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    Anesthetic management in Conn Seyndrome: Case report
    (Anestezi Dergisi, 2015) Altinişik, U?ur; Altinişik, Hatice Betül; Do?u, Tugba; Aydin, Halide; Erbaş, Mesut
    Objective: Primary hyperaldesteronism (Conn Syndrome) is a disease with characteristics that affect aspects of anesthesia. We present this Conn Syndrome case, with attacks of hypertension, late diagnosis and surrenalectomy planned, to draw attention to anesthetic management. Case Report: A 41-year old male monitored by the endocrinology service for Conn Syndrome applied to the anesthetic clinic with planned laparoscopic surrenalectomy. The case had fatigue and muscle weakness. He first had a hypertensive attack in 2002, however diagnosis wasnt made. The case was using aldactazide, olmesartan and lercanidipine. Examination showed no extra pathology. Preoperative KCl infusion was recommended. On operation; blood pressure (BP): 185/115 mmHg, K: 4.2 mmol L-1 and glucose:133 mg dL-1. Midazolam used for premedication. For induction 1 mg kg-1 fentanyl, 2 mg kg-1 propofol, 05 mg kg-1 lidocaine, and 0.6 mg kg-1 rocuronium were administered while 50%O2 %50 air mixture with additional 6%desflurane was used. Arterial catheterization was done. When BP was above 160/100 mmHg, 0.15 mg kg-1 h-1 remifentanil was started. Slight metabolic alkalosis was identified on blood gas check. The frequance and tidal volume were reduced using the mechanical ventilator. During the rest of the operation hemodynamics, blood gas, potassium and glucose values remained stable. The case woke without incident and was sent to the ward. Conclusion: Anesthesia in Conn Syndrome; hypertension, hypervolemia, hypokalemia and metabolic alkalosis may be observed; appropriate preoperative anti-hypertensive treatment and potassium replacement is extremely important. Additionally blood pressure, potassium and blood gas values require frequent monitoring. Also we believe that patients with advanced age require careful evaluation for increased insulin resistance and heart and renal failure linked to fibrosis.
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    Clinical Characteristics of Patients Diagnosed with Synthetic Cannabinoid (Bonsai) Intoxication in Intensive Care Unit
    (Galenos Yayincilik, 2015) Altinisik, Ugur; Altinisik, Hatice Betul; Simsek, Tuncer; Dogu, Tugba; Simsek, Esen; Aydin, Halide
    Objective: In recent years, synthetic cannabinoids (bonsai) poisoning is a widely seen case that needs to be treated in intensive care unit (ICU) in our country. In this study, it was aimed to discuss the clinical characteristics of patients diagnosed with synthetic cannabinoid intoxication followed in ICU. Material and Method: Patients followed in ICU of Canakkale Onsekiz Mart University and Canakkale State Hospital between 2014 and 2015 were studied retrospectively. Results: Twelve cases were included. In neurological system; confusions (n=4), drowsiness (n=7), restlessness/agitations (n=5), hallucinations (n=2), anxieties/panics (n=3), acute psychosis (n=1) and amnesias (n=11) were detected. One patient was intubated. In cardiovascular system; tachycardias (n=3), bradycardias (n=2), hypertensions (n=2), hypotension (n=1), and arrhythmias (n=2) were observed. In laboratory tests, leukocytosis (n=4), leukopenia (n=1), hypoglycemias (n=3), elevation in liver and renal function tests (n=1) were identified. The average recovery time was 19.3-hours and the average ICU stay was 3-days. Conclusion: In the synthetic cannabinoid intoxication cases; it should be kept in mind that seizure activities may occur in the first hours, myocardial infarction risk in the first 3-days. Liver-kidney functions should be monitored. Hypopotasemia is the most common electrolyte disorder. Cases without any complication are expected to recover in 24-hours. However, new types of synthetic cannabinoids are put on the market every day.
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    Effects of Inadvertent Perioperative Hypothermia on Metabolic and Inflammatory Mediators
    (Aves, 2019) Aydin, Halide; Simsek, Tuncer; Demiraran, Yavuz
    Objective: The aim of the present study was to investigate the effects of perioperative undesirable hypothermia on inflammatory (interleukin (IL)-8, IL-10, IL-18, IL-23 and pentraxin (PTX)-3) and metabolic responses (cortisol and insulin) and recovery time. Methods: A total of 60 patients between the ages of 18 and 65 years who were in the lumbar stabilisation operation were included in the study. In this prospective, randomised controlled study, two groups were constituted as with warmed (Group N) and not warmed (Group C) patients before and during the operation. Diuresis, blood loss, body temperature and side effects were recorded with IL-8, IL-10, IL-18, IL-23, PTX-3, cortisol and insulin levels. Results: Perioperative diuresis was significantly higher in Group C. Aldrete score was significantly higher in Group N with less shivering and vomiting in the postoperative period. IL-10, PTX-3 and cortisol levels were found to be significantly higher in Group C in the first postoperative hour. PTX-3 and cortisol were found to be significantly higher in Group C after 24 h of the operation. Insulin was significantly higher in Group N. In 72 h, IL-8 in Group N and cortisol level in Group C were significantly higher. Conclusion: Positive effects of heating the patients in the perioperative period on haemorrhage, diuresis, complications and recovery time were observed in our study. In addition, maintenance of normothermia appeared to modulate the biomarkers that indicate the inflammatory and metabolic responses.