how detailed information about the type of anaesthesia affect a patient's preference for anaesthesia among obstetric cases. Methods: One hundred fifty patients, scheduled for elective caesarean section (C/S), were surveyed before and after the C/S. The survey included three parts: the first part involved demographic features, anaesthesia preferences, prior opinions and experiences related to RA, and assessment of preoperative fears and reasons, and the second part involved persuasion of patients after reading the information sheet about RA. The final part was composed of postoperative satisfaction and complications related to the RA or GA depending on the patients' preferences. Complications were recorded on the anaesthesia chart. Results: Of all patients, 42.7% (n=64) approved and 48% (n=72) refused RA at the first preoperative anaesthesia visit. The remaining patients (n=14) had no idea of which anaesthesia type to choose. After being informed about RA in detail, 48 (66.6%) of the patients who previously refused RA and all patients who had no idea approved the procedure, and all of them were satisfied with the anaesthesia following the procedure. Conclusion: Our study revealed exactly that particularly obstetric anaesthetists should inform their patients about the advantages and disadvantages of all alternative types of anaesthesia. Effective and correct information is the major point.Amaç: Obstetrik hastalarda herhangi bir kontrendikasyonu yoksa, bölgesel anestezi ilk tercih edilmesi gereken ve en güveniliryöntemdir. Bu anket çalışmamızda obstetrik hastalarda bölgeselanesteziyi reddetme nedenlerini, iyi bir bilgilendirme sonrasındakigörüş değişikliklerini ve ameliyat sonrasındaki memnuniyet düzeylerini ölçmeyi amaçladık.Yöntemler: Etik kurul onayıyla preoperatif değerlendirme sırasında anestezi polikliniğine gelen gebelerden iki aşamalı bir anketformu doldurmaları istendi. Anketin ilk bölümünde anestezi tercihleri ve bölgesel anesteziyi reddetme nedenleri sorgulandıktansonra hastalara standart bir bilgilendirme broşürü okutuldu. Bilgilendirme sonrası anketin ikinci aşamasına geçilerek seçim değişiklikleri ve nedenleri sorgulandı. Girişim sonrasında tüm hastalarınanestezi seçimleriyle ilgili memnuniyetleri ve komplikasyonlarkaydedildi.Bulgular: Doğum öncesi anestezi polikliniğinde değerlendirilen150 ASA I veya II gebe verilen anket formunu doldurdu. Altmışdört gebe (%42,7) herhangi bir ön bilgilendirme yapmadan bölgesel anesteziyi tercih etti. Yetmiş iki gebe (%48) bölgesel anesteziyi reddetti. Bu gebelerin 16’sı (%11,1) daha önceki bölgeselanestezi deneyimlerinde yaşadıkları komplikasyonları neden olarak gösterdiler. Tüm gebeler standart bilgilendirilmeye tabi tutulduktan sonra 48 (%66,6) gebe bölgesel anesteziyi kabul etti ve buhastaların tamamının ameliyat sonrası memnuniyet değerlendirmesi ‘çok iyi’ şeklindeydi.Sonuç: Bu anket çalışması; etkin ve doğru bir bilgilendirmeylehastaların yöntem seçimlerini değiştirebileceklerini göstermiştir.Sonuçta hastaların ameliyat öncesi anestezistler tarafından bilgilendirmesinin önemi bir kez daha ortaya çıkmıştır