ÖZET Amaç: Bu çalışmada, hayatı tehdit eden komplikasyonlarla seyredebilen kraniyosinostoz nedeniyle ameliyat edilen çocuk hastalarda perioperatif anestezi yönetimini sunmayı amaçladık. Gereçler ve Yöntem: Ocak 2009-Ocak 2021 arasında opere edilen 26 kraniyosinostoz hastasının tamamının dosyasını geriye dönük olarak inceledik. Hastaların demografik verileri, ASA skorları, anestezi ve ameliyat süreleri, ek anomali koşulları, hava yolu ve kanama yönetimi ile komplikasyonları analiz edildi. Bulgular: Çalışmaya alınan 26 hastanın 16'sı trigonosefali, 4'ü skafosefali, 3'ü plajiyosefali ve 3'ü mikst tipte idi. Hastaların 20'si (%76.9) erkek, 6'sı (%23.1) kadındı. 26 hastanın beşinde (%19.23) ek anomaliler (1 Apert sendromu, 2 kardiyak anomali ve 2 hidrosefali) vardı. Ortalama ameliyat süresi 167.03 dk ve anestezi süresi 179.92 dk idi. Hastaların direkt laringoskopisinde CL skorları değerlendirildi. Beş hastada (%19.2) CL I, 13 hastada (%50.0) CL II ve 8 hastada (%30.8) CL III bulundu. Ameliyat sırasında 5 hastada (%19.23) şiddetli hipotansiyon gözlendi. Bu hastalara eş zamanlı kan ve sıvı infüzyonu ile 0.03 mg/kg/dk dozunda noradrenalin uygulandı. Ameliyat öncesi ortalama hematokrit değerleri %35.99, ameliyat sırasında %26.85 (0.001) olan hastaların preoperatif ve intraoperatif hematokrit değerleri arasında istatistiksel olarak anlamlı fark bulundu (p 0,001). Sonuç: Kraniosinostozlu pediatrik hastaların havayolu yönetiminin zor olduğunu ve intraoperatif masif kanama riski olduğunu saptadık. Bu hastalarda dikkatle planlanmış anestezi yönetimi gerekir. Anahtar Kelimeler: Kraniosinostoz, pediatrik hastalar, anestezi yönetimi, kanama yönetimi

Background:The study aims to determine the variation of shock index (SI) before and after vaginal delivery and establish standard reference values in mothers who have not postpartum hemorrhage. Materials and Methods: A total of 2534 women who delivered vaginally were enrolled in the study. This prospective cross-sectional study was completed between November 2018 and September 2019 in our referral hospital. The exclusion criteria were anemia, cesarean delivery, maternal heart diseases, maternal thyroid disease, gestational hypertensive disorders, patients received epidural anesthesia, and less than a 34 week 0 day gestation, patients who had postpartum hemorrhage (PPH). We defined PPH as blood loss > 1000 ml at the time of delivery. All patients' SI (heart rate/systolic blood pressure) were measured prepartum and at the 30th minutes, 1st and 2nd-hour postpartum period. Shock index reference ranges were measured separately according to BMI, age, and parity groups. Results: 10136 SI values were assessed. The mean age ± SD was 27.28±5.95 years. The mean BMI ± SD was 24.89±4.87 kg/m 2 . The prepartum and postpartum 30th minutes, 1st hour, and 2nd hour mean shock index values were 0.76±0.07; 0.85±0.12; 0.84±0.12 and 0.81±0.12 respectively. The variation in SI values was significant by the Tukey test (P < 0.05). Conclusions: For SI to be a diagnostic character in the issue of PPH, reference values must be known, so in this study shock index reference percentile ranges and mean ± standard deviation of SI values were established.

Background and Aim: The aim of this study is to investigate the magnetic resonance imaging (MRI) of patients with lumbar disc herniation (LDH) to identify the challenges associated with neuraxial anesthesia. Materials and Methods: The MRI images in the supine position of 203 patients admitted to hospital with complaints of lower back pain were studied. Medial sagittal slices of the lumbar spine were imaged from L1 to S1. LDH is classified as either bulging, extrusion, or protrusion. Results: For this study, 83 males and 120 females with a mean age of 43.18 ± 14.68 years were recruited. The highest herniation level was observed at L4–L5 in 145 (71.4%) patients: 76 instances of disc bulging (37.4%), 56 instances of extrusion (27.6%), and 13 instances of protrusion (6.4%). The longest distance between the skin and spinal cord was 60.06 ± 1.61 mm at L5–S1; the longest distance at width of the epidural space was 6.09 ± 1.95 mm at L3–L4. According to the disc herniation groups, no significant differences were found between the skin-to-dura distance, width of the epidural space, and depth of skin level to spinous process ( P > 0.05). Moreover, the anterior dura to cord distances was significantly different from normal patients ( P < 0.05). Indeed, there was a statistically weak and negative correlation between both the length and age of the lumbar spinal canal ( P < 0.05, r = −0.295). Conclusions: Lumbar disc pathologies can cause anatomical derangements in the spinal canal, which may cause neurologic deficits by neuraxial blockade.

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