nedim çekmen - Academia.edu (original) (raw)
Papers by nedim çekmen
Clinical Medical Reviews and Case Reports, Dec 31, 2022
Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment ... more Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment approach is the standard modality for autosomal dominant polycystic kidney disease (ADPKD) complications and lifelong 50% chronic renal failure risk, as renal transplantation is the only definitive treatment. We aimed to explain the anesthesia management of our patient who had an 18 kg cyst removed. There are various complications that; include hypertension, urinary tract infections, hematuria, pain due to solid organ compression, liver cysts, and hernias. Comprehensive preparation, including detailed anamnesis and physical examination, communication and multidisciplinary evaluation, are essential to prevent morbidity and mortality.
Research and Opinion in Anesthesia and Intensive Care
Journal of Education and Health Promotion
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19. On Marc... more BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19. On March 11, 2020, the WHO declared it a pandemic. SARS-CoV-2 indicates that it poses a significant threat to public health and global economy. The aim of the study was to determine (a) patient characteristics, (b) demographic characteristics, (c) comorbidities, diagnostic methods used, treatment, and outcomes, and (d) mortality rates of patients. MATERIALS AND METHODS: This retrospective cohort study included 352 hospitalized adult patients from Baskent University Hospital in Ankara who were confirmed cases of COVID-19 between March 2020 and March 2021. SPSS v. 14.0 was used for statistical analysis. RESULTS: Out of 352 patients, 55 died (males: 37, females: 18), while 297 survived (males: 162, females: 135). The most common comorbidities were hypertension (HT), diabetes mellitus (DM), coronary artery disease (CAD), cancer, Vitamin D deficiency, and chronic obstructive pulmonary disease. Comorbidities associated with mortality rate were obesity (33%) (P = 0.118), Vitamin D deficiency (28%) (P = 0.009), DM (25%) (P = 0.004), CAD (21.2%) (P = 0.142), cancer (20.9%) (P = 0.084), and HT (16.6%) (P = 0.90). Normal ward admission resulted in death in 67.3% and survival in 93.9% (P = 0.001), intensive care unit (ICU) admission resulted in death in 69.1% and survival in 18.5% (P = 0.001), and oxygen therapy was used in 80% death and survival in 39.4% (P = 0.001). CONCLUSIONS: Our study shows that male gender, advanced age, and presence of comorbidities in COVID 19 patients are at higher risk for severe disease, ICU admission, and death. We emphasize that morbidity and mortality can be reduced by early and comprehensive identification of risk factors and the warning systems that will meet the ICU needs of these patients.
Liver Anesthesiology and Critical Care Medicine, 2012
ABSTRACT The incidence of postoperative renal insufficiency and acute kidney injury (AKI) in pati... more ABSTRACT The incidence of postoperative renal insufficiency and acute kidney injury (AKI) in patients undergoing liver transplantation ranges from 20 % up to 90 % [1] and more than 80 % of these episodes occur within the first 2 postoperative days. Earlier studies found that mortality at 30 days was 50 % in patients who developed AKI and 29 % in non-AKI patients [2]. AKI necessitating renal replacement therapy has been associated with mortality rates from 55 to 90 % [3]. Risk factors for the development of AKI in these patients include preoperative renal dysfunction represented with a higher preoperative serum creatinine (SCrea), greater requirements for intraoperative blood transfusion, more frequent episodes of intraoperative hypotension, and other preexisting comorbidities [2].
Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment ... more Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment approach is the standard modality for autosomal dominant polycystic kidney disease (ADPKD) complications and lifelong 50% chronic renal failure risk, as renal transplantation is the only definitive treatment. We aimed to explain the anesthesia management of our patient who had an 18 kg cyst removed. There are various complications that; include hypertension, urinary tract infections, hematuria, pain due to solid organ compression, liver cysts, and hernias. Comprehensive preparation, including detailed anamnesis and physical examination, communication and multidisciplinary evaluation, are essential to prevent morbidity and mortality.
postoperative complications. However, in recent years, LT has been accepted as the only effective... more postoperative complications. However, in recent years, LT has been accepted as the only effective treatment in these patients with HPS. However, the risk of developing severe complications, mortality and morbidity after LT remains high, especially in severe HPS. In addition, in pulmonary AVF, typically in ESLD patients with HPS, the risk of development is very high [2,4]. Any change in PVR may affect and trigger the development of hypoxemia in HPS patients with or without AVF; therefore, these triggering factors must be avoided [1,2].
Perioperative Anaphylaxis (PA) occurs during the operation. It is a life-threatening systemic all... more Perioperative Anaphylaxis (PA) occurs during the operation. It is a life-threatening systemic allergic reaction. Although rare, it is most severe and has a high mortality and morbidity rate. In the development of PA, the leading causes are antibiotics and neuromuscular blocking agents (NMBAs). Diagnosis is difficult due to the physiological changes of many drugs administered during anesthesia. Immunoglobulin E (IgE) or non-IgE mechanisms are responsible for the primary mechanism of PA. The most common symptoms of PA are hypotension, hypoxemia, high airway pressures, and urticaria. PA usually discontinues surgery, prolonged hospital stays, and unexpected intensive care unit (ICU) hospitalizations, which may increase morbidity, mortality, and hospital costs. The most common causes of PA include NMBAs, beta-lactam antibiotics, latex, and chlorhexidine. In the perioperative period, the first step in the treatment is eliminating the causative agent, epinephrine, and adequate fluid resuscitation. In the postoperative period, serial serum tryptase measurements, skin tests, in vitro tests, and several tests must be performed to identify the responsible agent. Recognition, management, and prevention of PA are significant for all anesthesiologists, and knowledge of this subject is necessary. This review aims to emphasize PA's importance in our anesthesia practice.
Cholecystectomy management under dexmedetomidine sedation with thoracic epidural anesthesia in tw... more Cholecystectomy management under dexmedetomidine sedation with thoracic epidural anesthesia in two high-risk geriatric patients:Case reports and literature review. Çağla Yazar, Nedim Çekmen Thoracic epidural anaesthesia (TEA) is frequently used for anaesthesia and analgesia in today's practice. Although cholecystectomy is a surgical procedure performed under general anaesthesia (GA), many studies in recent years have shown that neuraxial techniques can be used safely. We aimed to present the anaesthesia management under dexmedetomidine sedation with TEA in high-risk patients who underwent laparoscopic cholecystectomy surgeries. Both patients were of geriatric age and had several comorbidities. In patients, we preferred TEA to avoid the cardiorespiratory effects of GA. Preoperative preparation of patients with a multidisciplinary approach, cooperation, and close follow-up is essential in preventing complications.
Archives of Anesthesia and Critical Care
The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some... more The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthro...
American Journal of Case Reports, Jan 7, 2010
Archives of Anesthesia and Critical Care
Crigler Najjar syndrome(CNS); is a disease in which the diphosphate glucuronosyltransferase (bili... more Crigler Najjar syndrome(CNS); is a disease in which the diphosphate glucuronosyltransferase (bilirubin-UGT) enzyme function, which plays a role in the glucuronidation of bilirubin, is deficient as a result of mutation in the uridine 5'-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene.1 As a result, non-hemolytic unconjugated hyperbilirubinemia is seen. Orthotopic liver transplantation (OLT) is seen as a curative treatment option in Crigler Najjar syndrome type 1 (CNS1). In this case report, we present our patients who were 11 months old and 8 years old with a diagnosis of CNS1, whose bilirubin levels were controlled by preoperative daily phototherapy and plasmapheresis, and who had OLT from their parents to two siblings. We wanted to show the importance of a close follow-up and multidisciplinary treatment approach in the early period before OLT in CNS1 patients and thus the benefit to the patient's prognosis in the postoperative period.
Anesteziologiia i reanimatologiia
Serotonin syndrome is the syndrome resulting from brain tissue serotonin accumulation and accompa... more Serotonin syndrome is the syndrome resulting from brain tissue serotonin accumulation and accompanying by central nervous system dysfunction and circulatory collapse, which leads to a serious mortal danger to life. A female patient aged 31 years, diagnosed as having chronic psychosis in the history, was admitted to an intensive care unit in a critical state for having taking an increased moclobemide dose. The patient developed cardiac arrest and cardiopulmonary resuscitation (CPR) was initiated. A 15-minute CPR recovered sinus rhythm and pulse on the peripheral arteries of the limbs. When consciousness and respiration improved, the patient was weaned from resuscitation and extubated on the second day. On day 4, the patient was transferred from the intensive care unit to the department of psychiatry. The authors consider that patients with overdosage of antipsychotic agents at a risk for such serious complications, such as cardiac arrest, should be necessarily monitored in the intens...
International Journal of Clinical Anesthesiology, 2023
Background: Direct laryngoscopy (DL) may cause hemodynamic changes due to stress response; may c... more Background: Direct laryngoscopy (DL) may cause hemodynamic changes due to stress
response; may cause increased morbidity and mortality in patients.
Methods: A 68-year-old patient was scheduled for cordectomy; 12 minutes after DL onset, sudden asystole, and cardiac arrest developed. Cardiopulmonary resuscitation was started, and spontaneous circulation was restored two minutes later. The conscious patient was extubated and taken to the intensive care unit.
Results and Conclusion: Asystole during general anesthesia is a rare and fatal complication. Vagotonic drugssympatholyticis, vagal responses, and neurological causes play a role in the etiology. We aimed to present the management of cardiac arrest under general anesthesia in our case.
Journal of Dental Anesthesia and Pain Medicine
Glycogen storage disease (GSD) is a group of inherited disorders, which result in the deficiency ... more Glycogen storage disease (GSD) is a group of inherited disorders, which result in the deficiency of enzymes involved in glycogen metabolism, leading to an accumulation of glycogen in various organs. Deficiency of amylo-1-6-glicosidase (debranching enzyme) causes glycogen storage disease type III (GSD III). The main problems that anesthesiologists face in patients with GSD III include hypoglycemia, muscle weakness, delayed awakening due to abnormal liver function, possible difficulty in airway, and cardiomyopathy. In the face of these difficulties, airway preparation and appropriate glucose monitoring and support during the fasting period are important. The doses of the drugs to be used should be calculated considering the increased volume of distribution and decreased metabolic activity of the liver. We present the case of a child with GSD IIIa who underwent dental prosedation under general anesthesia. She was also being prepared for liver transplantation. This case was additionally complicated by the patient's serious allergic reaction to eggs and milk.
International Journal of Innovative Research in Medical Science
Background: This study aimed to demonstrate that PiCCO monitoring can be early guidance for fluid... more Background: This study aimed to demonstrate that PiCCO monitoring can be early guidance for fluid monitoring and hemodynamic parameter analysis in the pediatric OLT population. Method: A single-centre, retrospective cohort study in pediatric patients who underwent OLT between September 2014 and October 2017. Results: Forty-one pediatric patients (aged 4 months to 17 years) underwent hemodynamic monitoring with PiCCO during OLT. Measurements including mean arterial pressure (MAP), central venous pressure (CVP) and cardiac index (CI) were significantly lower during the Tanhepatic phase when compared to Tbaseline and Tnewhepatic phases (p<0.05 for all). Among the patients whose mean of Tnewhepetic extravascular lung water index (EVLWI) measurements were more excellent than 7 mL/kg; more significant amounts of intraoperative blood transfused (p=0.027), higher graft recipient body weight ratio (GRWR) (p=0.016) and longer anesthesia times (p=0.046) were seen. The mean of Tnewhepatic st...
Medicine
Abstract Introduction: Bardet-Biedl syndrome, which compromises airway management and the cardiov... more Abstract Introduction: Bardet-Biedl syndrome, which compromises airway management and the cardiovascular and renal systems, is a rare ciliopathic syndrome characterized by multisystem involvement and varying genetic etiologies and clinical manifestations. Patient concerns: A 13-year-old female patient had a history of chronic renal failure, hypothyroidism, mental retardation, hypogonadotropic hypogonadism, obesity, and retinitis pigmentosa and was undergoing 4-hour hemodialysis 3 days a week. Diagnosis: We diagnosed Bardet-Biedl syndrome based on the results of genetic tests. Interventions: We performed renal transplantation under general anesthesia while considering the perioperative risks of airway obstruction and hypothermia. Outcomes: Multidisciplinary preoperative evaluation is crucial to avoid perioperative complications. The risk of an obstructed airway should be considered. Hypothyroidism is a rare consequence of Bardet-Biedl syndrome. Rocuronium and sugammadex are safe for anesthetic management during renal transplantation to address Bardet-Biedl syndrome. Conclusion: Safe anesthetic management can be achieved with the rigorous preoperative assessment of perioperative complications.
Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2010
Clinical Medical Reviews and Case Reports, Dec 31, 2022
Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment ... more Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment approach is the standard modality for autosomal dominant polycystic kidney disease (ADPKD) complications and lifelong 50% chronic renal failure risk, as renal transplantation is the only definitive treatment. We aimed to explain the anesthesia management of our patient who had an 18 kg cyst removed. There are various complications that; include hypertension, urinary tract infections, hematuria, pain due to solid organ compression, liver cysts, and hernias. Comprehensive preparation, including detailed anamnesis and physical examination, communication and multidisciplinary evaluation, are essential to prevent morbidity and mortality.
Research and Opinion in Anesthesia and Intensive Care
Journal of Education and Health Promotion
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19. On Marc... more BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19. On March 11, 2020, the WHO declared it a pandemic. SARS-CoV-2 indicates that it poses a significant threat to public health and global economy. The aim of the study was to determine (a) patient characteristics, (b) demographic characteristics, (c) comorbidities, diagnostic methods used, treatment, and outcomes, and (d) mortality rates of patients. MATERIALS AND METHODS: This retrospective cohort study included 352 hospitalized adult patients from Baskent University Hospital in Ankara who were confirmed cases of COVID-19 between March 2020 and March 2021. SPSS v. 14.0 was used for statistical analysis. RESULTS: Out of 352 patients, 55 died (males: 37, females: 18), while 297 survived (males: 162, females: 135). The most common comorbidities were hypertension (HT), diabetes mellitus (DM), coronary artery disease (CAD), cancer, Vitamin D deficiency, and chronic obstructive pulmonary disease. Comorbidities associated with mortality rate were obesity (33%) (P = 0.118), Vitamin D deficiency (28%) (P = 0.009), DM (25%) (P = 0.004), CAD (21.2%) (P = 0.142), cancer (20.9%) (P = 0.084), and HT (16.6%) (P = 0.90). Normal ward admission resulted in death in 67.3% and survival in 93.9% (P = 0.001), intensive care unit (ICU) admission resulted in death in 69.1% and survival in 18.5% (P = 0.001), and oxygen therapy was used in 80% death and survival in 39.4% (P = 0.001). CONCLUSIONS: Our study shows that male gender, advanced age, and presence of comorbidities in COVID 19 patients are at higher risk for severe disease, ICU admission, and death. We emphasize that morbidity and mortality can be reduced by early and comprehensive identification of risk factors and the warning systems that will meet the ICU needs of these patients.
Liver Anesthesiology and Critical Care Medicine, 2012
ABSTRACT The incidence of postoperative renal insufficiency and acute kidney injury (AKI) in pati... more ABSTRACT The incidence of postoperative renal insufficiency and acute kidney injury (AKI) in patients undergoing liver transplantation ranges from 20 % up to 90 % [1] and more than 80 % of these episodes occur within the first 2 postoperative days. Earlier studies found that mortality at 30 days was 50 % in patients who developed AKI and 29 % in non-AKI patients [2]. AKI necessitating renal replacement therapy has been associated with mortality rates from 55 to 90 % [3]. Risk factors for the development of AKI in these patients include preoperative renal dysfunction represented with a higher preoperative serum creatinine (SCrea), greater requirements for intraoperative blood transfusion, more frequent episodes of intraoperative hypotension, and other preexisting comorbidities [2].
Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment ... more Polycystic kidney disease is a multisystemic familial inherited disease. A symptomatic treatment approach is the standard modality for autosomal dominant polycystic kidney disease (ADPKD) complications and lifelong 50% chronic renal failure risk, as renal transplantation is the only definitive treatment. We aimed to explain the anesthesia management of our patient who had an 18 kg cyst removed. There are various complications that; include hypertension, urinary tract infections, hematuria, pain due to solid organ compression, liver cysts, and hernias. Comprehensive preparation, including detailed anamnesis and physical examination, communication and multidisciplinary evaluation, are essential to prevent morbidity and mortality.
postoperative complications. However, in recent years, LT has been accepted as the only effective... more postoperative complications. However, in recent years, LT has been accepted as the only effective treatment in these patients with HPS. However, the risk of developing severe complications, mortality and morbidity after LT remains high, especially in severe HPS. In addition, in pulmonary AVF, typically in ESLD patients with HPS, the risk of development is very high [2,4]. Any change in PVR may affect and trigger the development of hypoxemia in HPS patients with or without AVF; therefore, these triggering factors must be avoided [1,2].
Perioperative Anaphylaxis (PA) occurs during the operation. It is a life-threatening systemic all... more Perioperative Anaphylaxis (PA) occurs during the operation. It is a life-threatening systemic allergic reaction. Although rare, it is most severe and has a high mortality and morbidity rate. In the development of PA, the leading causes are antibiotics and neuromuscular blocking agents (NMBAs). Diagnosis is difficult due to the physiological changes of many drugs administered during anesthesia. Immunoglobulin E (IgE) or non-IgE mechanisms are responsible for the primary mechanism of PA. The most common symptoms of PA are hypotension, hypoxemia, high airway pressures, and urticaria. PA usually discontinues surgery, prolonged hospital stays, and unexpected intensive care unit (ICU) hospitalizations, which may increase morbidity, mortality, and hospital costs. The most common causes of PA include NMBAs, beta-lactam antibiotics, latex, and chlorhexidine. In the perioperative period, the first step in the treatment is eliminating the causative agent, epinephrine, and adequate fluid resuscitation. In the postoperative period, serial serum tryptase measurements, skin tests, in vitro tests, and several tests must be performed to identify the responsible agent. Recognition, management, and prevention of PA are significant for all anesthesiologists, and knowledge of this subject is necessary. This review aims to emphasize PA's importance in our anesthesia practice.
Cholecystectomy management under dexmedetomidine sedation with thoracic epidural anesthesia in tw... more Cholecystectomy management under dexmedetomidine sedation with thoracic epidural anesthesia in two high-risk geriatric patients:Case reports and literature review. Çağla Yazar, Nedim Çekmen Thoracic epidural anaesthesia (TEA) is frequently used for anaesthesia and analgesia in today's practice. Although cholecystectomy is a surgical procedure performed under general anaesthesia (GA), many studies in recent years have shown that neuraxial techniques can be used safely. We aimed to present the anaesthesia management under dexmedetomidine sedation with TEA in high-risk patients who underwent laparoscopic cholecystectomy surgeries. Both patients were of geriatric age and had several comorbidities. In patients, we preferred TEA to avoid the cardiorespiratory effects of GA. Preoperative preparation of patients with a multidisciplinary approach, cooperation, and close follow-up is essential in preventing complications.
Archives of Anesthesia and Critical Care
The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some... more The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthro...
American Journal of Case Reports, Jan 7, 2010
Archives of Anesthesia and Critical Care
Crigler Najjar syndrome(CNS); is a disease in which the diphosphate glucuronosyltransferase (bili... more Crigler Najjar syndrome(CNS); is a disease in which the diphosphate glucuronosyltransferase (bilirubin-UGT) enzyme function, which plays a role in the glucuronidation of bilirubin, is deficient as a result of mutation in the uridine 5'-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene.1 As a result, non-hemolytic unconjugated hyperbilirubinemia is seen. Orthotopic liver transplantation (OLT) is seen as a curative treatment option in Crigler Najjar syndrome type 1 (CNS1). In this case report, we present our patients who were 11 months old and 8 years old with a diagnosis of CNS1, whose bilirubin levels were controlled by preoperative daily phototherapy and plasmapheresis, and who had OLT from their parents to two siblings. We wanted to show the importance of a close follow-up and multidisciplinary treatment approach in the early period before OLT in CNS1 patients and thus the benefit to the patient's prognosis in the postoperative period.
Anesteziologiia i reanimatologiia
Serotonin syndrome is the syndrome resulting from brain tissue serotonin accumulation and accompa... more Serotonin syndrome is the syndrome resulting from brain tissue serotonin accumulation and accompanying by central nervous system dysfunction and circulatory collapse, which leads to a serious mortal danger to life. A female patient aged 31 years, diagnosed as having chronic psychosis in the history, was admitted to an intensive care unit in a critical state for having taking an increased moclobemide dose. The patient developed cardiac arrest and cardiopulmonary resuscitation (CPR) was initiated. A 15-minute CPR recovered sinus rhythm and pulse on the peripheral arteries of the limbs. When consciousness and respiration improved, the patient was weaned from resuscitation and extubated on the second day. On day 4, the patient was transferred from the intensive care unit to the department of psychiatry. The authors consider that patients with overdosage of antipsychotic agents at a risk for such serious complications, such as cardiac arrest, should be necessarily monitored in the intens...
International Journal of Clinical Anesthesiology, 2023
Background: Direct laryngoscopy (DL) may cause hemodynamic changes due to stress response; may c... more Background: Direct laryngoscopy (DL) may cause hemodynamic changes due to stress
response; may cause increased morbidity and mortality in patients.
Methods: A 68-year-old patient was scheduled for cordectomy; 12 minutes after DL onset, sudden asystole, and cardiac arrest developed. Cardiopulmonary resuscitation was started, and spontaneous circulation was restored two minutes later. The conscious patient was extubated and taken to the intensive care unit.
Results and Conclusion: Asystole during general anesthesia is a rare and fatal complication. Vagotonic drugssympatholyticis, vagal responses, and neurological causes play a role in the etiology. We aimed to present the management of cardiac arrest under general anesthesia in our case.
Journal of Dental Anesthesia and Pain Medicine
Glycogen storage disease (GSD) is a group of inherited disorders, which result in the deficiency ... more Glycogen storage disease (GSD) is a group of inherited disorders, which result in the deficiency of enzymes involved in glycogen metabolism, leading to an accumulation of glycogen in various organs. Deficiency of amylo-1-6-glicosidase (debranching enzyme) causes glycogen storage disease type III (GSD III). The main problems that anesthesiologists face in patients with GSD III include hypoglycemia, muscle weakness, delayed awakening due to abnormal liver function, possible difficulty in airway, and cardiomyopathy. In the face of these difficulties, airway preparation and appropriate glucose monitoring and support during the fasting period are important. The doses of the drugs to be used should be calculated considering the increased volume of distribution and decreased metabolic activity of the liver. We present the case of a child with GSD IIIa who underwent dental prosedation under general anesthesia. She was also being prepared for liver transplantation. This case was additionally complicated by the patient's serious allergic reaction to eggs and milk.
International Journal of Innovative Research in Medical Science
Background: This study aimed to demonstrate that PiCCO monitoring can be early guidance for fluid... more Background: This study aimed to demonstrate that PiCCO monitoring can be early guidance for fluid monitoring and hemodynamic parameter analysis in the pediatric OLT population. Method: A single-centre, retrospective cohort study in pediatric patients who underwent OLT between September 2014 and October 2017. Results: Forty-one pediatric patients (aged 4 months to 17 years) underwent hemodynamic monitoring with PiCCO during OLT. Measurements including mean arterial pressure (MAP), central venous pressure (CVP) and cardiac index (CI) were significantly lower during the Tanhepatic phase when compared to Tbaseline and Tnewhepatic phases (p<0.05 for all). Among the patients whose mean of Tnewhepetic extravascular lung water index (EVLWI) measurements were more excellent than 7 mL/kg; more significant amounts of intraoperative blood transfused (p=0.027), higher graft recipient body weight ratio (GRWR) (p=0.016) and longer anesthesia times (p=0.046) were seen. The mean of Tnewhepatic st...
Medicine
Abstract Introduction: Bardet-Biedl syndrome, which compromises airway management and the cardiov... more Abstract Introduction: Bardet-Biedl syndrome, which compromises airway management and the cardiovascular and renal systems, is a rare ciliopathic syndrome characterized by multisystem involvement and varying genetic etiologies and clinical manifestations. Patient concerns: A 13-year-old female patient had a history of chronic renal failure, hypothyroidism, mental retardation, hypogonadotropic hypogonadism, obesity, and retinitis pigmentosa and was undergoing 4-hour hemodialysis 3 days a week. Diagnosis: We diagnosed Bardet-Biedl syndrome based on the results of genetic tests. Interventions: We performed renal transplantation under general anesthesia while considering the perioperative risks of airway obstruction and hypothermia. Outcomes: Multidisciplinary preoperative evaluation is crucial to avoid perioperative complications. The risk of an obstructed airway should be considered. Hypothyroidism is a rare consequence of Bardet-Biedl syndrome. Rocuronium and sugammadex are safe for anesthetic management during renal transplantation to address Bardet-Biedl syndrome. Conclusion: Safe anesthetic management can be achieved with the rigorous preoperative assessment of perioperative complications.
Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2010