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Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth pain intensive care 2022. [DOI: 10.35975/apic.v26i4.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objective: Corona pandemic has had profound effects on the practice of healthcare delivery across the globe. The institutional practices and protocols had to be rewritten to cope up with the surge of corona patients and to save the staff and the non-corona patients. We evaluated the emergency surgery cases during the first wave of COVID-19 after the decision to stop elective surgeries, in regard to differences in terms of case distribution, patient profile, anesthesia methods used and the management, and compared with an equivalent period before the pandemic.
Methodology: Patient files related to emergency surgery from October-November 2019 and April-May 2020, were retrospectively evaluated. Assessment parameters included age, gender, surgical discipline, ASA score, type of anesthesia, time to discharge, reoperation, laparoscopic or open surgery.
Results: The most common surgical cases in both periods belonged to general surgery. While the number of patients in ASA-I decreased during the COVID period, those in ASA-II increased. We found that while general anesthesia was preferred in majority of the surgeries during the non-COVID period, spinal anesthesia gained popularity in the COVID period (p < 0.05).
Conclusion: The decrease in the number of patients with ASA-I indicates a change in the surgeons’ priorities in emergency surgery cases. Although there is a worldwide approach to the use of laparoscopic surgery, the use of open surgical techniques increased in our hospital.
Key words: Covid-19; Pandemic, Emergency surgery
Citation: Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth. pain intensive care 2022;26(3):469-473; DOI: 10.35975/apic.v26i4.1949
Received: Sep 29, 2021; Reviewed: Jan 10, 2022; Accepted: Mar 26, 2022
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Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth pain intensive care 2022. [DOI: 10.35975/apic.v26i1.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset.
Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service.
Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p < 0.05). Significant higher mean values of hemodynamic findings in the ketofol group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p < 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05).
Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation.
Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation
Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109.
DOI: 10.35975/apic.v26i1.1775
Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021
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Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. APIC 2021. [DOI: 10.35975/apic.v25i2.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The higher incidence of comorbidities in advanced age causes difficulties in anesthesia management. When choosing the anesthesia technique in old aged patients, our target must be to avoid aggravating the existing systemic diseases and avoid disturbing the hemodynamics to ensure their rapid return to routine life. In this case report, we present our choice of infraclavicular nerve block accompanied with spinal anesthesia in a patient with advanced age and several comorbidities, who sustained multiple trauma. The surgery of the patient was successfully performed with minimal effects on the hemodynamics, and he was transferred to the clinic. We stress careful selection of the most appropriate anesthesia technique according to the existing state of the patient, and opting for appropriate nerve blocks even to the patients with respiratory problems.
Key words: Advanced age; Trauma; Spinal anesthesia; Infraclavicular block
Citation: Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. Anaesth. pain intensive care 2021;25(2):222-224. DOI: 10.35975/apic.v25i2.1475
Received: 1 December 2020, Reviewed: 7 February 2021, Accepted: 23 February 2021
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Gulec H, Piskinel Y, Sahap M, Balci CA, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. APIC 2021. [DOI: 10.35975/apic.v25i2.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Central venous cannulation through femoral veins is known to be associated with various complications. Early complications include extravasation and collection of blood, fluid, and/or contrast material in the retroperitoneal spaces or the peritoneal cavity, whereas late complications include abdominal compartment syndrome (ACS).
A 30-year-old patient was admitted to the emergency department and brought into the operating room with a preliminary diagnosis of pelvic fracture and acute abdomen. An intravenous catheter was placed into the peripheral vein and a central venous catheter in the femoral vein, in the emergency room through which blood was transfused. At the start of the operation, it was found that intraperitoneal bleeding was caused by a perforation associated with the femoral catheter.
We conclude that in the case of acute abdomen, if the femoral venous catheter was already placed in the emergency room, proper placement should be confirmed with ultrasound imaging.
Key words: Central venous catheterization; Femoral vein; Complications; Acute abdomen; Ultrasound imaging; Emergency care
Citation: Piskinel Y, Sahap M, Balci CA, Gulec H, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. Anaesth. pain intensive care 2021;25(2):203-205. DOI: 10.35975/apic.v25i2.1466
Received: 23 November 2020. Reviewed: 10 February 2021, Accepted: 1 February 2021
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Erkilic E, Gulec H, Konya ZY, Hocuk S, Aydın EU, Sahap M. Three difficult airway management strategies in the same patient at three different times. APIC 2020. [DOI: 10.35975/apic.v24i4.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Unpredictable difficult intubation is a commonly faced clinical issue and one of the most important reasons of morbidity related to anesthesia. We present a case of a 50 y old, 100 kg, 1.8 m tall (BMI=37) male patient, taken to OR (transoral robotic) for a planned biopsy because of a mass in his larynx. Videolaryngoscope was used two times but still intubation was unsuccessful.
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Turan M, Kaya S, Tas S, Bas A, Gulec H, Sahap M, Erkilic E, But A. Spinal anesthesia and infraclavicular brachial plexus block for upper extremity reconstruction requiring grafting. APIC 2020. [DOI: 10.35975/apic.v24i4.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Combined use of upper limb blocks in the same surgery with lower limb central blocks is rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in such surgeries. However, the use of ultrasound provides reliable anesthetic accumulation around the nerves, thereby reducing the need for local anesthetics, furthermore local anesthetic is used in spinal anesthesia compared to epidural anesthesia is much less.
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Gulec H, Gulec H, Ozayar E, Alkan A, Kacan M, Babayigit M, Kurtay A, Demirkale I, Horasanli E. Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty. APIC 2020. [DOI: 10.35975/apic.v24i4.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is a lack of consensus on the combination doses of local anesthetics and opioids for spinal anesthesia in patients undergoing total knee arthroplasty (TKA) surgery. Opioids and local anesthetic combinations are associated with many postoperative side effects at high doses. We aimed to assess the use of the lowest possible doses of intrathecal bupivacaine and morphine for TKA.
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Unsal G, Karaca S, Onan N, Oz YC, Aydın S, Aydöner H, Gulec H, Ongun E, Eren N. Sexual dysfunctions and treatment compliance in individuals with psychotic disorder. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionSexual dysfunctions are more common in individuals with psychotic disorders and has a major impact on both quality of life and compliance.ObjectivesThe purpose of this study is to investigate whether a relationship between sexual dysfunction and level of treatment compliance in individuals with psychotic disorders.MethodsThe sample group of the study consisted of 173 in-patients who agreed to participate were selected by random sampling method. The permission was obtained from the hospital's ethics committee. In this study, to assess the sexual functionality Golombok-Rust inventory of sexual satisfaction male and female form and to assess the treatment compliance; medical treatment compliance rate scale is used.ResultsWhen sexual problems and treatment compliance compared to gender, subscales of satisfaction (t = 4,423, P = 0.000), avoidance (t = 3.348, P = 0.001), touch (t = 2.165, P = 0.032) and overall total (t = 4.015, P = 0.000), although a statistically significant difference was found, there were no differences in treatment compliance. Aditionally, there is no relation between sexual problems and treatment compliance in men. It is also found that there is a weak negative statistical relation amongst treatment compliance and communication (r = −0.244, P = 0.027), avoidance (r = −0.270, P = 0.014), anorgasmia (r = −0.253, P = 0.022) and overall total (r = −0.249, P = 0.024) in women. According to these findings while sexual problems increase, treatment compliance decreases.ConclusionsThe level of compliance to the treatment and subscales of sexual problems; satisfaction, avoidance, and touch mean scores differ from each other. There was a weak negative correlation in between Women's compliance and sexual problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gulec H, Babayigit M, Kurtay A, Sahap M, Ulus F, Tutal Z, Horasanli E. Seizure due to multiple drugs intoxication: a case report. Braz J Anesthesiol 2016; 66:651-653. [DOI: 10.1016/j.bjane.2014.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/05/2014] [Indexed: 11/30/2022] Open
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Gulec H, Babayigit M, Kurtay A, Sahap M, Ulus F, Tutal Z, Horasanli E. Convulsão por causa de intoxicação por múltiplas drogas: relato de caso. Braz J Anesthesiol 2016. [DOI: 10.1016/j.bjan.2014.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ozayar E, Kurtay A, Gulec H, Alkan A, Bulus H, Horasanli E. Abstract PR595. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492975.02291.a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ozayar E, Kurtay A, Gulec H, Sahap M, Bulus H, Horasanli E. Bougie Effects on Endotracheal Cuff Pressure and Sore Throat in Bariatric Surgery. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Esra Ozayar
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Aysun Kurtay
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Handan Gulec
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University, Ankara, Turkey
| | - Mehmet Sahap
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Hakan Bulus
- Department of General Surgery, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Eyup Horasanli
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University, Ankara, Turkey
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Ozayar E, Gulec H, Bayraktaroglu M, Tutal ZB, Kurtay A, Babayigit M, Ozayar A, Horasanli E. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist. J Endourol 2015; 30:184-8. [PMID: 26415121 DOI: 10.1089/end.2015.0517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. PATIENTS AND METHODS Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. RESULTS SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). CONCLUSION Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.
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Affiliation(s)
- Esra Ozayar
- 1 Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital , Ankara, Turkey
| | - Handan Gulec
- 2 Department of Anesthesiology and Reanimation, Yildirim Beyazit University , Ankara, Turkey
| | - Merve Bayraktaroglu
- 1 Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital , Ankara, Turkey
| | - Zehra Baykal Tutal
- 1 Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital , Ankara, Turkey
| | - Aysun Kurtay
- 1 Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital , Ankara, Turkey
| | - Munire Babayigit
- 1 Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital , Ankara, Turkey
| | - Asim Ozayar
- 3 Department of Urology, Ankara Ataturk Training and Research Hospital , Ankara, Turkey
| | - Eyup Horasanli
- 2 Department of Anesthesiology and Reanimation, Yildirim Beyazit University , Ankara, Turkey
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Baykal Tutal Z, Gulec H, Derelı N, Babayıgıt M, Kurtay A, Inceoz H, Horasanlı E. Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients. Ir J Med Sci 2015; 185:699-704. [PMID: 26329313 DOI: 10.1007/s11845-015-1348-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/25/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS In this study, we compared duration for reaching desired Ramsay Sedation Score (RSS) and postoperative recovery according to Modified Aldrete Score (MAS) of propofol and propofol-ketamine combination in a group of colonoscopy patients. Rates of cardiovascular, respiratory, laryngospasm, visual and nausea/vomiting complications were also compared as secondary outcomes. METHODS This is a double-blinded prospective randomized controlled trial. 95 patients were included and blocked randomized to either propofol (GroupP, n: 47) or propofol-ketamine (GroupPK, n: 48). GroupP patients received 0.5 mg/kg propofol and GroupPK received 0.5 mg/kg ketamine-propofol. Subjects were monitorized noninvasively preoperatively and every 5 min during procedure. RSS was recorded for every minute before starting procedure and for every 5 min during procedure. Recovery after colonoscopy was evaluated according to MAS. Same observer checked for MAS just after procedure in postoperative 1 min and for every 3 min during follow-up. Postoperative respiratory depression was defined as rate <10/min, hypercapnia/hypercarbia-arterial CO2 tension >50 mmHg or SO2 <90 while hypotension was defined as a decrease of 20 % in mean blood pressure compared to initial values. RESULTS GroupPK patients needed shorter duration for achieving RSS ≥ 4 (p: 0.038) but longer duration for achieving MAS ≥ 9 (p: 0.005). GroupP's intraoperative blood pressures and heart rates were significantly lower compared to initial values. We observed that respiratory depression (19.1 vs 0 %, p: 0.001), hypotension (29.8 vs 10.4 %, p: 0.018), and nausea/vomiting (17 vs 4.2 %, p: 0.041) were significantly more common in GroupP. CONCLUSION Propofol-ketamine combination is an advantageous choice in means of achieving sedation in a shorter period of time, a better hemodynamic stability, less nausea and vomiting and respiratory complication rates. Yet it seems that this choice might be related with longer recovery duration.
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Affiliation(s)
- Z Baykal Tutal
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - H Gulec
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - N Derelı
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - M Babayıgıt
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - A Kurtay
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - H Inceoz
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - E Horasanlı
- Departments of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
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Sunbul M, Sunbul EA, Kanar B, Yanartas O, Aydin S, Bacak A, Gulec H, Sari I. The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea. ACTA ACUST UNITED AC 2015; 116:654-8. [DOI: 10.4149/bll_2015_125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sunbul M, Sunbul EA, Kanar B, Yanartas O, Aydin S, Bacak A, Gulec H, Sari I. Plasma oxytocin levels are reduced in Slovak autistic boys. BRATISL MED J 2015; 116:659-661. [PMID: 26621162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA. METHODS The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count. RESULTS While 130 patients (91 male, mean age: 49.9 ± 9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87 ± 0.80 vs 1.49 ± 0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %. CONCLUSIONS NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30).
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Gulec H, Sahin S, Ozayar E, Degerli S, Bercin F, Ozdemir O. [Ketamine-propofol sedation in circumcision]. Rev Bras Anestesiol 2014; 65:367-70. [PMID: 26363694 DOI: 10.1016/j.bjan.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/10/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE to compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation. METHODS 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II. RESULTS in the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p>0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p<0.050). CONCLUSION propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.
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Goktug A, Gulec H, Takmaz SA, Turkyilmaz E, Basar H. [Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin]. Rev Bras Anestesiol 2014; 65:338-42. [PMID: 26363689 DOI: 10.1016/j.bjan.2014.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/02/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Injection pain after propofol administration is common and may disturb patients' comfort. The aim of this study was to compare effectiveness of intravenous (iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand or antecubital vein on eliminating propofol injection pain. METHOD There were 147 patients and they were grouped according to the analgesic administered. Metoprolol (n=31, Group M), lidocaine (n=32, Group L) and nitroglycerin (n=29, Group N) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evaluated by 4 point scale (0 - no pain, 1 - light pain, 2 - mild pain, 3 - severe pain) in 5, 10, 15 and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathways for injection and location of operations were analyzed for their effect on total pain score. RESULTS There were no differences between the groups in terms of total pain score (p=0.981). There were no differences in terms of total pain score depending on ASA, education level, location of operation. However, lidocaine was more effective when compared with metoprolol (p=0.015) and nitroglycerin (p=0.001) among groups. Although neither lidocaine nor metoprolol had any difference on pain management when applied from antecubital or dorsal hand vein (p>0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lower pain scores (p=0.001). CONCLUSION We found lidocaine to be the most effective analgesic in decreasing propofol related pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.
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Affiliation(s)
- Asutay Goktug
- Departamento de Anestesiologia, Ankara Education and Research Hospital, Ankara, Turquia
| | - Handan Gulec
- Departamento de Anestesiologia, Kecioren Education and Research Hospital, Ankara, Turquia.
| | - Suna Akin Takmaz
- Departamento de Anestesiologia, Ankara Education and Research Hospital, Ankara, Turquia
| | - Esra Turkyilmaz
- Departamento de Anestesiologia, Zekai Tahir Burak Education and Research Hospital, Ankara, Turquia
| | - Hulya Basar
- Departamento de Anestesiologia, Ankara Education and Research Hospital, Ankara, Turquia
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Gulec H, Sahin S, Ozayar E, Degerli S, Bercin F, Ozdemir O. Ketamine-propofol sedation in circumcision. Braz J Anesthesiol 2014; 65:367-70. [PMID: 26323735 DOI: 10.1016/j.bjane.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/10/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation. METHODS 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II. RESULTS In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p>0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p<0.050). CONCLUSION Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.
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Goktug A, Gulec H, Takmaz SA, Turkyilmaz E, Basar H. Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin. Braz J Anesthesiol 2014; 65:338-42. [PMID: 26323730 DOI: 10.1016/j.bjane.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Injection pain after propofol administration is common and may disturb patients' comfort. The aim of this study was to compare effectiveness of intravenous (iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand or antecubital vein on eliminating propofol injection pain. METHOD There were 147 patients and they were grouped according to the analgesic administered. Metoprolol (n=31, Group M), lidocaine (n=32, Group L) and nitroglycerin (n=29, Group N) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evaluated by 4 point scale (0 - no pain, 1 - light pain, 2 - mild pain, 3 - severe pain) in 5, 10, 15 and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathways for injection and location of operations were analyzed for their effect on total pain score. RESULTS There were no differences between the groups in terms of total pain score (p=0.981). There were no differences in terms of total pain score depending on ASA, education level, location of operation. However, lidocaine was more effective when compared with metoprolol (p=0.015) and nitroglycerin (p=0.001) among groups. Although neither lidocaine nor metoprolol had any difference on pain management when applied from antecubital or dorsal hand vein (p>0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lower pain scores (p=0.001). CONCLUSION We found lidocaine to be the most effective analgesic in decreasing propofol related pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.
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Affiliation(s)
- Asutay Goktug
- Department of Anaesthesiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Handan Gulec
- Department of Anaesthesiology, Kecioren Education and Research Hospital, Ankara, Turkey.
| | - Suna Akin Takmaz
- Department of Anaesthesiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Esra Turkyilmaz
- Department of Anaesthesiology, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | - Hulya Basar
- Department of Anaesthesiology, Ankara Education and Research Hospital, Ankara, Turkey
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Abstract
Tricyclic antidepressant overdose is one of the most common cause of serious drug poisonings. Sometimes amitriptyline intoxication can be difficult to treat with standard treatments. At that case hemodiafiltration (HD) can be an eligible choice. We report a successful treatment of severe case using hemodiafiltration in addition to the supportive measures. Management with gastric lavage, activated charcoal, alkalinization and supportive care is the common approach and not enough for patients in deep coma. We satisfied that HD may have a beneficial role in lethal doses of amitriptyline as an additional therapy.
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Affiliation(s)
- Esra Ozayar
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
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Yagmurdur H, Gunal S, Yildiz H, Gulec H, Topkaya C. The effects of carbohydrate-rich drink on perioperative discomfort, insulin response and arterial pressure in spinal aesthesia. J Res Med Sci 2012; 16:1483-9. [PMID: 22973351 PMCID: PMC3430067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 10/14/2011] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to investigate the role of carbohydrate-rich drink (CHO) on perioperative discomfort, hemodynamic changes, and insulin response in patients undergoing surgery with spinal anesthesia. METHODS Forty-four adult patients were assigned to one of the two groups of 22, namely preparation with CHO (CHO group) or fasting from midnight (control group). Ten different discomfort variables, blood glucose and insulin concentrations, and hemodynamic changes were recorded during the perioperative period. RESULTS Preparation with CHO was effective in reducing hunger, thirst, malaise, unfitness, and, to some extent, anxiety (p < 0.05). Plasma glucose and insulin concentrations were increased in the CHO group (p < 0.05). Plasma glucose increased and insulin decreased in the control group (p < 0.05). In the control group, mean arterial pressure was lower compared to the CHO group (p < 0.05). CONCLUSIONS Preparation with CHO before spinal anesthesia is advantageous due to reducing perioperative discomfort, improving insulin response and stabilizing mean arterial pressure.
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Affiliation(s)
- Hatice Yagmurdur
- Associate Professor, Clinic of Anesthesiology and Reanimation, The Ministry of Health Ankara Research and Training Hospital, Ankara, Turkey
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Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score". Urology 2012; 80:512-8. [PMID: 22840867 DOI: 10.1016/j.urology.2012.02.072] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/17/2012] [Accepted: 02/28/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the prognostic factors associated with the treatment efficacy of retrograde intrarenal surgery (RIRS) and develop a scoring system for predicting the stone-free rate after this surgery. METHODS We performed a retrospective analysis of 207 patients who underwent RIRS for renal stones between January 2009 and September 2011. Patient age, gender, body mass index, stone size, stone side, stone location, stone composition, number of stones, lower pole infundibulopelvic angle, using anticoagulant therapy, abnormal skeletal anatomy, and abnormal renal anatomy were investigated as potential preoperative predictive factors. RESULTS The present study included 111 (53.6%) men and 96 (46.4%) women. Mean patient age was 32.9 ± 18.8 years (range 1-74) and mean stone size was 16.2 ± 4.1 mm (range 8-40). Overall, 178 of the 207 (86%) patients were stone free after the initial treatment. Univariate analysis showed that stone size (P <.001), stone location (P = .025), stone composition (P = .01), stone number (P = .049), renal malformations (P = .042), and lower pole infundibulopelvic angle (P = .003) had significant influence on the stone-free rate after RIRS. Multivariate analysis excluded stone location from the logistic regression model, whereas other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. CONCLUSION Our study demonstrated that stone size, stone number, stone composition, infundibulopelvic angle, and renal malformations are significant predictors of RIRS outcome. A scoring system based on these factors helps separate patients into outcome groups and facilitates treatment planning.
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Affiliation(s)
- Berkan Resorlu
- Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey.
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Gulec H, Akarsu S, Degerli S, Bercin F, Dereli N, Sahin S. Pulmonary edema due to mitral stenosis in pregnancy: A Case Report. Turk J Obstet Gynecol 2012. [DOI: 10.5505/tjod.2012.68553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gulec H, Degerli S, Ozayar E, Bercin F, Sahin S. Pleural effusion due to intraoperative rupture of an infected renal cyst. Korean J Anesthesiol 2012; 62:497-8. [PMID: 22679551 PMCID: PMC3366321 DOI: 10.4097/kjae.2012.62.5.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Handan Gulec
- Department of Anesthesiology and Reanimation, Kecioren Educational Research Hospital, Ankara, Turkey
| | - Semih Degerli
- Department of Anesthesiology and Reanimation, Kecioren Educational Research Hospital, Ankara, Turkey
| | - Esra Ozayar
- Department of Anesthesiology and Reanimation, Kecioren Educational Research Hospital, Ankara, Turkey
| | - Fatma Bercin
- Department of Anesthesiology and Reanimation, Kecioren Educational Research Hospital, Ankara, Turkey
| | - Saziye Sahin
- Department of Anesthesiology and Reanimation, Kecioren Educational Research Hospital, Ankara, Turkey
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Cuvas O, Gulec H, Karaaslan M, Basar H. The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine. Anaesthesia 2009; 64:14-8. [DOI: 10.1111/j.1365-2044.2008.05680.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cuvas O, Gulec H, Karaaslan M, Basar H. Spinal anaesthesia for pilonidal cyst-sinus operations in prone position: Bupivacaine versus levobupivacaine. Eur J Anaesthesiol 2008. [DOI: 10.1097/00003643-200805001-00378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Topbas M, Cakirbay H, Gulec H, Akgol E, Ak I, Can G. The prevalence of fibromyalgia in women aged 20-64 in Turkey. Scand J Rheumatol 2005; 34:140-4. [PMID: 16095011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) in women aged 20-64 in the city of Trabzon, Turkey, and to evaluate associated demographic variables. METHODS A minimum of 1825 subjects eligible for the study was calculated, and 2000 subjects were eventually planned for inclusion. Of these, 1930 subjects participated in the screening phase (a participation rate of 96.5%). The screening protocol included several interview items that have been defined as components of FMS. Subjects were also asked questions concerning demographics. Individuals with positive screening results were invited to be examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS using the 1990 American College of Rheumatology (ACR) classification criteria. RESULTS Seventy of the 1930 women were diagnosed with FMS. The prevalence of fibromyalgia was 3.6% (95% CI 2.8-4.4). The prevalence was highest in the 50-59 age group (10.1%, 95% CI 8.8-11.4), in the uneducated (10.7%, 95% CI 9.3-12.1), in the widowed (8.8%, 95% CI 7.5-10.1), and in subjects with an annual household income of < USD 2000 (7.3%, 95% CI 6.1-8.5). CONCLUSION This cross-sectional study is the first report of the prevalence of FMS in Turkey. These data will assist decision-making in the health system.
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Affiliation(s)
- M Topbas
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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