Analgesic Efficacy of Erector Spinae Plane Block in Pediatric Abdominal Surgery: Guidance with Conventional Method and NOL: Case Series.

Background: Erector spinae plane (ESP) block is a regional anesthesia technique that blocks both somatic and visceral nerve fibers. Despite its high analgesic potential, its mechanism of action is not yet fully understood. The ultrasound-guided ESP block, which can be easily performed, makes important contributions to the control of intraoperative pain in pediatric patients undergoing abdominal surgery. The follow-up of pain in the intraoperative period is usually done by evaluating the changes in hemodynamic parameters. Due to physiological differences in pediatric patients, it is more difficult to do this with only hemodynamic changes than in adult patients. Aim: The NOL® (Nociception Level) monitor calculates the nociception/pain score by evaluating many parameters through a proprietary algorithm. Our primary aim was to demonstrate the effectiveness of ESP block with an advanced pain monitor in this patient group; our secondary aim was to investigate the necessity of pain monitors in the pediatric patient group. Methods: In this case series, we applied intraoperative NOL® monitoring in addition to standard monitoring (ECG, SpO2, heart rate, EtCO2) in pediatric patients (16 cases) who were scheduled for abdominal surgery and underwent ESP block. Results: Considering the hemodynamic data, NOL values, postoperative pain scores, side effects, and complications, it was concluded that ESP block can be used safely in this patient group. Although the hemodynamic data and the NOL® index were compatible with each other after a nociceptive stimulus, the NOL index was less affected by other variables and gave the clinician clearer information about pain.

Assessment of pulp volume changes after surgically assisted rapid palatal expansion.

Maxillary transverse deficiency is a common skeletal problem. When the patient is younger, it is treated by rapid palatal expansion by using orthodontic appliances. If this fails or the patient is older, which means skeletal growth is completed, surgically aided rapid palatal expansion (SARPE) becomes necessary. In this technique, after the osteotomies have been made, the two maxillary bones are distracted by tooth-borne device. Since a tooth-borne device will apply the distraction forces on the teeth, the pulp volumes may change. Our aim was to investigate the volume changes of the tooth pulps after SARPE in which a tooth-borne device was used. We scanned our database and included 20 patients (7 males and 13 females) aging between 16 and 30 (mean 19.5±3.97) to this retrospective study. All the patients had undergone SARPE surgeries and they had pre-surgery and postconsolidation cone beam computerized tomography (CBCT) images. All the surgeries had been done in similar ways; all the patients had used similar tooth-borne modified acrylic bonded expansion device. We divided the maxillary teeth into three groups: the incisors, the premolars and the molars. We imported the CBCT images of each patient into 3D Slicer software. We calculated volumes of pulps for all maxillary teeth. We compared volumes with paired t test. Statistical significance level was accepted as P< .05. The devices had been left in place between 83 and 179 days including distraction and consolidation periods (mean 121.35±27.83 days). Amount of the expansions varied between 6.03mm and 11.16mm (mean 7.19±1.18mm). We found a statistically significant decrease of the pulp volumes in incisor, premolar and molar teeth (P<.001) between pre-surgery and postconsolidation periods. When using tooth-borne devices in SARPE, their impacts on teeth pulps should also be considered.

Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety?

BACKGROUND: The aim of this prospective clinical study was to investigate the effectiveness of binaural beats and music at a frequency of 432 Hz and compare which method is more effective for reducing preoperative dental anxiety in impacted third molar surgery. MATERIAL AND METHODS: Ninety patients were randomly selected to the binaural beats group, music group and control group. Visual analog scale used to evaluate dental anxiety before the local anesthesia in the first measurement. Local anesthesia was applied to the all patients. Patients in the music group listened to 432 Hz tuned music using earphones for 10 minutes. Patients in the binaural beats group listened to binaural beats using earphones (for the right ear, 220 Hz and for the left ear 210 Hz) for 10 minutes. No special treatment was applied to the patients in control group. In the second measurement, dental anxiety was measured again in all three groups. For analysis of differences between three groups was used One way Anova and Kruskal Wallis test. RESULTS: Twenty seven male and 53 female patients included the study. In the first measurement, the same level of anxiety was recorded in all three groups. (p=0.811) There was a significant decrease in anxiety in both the binaural beats and music group in the second measurement. (p<0.001). CONCLUSIONS: Binaural beats and 432 Hz tuned music are a valid non pharmacological adjuvant to reduce dental anxiety in impacted third molar surgery. They have a positive effect to reduce the dental anxiety.

Aborted donor hepatectomy in living donor liver transplantation: lessons learned.

BACKGROUND: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. METHODS: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. RESULTS: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. CONCLUSIONS: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.

Are YouTube videos related to dental implant useful for patient education?

PURPOSE: The aim of the research was to assess the quality of obtained information from YouTube videos related to dental implant. MATERIALS AND METHODS: "Dental implant" word was used as a key word in YouTube videos in this study. Videos were evaluated by three oral and maxillofacial surgeons. The first 150 videos were screened. After exclusion criterias, seventy-four videos were investigated regard to content's usefulness. The usefulness scores of the videos were poor (0), moderate (1) and excellent (2). Upload sources were recorded that were categorized as the individual users, health care professionals, and health companies. The type of videos was classified 3 sections: educational videos, patient's experience, and scientifically erroneous. We examined videos for the content presence in eight non-mutually exclusive domains of dental implant. RESULTS: Seventy-four videos were evaluated. The usefulness score of the videos ranged from 0-2 and the average was 0.324. The most discussed topics were regarding with procedures of dental implant (42.57%), however, the least one was related to contraindications (1%). No significant correlation was found between the source of upload and video usefulness score (P=0.086). There was a significant difference between number of comments and the video types. (P=0.002). CONCLUSION: Our outcome emphasized that YouTube videos related to dental implant were a limited source for the patients. Many issues regarding dental implant were ignored in these videos.

Comparison of two different flap designs for bilateral impacted mandibular third molar surgery.

OBJECTIVE: We compared the effect of lingual-based triangular flap with buccal-based triangular flap on postoperative complications in impacted third molar surgery. MATERIAL AND METHODS: Thirty patients aged between 18 and 36 (mean age 19.65±2.14) were included. They all had bilateral impacted third molars. We used buccal-based triangular flap on a randomly selected side (Group 1) and lingual-based triangular flap on the other side (Group 2). We evaluated pain during 7 days after the surgery; swelling and trismus on postoperative 2., 7. and 14. days; wound dehiscence and alveolar osteitis incidence on postoperative 7. and 14. days. RESULTS: Pain was significantly higher in Group 2 during 7 days postoperatively (P<.05). Trismus and swelling were also more prominent in Group 2 on postoperative days 2 and 7. In Group 2, the duration of the surgery in was longer than Group 1 (P<.05). In Group 1, 17 patients (56.7%) had wound dehiscence and 6 patients (20%) in Group 2 (P<.05). No alveolar osteitis developed in either groups. CONCLUSION: The buccal-based triangular flap seems better with regard to postoperative pain, swelling and trismus. On the other hand, the lingual-based triangular flap had a lesser incidence for wound dehiscence.

Effects of recurrent sevoflurane anesthesia on cognitive functions with streptozotocin induced Alzheimer disease.

OBJECTIVE: We aimed to investigate the effects of recurrent sevoflurane anesthesia on cognitive functions in Alzheimer Disease. MATERIALS AND METHODS: Rats were divided into 4 groups as followed: control (Group C), sevoflurane (Group S), Alzheimer's (Group A) and Alzheimer's + sevoflurane (Group AS)]. Cognitive functions were evaluated with Radial Arm Maze Test (RAMT). Alzheimer model was created by administering 3 mg/kg (10 µl) STZ. Sevoflurane was administered to S and AS groups. Serum samples and hippocampus tissues were analyzed. RESULTS: In RAM test, the entry-exit data were significantly decreased in A and AS groups. After the 2nd and 3rd administration of anesthesia, the numbers were significantly decreased in Group S. Glial-fibrillary-acidic protein levels were significantly higher in AS compared to the C and S groups. The brain tissue caspase 3 activity was less than 1% in all rats in the Group C, 3 % in 2 rats and 1 % in 1 rat in the Group AS. In A and AS group, serum catalase, myeloperoxidase and ferroxidase activities were found to be higher than in the other groups and myeloperoxidase activity was higher in the AS than in the A Group. Serum native thiol, total thiol and disulfide levels were found to be significantly different in the A and AS groups. CONCLUSION: Sevoflurane anesthesia negatively affected the cognitive functions (Tab. 5, Fig. 10, Ref. 51).

Is there any relationship between clinical parameters and histopathologic features of gallbladder specimens obtained from living liver donors?

OBJECTIVE: To investigate whether there is any relationship between the clinical parameters and the histopathological features of the gallbladder (GB) specimens obtained from living liver donors (LLDs). METHODS: The demographic (age, sex, height, weight, and BMI), clinical (liver graft type, liver graft weight, and GB volume), microbiological (bile culture), and histopathological (width, length, wall thickness, and microscopic properties of the GB specimen) data of 169 LLDs, who underwent living donor hepatectomy between October 2015 and October 2017, were prospectively recorded and retrospectively analyzed. The LLDs were compared with respect to sex (male vs. female) and the histopathological features of the GB (normal structure vs. chronic cholecystitis vs. cholesterolosis/polyps/cholelithiasis). RESULTS: There were no significant differences between both sexes with respect to age, graft type, and some features of GB (volume, wall thickness, width, length, and bile culture). On one hand, there were significant differences between both sexes with regard to height (P < 0.001), weight (P < 0.001), BMI (P < 0.001), histopathological findings (P = 0.003), and graft size (P = 0.003). Comparison with regard to GB's histopathological features revealed no significant differences between the three groups with respect to age, weight, and some features of GB (volume, length, width, and bile culture). On the other hand, the three groups were significantly different in terms of sex (P = 0.003), height (P = 0.008), BMI (P = 0.002), and wall thickness (P = 0.044). Bile culture proliferation occurred in none of the patients except for one patient. CONCLUSION: This study is the first to assess GB's volume, dimensions, and bile culture in healthy individuals such as LLDs.

Non-HACEK Gram-negative bacillus endocarditis.

PATIENTS AND METHODS: Retrospective analysis of clinical data using 26 diagnosed non-HACEK Gram-negative infective endocarditis cases from nine hospitals in Turkey. RESULTS: Mean age of patients was 53 (28-84) years, with a 23% case fatality. Nineteen (73%) of the 26 patients had at least one predisposing factor. The presence of a central venous catheter was the most common predisposing factor (7/26 patients). Pseudomonasaeruginosa (7/26 patients) and Escherichiacoli (7/26 patients) were the most common pathogens. The median duration of the antibiotic therapy was 42 days (range 3-84 days). Surgical procedures were performed in 10 patients. The case fatality was similar in patients who did or did not undergo surgery (20% vs. 25%).

The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study

Background: Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction. Material and Methods: This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured. Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia. Results: None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05). Conclusions: As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually

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The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study.

BACKGROUND: Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction. MATERIAL AND METHODS: This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured. Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia. RESULTS: None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05). CONCLUSIONS: As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually.

Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum following Endoscopic Retrograde Cholangiopancreatography in a Living Liver Donor.

Despite having many advantages, living donor liver transplantation has not been adopted by western countries due to risk of nearly life-threatening complications after living donor hepatectomy (LDH). Herein, we aimed at presenting the management of a 19-year-old patient who suffered life-threatening complications after right lobe LDH. A multiple detector computed tomography (MDCT) revealed a bilioma at the cut surface of the remnant liver, for which a transhepatic drainage catheter was placed. Endoscopic retrograde cholangiopancreatography (ERCP) performed to decompress biliary tract, but the biliary tract could not be cannulized due to post-precut bleeding. On the next day, extensive crepitation was detected and MDCT showed subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum (ERCP-related duodenal perforation?). However, the patient showed significant deterioration of physical examination findings, fever, and infectious parameters, and therefore was taken to the operating room. Kocher maneuver revealed no apparent duodenal perforation. Then, a 2-mm bile duct was found open at the caudate lobe, through which bile leaked. Then, common bile duct exploration and T-tube placement were performed, followed by suture closure of the bile orifice at the caudate lobe. Massive air previously identified completely disappeared one week after the operation.

Neutrophil lymphocyte ratio predicts postoperative pain after orthognathic surgery.

BACKGROUND AND AIM: Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery. MATERIALS AND METHODS: We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam - as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters. RESULTS: Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ2 = 4.779, P = 0.029). CONCLUSIONS: Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.

Effectiveness of binaural beats in reducing preoperative dental anxiety.

Binaural beats are an auditory illusion perceived when two different pure-tone sine waves are presented one to each ear at a steady intensity and frequency. We evaluated their effectiveness in reducing preoperative anxiety in dentistry. Sixty patients (30 in each group) who were to have impacted third molars removed were studied (experimental group: 20 women and 10 men, mean (range) age 24 (18-35) years, and control group: 22 women and 8 men, mean (range) age 28 (15-47) years). All patients were fully informed about the operation preoperatively, and their anxiety recorded on a visual analogue scale (VAS). The local anaesthetic was given and the patients waited for 10minutes, during which those in the experimental group were asked to listen to binaural beats through stereo earphones (200Hz for the left ear and 209.3Hz for the right ear). No special treatment was given to the control group. In both groups anxiety was then recorded again, and the tooth removed in the usual way. The paired t test and t test were used to assess the significance of differences between groups. The degree of anxiety in the control group was unchanged after the second measurement (p=0.625), while that in the experimental group showed a significant reduction in anxiety (p=0.001). We conclude that binaural beats may be useful in reducing preoperative anxiety in dentistry.

Which maternal personality traits affect child behaviour during dental treatment.

AIM: Maternal personality traits affect child dental behaviour and have a potential link with dental treatment methods. This study aims to evaluate which maternal personality traits affect child dental behaviour. MATERIALS AND METHODS: Research was carried out upon 60 children aged between 3-12 years, who had been admitted to our clinic for tooth extraction. All children were evaluated by means of the Frankl Behavior Scale (FBS): degrees I and II represent negative behaviours, while III and IV positive behaviour. Thirty children with FBS degree III and IV were assigned to Group I and 30 children with FBS degree I and II were assigned to Group II. Children in Group I underwent tooth extraction with local anaesthesia. Children in Group II underwent tooth extraction under deep sedation. During the first visit, the mothers were tested with the Minnesota Multiphasic Personality Inventory to evaluate personality traits. All mothers in Group I and half the mothers in Group II filled a complete and valid test. RESULTS: Group I and II mothers were compared according to the test results: scores of the Minnesota Multiphasic Personality Inventory (MMPI) test were significantly higher in Group II (p<0.05). CONCLUSION: We hypotetise that character features of mothers of children with negative dental behaviour and positive dental behaviour are different and affect child dental behaviour.

Retained Foreign Body in Transplanted Liver.

Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.

Rapid Detection of Bloodstream Pathogens in Liver Transplantation Patients With FilmArray Multiplex Polymerase Chain Reaction Assays: Comparison With Conventional Methods.

BACKGROUND: Bloodstream infection (BSI) is an important concern in transplant patients. Early intervention with appropriate antimicrobial therapy is critical to better clinical outcome; however, there is significant delay when conventional identification methods are used. METHODS: We aimed to determine the diagnostic performance of the FilmArray Blood Culture Identification Panel, a recently approved multiplex polymerase chain reaction assay detecting 24 BSI pathogens and 3 resistance genes, in comparison with the performances of conventional identification methods in liver transplant (LT) patients. A total of 52 defined sepsis episodes (signal-positive by blood culture systems) from 45 LT patients were prospectively studied. RESULTS: The FilmArray successfully identified 37 of 39 (94.8%) bacterial and 3 of 3 (100%) yeast pathogens in a total of 42 samples with microbial growth, failing to detect only 2 of 39 (5.1%) bacterial pathogens that were not covered by the test panel. The FilmArray could also detect additional pathogens in 3 samples that had been reported as having monomicrobial growth, and it could detect Acinetobacter baumannii in 2 samples suspected of skin flora contamination. The remaining 8 blood cultures showing a positive signal but yielding no growth were also negative by this assay. Results of MecA, KPC, and VanA/B gene detection were in high accordance. The FilmArray produced results with significantly shorter turnaround times (1.33 versus 36.2, 23.6, and 19.5 h; P < .05) than standard identification methods, Vitek II, and Vitek MS, respectively. CONCLUSIONS: This study showed that the FilmArray appeared as a reliable alternative diagnostic method with the potential to mitigate problems with protracted diagnosis of the BSI pathogens in LT patients.

Effects of different positive end-expiratory pressure values on liver function and indocyanine green clearance test in liver transplantation donors: a prospective, randomized, double-blind study.

INTRODUCTION: The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients. METHODS: ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy. RESULTS: The positive end-expiratory pressure (PEEP) was 0 cm H20 in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P < .05). CONCLUSIONS: Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.