Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Awareness of Respiratory Failure Can Predict Early Postoperative Pulmonary Complications in Liver Transplant Recipients(2015) Ulubay, Gaye; Kirnap, Mahir; Dedekarginoglu, Balam Er; Kupeli, Elif; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-5826-1997; 0000-0003-2478-9985; 0000-0002-5525-8207; 26640928; AAJ-8097-2021; AAH-9198-2019; AAB-5345-2021; AAB-5064-2021; AAR-4338-2020Objectives: Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients. Materials and Methods: Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure. Results: Our study included 204 (148 men and 56 women; mean age 43.0.4 +/- 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit. Conclusions: Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.Item Anesthetic and Perioperative Management of Nontransplant Surgery in Patients After Liver Transplant(2017) Ersoy, Zeynep; Ayhan, Asude; Ozdemirkan, Aycan; Polat, Gulsah Gulsi; Zeyneloglu, Pinar; Arslan, Gulnaz; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0003-2312-9942; 0000-0002-3462-7632; 0000-0003-3299-6706; 0000-0001-8285-0372; 28260430; AAF-3066-2021; AAH-7003-2019; C-3736-2018; AAJ-8097-2021; AAJ-2066-2021Objectives: We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures. Materials and Methods: We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Baskent University Hospital. Results: The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative blood-product transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%). Conclusions: Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any post operative graft dysfunction.Item Association Between Preoperative Pulmonary Risk Scores and Postoperative Complications in Renal Transplant Recipients(2016) Kupeli, Elif; Dedekarginoglu, Balam Er; Ulubay, Gaye; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0003-2478-9985; 0000-0002-3462-7632; 27805520; AAB-5345-2021; AAB-5064-2021; AAJ-8097-2021Objectives: Patients who are being considered for renal transplant must undergo thorough preoperative pulmonary evaluation to determine risk of post operative pulmonary complications. The aim of this study was to determine the relation between the preoperative pulmonary risk factor score and pulmonary complications in patients undergoing renal transplant. Materials and Methods: Medical records of patients who underwent renal transplant at our institution between 2004 and 2015 were retrospectively reviewed. Patient demographics, smoking history, comorbidities, and preoperative pulmonary risk factors (age, oxygen saturation, hemoglobin level, type of incision, duration of surgery, history of lower respiratory tract infection 1 month before surgery, urgency of surgery), and type of pulmonary complications within 1 month after transplant were recorded. Results: Our study included 131 patients (94 male patients; mean age of 38.25 +/- 12.96 y). Of total patients, 21(16%) developed complications during the first month after transplant, with 10 of the 21 (7.6% overall) developing pulmonary complications. These complications were pleural effusion (2 patients), pneumonia (3 patients), respiratory failure (2 patients), and pulmonary embolism (1 patient). There were no deaths directly attributed to the pulmonary complications. A significant correlation was observed between the preoperative pulmonary risk factor score and postoperative pulmonary complications in renal transplant recipients (P =.003). A positive correlation between the preoperative pulmonary scores and postoperative pulmonary complications existed among life-long nonsmokers (r = 0.371; P =.003). Conclusions: Renal transplant is an established modality in treatment of chronic renal failure. Prevention of pulmonary complications is essential for successful outcomes following transplant. Health care professionals involved with renal transplant and transplant centers should be aware of preoperative pulmonary risk factors. Patients should be observed so that these risk factors can be reduced before planned transplant. Moreover, we also suggest that smoking history should be considered as a preoperative pulmonary risk factor as it was found to be a factor leading to postoperative pulmonary complications in our study.