Acute renal failure is one of the major complications seen after cardiovascular surgery and frequently has a high morbidity and mortality risks. Depending on the criteria determining the complications, risk of acute renal failure after cardiovasculer surgery is changing between 5-31 %, besides the incidence  of acute renal failure requiring dialysis is 1 %. Recently acute renal failure is referred to acute renal injury. In this review the subjects such as acute renal failure, RIFLE classification, causes, diagnostic methods and early stage markers for acute renal failure will be discussed generally. Especially causes of acute renal failure seen after cardiovasculer surgery, risk evaluation, treatment methods, usage of  markers and pharmacological approaches to prevent the development of acute renal failure will also be discussed by giving references to the studies on these subjects in the literature.

Key words: acute renal failure, acute kidney injury, RIFLE classification

Abdullah DEMİRHAN *, Rauf GÜL **, Süleyman GANİDAĞLI **, Senem KORUK **,
Ayşe MIZRAK **, Maruf ŞANLI ***, Ünsal ÖNER **

In this case we present the importance of triple cerebral monitorization and our experiences in a highly-risky patient’s aortic arc surgery.

A male patient with a  Marfan syndrome had been operated for type 1 aortic dissection in 1999 and again  for aortic aneurysm in 2006. Aortic arcus surgery was planned in elective conditions. Besides routine monitorization, cerebral cortical synaptic activity changes were monitored by electroencephalography and 95 % spectral edge frequency values, cerebral oxygen saturation were measured with near-infrared spectroscopy and flow velocity of middle cerebral artery was measured by transcranial Doppler ultrasound system. During deep hypothermic circulatory arrest (18°C), antegrade selective cerebral perfusion was performed at 700 mL min-1. During selective cerebral perfusion, right and left spectral edge frequency values were 0 to 2, right and left cerebral oxygen saturations were between 72 to 80 %, and middle cerebral arterial blood flow velocities were between 10 to 23 cm sec-1. The patient was extubated at postoperative 22. hour and discharged from intensive care unit at postoperative third day.

We think that we provided the maximum patient safety for our highly risky patient who was predicted to endure prolonged selective cerebral perfusion during lower  cerebral oxygenation by ensuring adequate cerebral oxygenation and perfusion by using triple cerebral monitorization during selective cerebral perfusion.

Key words: aortic arc surgery, cerebral protection, deep hipotermic arrest

Mediastinoscopy is an important surgical method for the assessment of the mediastinal pathologies and grading of the lung cancers. In this case report, we aimed to present right pulmonary artery bleeding  during anterior cervical mediastinoscopy and its anesthetic management in the light of the literature.

Key words: mediastinoscopy, bleeding, right pulmonary artery, anesthesia