Valproic acid (VPA) intoxication incidence is increasing, because of the use of VPA in psychiatric disorders. The most common finding of VPA intoxication is central nervous system depression which leads to coma and respiratory depression. Pancreatitis, hyperammonemia, metabolic, and bone marrow failure (thrombocytopenia and leukopenia) have also been described. Treatment is mainly supportive. We present the case of an 18-year-old female patient, who made an attempt to autolysis with VPA. Our patient's VPA plasma level was very high (924 μg/mL), confirming that it was a severe intoxication. Our treatment including levocarnitine (50 mg/kg per day for 3 days), and high-flux hemodialysis was performed for four hours. The patient's hemodynamic status and mental function improved in conjunction with the acute reduction in VPA concentrations. Her subsequent hospital course was complicated by transient thrombocytopenia and levocarnitine induced hypophosphatemia. By day 6, the patient's laboratory values had completely normalized, and she was transferred to an inpatient psychiatric facility for continuing therapy.

Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety.

ÖZETAmaç: Aort anevrizma onarım operasyonlarında farklı cerrahi kanülasyon teknikleri, ısı regülasyonu ve beyin koruma yöntemlerinin mortalite üzerinde etkili perioperatif risk faktörleri ile ilişkisinin incelenmesini amaçladık. Bu nedenle; derin hipotermik sirkulatuar arrest (DHSA) ve retrograd serebral perfüzyon (RSP) altında femoral veya aortik kanülasyon ile uygulanan hastalar, orta derecede hipotermik sirkulatuar arrest (OHSA) ve selektif antegrad serebral perfüzyon (SASP) altında aksiller kanülasyon uygulanan hastalar karşılaştırıldı.Gereç ve Yöntem: Aortik ark anevrizma onarım operasyonu olan 110 ardışık hasta prospektif nonrandomize bir çalışma planı içeri-sinde üç ayrı gruba cerrahi patoloji, operasyon ve anestezi tekniklerine dayanılarak ayrıldı. Grup 1'de; femoral kanülasyon, DHSA (22-25°C), ve RSP uygulanırken, Grup 2'de; aksiller kanülasyon, OHSA ve SASP, Grup 3'te; aortik kanülasyon, DHSA ve RSP uygulandı. Perioperatif risk faktörleri araştırıldı.Bulgular: Üç grup karşılaştırıldığında kros klamp ve kardiyopulmoner baypas (KPB) süreleri (dk.) farklı idi (Grup 1'de; 75,62±26,28 ve144,15±66,71, Grup 2'de; 60,57±26,32 ve 109,09±45,38, Grup 3'te; 72,90±23,33 ve 120,83±53,46 sırası ile p=0,021). Mortalite hızlarının karşılaştırması; Grup 1'de 10/34 (% 29,4), Grup 2'de 3/47 (% 6,4) ve Grup 3'te 3/29 (% 10,3) (p=0,011) hasta olduğunu gösterdi. IABP kullanımı, kalp yetmezliği, atrial ritim bozukluklarının mortalite için bağımsız risk faktörleri olduğu saptandı (% 95 gü-ven aralığında; Hosmer and Lemeshow testi, ki kare=5,71 ve p=0,68).Sonuç: OHSA, SASP ve aksiller kanülasyon ile aortik ark anevrizma onarımı geçiren hastalarda morbidite ve mortalite DHSA, RSP ve femoral veya aortik kanülasyon yapılan hastalar ile karşılaştırıldığında daha az oranda gözlenmektedir.Anahtar kelimeler: Aortik anevrizma, derin hipotermik sirkülatuar arrest, orta derecede hipotermik sirkulatuar arrest SUMMARY The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and SurvivalObjective: Our aim was to investigate the relation between perioperative risk factors influencing mortality and different methods of surgical cannulation, temperature regulation and cerebral protection in patients undergoing aortic aneurysm repair surgery. For this purpose; patients requiring deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and femoral or aortic cannulation were compared with patients requiring axillary cannulation, moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).Material and Methods: 110 consecutive patients undergoing aortic arch aneurysm repair surgery were divided into three groups in a prospective, nonrandomized study plan depending on surgical pathology, operation and anesthesia techniques. In Group 1, femoral cannulation, DHCA (22-25°C) and RSP ; in Group 2, axillary cannulation, MHCA (26-28°C) and SACP, whereas, in Group 3, aortic cannulation, DHCA and RCP were per...

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