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    Brain death: Our experiences in intensive care unit
    (2019) Yesiler, Fatma Irem; Kosovali, Behiye Deniz; Bayar, Mustafa Kemal
    Aim: The aim of this study was to examine patients retrospectively with brain death (BD) who were diagnosed in our intensive care unit (ICU). Material and Methods: This retrospective descriptive study evaluated 24 patients with diagnosed BD in the ICU between January 2012 and December 2015 using digital patient records. We registered demographic, clinical and laboratory findings, Acute Physiology and Chronic Health Evaluation System (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Score (GCS), development of complications, donation rate, time of BD diagnosis and length of ICU stay. Results: Twenty-four patients (11 males, 13 females) with BD whose ages were between 24–83 years old. The etiologies of BD diagnosis were medical causes in 20 cases (83.3 %) and traumatic causes in 4 cases (16.7 %). Subarachnoid haemorrhage due to a cranial aneurysm was the most common cause of ICU admission (n = 6). The mean APACHE II score was 16 ± 5.2, GCS was 4.25 ± 2.5, and the SOFA score was 8.4 ± 3.5 on ICU admission. The mean time of BD diagnosis was 147.8 ± 19 hours and the mean length of ICU stay was 8.8 ± 7.7 days. Confirmatory tests (cranial angiography, cranial Doppler, cranial CT angiography) were performed on 16 patients. The acceptance rate for organ donation was 45.8% (n = 11). Conclusion: The intensivist should target to both confirm and declare the diagnosis of BD in the shortest time and increase the number of organs transplanted per donor.
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    Perioperative High-Dose Amiodarone Elevates Nitric Oxide Levels in Patients Undergoing Coronary Artery Bypass Surgery.
    (Allied Acad, 2013) Uysal, Ayhan; Azak, Soner; Colak, M. Cengiz; Burma, Oktay; Ozguler, I. Murat; Ustundag, Bilal; Bayar, Mustafa Kemal
    The aim of the current study was to assess the effects of the Class III antiarrhythmic drug amiodarone on arterial blood Nitric oxide (NO) levels together with malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-px), and catalase (CAT) levels in patients undergoing coronary artery bypass surgery (CABG). Twenty patients undergoing CABG were included in the study. The patients were divided into control and amiodarone groups (n=10 in each group). The patients in group 1 did not receive any drugs. The patients in group II received 4X400 mg/day amiodarone on the day before surgery, 2X600 mg/day amiodarone on the day of surgery, and 2X400 mg/day amiodarone for the first consecutive four days after the surgery. NO, MDA, SOD, GSH-px, and CAT values were measured for biochemical evaluation of oxidative stress before the induction of anesthesia (T-A), before CPB (T-CPB), five minutes after the clamp was removed (T-c), after protamine (T-P), and on postoperative days 1 (T-1), 3 (T-3), and 5 (T-5). Hemodynamic changes of all patients were recorded at before the induction of anesthesia (TA), before CPB (TCPB), after protamine (T-P), and on postoperative day 1 (T1). Amiodarone elevated NO levels at all times during the study period but did not cause changes in MDA, SOD, GSH-px, or CAT. In addition, amiodarone decreased mean pulmonary artery pressure, pulmonary capillary wedge pressure, and heart rate in these patients. No side effect due to drug was observed. Heart rate was found more decreased in amiodarone group at T-1 and T-2 stages when compared with controls (p<0.05). Perioperative high- dose amiodarone might be beneficial for patients who are pulmonary hypertensive and are undergoing CABG.