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Kiziltepe U, Ince I, Senkal M, Surer S, Duvan I, Ersoy O, Delibalta O, Mavi O, Sahin E. Total aortic arch replacement without deep hypothermic circulatory arrest in type A aortic dissection: Left axillar artery for arterial cannulation. JTCVS Tech 2023; 22:120-131. [PMID: 38152213 PMCID: PMC10750496 DOI: 10.1016/j.xjtc.2023.08.020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Total aortic arch replacement (TAR) necessitates hypothermic circulatory arrest (CA). The frozen elephant trunk technique (FET) additionally requires commercial hybrid grafts. Herein we describe a novel modified FET technique without CA using standard grafts thanks to left axillary artery (LAxA) cannulation in patients with acute type A aortic dissection. Methods LAxA anastomosis is made first using a homemade debranching graft, and cardiopulmonary bypass is initiated, followed by anastomoses of left common carotid and innominate arteries. The rest of the operation is performed with complete cerebral perfusion. Following replacement of ascending aorta/root, cardiac reperfusion is started using a root cannula which continues throughout the procedure. Distal arch anastomosis is performed clamp-on, allowing lower body perfusion via left subclavian artery. Lower body perfusion is interrupted for 5 to 8 minutes to deploy an endograft to complete a modified FET. Following cannulation of distal arch graft, perfusion of distal aorta is restarted, and all three grafts are incorporated to construct a neo-ascending aorta and arch. Results Between December 2018 and May 2022, 38 patients underwent TAR without operative mortality. Hospital mortality was %15.7, and spinal cord ischemia and stroke were not encountered in surviving patients. The mean lower body CA time was 7.2 ± 2.8 minutes. Conclusions TAR using standard endografts without CA is possible with LAxA cannulation. To perform a FET, only a short interruption of lower body circulation is sufficient to deploy an endograft, also improving hemostasis of distal anastomosis. Further studies are required with a higher number of patients to evaluate the efficiency of this novel technique.
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Affiliation(s)
- Ugursay Kiziltepe
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ilker Ince
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Melike Senkal
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Suleyman Surer
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Duvan
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ozgur Ersoy
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Omer Delibalta
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Osman Mavi
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Elif Sahin
- Department of Cardiovascular Surgery, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Karakaya MA, Darcin K, Ince I, Yenigun Y, Kasali K, Dostbil A. Evaluation of brachial plexus stiffness in different arm and head positions by sonoelastography. Medicine (Baltimore) 2023; 102:e35559. [PMID: 37832128 PMCID: PMC10578761 DOI: 10.1097/md.0000000000035559] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Intraoperative positioning-related nerve injuries, particularly those affecting the brachial plexus, are concerning complications believed to arise from stretching and/or compression of peripheral nerves. Although sonoelastography, a new ultrasound technology, is emerging as a valuable tool in the musculoskeletal system, its utility in evaluating peripheral nerves remains unclear. This study aimed to utilize sonoelastography to assess the brachial plexus during surgery, specifically investigating changes in its stiffness values in relation to different head and arm positions. In this prospective cohort study, bilateral brachial plexuses of 8 volunteers in 3 different positions were enrolled. Using a high-frequency linear probe, the stiffness of the brachial plexus was quantitatively measured in kilopascals (kPa) under 3 different positions: neutral, head rotated, and head rotated with arm hyperabducted. Intra-class agreement was evaluated. The stiffness of the brachial plexus was 7.39 kPa in the neutral position (NP), 10.28 kPa with head rotation, and 17.24 kPa when the head was turned, and the ipsilateral arm was hyperabducted. Significant increases were observed in stiffness values when the head was turned, whether ipsilaterally or contralaterally, and during hyperabduction of the arm while the head was turned (for all P < .001). Strong intra-class correlations were found for the measurements of stiffness values (ICC = 0.988-0.989; P < .001; Cronbach Alpha = 0.987-0.989). Sonoelastography revealed significant increases in the stiffness of the brachial plexus with various head rotations and arm positions compared to the neutral state. These findings suggest that sonoelastography could potentially serve as a valuable tool for assessing the risk of brachial plexus injury during surgery and for guiding optimal patient positioning. Further research with larger sample sizes is needed to establish definitive clinical applications.
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Affiliation(s)
| | - Kamil Darcin
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Ilker Ince
- Department of Anesthesiology and Perioperative Medicine, Penn State University, Milton S Hershey Medical Center, Pennsylvania, USA
| | - Yilmaz Yenigun
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Kamber Kasali
- Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University Hospital, Erzurum, Turkey
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3
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Kiziltepe U, Ince I, Senkal M, Surer S, Duvan I, Ersoy O, Seren M, Delibalta O, Mavi O, Sahin E. Total Aortic Arch Replacement without Total Circulatory Arrest and Deep Hypothermia: A New Modification of Frozen Elephant Trunk Technique Using Left Axillar Artery for Arterial Cannulation. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2023.01.173] [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: 03/18/2023]
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Dostbil A, Ince I, Altinpulluk EY, Perez MF, Peksoz U, Cimilli G, Kasali K, Atalay C, Ozmen O, Sahin T, Yilmaz EP. Analgesic effect of erector spinae plane block after cesarean section: A randomized controlled trial. Niger J Clin Pract 2023; 26:153-161. [PMID: 36876603 DOI: 10.4103/njcp.njcp_1636_21] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section. Aim We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia. Patients and Methods Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively. Results The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 μg vs. 423.08 ± 212.55 μg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively). Conclusion Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.
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Affiliation(s)
- A Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - I Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA, Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain
| | - E Y Altinpulluk
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA; Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain; Department of Anaesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - M F Perez
- Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School; Department of Anesthesia, Hospital Universitario de Móstoles, Madrid, Spain
| | - U Peksoz
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - G Cimilli
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - K Kasali
- Anesthesiology Clinical Research Office, Ataturk University; Department of Biostatistics, Ataturk University School of Medicine, Erzurum, Turkey
| | - C Atalay
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - O Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - T Sahin
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - E P Yilmaz
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
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Dagasan Cetin G, Dostbil A, Aksoy M, Kasali K, Ince R, Kahramanlar AA, Atalay C, Topdagi Yilmaz EP, Ince I, Ozkal MS. Intraperitoneal instillation versus wound infiltration for postoperative pain relief after cesarean delivery: A prospective, randomized, double-blind, placebo-controlled trial. J Obstet Gynaecol Res 2023; 49:209-219. [PMID: 36270632 DOI: 10.1111/jog.15469] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/19/2023]
Abstract
AIM To compare local anesthetic wound infiltration with intraperitoneal instillation of local anesthetic for analgesia after cesarean section under spinal anesthesia. METHODS This study was conducted on 150 pregnant women undergoing elective cesarean section under spinal anesthesia. Spinal anesthesia was performed with 7 mg isobaric bupivacaine and 15 μcg fentanyl. The patients were randomized into three groups of 50 patients each: Group local anesthetic wound infiltration (LWI): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was administered subcutaneous wound infiltration at the end of surgery prior to skin closure and 20 ml saline was instilled into the uterine peritoneal area before fascia closure. Group intraperitoneal local anesthetic (IPLA): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was instilled into the uterine peritoneal area and 20 ml saline was administered subcutaneous wound infiltration. Group Placebo: 20 ml saline was instilled into the uterine peritoneal area and 20 ml saline was administered local subcutaneous wound infiltration. Pain scores at rest and on movement, total fentanyl consumption at 24 h, maternal satisfaction, and the time to first analgesic request were recorded. RESULTS No statistically significant difference was observed in the postoperative pain scores at rest at 2, 12, and 24 h (p = 0.314, 0.343, and 0.735, respectively) and on movement at 12 and 24 h (p = 0.318 and 0.642, respectively) between the groups. The pain scores on movement at 2 h were significantly lower in Group IPLA compared with Group Placebo (p = 0.047). There were no significant differences between the groups in terms of total fentanyl consumption and the time to first analgesic request. CONCLUSION The use of intraperitoneal instillation of bupivacaine and lidocaine reduces early the pain score on movement in women undergoing cesarean section under spinal anesthesia.
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Affiliation(s)
- Gozdenur Dagasan Cetin
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Kamber Kasali
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ramazan Ince
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Agah Abdullah Kahramanlar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Canan Atalay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Emsal Pınar Topdagi Yilmaz
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Obstetrics and Gynecology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ilker Ince
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, Altınbas University, İstanbul, Turkey
| | - Mırac Selcen Ozkal
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Kar M, Ince I, Yildirim C, Burukoğlu Dönmez D, Karasulu Y, Cingi C. Development of an intranasal formulation containing indomethacin and xylometazoline for rhinosinusitis treatment. Eur Rev Med Pharmacol Sci 2022; 26:65-71. [PMID: 36524913 DOI: 10.26355/eurrev_202212_30486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Use of the nasal route of drug administration dates back many years and is used both to achieve topical treatments and to allow systemic absorption. The objective was to develop a formulation with novel features which enhance prolonged contact with the nasal and sinusal lining, since this should increase any therapeutic benefit. The anti-inflammatory drug selected was indomethacin, which was combined with xylometazoline, an effective nasal decongestant agent. MATERIALS AND METHODS 28 Sprague-Dawley rats were used. They were then allocated at random to one of the four groups of equal size. All rats received a nasal application of 50mL of the platelet-activating factor solution at a concentration of 16 µg/mL and had induced rhinosinusitis. Indomethacin or xylometazoline HCl or both were dissolved in the oily phase of the solution and then a magnetic stirrer was used to homogenize the solution for 60 min at room temperature. All the O/W solutions exhibited stability and remained at neutral pH for the entire duration of the experiment. The only intervention was application of inactive 0.9% saline in group 1. The intervention was nasal application of xylometazoline and indomethacin in the combined formulation in group. The intervention was nasal application of xylometazoline only in group 3. The intervention was nasal application of indomethacin only in group 4. RESULTS For the animals in group 1 (the controls), the mucosa had sustained a significant level of damage and the vessels were highly congested. Inflammatory cells were extensively infiltrating the mucosa. (Figure 1 - A1, 2, 3). In group 2, by contrast, the vessels were hardly congested and there were very few infiltrates. The epithelium appeared completely intact (Figure 1 - B1, 2, 3). Furthermore, when groups 1 and 2 were compared in terms of congested vessels, inflammatory cellular infiltrates and injury to the epithelium, the differences reached statistical significance, with p-values of <0.01, >0.001 and <0.001, respectively. Comparison of groups 2 and 4 with the control group also revealed statistically significant differences in terms of cellular infiltrates (p<0.001) and damage to the epithelium (p<0.001). For the degree of congestion of the vessels, however, the difference between groups was not at the level of statistical significance (p<0.071). Groups 3 and 4 differed at a statistically significant level in terms of degree of congested vessels, cellular infiltrates, and damage to the epithelium (p<0.025 and p<0.001). The sections from rats in groups 2 and 3 had a lower degree of congested vessels, which may be due to the actions of xylometazoline. CONCLUSIONS In the future, topically applied intranasal NSAIDs will be valuable formulations. Innovative types of formulation, such as those demonstrating thixotropic behavior, permit the agent to remain in prolonged contact with the nasal and sinusal lining. Alongside increased efficacy, these preparations will also improve the side effect profile of NSAIDs, largely eliminating systemic effects.
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Affiliation(s)
- M Kar
- Department of Otorhinolaryngology, Alaaddin Keykubat University, Alanya Training and Research Hospital, Alanya, Turkey.
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Kahramanlar AA, Aksoy M, Ince I, Dostbıl A, Karadenız E. The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study. J INVEST SURG 2022; 35:1694-1699. [PMID: 35848451 DOI: 10.1080/08941939.2022.2098544] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE/AIM OF THE STUDY The purpose of this triple-blind randomized study is to compare the postoperative analgesic efficacy of Mid-Point Transverse Process Pleura Block (MTP) and Paravertebral Block (PVB) in patients undergoing breast surgery. MATERIALS AND METHODS The study was retrospectively registered on ClinicalTrials.gov (NCT05332028). A total of 64 patients undergoing unilateral simple mastectomy operation due to breast cancer were included in the study. Before the anesthesia procedure, participants were randomly assigned to one of two groups: Group 1: Participants undergoing PVB or Group 2: Participants undergoing MTP block. All block applications were performed using 20 mL of 0.25% bupivacaine. Routine general anesthesia protocol was performed on all patients. In the postanesthetic care unit, fentanyl infusion was given to all patients postoperatively via a patient-controlled analgesia device. Postoperative fentanyl consumption, time to the first request for analgesia, VAS score values at rest and in motion, and blocked dermatome areas were recorded. RESULTS Postoperative total opioid consumption, the number of patients given rescue analgesia, the time requiring postoperative supplemental analgesia, postoperative pain scores at rest and in motion, and blocked dermatome areas at both anterior and posterior lower and upper limits were not different between groups (p > 0.05, for all). CONCLUSIONS It was concluded that ultrasound-guided PVB and MTP blocks have similar postoperative analgesic efficacy in patients undergoing breast surgery. The MTP block may be preferred as an alternative to PVB for breast surgeries with less risk of complications.
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Affiliation(s)
- Agâh Abdullah Kahramanlar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
| | - Mehmet Aksoy
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Türkiye.,Department of Anesthesiology and Reanimation, Altınbas University, Medical Park Hospital School of Medicine University, Istanbul, Türkiye
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Türkiye.,Department of Anesthesiology and Reanimation, Altınbas University, Medical Park Hospital School of Medicine University, Istanbul, Türkiye
| | - Aysenur Dostbıl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Türkiye.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Türkiye
| | - Erdem Karadenız
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Türkiye
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Shimada T, Mascha EJ, Yang D, Bravo M, Rivas E, Ince I, Turan A, Sessler DI. Intra-operative hypertension and myocardial injury and/or mortality and acute kidney injury after noncardiac surgery: A retrospective cohort analysis. Eur J Anaesthesiol 2022; 39:315-323. [PMID: 35066561 DOI: 10.1097/eja.0000000000001656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Whether intra-operative hypertension causes postoperative complications remains unclear. OBJECTIVE We sought to assess whether there is an absolute systolic hypertensive threshold associated with increased odds of a composite of postoperative myocardial injury and mortality, and acute kidney injury. DESIGN A retrospective cohort analysis using an electronic medical record registry. SETTING The Cleveland Clinic Main Campus, Cleveland, Ohio, USA, between January 2005 and December 2018. PATIENTS A total of 76 042 adults who had inpatient noncardiac surgery lasting at least an hour, creatinine recorded preoperatively and postoperatively, and had an available clinic blood pressure within 6 months before surgery. MAIN OUTCOME MEASURES Univariable smoothing and multivariable logistic regression were used to estimate the probability of each outcome as a function of the highest intra-operative pressure for a cumulative 5, 10, or 30 min. We further assessed whether the relationships between intra-operative hypertension and each outcome depended on baseline systolic blood pressure. RESULTS The composite of myocardial injury and mortality was observed in 1.9%, and acute kidney injury in 4.5% of patients. After adjustment for confounders, there was little or no relationship between systolic pressure and either outcome over the range from 120 to 200 mmHg. There were also no obvious change points or thresholds above which odds of each outcome increased. And finally, there was no interaction with preoperative clinic blood pressure. CONCLUSIONS There was no clinically meaningful relationship between intra-operative systolic pressure and the composite of myocardial injury and mortality, or acute kidney injury, over the range from 120 and 200 mmHg.
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Affiliation(s)
- Tetsuya Shimada
- From the Departments of Outcomes Research ( TS, EJM, DY, MB, ER, II, AT, DIS) , Quantitative Health Sciences (EJM, DY), General Anesthesiology (AT), Cleveland Clinic, Cleveland, Ohio, USA, Department of Anesthesiology, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan (TS), Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan (TS), Department of Anesthesia Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain (ER), Altinbas University, Bahcelievler Medical Park Hospital, Istanbul, Turkey (II)
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Qiu Y, Rivas E, Tanios M, Sreedharan R, Mao G, Ince I, Salih A, Saab R, Devarajan J, Ruetzler K, Turan A. Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis. Braz J Anesthesiol 2022; 73:3-9. [PMID: 35182552 PMCID: PMC9801211 DOI: 10.1016/j.bjane.2022.02.002] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/06/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. METHODS We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. RESULTS Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p = 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p = 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p = 0.002) than in winter. CONCLUSIONS In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.
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Affiliation(s)
- Yuwei Qiu
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Shanghai Jiao Tong University, Shanghai Chest Hospital, Department of Anesthesiology, Shanghai, China
| | - Eva Rivas
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Universidad de Barcelona, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Anesthesiology, Barcelona, Spain
| | - Marianne Tanios
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Roshni Sreedharan
- Cleveland Clinic, Anesthesiology Institute, Department of Intensive Care and Resuscitation, Cleveland, USA
| | - Guangmei Mao
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, USA
| | - Ilker Ince
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Altinbas University, School of Medicine, Department of Anesthesiology and Reanimation, Bahcelievler Medical Park Hospital, Istanbul, Turkey
| | - Ahmed Salih
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Remie Saab
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Jagan Devarajan
- Medina Hospital, Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Medina, USA
| | - Kurt Ruetzler
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Cleveland, USA
| | - Alparslan Turan
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA; Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Cleveland, USA.
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Karakaya MA, Ince I, Kucukerdem OB, Bas A, Gurkan Y. Assessment of sciatic nerve block success with elastography: new perspective for the nerve blocks. Minerva Anestesiol 2021; 87:1380-1381. [PMID: 34874137 DOI: 10.23736/s0375-9393.21.15819-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Muhammet A Karakaya
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Ataturk University Hospital, Erzurum, Turkey - .,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.,Morphological Madrid Research Center (MoMaRC), Madrid, Spain
| | - Osman B Kucukerdem
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
| | - Ali Bas
- Department of Orthopedics and Traumatology, Koç University Hospital, Istanbul, Turkey
| | - Yavuz Gurkan
- Department of Anesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey
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11
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Aydin Y, Ulas AB, Ince I, Kalin A, Can FK, Gundogdu B, Kasali K, Kerget B, Ogul Y, Eroglu A. Evaluation of albendazole efficiency and complications in patients with pulmonary hydatid cyst. Interact Cardiovasc Thorac Surg 2021; 34:245-249. [PMID: 34587626 PMCID: PMC8766210 DOI: 10.1093/icvts/ivab259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study investigated the efficacy and complications of albendazole use after surgery in patients with pulmonary hydatid cysts. METHODS One hundred fifty-three consecutive patients who met the study criteria out of 215 patients who received prophylaxis with albendazole after surgery for isolated pulmonary hydatid cysts in our clinic between January 2011 and December 2020 were analysed retrospectively. RESULTS Eighty-six out of 153 (56.2%) of cases were male and 67 (43.8%) were female. The average age was 24.6 ± 17.4 (between 3 and 71 years), 76 of them (49.7%) were 18 years old and younger, while 77 (50.3%) were adults. All cases were approached transthoracically and a total of 170 operations were performed on the 153 cases. Fever, weakness and dizziness were reported in only one patient who was given albendazole treatment. A partial increase in liver enzymes was observed in 16 cases (10.5%) after albendazole treatment. Mild leukopoenia and neutropenia were observed in only one of the cases. In 1 case, a second operation was performed 30 months later due to recurrence. Albendazole treatment was not required to be discontinued in any of the cases. Mortality was not observed in any of the cases. Factors such as mean age, cyst size and hospitalization period did not have a statistically significant effect on any changes in liver enzymes tests following albendazole therapy (P > 0.05). CONCLUSIONS Albendazole treatment can safely be used for postoperative prophylaxis in patients with pulmonary hydatid cysts in a controlled manner without causing serious complications. Subj collection 152.
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Affiliation(s)
- Yener Aydin
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ilker Ince
- Anesthesiology Clinical Research Office, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fatma Kesmez Can
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Betul Gundogdu
- Department of Pathology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Kamber Kasali
- Department of Bioistatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Bugra Kerget
- Department of Pulmonary Diseases, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yasemin Ogul
- Department of Medicinal Biochemistry, Regional Training and Research Hospital, Health Sciences University, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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12
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Shimada T, Cohen B, Shah K, Mosteller L, Bravo M, Ince I, Esa WAS, Cywinski J, Sessler DI, Ruetzler K, Turan A. Associations between intraoperative and post-anesthesia care unit hypotension and surgical ward hypotension. J Clin Anesth 2021; 75:110495. [PMID: 34560444 DOI: 10.1016/j.jclinane.2021.110495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/14/2021] [Revised: 08/03/2021] [Accepted: 08/23/2021] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To test whether patients who experience hypotension in the post-anesthesia care unit or during surgery are most likely to experience hypotension on surgical wards. DESIGN A prediction study using data from two randomized controlled trials. SETTING Operating room, post-anesthesia care unit, and surgical ward. PATIENTS 550 adult patients having abdominal surgery with ASA physical status I-IV. INTERVENTIONS Blood pressure measurement per routine intraoperatively, and with continuous non-invasive monitoring postoperatively. MEASUREMENTS The primary predictors were minimum mean arterial pressure (<60, <65, <70 and < 80 mmHg) and minimum systolic blood pressure (<70, <75, <80, <85 mmHg) in the post-anesthesia care unit. The secondary predictors were intraoperative minimum blood pressures with the same thresholds as the primary ones. Our outcome was ward hypotension defined as mean pressure < 70 mmHg or systolic pressure < 85 mmHg. A threshold was considered clinically useful if both sensitivity and specificity exceeded 0.75. MAIN RESULTS Minimum mean and systolic pressures in the post-anesthesia care unit similarly predicted ward mean or systolic hypotension, with the areas under the curves near 0.74. The best performing threshold was mean pressure < 80 mmHg in the post-anesthesia care unit which had a sensitivity of 0.41 (95% confidence interval [CI], 0.35, 0.47) and specificity of 0.91 (95% CI, 0.87, 0.94) for ward mean pressure < 70 mmHg and a sensitivity of 0.44 (95% CI, 0.37, 0.51) and specificity of 0.88 (95% CI, 0.84, 0.91) for ward systolic pressure < 85 mmHg. The areas under the curves using intraoperative hypotension to predict ward hypotension were roughly similar at about 0.60, with correspondingly low sensitivity and specificity. CONCLUSIONS Intraoperative hypotension poorly predicted ward hypotension. Pressures in the post-anesthesia care unit were more predictive, but the combination of sensitivity and specificity remained poor. Unless far better predictors are identified, all surgical inpatients should be considered at risk for postoperative hypotension.
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Affiliation(s)
- Tetsuya Shimada
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Department of Anesthesiology, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Barak Cohen
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Karan Shah
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Lauretta Mosteller
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States
| | - Mauro Bravo
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States
| | - Ilker Ince
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Wael Ali Sakr Esa
- Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, United States
| | - Jacek Cywinski
- Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel I Sessler
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt Ruetzler
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, United States
| | - Alparslan Turan
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, United States.
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13
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Yamak Altinpulluk E, Nystad D, Valdes-Vilchesa LF, Gallucio F, Ince I, Ergonenc T, Salazar C, Fajardo Perez M. A case of successful regional anesthesia management for awake scapular fracture surgery. Minerva Anestesiol 2021; 87:1276-1277. [PMID: 34337921 DOI: 10.23736/s0375-9393.21.15813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ece Yamak Altinpulluk
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain - .,Consortium of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH, USA - .,Anesthesiology Department, Cerrahpsa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey - .,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey -
| | - David Nystad
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Anesthesiology Department, University Hospital North Norway, Tromsø, Norway
| | - Luis F Valdes-Vilchesa
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Anesthesiology Department, Hospital Costa del Sol, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - Felice Gallucio
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Ilker Ince
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Consortium of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH, USA.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Tolga Ergonenc
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Department of Anesthesiology, Akyazi Pain and Palliative Care Center, Sakarya, Turkey.,Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Carlos Salazar
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Anesthesiology Department 12 de Octubre Universitary Hospital, Madrid, España
| | - Mario Fajardo Perez
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain, EchoTraining School, Madrid, Spain.,Anesthesiology Department, Mostoles Universitary Hospital, Móstoles, Spain
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14
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Aksoy M, Dostbil A, Aksoy AN, Ince I, Bedir Z, Ozmen O. Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial. J Clin Anesth 2021; 75:110469. [PMID: 34314906 DOI: 10.1016/j.jclinane.2021.110469] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE This study aimed to compare the effects of high doses of ondansetron and granisetron before spinal anesthesia on hemodynamic parameters in patients undergoing elective cesarean section. DESIGN A double-blinded randomized placebo-controlled trial. SETTING Operating room. PATIENTS A total of 120 parturients with term pregnancy undergoing elective cesarean section with combined spinal-epidural anesthesia were included. INTERVENTIONS Three groups (n = 40 for each group) were formed by randomization. Five minutes before the anesthesia procedure, Group I received 8 mg intravenous (IV) ondansetron diluted in 10 ml normal saline, Group II received IV 3 mg granisetron diluted in 10 ml normal saline, and Group III received IV 10 ml normal saline. MEASUREMENTS Following intrathecal drug administration, intraoperative hemodynamic changes were recorded every 2 min for 20 min and then every 5 min until the end of the operation. MAIN RESULTS Twenty patients (50%) in Group I, 12 patients (30%) in Group II, and 29 patients (72.5%) in Group III had hypotension requiring treatment with IV ephedrine (P = 0.001). The ephedrine requirement in Group III was significantly higher than in Groups I (P = 0.033) and II (P < 0.001). Also, the ephedrine requirement in Group II was lower than in Group I, but the difference was not statistically significant (P = 0.055). The mean arterial pressure for the three groups differed in the 10th, 18th, and 60th minutes. The number of patients with nausea or vomiting was lower in Groups I and II than in Group III (P < 0.001). At 5 min, the Apgar scores were higher than 8 for all neonates. Postoperative scores for the visual analogue scale were similar for all groups. CONCLUSIONS It was concluded that prophylactic IV administration of 3 mg of granisetron or 8 mg of ondansetron before spinal anesthesia results in a significantly lower ephedrine requirement compared to placebo.
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Affiliation(s)
- Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Ayse Nur Aksoy
- Department of Obstetrics and Gynecology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Zehra Bedir
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ozgur Ozmen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
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15
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Qiu Y, Sessler DI, Chen L, Halvorson S, Cohen B, Bravo M, Ince I, Maheshwari K, Kurz A. Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients. J Intensive Care Med 2021; 37:655-662. [PMID: 34196246 DOI: 10.1177/08850666211021330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients. METHOD We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium. RESULTS We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36). CONCLUSION Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
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Affiliation(s)
- Yuwei Qiu
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China
| | | | - Liang Chen
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Sven Halvorson
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Mauro Bravo
- Department of Outcomes Research, Cleveland Clinic, OH, USA
| | - Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, OH, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH, USA
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16
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Okucu F, Aksoy M, Ince I, Aksoy AN, Dostbıl A, Ozmen O. Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions. Anaesthesist 2021; 70:30-37. [PMID: 34159412 DOI: 10.1007/s00101-021-00995-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients. OBJECTIVE This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section. MATERIAL AND METHODS In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded. RESULTS In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04). CONCLUSION Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.
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Affiliation(s)
- Fatma Okucu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. .,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Ayse Nur Aksoy
- Department of Obstetrics and Gynecology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Aysenur Dostbıl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Ozgur Ozmen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
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17
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Aydin Y, Ulas AB, Ince I, Kuran E, Keskin H, Kirimli SN, Kasali K, Ogul H, Eroglu A. Modified capitonnage technique for giant pulmonary hydatid cyst surgery. Interact Cardiovasc Thorac Surg 2021; 33:721-726. [PMID: 34041544 DOI: 10.1093/icvts/ivab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/01/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts. METHODS Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded. RESULTS Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients. CONCLUSIONS The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.
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Affiliation(s)
- Yener Aydin
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey.,Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Ilker Ince
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Emre Kuran
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Hilmi Keskin
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Sevde Nur Kirimli
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Kamber Kasali
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Biostatistics, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Hayri Ogul
- Anesthesiology, Clinical Research Office, Ataturk University, School of Medicine, Erzurum, Turkey.,Department of Radiology, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Ataturk University, School of Medicine, Erzurum, Turkey
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18
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Ince I, Chiu A, Sagir A, Chahar P, Lin J, Douglas A, Adi A, Fang J, Mao G, Turan A. Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study. J Cardiothorac Vasc Anesth 2021; 35:3021-3026. [PMID: 34148803 DOI: 10.1053/j.jvca.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors aimed to evaluate the effects of postoperative pain on the incidence of atrial fibrillation and delirium in patients having surgery with cardiopulmonary bypass (CPB). DESIGN Post hoc analysis of the (An investigator-initiated, multicentre, double-blind trial (ClinicalTrials NCT02004613) (DECADE)), a randomized, placebo-controlled trial. SETTING Tertiary, academic hospital. PARTICIPANTS Six hundred five adults from the DECADE enrolled at Cleveland Clinic Main Campus, who had had surgery with CPB. INTERVENTIONS Dexmedetomidine versus placebo started before surgical incision and postoperatively was maintained until 24 hours. MEASUREMENTS Primary outcomes were atrial fibrillation, diagnosed by clinicians in the intensive care unit (ICU), presence of delirium assessed with the Confusion Assessment Method for the ICU, data on pain scores, and opioid consumption, occurring between ICU admission and the earlier of postoperative day five or hospital discharge. RESULTS Postoperative pain levels were similar among patients with or without atrial fibrillation. Two hundred six (34%) patients had atrial fibrillation and ninety-two (15%) had delirium before hospital discharge within the first five postoperative days. The risk of atrial fibrillation was not significantly different between groups (hazard ratio: 1.09; 97.5% confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no associations between postoperative pain and the risk of postoperative delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57). Postoperative opioid consumption was neither significantly associated with postoperative atrial fibrillation nor delirium. CONCLUSIONS Atrial fibrillation and delirium was not associated with pain after cardiac surgery. Opioid use was not associated with atrial fibrillation and delirium. Because both atrial fibrillation and delirium have a multifactorial nature, further studies should be focused on other plausible mechanisms.
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Affiliation(s)
- Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Andrew Chiu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Afrin Sagir
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Praveen Chahar
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jia Lin
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Aaron Douglas
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Ahmad Adi
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jonathan Fang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Guangmei Mao
- Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH.
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19
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Affiliation(s)
- Mustafa Yesilyurt
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology, Medical Faculty, Ataturk University, Erzurum, Turkey.,Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Zakir Sakci
- Department of Radiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ilker Ince
- Department of Anesthesiology, Medical Faculty, Ataturk University, Erzurum, Turkey.,Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey.,Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
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20
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Saager L, Ruetzler K, Turan A, Maheshwari K, Cohen B, You J, Mascha EJ, Qiu Y, Ince I, Sessler DI. Do It Often, Do It Better: Association Between Pairs of Experienced Subspecialty Anesthesia Caregivers and Postoperative Outcomes. A Retrospective Observational Study. Anesth Analg 2021; 132:866-877. [PMID: 33433116 DOI: 10.1213/ane.0000000000005318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience. METHODS We included patients having surgery lasting at least 30 minutes. Using cluster analysis, attending anesthesiologists, and Certified Registered Nurse Anesthetists (CRNAs) were identified as experienced or inexperienced caregivers for each type of surgery at the case level. We then compared surgeries for which anesthesia was provided by a pair of experienced caregivers versus a pair of inexperienced caregivers on our composite outcome. We estimated the average relative effect (ie, the exponentiated average log odds ratio) of receiving anesthesia from an experienced versus inexperienced caregiver pair across the 7 components of the composite outcome using a generalized estimating equation (GEE) model to adjust for between-component correlation and with inverse propensity score weighing to adjust for potential confounding from a host of variables. RESULTS A total of 8968 patients who received anesthesia care by an experienced pair were compared with 25,361 patients who received care from an inexperienced pair, adjusting for potential confounding. The incidence of composite complications (ie, any component event) was 7.6% (677/8968) for experienced pairs and 12% (2976/25,361) for inexperienced pairs (P < .001). Care by experienced pairs of caregivers was associated with lower odds of the composite outcome with an estimated average relative effect odds ratio across the individual components of 0.61 (95% confidence interval [CI], 0.54-0.71), P < .001. Among the 7 components of the primary outcome, experienced pairs of providers had significantly lower estimated odds of bleeding, infection, and mortality. CONCLUSIONS Anesthesia care by experienced pairs was associated with fewer bleeding complications, fewer infections, shorter hospitalization, and reduced in-hospital mortality.
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Affiliation(s)
- Leif Saager
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Kurt Ruetzler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alparslan Turan
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kamal Maheshwari
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Barak Cohen
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Division of Anesthesia, Critical Care and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jing You
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Edward J Mascha
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Yuwei Qiu
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ilker Ince
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Daniel I Sessler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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21
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Frechen S, Ince I, Dallmann A, Gerisch M, Jungmann N, Becker C, Lobmeyer M, Trujillo M, Xu S, Burghaus R, Meyer M. Physiologically-based pharmacokinetic (PBPK) exploration of extrinsic factors influencing vericiguat pharmacokinetics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Vericiguat is a once daily, novel oral stimulator of soluble guanylate cyclase (sGC) that showed clinical benefit in the Phase III VICTORIA study in heart failure patients with reduced ejection fraction (HFrEF, NCT02861534). Nonclinical and clinical studies demonstrated that the primary route of elimination of vericiguat was glucuronidation to an inactive metabolite M-1 (N-glucuronide). This glucuronidation was catalyzed by uridine 5'-diphospho-glucuronosyltransferases (UGT)1A9 as well as UGT1A1, thus vericiguat may have a potential for victim drug-drug interaction (DDI) when co-administered with potent UGT inhibitors.
Purpose
In a clinical DDI study with mefenamic acid as an UGT1A9 inhibitor no clinically relevant increase in vericiguat exposure in healthy subjects was observed (EudraCT 2014–000764–17). This analysis aims to prospectively investigate as extrinsic factors the DDI potential with atazanavir as a selective UGT1A1 inhibitor via full dynamic physiologically-based pharmacokinetic (PBPK) modelling.
Methods
A PBPK model for vericiguat and M-1 in healthy adults was built with PK-Sim (PBPK platform as part of the Open Systems Pharmacology Suite) by integrating physicochemical, in vitro metabolism and transporter data as well as PK data from clinical pharmacology studies in order to assess the victim DDI potential of vericiguat when co-administered with UGT inhibitors. First, PBPK models for mefenamic acid and atazanavir were separately developed and verified using published literature data. The PBPK model for vericiguat was then verified with regard to its fraction of metabolism by UGTs by comparing simulated and observed data of the clinical mefenamic acid DDI study. Finally, the UGT1A1 DDI potential of vericiguat was prospectively predicted by simulating an in silico study between the UGT1A1 inhibitor atazanavir and vericiguat.
Results
In line with the results of the clinical DDI study with mefenamic acid, an increase in total vericiguat exposure by 14% (area under the concentration time curve ratio (AUCR) of 1.14 (geoCV 5.3%; 90% population interval: 1.06 to 1.25) and peak exposure increase by 6% (CmaxR of 1.06; geoCV 5.9%; 90% population interval: 1.01 to 1.20) was simulated using the PBPK model. A prospective prediction of a virtual DDI trial between the UGT1A1 inhibitor atazanavir yielded an AUCR of 1.12 (geoCV 2.9%; 90% population interval: 1.07 to 1.17) and a CmaxR of 1.04 (geoCV 1.1%; 90% population interval: 1.03 to 1.06). The proposed population intervals for AUCR and CmaxR for both DDI studies lie within the default no-effect boundary of 0.80 to 1.25 according to the to January 2020 FDA DDI guideline.
Conclusion(s)
Results of UGT1A9-DDI simulations were consistent with those of the clinical study-The prospective UGT1A1-DDI simulation results suggest a low potential for vericiguat to be subject to DDI when co-administered with UGT1A1 inhibitors.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Funding for this research was provided by Bayer and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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Affiliation(s)
- S Frechen
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - I Ince
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - A Dallmann
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | | | | | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Lobmeyer
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Trujillo
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - S Xu
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - R Burghaus
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
| | - M Meyer
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
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22
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Tsui BCH, Sun LY, Ip VHY, Malik MF, Ince I, Elsharkawy H. Diaphragm-sparing erector spinae plane block for shoulder surgery: emerging evidence. Reg Anesth Pain Med 2020; 46:287-288. [PMID: 32474419 DOI: 10.1136/rapm-2020-101599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Lisa Y Sun
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Mohammed F Malik
- Department of Anesthesia & Perioperative Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ilker Ince
- Anesthesiology Clinical Research Office, Ataturk Universitesi, Erzurum, Turkey
| | - Hesham Elsharkawy
- Department of Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Qiu Y, Wu J, Huang Q, Lu Y, Xu M, Yang D, Ince I, Sessler DI. Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery: A randomised trial. Eur J Anaesthesiol 2020; Publish Ahead of Print. [PMID: 32205572 DOI: 10.1097/eja.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serratus anterior and paravertebral blocks can both be used for video-assisted thoracic surgery. However, serratus anterior blocks are easier to perform, and possibly safer. We therefore tested the primary hypothesis that serratus anterior plane blocks and thoracic paravertebral blocks provide comparable analgesia for video-assisted thoracic surgery. Secondarily, we tested the hypothesis that both blocks lengthen the time to onset of surgical pain and reduce the need for rescue tramadol. METHODS Patients having video-assisted thoracic lobectomy or segmentectomy were randomly allocated to ultrasound-guided thoracic paravertebral blocks, n = 30; ultrasound-guided serratus anterior plane blocks, n = 30; or, general anaesthesia alone, n = 30. Visual analogue pain scores analogue pain scores at rest, during coughing and Prince-Henry pain scores were used to assess postoperative analgesia. Our primary analysis was noninferiority of serratus anterior blocks compared with paravertebral blocks. RESULTS Baseline characteristics were comparable among the three groups. Two hours after surgery, the mean difference in visual analogue pain scores between the serratus anterior and paravertebral blocks was 0.0 (96.8% CI -0.4 to 0.3) cm at rest, -0.2 (-0.8 to 0.4) cm during coughing and -0.1(-0.5 to 0.3) for Prince-Henry pain scores. After 24 h, the mean difference was 0.0 (-0.7 to 0.8) cm at rest, 0.1 (-0.8 to 0.9) cm during coughing and 0.1(-0.4 to 0.6) for Prince-Henry pain scores. All differences were significantly noninferior. Time to onset of pain after surgery was 19 ± 5 (SD) hours with serratus anterior blocks, 16 ± 5 h with paravertebral blocks and 12 ± 5 h with general anaesthesia. Anaesthesia with either block was associated with significantly less intra-operative propofol and sufentanil, reduced postoperative rescue analgesia (tramadol) and less postoperative nausea and vomiting compared with general anaesthesia alone. Patients with serratus anterior block had a significantly lower incidence of intra-operative hypotension and requirement for intra-operative vasopressor (3.4%), compared with general anaesthesia alone. Serratus anterior block took less time to perform than paravertebral block (5.1 ± 1.1 min versus 10.1 ± 2.9 min). CONCLUSION Serratus anterior plane blocks, which are easier and quicker than paravertebral blocks, provide comparable analgesia in patients having video-assisted thoracic surgery. CLINICAL TRIAL NUMBER AND REGISTRY URL ChiCTR1800017671; http://www.chictr.org.cn/hvshowproject.aspx?id=13510.
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Affiliation(s)
- Yuwei Qiu
- From the Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (YQ, JW, QH, YL, MX); Department of Outcomes Research, Anesthesiology Institute (YQ, DY, II, DIS); Outcomes Research Consortium (JW); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA (DY); Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey (II)
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24
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Ince I, Kilicaslan A. Combination of Lumbar Erector Spinae Plane Block (LESP) and Pericapsullar Nerve Group (PENG) block in hip surgery. J Clin Anesth 2020; 61:109672. [DOI: 10.1016/j.jclinane.2019.109672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/23/2019] [Indexed: 01/08/2023]
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25
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Ince I, Dostbil A, Ozmen O, Aksoy M, Karadeniz E. Subtransverse process interligamentary (STIL) plane block for postoperative pain management after breast surgery. J Clin Anesth 2020; 61:109649. [DOI: 10.1016/j.jclinane.2019.109649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
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26
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Elsharkawy H, Ince I, Hamadnalla H, Drake RL, Tsui BCH. Cervical erector spinae plane block: a cadaver study. Reg Anesth Pain Med 2020; 45:552-556. [DOI: 10.1136/rapm-2019-101154] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
BackgroundCervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment. This study utilizes cadaveric models to evaluate the spread of ESP injections at the C6 and C7 levels to determine whether the injection can reach the BP and its surrounding structures.MethodsFor each of the five cadavers, an ESP injection posterior to the transverse process of C6 was performed on one side, and an ESP injection posterior to the transverse process of C7 was performed on the contralateral side. Injections were performed under ultrasound guidance and consisted of a 20 mL mixture of 18 mL water and 2 mL India ink. After cadaver dissection, craniocaudal and medial-lateral extent of the dye spread in relation to musculoskeletal anatomy as well as direct staining relevant nerves was recorded. The degree of dye staining was categorized as “deep,” “faint,” or “no.”ResultsThe phrenic nerve was deeply stained in 1 injection and faintly stained in 2 injections. Caudally, variable staining of C8 (100%) and T1 (50%) roots were seen. Faintly staining at C4 root was only seen in one sample (10%). There was variable staining of the anterior scalene muscles (40%) anterior to the BP and the rhomboid intercostal plane caudally (30%).ConclusionsUltrasound-guided cervical (C6 and C7) ESP injections consistently stain the roots of the BP and dorsal rami. This study supports the notion that the cervical ESP block has the potential to provide analgesia for patients undergoing shoulder and cervical spine surgeries.
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Ozmen O, Aksoy M, Ince I, Dostbil A, Dogan N, Kursad H. Comparing the Clinical Features and Trauma Scores of Trauma Patients Aged Under 65 Years with Those of Patients Aged over 65 Years in the Intensive Care Unit: A Retrospective Study for Last Ten Years. Eurasian J Med 2020; 52:1-5. [PMID: 32158304 DOI: 10.5152/eurasianjmed.2019.19194] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This retrospective study aimed to compare the clinical characteristics and trauma scores of Intensive Care Unit (ICU) trauma patients 65 years and older with the patients under 65 years old. Materials and Methods Trauma patients (n=161) who stayed at least 24 hours in ICU were included. Patients younger than 65 years were included into Group 1 (n=109) and patients aged ≥65 years (n=52) were included into Group 2. Patient characteristics and trauma index scores (GCS; APACHE II score, ISS; TRISS and RTS) at ICU admission were calculated. Results The patients in Group 2 had more comorbid disease compared with Group 1 (61.5%, 6.4%) (p=0.001). The Trauma-related Injury Severity Score score were higher in Group 1 (49.76±33.75) compared with Group 2 (35.38±34.93) (p=0.006). The APACHE II score were higher in Group 2 (20.08±7.60) compared with Group 1 (17.00±6.90) (p=0.007). The need for invasive mechanical ventilation and tracheostomy were more frequent in Group 2 trauma patients compared with those of patients in Group 1 (92.3%, 73.4%; p=0.003; 26.9%, 8.3%; p=0.002; respectively). The need for transfusion of packed red blood cell suspension (PRBC) was more frequent in Group 2 compared with Group 1 (92.3%, 55.0%; respectively) (p=0.001). The mortality rate was found to be higher in Group 2 compared with Group 1 (48.1%, 19.3%; respectively) (p=0.001). Conclusion The elderly trauma patients have more comorbid disease, higher scores for APACHE II and lower scores for TRISS, more mechanical ventilation and tracheostomy requirements and higher mortality rate compared with young trauma patients.
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Affiliation(s)
- Ozgur Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Nazim Dogan
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Husnu Kursad
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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Duncan AE, Jia Y, Soltesz E, Leung S, Yilmaz H, Mao G, Timur AA, Kottke‐Marchant K, Rogers HJ, Ma C, Ince I, Karimi N, Yagar S, Trombetta C, Sessler DI. Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic function in cardiac surgical patients: a randomised controlled trial. Anaesthesia 2020; 75:1180-1190. [PMID: 32072617 PMCID: PMC9291605 DOI: 10.1111/anae.14994] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 01/27/2023]
Abstract
Whether third‐generation hydroxyethyl starch solutions provoke kidney injury or haemostatic abnormalities in patients having cardiac surgery remains unclear. We tested the hypotheses that intra‐operative administration of a third‐generation starch does not worsen postoperative kidney function or haemostasis in cardiac surgical patients compared with human albumin 5%. This triple‐blind, non‐inferiority, clinical trial randomly allocated patients aged 40–85 who underwent elective aortic valve replacement, with or without coronary artery bypass grafting, to plasma volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our primary outcome was postoperative urinary neutrophil gelatinase‐associated lipocalin concentrations, a sensitive and early marker of postoperative kidney injury. Secondarily, we evaluated urinary interleukin‐18; acute kidney injury using creatinine RIFLE criteria, coagulation measures, platelet count and function. Non‐inferiority (delta 15%) was assessed with correction for multiple comparisons. We enrolled 141 patients (69 starch, 72 albumin) as planned. Results of the primary analysis demonstrated that postoperative urine neutrophil gelatinase‐associated lipocalin (median (IQR [range])) was slightly lower with hydroxyethyl starch (5 (1–68 [0–996]) ng.ml−1) vs. albumin (5 (2–74 [0–1604]) ng.ml−1), although not non‐inferior [ratio of geometric means (95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected variability. Urine interleukin‐18 concentrations were reduced, but interleukin‐18 and kidney injury were again not non‐inferior. Of 11 individual coagulation measures, platelet count and function, nine were non‐inferior to albumin. Two remaining measures, thromboelastographic R value and arachidonic acid‐induced platelet aggregation, were clinically similar but with wide confidence intervals. Starch administration during cardiac surgery produced similar observed effects on postoperative kidney function, coagulation, platelet count and platelet function compared with albumin, though greater than expected variability and wide confidence intervals precluded the conclusion of non‐inferiority. Long‐term mortality and kidney function appeared similar between starch and albumin.
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Affiliation(s)
- A. E. Duncan
- Departments of Cardiothoracic Anesthesiology and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - Y. Jia
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - E. Soltesz
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Cleveland OH USA
| | - S. Leung
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - H.O. Yilmaz
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - G. Mao
- Departments of Quantitative Health Sciences and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - A. A. Timur
- Department of Laboratory Medicine Cleveland Clinic Cleveland OH USA
| | - K. Kottke‐Marchant
- Department of Pathology and Laboratory Administration Cleveland Clinic Cleveland OH USA
| | - H. J. Rogers
- Department of Laboratory Medicine Cleveland Clinic Cleveland OH USA
| | - C. Ma
- Departments of Quantitative Health Sciences and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - I. Ince
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - N. Karimi
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - S. Yagar
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - C. Trombetta
- Department of Cardiothoracic Anesthesiology Cleveland Clinic Cleveland OH USA
| | - D. I. Sessler
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
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Elsharkawy H, Ince I, Malik MF, Roques V. Rhomboid Intercostal Catheters for Postoperative Pain After Scapular Fracture Surgery. Pain Medicine 2020; 21:2608-2610. [DOI: 10.1093/pm/pnz334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hesham Elsharkawy
- Department of General Anesthesia and Pain Management, Outcomes Research, Anesthesiology Institute, Cleveland, Ohio
- CCLCM of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, TURKEY
| | - Mohammed Faysal Malik
- Department of Regional Anesthesia and Acute Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vicente Roques
- Anesthesia, Intensive Care and Chronic Pain Treatment, University Hospital Virgen de la Arrixaca, Murcia, Spain
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Ozmen O, Ince I, Aksoy M, Dostbil A, Atalay C, Kasali K. The Effect of the Modified Thoracolumbar Interfacial Nerve Plane Block on Postoperative Analgesia and Healing Quality in Patients Undergoing Lumbar Disk Surgery: A Prospective, Randomized Study. Medeni Med J 2019; 34:340-345. [PMID: 32821459 PMCID: PMC7433717 DOI: 10.5222/mmj.2019.36776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: The purpose of this study was to investigate the effect of the modified thoracolumbar interfascial plane block (TLIP) on postoperative analgesia and quality of recovery in patients undergoing lumbar disk surgery. Method: Ninety patients scheduled for lumbar disk surgery were divided into a control group (Group C) and a modified TLIP block group (Group T). Controlled analgesia was administered to both groups. Pain evaluation was performed at 30 min and at 1., 2., 4., 8.,12., and 24. hrs using a VAS scale, with patients at rest and duringand patients completed the QoR-40 quality of recovery inventory. Results: Fentanyl used during postoperative 24 hours was 742.5±220.3 mcg in Group C and 446.0±241.98 in Group T. Postoperative fentanyl consumption was statistically significantly lower in Group T (p<0.001) with a statistically significant intergroup difference. The patient’s pain, physical independence, physical comfort, psychological support, and emotional support were compared using the QoR-40 questionnaire survey. Significant differences in favor of Group T were observed (p<0.001, p=0.017, p=0.002, p=0.001 and p<0.001, respectively). Static and dynamic pain scores in Group C and Group T were recorded at 30 min and at 1, 2, 4, 8, 12, and 24h. Mean static scores were statistically significantly different in favor of Group T with the exception of 8th and 12h assessments (p<0.05). Dynamic scores were statistically significantly different in favor of Group T at all time points (p<0.05). Conclusion: Pain scores, opioid consumption and QoR-40 values after lumbar disk surgery were superior in the group undergoing TLIP. We think that the modified TLIP block may be an important method in terms of postoperative analgesia and patient recovery for lumbar spinal disk surgery.
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Affiliation(s)
- Ozgur Ozmen
- Ataturk University, School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey
| | - Ilker Ince
- Ataturk University, School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Ataturk University, Clinical Research Office, Erzurum, Turkey
| | - Mehmet Aksoy
- Ataturk University, School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Ataturk University, Clinical Research Office, Erzurum, Turkey
| | - Aysenur Dostbil
- Ataturk University, School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Ataturk University, Clinical Research Office, Erzurum, Turkey
| | - Canan Atalay
- Ataturk University, School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Ataturk University, Clinical Research Office, Erzurum, Turkey
| | - Kamber Kasali
- Ataturk University, School of Medicine, Department of Biostatistics, Erzurum, Turkey.,Ataturk University, Clinical Research Office, Erzurum, Turkey
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Ince I, Kilicaslan A, Roques V, Elsharkawy H, Valdes L. The clavipectoral fascia plane block: Reply to Dr. Altinpulluk. J Clin Anesth 2019; 61:109681. [PMID: 31831283 DOI: 10.1016/j.jclinane.2019.109681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ilker Ince
- Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland Clinic, OH, USA.
| | - Alper Kilicaslan
- Department of Anesthesiology and Reanimation, School of Meram Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Vicente Roques
- Intensive Care and Chronic Pain Treatment, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Hesham Elsharkawy
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luis Valdes
- Department of Anesthesiology and Reanimation, Hospital Universitario Costa del Sol, Marbella, Spain
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Ince I, Kilicaslan A, Roques V, Elsharkawy H, Valdes L. Ultrasound-guided clavipectoral fascial plane block in a patient undergoing clavicular surgery. J Clin Anesth 2019; 58:125-127. [DOI: 10.1016/j.jclinane.2019.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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33
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Ince I, Shimada T, Ueshima H, Hassan M, Turan A. Thoraco lumbar interfascial plane (TLIP) block: A systematic review of the literature. J Clin Anesth 2019; 61:109655. [PMID: 31780272 DOI: 10.1016/j.jclinane.2019.109655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/01/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ilker Ince
- Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, TR-25240 Erzurum, Turkey.
| | - Tetsuya Shimada
- Department of Pharmacology, National Defense Medical College, Saitama, Japan
| | - Hironobu Ueshima
- Department of Anesthesiology, Showa University Hospital, Tokyo, Japan.
| | - Mohamed Hassan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
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Kilicaslan A, Ince I, Sarkilar G, Dereli Y. Ultrasound guided fascia lata plane block: A novel anesthetic technique for percutaneous endovascular procedures. J Clin Anesth 2019; 61:109624. [PMID: 31668473 DOI: 10.1016/j.jclinane.2019.09.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Alper Kilicaslan
- Department of Anaesthesiology and Reanimation, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.
| | - Ilker Ince
- Department of Anaesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Gamze Sarkilar
- Department of Anaesthesiology and Reanimation, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yuksel Dereli
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
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Abstract
We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed.
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Affiliation(s)
- Mohammad Z Khan
- From the Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio
| | - Ilker Ince
- From the Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Wael Ali Sakr Esa
- From the Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio
| | - Alparslan Turan
- From the Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio
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36
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Ince I, Aksoy M, Ozmen O. Ultrasound guided erector spinae plane block for postoperative analgesia in a 13 year-old child undergoing abdominal surgery: A new approach. J Clin Anesth 2019; 55:77-78. [DOI: 10.1016/j.jclinane.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 11/27/2022]
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Maheshwari K, Shimada T, Fang J, Ince I, Mascha EJ, Turan A, Kurz A, Sessler DI. Hypotension Prediction Index software for management of hypotension during moderate- to high-risk noncardiac surgery: protocol for a randomized trial. Trials 2019; 20:255. [PMID: 31053082 PMCID: PMC6499972 DOI: 10.1186/s13063-019-3329-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypotension is associated with serious complications, including myocardial infarction, acute kidney injury, and mortality. Consequently, predicting and preventing hypotension may improve outcomes. We will therefore determine if use of a novel hypotension prediction tool reduces the duration and severity of hypotension in patients having non-cardiac surgery. METHODS/DESIGN We will conduct a two-center, pragmatic, randomized controlled trial (N = 213) in noncardiac surgical patients > 45 years old who require intra-arterial blood pressure monitoring. All participating patients will be connected to a Flortrac IQ sensor and EV1000 platform (Edwards Lifesciences, Irvine). They will be randomly assigned to blinded or unblinded arms. The Hypotension Prediction Index (HPI) and advanced hemodynamic information will be universally recorded, but will only be available to clinicians when patients are assigned to unblinded monitoring. The primary outcome will be the effect of HPI software guidance on intraoperative time-weighted average mean arterial pressure under a threshold of 65 mmHg, which will be assessed with a Wilcoxon-Mann-Whitney 2-sample, two-tailed test. DISCUSSION Our trial will determine whether the Hypotension Prediction Index and associated hemodynamic information substantively reduces hypotension during non-cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT03610165 . Registered on 1 August 2018.
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Affiliation(s)
- Kamal Maheshwari
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA. .,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA.
| | - Tetsuya Shimada
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA.,Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Jonathan Fang
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA
| | - Ilker Ince
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA.,Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Edward J Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Lerner Research Institute and Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA
| | - Andrea Kurz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA.,Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31, Cleveland, OH, 44195, USA
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38
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Demir U, Ince I, Aksoy M, Dostbil A, Arı MA, Sulak MM, Kose M, Tanios M, Ozmen O. The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery. J INVEST SURG 2019; 34:82-88. [PMID: 30966835 DOI: 10.1080/08941939.2019.1576809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (μg) in the dexketoprofen group, and 490.00 ± 408.98 (μg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups' demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.
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Affiliation(s)
- U Demir
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - I Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Aksoy
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - A Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M A Arı
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M M Sulak
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Kose
- Department of Orthopaedic Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Tanios
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - O Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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39
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Ozmen O, Mutlu V, Ince I, Karadeniz E, Aksoy M, Kaya Z. Single-dose intravenous ibuprofen versus ultrasound and #8209;guided bilateral superficial cervical plexus block for post and #8209;thyroidectomy pain: A randomized study. Med-Science 2019. [DOI: 10.5455/medscience.2019.08.9098] [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: 11/03/2022] Open
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40
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Mutlu V, Ince I. Preemptive intravenous ibuprofen application reduces pain and opioid consumption following thyroid surgery. Am J Otolaryngol 2019; 40:70-73. [PMID: 30472123 DOI: 10.1016/j.amjoto.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate the effects of preemptive a single dose IV ibuprofen on postoperative 48 h opioid consumption and postoperative pain in patients undergoing thyroidectomy. METHODS The study included 40 patients aged 18 to 65, scheduled for elective thyroidectomy. Patients were randomly divided into 2 groups. Control group (n = 20) received 100 mL saline solution 15 min before surgery, while study group (n = 20) received 800 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgical team using the same technique. Postoperative analgesia was assessed using a visual analogue scale (VAS) and the amount of consumption of 48 h postoperative fentanyl with patient-controlled analgesia (PCA) and additional analgesia requirements were recorded. When additional analgesia was required, 1000 mg IV paracetamol was used. RESULTS VAS scores in the ibuprofen group were found lower than the control group in the all-time points (p < 0.05). Opioid consumption in the 48 h was significantly higher in the control group than the ibuprofen group (p < 0.001). Using of rescue analgesia was significantly higher in the control group than the ibuprofen group, statistically (p < 0.05). A significant difference was observed between two groups in terms of side effects of fentanyl consumption (nausea and vomiting) (p < 0.001). CONCLUSION To use preemptive a single dose IV ibuprofen decreases pain scores and postoperative opioid consumption in patients following thyroidectomy. Additionally, this application increase the patient comfort reducing nausea and vomiting in early postoperative period.
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41
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Ince I, Hamadnalla H, Fang J, Shimada T, Hassan M. Ultrasound-guided erector spinae plane block for acute herpes zoster pain management: Is it safe? Am J Emerg Med 2018; 37:1192. [PMID: 30573224 DOI: 10.1016/j.ajem.2018.12.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ilker Ince
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Turkey; Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Hassan Hamadnalla
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Jonathan Fang
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Tetsuya Shimada
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA; Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Mohamed Hassan
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
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42
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Ince I, Hamadnalla H, Hassan M, Qiu Y. Ultrasound-guided quadratus lumborum plane block for congenital hip dislocation surgery: Dermatomes and osteotomes. J Clin Anesth 2018; 54:140. [PMID: 30508809 DOI: 10.1016/j.jclinane.2018.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ilker Ince
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turkey; Anesthesiology Institute, Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Hassan Hamadnalla
- Anesthesiology Institute, Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Mohamed Hassan
- Anesthesiology Institute, Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
| | - Yuwei Qiu
- Anesthesiology Institute, Outcomes Research Department, Cleveland Clinic, Cleveland, OH, USA.
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43
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Ince I, Ozmen O, Aksoy M, Zeren S, Ulas AB, Aydin Y. Erector Spinae Plane Block Catheter Insertion under Ultrasound Guidance for Thoracic Surgery: Case Series of Three Patients. Eurasian J Med 2018; 50:204-206. [PMID: 30515044 DOI: 10.5152/eurasianjmed.2018.18147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The erector spinae plane (ESP) block is a novel plane block first reported for thoracic analgesia. It affects the dorsal and ventral rami of the thoracic nerves. Owing to the ease of the technique and decreased risk of complication of the ESP block under ultrasound guidance, it can be a preferable procedure compared with other invasive techniques, such as neuraxial and nerve blocks. In this case report, we presented three patients who had thoracic surgery under general anesthesia. The ESP block and catheter placement was applied to the patients before operation. The catheter was inserted deep into the erector spinae muscle and was used successfully for postoperative pain management.
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Affiliation(s)
- Ilker Ince
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ozgur Ozmen
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Sumeyra Zeren
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
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Gozeler MS, Sakat MS, Kilic K, Ozmen O, Can A, Ince I. Does a single-dose preemptive intravenous ibuprofen have an effect on postoperative pain relief after septorhinoplasty? Am J Otolaryngol 2018; 39:726-730. [PMID: 30077350 DOI: 10.1016/j.amjoto.2018.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Septorhinoplasty is a surgical procedure widely employed by otolaryngologists and plastic surgeons. The purpose of this study was to investigate the effects of a single pre-emptive dose of iv ibuprofen on postoperative pain and opioid consumption in patients undergoing septorhinoplasty. MATERIAL AND METHODS 50 patients scheduled for septorhinoplasty were included in this prospective, randomized, double-blinded study. Control group (n = 25) was administered 100 mL iv saline solution 30 min preoperatively, while Ibuprofen group (n = 26) received 800 mg ibuprofen iv. in 100 mL saline solution. Intravenous fentanyl was administered with a Patient Controlled Analgesia device after surgery for postoperative pain management. Postoperative pain was evaluated using a Visual Analogue Scale (VAS) with 0 representing no pain and 10 the worst pain possible. RESULTS VAS scores at 10, 20, and 30 min and at 1, 2, 4, 8, 12 and 24 h were lower in the ibuprofen group than in the control group (p < 0.05). Total fentanyl consumption was lower in the ibuprofen group compared to the placebo group (148.8 ± 86.4 mcq vs 338.00 ± 81.00 mcq), respectively. CONCLUSION We suggest that the pre-emptive use of iv ibuprofen at a dosage of 800 mg 30 min before septorhinoplasty will be beneficial in reducing opioid consumption and pain scores.
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Affiliation(s)
- Mustafa Sitki Gozeler
- Ataturk University, Faculty of Medicine, Department of Otorhinolaryngology, Erzurum, Turkey.
| | - Muhammed Sedat Sakat
- Ataturk University, Faculty of Medicine, Department of Otorhinolaryngology, Erzurum, Turkey
| | - Korhan Kilic
- Ataturk University, Faculty of Medicine, Department of Otorhinolaryngology, Erzurum, Turkey
| | - Ozgur Ozmen
- Ataturk University, Faculty of Medicine, Department of Anesthesiology, Erzurum, Turkey
| | - Abdullah Can
- Regional Training and Research Hospital, Clinics of Anesthesiology, Erzurum, Turkey
| | - Ilker Ince
- Ataturk University, Faculty of Medicine, Department of Anesthesiology, Erzurum, Turkey
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Ince I, Ozmen O, Dostbil A. Ultrasound guided Quadratus Lumborum block for pediatric extracorporeal shock wave lithotripsy: Safety and indication? J Clin Anesth 2018; 49:14. [PMID: 29807212 DOI: 10.1016/j.jclinane.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ilker Ince
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Turkey.
| | - Ozgur Ozmen
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Turkey
| | - Aysenur Dostbil
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Turkey
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46
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Aydin Y, Ince I, Turkyilmaz A, Eroglu A. Lung Hydatid Cyst Treatment With Laparotomy: A New and Different Technique. Ann Thorac Surg 2018; 106:e183-e184. [PMID: 29750934 DOI: 10.1016/j.athoracsur.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
This report presents the case of a patient with a pulmonary hydatid cyst. The patient underwent laparotomy for hepatic and splenic cysts, and cystotomy and capitonnage were perfomed using a transdiaphragmatic intervention. The pulmonary hydatid cyst was located at the base of the lung and near the diaphragm. The diaphragm was cut about 5 cm at the front, and the thorax was entered.The pulmonary cyst was treated intraabdominally. This technique is effective and safe, and it prevents the patient from undergoing a second operation. The suggestion is that this technique, which has not been defined before, can be applied safely in carefully selected patients.
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Affiliation(s)
- Yener Aydin
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Atila Turkyilmaz
- Department of Thoracic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Ince I, Arı MA, Sulak MM, Aksoy M. Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom. Rev Bras Anestesiol 2018; 68:260-265. [DOI: 10.1016/j.bjan.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/09/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022] Open
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48
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Ince I, Arı MA, Sulak MM, Aksoy M. Comparison of transverse short-axis classic and oblique long-axis “Syringe-Free” approaches for internal jugular venous catheterization under ultrasound guidance. Brazilian Journal of Anesthesiology (English Edition) 2018. [PMID: 29478705 PMCID: PMC9391733 DOI: 10.1016/j.bjane.2017.12.002] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background and objectives Methods Results Conclusion
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49
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Ciftci B, Aksoy M, Ince I, Ahıskalıoglu A, Yılmazel Ucar E. The Effects of Positive End-Expiratory Pressure at Different Levels on Postoperative Respiration Parameters in Patients Undergoing Laparoscopic Cholecystectomy. J INVEST SURG 2017; 31:114-120. [PMID: 28340306 DOI: 10.1080/08941939.2017.1296984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose/Aim of the study: We investigated the effects of different positive end-expiratory pressure (PEEP) levels on postoperative respiration parameters in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS One hundred and five consecutive patients were randomly divided to three groups (n = 35, for each group). Group I did not receive PEEP whereas group II received PEEP as 5 cmH2O and group III received PEEP as 8 cm H2O. Measurements with spirometer were taken 1 hour before the operation (T1) and, 1 (T2), 6 (T3), and 24 hours (T4) after extubation by an anesthetist. Forced expiratory volume (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were recorded. RESULTS Group I had higher FVC values measured at T2 time point compared with other groups (p < 0.05, for both groups). There was a statistically significant difference between group I and group III in terms of the FVC values measured at T3 and T4 time points (p = 0.05 and p < 0.05, retrospectively). A statistical difference was found between group I and group II in terms of FEV1 measured at T2 time point (p < 0.05). Group I had higher FEV1 values measured at T3 and T4 time points compared to group III (p = 0.05, P<0.05; respectively). Group III had lower PEF values measured at T4 time point compared to group I and II (p < 0.05). CONCLUSIONS We concluded that PEEP with 5 or 8 cmH2O has negative effects on lung function tests measured with spirometer during postoperative 1st, 6th, and 24th hours in patients underwent elective laparoscopic cholecystectomy.
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Affiliation(s)
- Bahadır Ciftci
- a Department of Anaesthesiology and Reanimation, Faculty of Medicine , Ataturk University , Erzurum , Turkey
| | - Mehmet Aksoy
- a Department of Anaesthesiology and Reanimation, Faculty of Medicine , Ataturk University , Erzurum , Turkey
| | - Ilker Ince
- a Department of Anaesthesiology and Reanimation, Faculty of Medicine , Ataturk University , Erzurum , Turkey
| | - Ali Ahıskalıoglu
- a Department of Anaesthesiology and Reanimation, Faculty of Medicine , Ataturk University , Erzurum , Turkey
| | - Elif Yılmazel Ucar
- b Department of Pulmonary Diseases , Faculty of Medicine , Ataturk University , Erzurum , Turkey
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Ince I, Aksoy M, Celik M. Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery? Eurasian J Med 2017; 48:167-171. [PMID: 28149139 DOI: 10.5152/eurasianjmed.2016.0256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Distal nerve blocks are used in the event of unsuccessful blocks as rescue techniques. The primary purpose of this study was to determine the sufficiency for anesthesia of distal nerve block without the need for deep sedation or general anesthesia. The secondary purpose was to compare block performance times, block onset times, and patient and surgeon satisfaction. MATERIALS AND METHODS Patients who underwent hand surgery associated with the innervation area of the radial and median nerves were included in the study. Thirty-four patients who were 18-65 years old and American Society of Anesthesiologists grade I-III and who were scheduled for elective hand surgery under conscious nerve block anesthesia were randomly included in an infraclavicular block group (Group I, n=17) or a radial plus median block group (Group RM, n=17). The block performance time, block onset time, satisfaction of the patient and surgeon, and number of fentanyl administrations were recorded. RESULTS The numbers of patients who needed fentanyl administration and conversion to general anesthesia were the same in Group I and Group RM and there was no statistically significant difference (p>0.05). The demographics, surgery times, tourniquet times, block perfomance times, and patient and surgeon satisfaction of the groups were similar and there were no statistically significant differences (p>0.05). There was a statistically significant difference in block onset times between the groups (p<0.05). CONCLUSIONS Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.
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Affiliation(s)
- Ilker Ince
- Department of Anesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
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