Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications. Different fluid management protocols are in use for this purpose. Our primary goal was to compare the effects of conventional fluid management (CFM) with the Pleth Variability Index (PVI) guided goal-directed fluid management (GDFM) protocols on the amount of crystalloids administered, blood lactate, and serum creatinine levels during the intraoperative period. The length of hospital stay was our secondary goal. Seventy ASA I-II elective colorectal surgery patients were randomly assigned to CFM or GDFM for fluid management. The hemodynamic data and the data obtained from ABG were recorded at the end of induction and during the follow-up period at 1 h intervals. In the preoperative period and at 24 h postoperatively, blood samples were taken for the measurement of hemoglobin, Na, K, Cl, serum creatinine, albumin and blood lactate. In the first 24 h after surgery, oliguria and the time of first bowel movement were recorded. Length of hospital stay was also recorded. Intraoperative crystalloid administration and urine output were statistically significantly higher in CFM group (p < 0.001, p: 0.018). The end-surgery fluid balance was significantly lower in Group GDFM. Preoperative and postoperative Na, K, Cl, serum albumin, serum creatinine, lactate and hemoglobin values were similar between the groups. The time to passage of stool was significantly short in Group-GDFM compared to Group-CFM (p = 0.016). The length of hospital stay was found to be similar in both group. PVI-guided GDFM might be an alternative to CFM in ASA I-II patients undergoing elective colorectal surgery. However, further studies need to be carried out to search the efficiency and safety of PVI.

Coarctation of the aorta discovered in adulthood is uncommon. The formation of aneurysms from the coarctation segment and in the low‐pressure area is even rarer. The surgical management of coarctations can be challenging due to calcifications and concomitant cardiovascular and lung disease. We present a case with coronary artery disease, bilateral bullae, left subclavian artery aneurysm, saccular aortic aneurysms originating proximal to the coarctation and from the coarctation itself, and a remnant of ductus arteriosus. The surgical management and possible histopathologic causes for aneurysm formation are discussed.

INTRODUCTION: Postoperative nasocomial pneumonia (PoNP) is the pneumonia that develops 48 hours after the surgery. The risk of PoNP is 3-20 times higher when endotracheal tube (ET) was used. Therefore ETs with drainage lumens allowing subglottic secretion were produced (SSD-ET). The risk of PoNP has increased in cardiac surgery. There are limited number of studies on SSD-ET and VAP in the literature on patients under going fast-track cardiac anesthesia protocol. The aim of our study is to compare the protective effect of the SSD-ET on the extubation time and the development of PoNP in the patients having open heart surgery under going fast-track cardiac anesthesia protocols. METHODS: A prospective, non-blind, randomized trial was conducted. Patients scheduled for cardiac surgery were randomly assigned to receive Standart Tube Group (Group 1) or Subglottic Aspiration Tube Group (Group 2). 60 patients were included in the study. The diagnosis of PoNP is determined according to the diagnostic criteria of 2015 “Centersfor Disease Control and Prevention (CDC)”(1). A two-sided p-value <0.05 was considered as statistically significant. RESULTS: Extubation time was 12.65 h in group SSD-ET, it was revealed as 16.88 h in the S-ET group. Hence, the extubation time was significantly shorter in the SSD-ET group (<0.027) DISCUSSION AND CONCLUSION: Our study has showed that SSD-ETs decreased the extubation time in patients who underwent open heart surgery, although they did not directly affect the development of PoNP

Günümüzde teknoloji, cerrahi ve anestezideki gelişmeler ameliyat öncesi ve ameliyat sonrası hasta bakımında ilerlemelere neden olmuş ve artık cerrahi en son başvurulan tedavi yöntemi olmaktan çıkmıştır. Abdominal cerrahiye yönelik girişimler mide, safra, karaciğer, dalak, pankreas, ince bağırsak ve kalın bağırsaktaki hastalıkları kapsamakta ve ileri yaş grubunda cerrahi gerektiğinde komorbid hastalıkları nedeniyle ilave sorunları da beraberinde getirmektedir. Acil olduğu durumlarda bu sorunlar daha da artmaktadır. Bu derlemede abdominal cerrahi yapılacak hastalarda perioperatif anestezi yönetimini anlatmayı amaçladık.

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