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Öğe Acetaminophen reduces acute and persistent incisional pain after hysterectomy(Edizioni Luigi Pozzi, 2018) Koyuncu, Onur; Hakimoglu, Sedat; Ugur, Mustafa; Akkurt, Cagla; Turhanoglu, Selim; Sessler, Daniel; Turan, AlparslanOBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [121, Q3]: 0 [0, 01) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain.Öğe Addition of Ketamine to Propofol-Alfentanil Anesthesia May Reduce Postoperative Pain in Laparoscopic Cholecystectomy(Lippincott Williams & Wilkins, 2013) Karcioglu, Murat; Davarci, Isil; Tuzcu, Kasim; Bozdogan, Yusuf B.; Turhanoglu, Selim; Aydogan, Akin; Temiz, MuhyittinObjective: The aim of this study was to assess whether intravenous anesthesia supplemented with ketamine reduces postoperative pain after elective laparoscopic cholecystectomy. Materials and Methods: Forty patients were enrolled and randomized 1: 1 into one of 2 groups: the propofol group (received propofol and alfentanil supplemented with saline) and the ketamine group (received propofol and alfentanil with ketamine). The study was double-blind. The number and amount of the intraoperative additional alfentanil doses were recorded. Pain assessments and cumulative analgesic consumption at postanesthesia care unit (PACU) admission, PACU discharge, postoperative 24th hour, and hospital discharge were recorded. Results: The visual analog scale scores at PACU admission, PACU discharge, postoperative 24th hour, and hospital discharge were significantly lower in the ketamine group than the propofol group. The pain visual analog scale >= 75 at the postoperative 24th hour for the propofol group was also significantly lower (P < 0.035) than that of the ketamine group. The difference in analgesic consumption between groups was statistically significant (P < 0.001). Conclusions: Our study showed that ketamine supplemented with propofol and alfentanil produced better analgesia intraoperatively and postoperatively and decreased analgesic consumption compared with the propofol group after laparoscopic cholecystectomy.Öğe Assessment of the perioperative period in civilians injured in the Syrian Civil War(Elsevier Science Inc, 2015) Hakimoglu, Sedat; Karcioglu, Murat; Tuzcu, Kasim; Davarci, Isil; Koyuncu, Onur; Dikey, Ismail; Turhanoglu, SelimBackground: Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. Materials and methods: The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. Results: The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. Conclusion: Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe CHANGES IN TRYPTASE LEVELS DURING CARDIAC SURGERY IN PATIENTS AT LOW RISK FOR ALLERGIC REACTIONS(Dnipro State Medical Univ, 2022) Oksar, Menekse; Baytan, Hasibe G.; Turhanoglu, Selim; Aybek, Tayfun; Ardicoglu, Nazife Y.; Ozcan, OguzhanTryptase test can be used as a clinical marker of mast cell activation. The present study is was aimed to identify variations in serum tryptase levels and their possible relationships with allergic reactions to protamine in low-risk patients undergoing cardiac bypass surgery. Thirty patients according to American Society of Anesthesiologists physical status III who underwent cardiac bypass surgery were enrolled. This prospective, non-randomised, clinical study was conducted in an operating room. Venous blood samples for tryptase measurements were obtained from cardiac bypass surgery patients upon admission to the operating room and immediately before and 30 min after the initiation of protamine administration. Signs of allergic reactions were recorded and management steps based on rapid effect response-based clinical assessments for diagnosis and treatment decisions during protamine administrations were described. Serum tryptase levels and clinical signs of allergic reactions, primarily mean arterial pressure (MAP), were recorded. Serum tryptase levels increased significantly and progressively during the bypass procedure (study power, 80%; sample size, 28; power of analysis, 99.8% with alpha=0.05); however, tryptase levels did not reach a sufficiently high level to confirm an allergic reaction. The MAP and heart rate decreased in 50% of the patients. Although tryptase increased significantly when compared with baseline levels, protamine-associated increases were not significant and failed to provide an unequivocal indication of an allergic response to protamine.Öğe Comparison of Recovery Characteristics, Postoperative Nausea and Vomiting, and Gastrointestinal Motility With Total Intravenous Anesthesia With Propofol Versus Inhalation Anesthesia With Desflurane for Laparoscopic Cholecystectomy: A Randomized Controlled Study(Elsevier Science Inc, 2009) Akkurt, B. Cagla Ozbakis; Temiz, Muhyittin; Inanoglu, Kerem; Aslan, Ahmet; Turhanoglu, Selim; Asfuroglu, Zeynel; Canbolant, ElifBACKGROUND: Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 mu g/kg) or desflurane (4%-6%) and alfentanil (20 mu g/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements In a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after Surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study. (Curr Ther Res Clin Exp. 2009;70:94-103) (C) 2009 Excerpta Medica Inc.Öğe Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial(Elsevier Science Inc, 2015) Koyuncu, Onur; Turhanoglu, Selim; Akkurt, Cagla Ozbakis; Karcioglu, Murat; Ozkan, Mustafa; Ozer, Cahit; Sessler, Daniel I.Study Objective: To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONY) than the cholinesterase inhibitor neostigmine. Design: Prospective, randomized, double-blinded study. Setting: University-affiliated hospital. Patients: One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery. Interventions: Patients were randomly assigned to neostigmine (70 mu g/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade. Measurements: We recorded PONY, recovery parameters, antiemetic consumption, and side effects. Main Results: Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P <.05), but thereafter low and comparable. Postoperative antiemetic and analgesic consumption were similar in each group. Extubation (median [interquartile range], 3 [1-3.25] vs 4 [1-3.25]; P <.001) first eye opening (4 [3-7.25] vs 7 [5-11]; P <.001), and head lift (4 [2-7.25] vs 8 [11-25]; P <.001) in minutes were shorter in patients given sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine. Conclusions: Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONY compared with neostigmine and atropine. (C) 2014 Elsevier Inc. All rights reserved.Öğe Comparison of the postoperative effects of the erector spinae plane block and local infiltration analgesia in patients operated with lumbotomy surgery incision: Randomized clinical study(Lippincott Williams & Wilkins, 2024) Hakimoglu, Sedat; Ozdemir, Taner; Comez, Mehmet Selim; Urfali, Senem; Yildirak, Ekrem; Gorur, Sadik; Turhanoglu, SelimBackground:Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees.Methods:Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours.Results:There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 +/- 165.23 mu g in the intraoperative ESPB group and 296.67 +/- 110.59 mu g in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 +/- 14.47 mg vs 57.23 +/- 15.5 mg and additional analgesic-paracetamol: 2.1 +/- 1.06 vs 4.27 +/- 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 +/- 8.1 in the LIA group, while it was 19.33 +/- 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05).Conclusions:In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.Öğe Cost-Conscious of Anesthesia Physicians: An awareness survey(Professional Medical Publications, 2015) Hakimoglu, Sedat; Hanci, Volkan; Karcioglu, Murat; Tuzcu, Kasim; Davarci, Isil; Kiraz, Hasan Ali; Turhanoglu, SelimObjective: Increasing competitive pressure and health performance system in the hospitals result in pressure to reduce the resources allocated. The aim of this study was to evaluate the anesthesiology and intensive care physicians awareness of the cost of the materials used and to determine the factors that influence it. Methods: This survey was conducted between September 2012 and September 2013 after the approval of the local ethics committee. Overall 149 anesthetists were included in the study. Participants were asked to estimate the cost of 30 products used by anesthesiology and intensive care units. Results: One hundred forty nine doctors, 45% female and 55% male, participated in this study. Of the total 30 questions the averages of cost estimations were 5.8% accurate estimation, 35.13% underestimation and 59.16% overestimation. When the participants were divided into the different groups of institution, duration of working in this profession and sex, there were no statistically significant differences regarding accurate estimation. However, there was statistically significant difference in underestimation. In underestimation, there was no significant difference between 16-20 year group and >20 year group but these two groups have more price overestimation than the other groups (p=0.031). Furthermore, when all the participants were evaluated there were no significant difference between age-accurate cost estimation and profession time-accurate cost estimation. Conclusion:Anesthesiology and intensive care physicians in this survey have an insufficient awareness of the cost of the drugs and materials that they use. The institution and experience are not effective factors for accurate estimate. Programs for improving the health workers knowledge creating awareness of cost should be planned in order to use the resources more efficiently and cost effectively,Öğe The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report(Elsevier Science Inc, 2014) Karcioglu, Murat; Davarci, Isil; Kirecci, Nuray; Akcay, Adnan Burak; Turhanoglu, Selim; Tuzcu, Kasim; Hakimoglu, SedatBackground and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients(Wiley, 2015) Koyuncu, Onur; Turhanoglu, Selim; Tuzcu, Kasim; Karcioglu, Murat; Davarci, Isil; Akbay, Ercan; Cevik, CengizBackground: Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use. Methods: 100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups:COHb 3 or 4gdl(-1). We considered a composite of complications during the 7days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours. Results: There were 36 patients in the low-exposure group COHb [1.81.2gdl(-1)], and 64 patients were in the high-exposure group [6.4 +/- 2.1gdl(-1)]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P<0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P=0.0001, OR:7.4 (95%Cl, lower=2.5-upper=21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P=0.020 (95%CI, lower=-1.21-upper=-0.80), P=0.026 (95%CI, lower=-0.03-upper=0.70)], and tramadol use increased at 4h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P=0.012) and 24h (3.5 (0-8) vs 6 (5-9) mg, P=0.008). Conclusion: High preoperative COHb concentrations are associated with increased postoperative complications and pain.Öğe The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial(Elsevier Science Inc, 2017) Koyuncu, Onur; Leung, Steve; You, Jing; Oksar, Menekse; Turhanoglu, Selim; Akkurt, Cagla; Dolapcioglu, KenanObjectives: To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. Design: Randomized, double-blinded study. Patients: 120 patients ASA I-II who underwent abdominal hysterectomy. Interventions: All the patients were given 1 g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCI (8 mg, 2 ml IV) (Group I, N = 60) and saline (2 ml IV) (Group II, N = 60) at the skin closure. Measurement: Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. Main results: Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1 h [by 13 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [QI, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P = 0.95. Conclusions: Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived. (C) 2017 Elsevier Inc. All rights reserved.Öğe Effects of Intravenous Small Dose Ketamine and Midazolam on Postoperative Pain Following Knee Arthroscopy(Wiley, 2009) Akkurt, Buket Cagla Ozbakis; Inanoglu, Kerem; Kalacı, Aydıner; Turhanoglu, Selim; Asfuroglu, Zeynel; Tumkaya, FerayBackground: The aim of this randomized, double blind, controlled study was to assess the effect of intravenous coadministration of small dose midazolam with ketamine on postoperative pain and spinal block level. Methods: Sixty patients undergoing arthroscopic knee surgery under spinal anesthesia were randomized into three groups: Group I (saline control); group II (ketamine 0.15 mg/kg i.v.); and group III (ketamine 0.15 mg/kg + midazolam 0.01 mg/kg i.v.). Sedation scores, visual analogue scores, time to first postoperative analgesic, total meperidine consumption, patient satisfaction, sensory and motor block levels, and two segments regression times were assessed. Results: Sedation scores were significantly lower in group I when compared with groups II and III at 1, 3, 5, and 10 minutes after administration of the spinal anesthetic (P = 0.001). Sensory block was significantly higher in group III (P = 0.001) in comparison with group II. Two segment regression time was significantly longer in group II than group I, whereas no difference was found between groups II and III. Total meperidine consumption was significantly higher in group I (P = 0,001). Patient satisfaction was significantly higher in group III compared with group I (P = 0.001), but no difference was found between groups II and III (P = 0.3). Conclusion: Ketamine improved the postoperative pain patient satisfaction, increased the maximal sensory level, and was associated with lower sedation scores in the first 15 minutes after administration. Group I was also associated with decreased total meperidine consumption and delayed the time to first recue analgesic administration. Coadministration of ketamine and midazolam did not provide any further benefit over ketamine alone.Öğe Evaluation of nosocomial infections and risk factors in critically ill patients(Int Scientific Information, Inc, 2011) Ozer, Burcin; Akkurt, Cagla Ozbakis; Duran, Nizami; Onlen, Yusuf; Savas, Lutfu; Turhanoglu, SelimBackground: Nosocomial infections are one of the most serious complications in intensive care unit patients because they lead to high morbidity, mortality, length of stay and cost. The aim of this study was to determine the nosocomial infections, risk factors, pathogens and the antimicrobial susceptibilities of them in intensive care unit of a university hospital. Material/Methods: The patients were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory. Results: 20.1% of the patients developed a total of 40 intensive care unit-acquired infections for a total of 988 patient-days. The infection sites were the lower respiratory tract, urinary tract, bloodstream, wound, and the central nervous system. The respiratory deficiency, diabetes mellitus, usage of steroid and antibiotics were found as the risk factors. The most common pathogens were Enterobacteriaceae, Staphylococcus aureus, Candida species. No vancomycin resistance was determined in Gram positive bacteria. Imipenem and meropenem were found to be the most effective antibiotics to Enterobacteriaceae. Conclusions: Hospital infection rate in intensive care unit is not very high. The diabetes mellitus, length of stay, usage of steroids, urinary catheter and central venous catheter were determined as the risk factors by the final logistic regression analysis. These data, which were collected from a newly established intensive care unit of a university hospital, are important in order to predict the infections and the antimicrobial resistance profile that will develop in the future.Öğe Fatal interstitial pneumonia as an advers reaction in patient with rheumatoid arthritis: a case report(Turkish League Against Rheumatism-T L A R, 2008) Kaya, Sedat; Turhanoglu, Selim; Turhanoglu, Ayse DicleAcute interstitial pneumonia developed three weeks after the administration of leflunomide(LEF) in a 53-year-old woman with rheumatoid arthritis. She developed nausea and diarrhea as well as dyspnea before coming to the hospital and LEF treatment was stopped. She suddenly experienced severe dyspnea and her chest x-ray showed reticular shadows in her lower lung fields which had not been detected before. Partial oxygen pressure of her arterial blood fell all of a sudden, which necessitated an emergency admission to the intensive care unit. After endotracheal intubation, mechanical ventilation support was started due to acute respiratory failure. The patient died of respiratory failure 7 days after the onset of acute interstitial pneumonia.Öğe Intravenous ketamine and local bupivacaine infiltration are effective as part of a multimodal regime for reducing post-tonsillectomy pain(Int Scientific Information, Inc, 2009) Inanoglu, Kerem; Akkurt, B. Cagla Ozbakis; Turhanoglu, Selim; Okuyucu, Semsettin; Akoglu, ErtapBackground: The aim of this study was to investigate the effects of a multimodal analgesic regimen, including intravenous ketamine and peritonsillar infiltration of bupivacaine, on post-tonsillectomy pain in children. Material/Methods: Ninety children aged 2-12 years, undergoing tonsillectomy, were enrolled in this randomized, controlled and double-blinded study. Group I (n=30) received intravenous and peritonsillar saline, group II (n=30) received intravenous saline and peritonsillar bupivacaine, and group III (n=30) received intravenous 0.5 mg/kg ketamine and peritonsillar 0.25% bupivacaine (3-5 ml per tonsil). Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24 h postoperatively. Results: No difference was found in the demographic data among the groups. Group I patients who received intravenous and peritonsillar saline solution as placebo had higher pain scores at 15(th) min, and Ist and 4(th) h than group II, and at all time intervals, than group III (P<0.05). Patients in group III also had significantly lower pain scores than group II at all time intervals except at 15(th) min (P<0.05). Analgesic requirements and the time to first analgesia were also significantly (P<0.05) better in the ketamine group. Conclusions: Intravenous ketamine and peritonsillar infiltration with bupivacaine are safe and effective as part of a multimodal regime in reducing post-tonsillectomy pain.Öğe Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?(Springer Tokyo, 2009) Turhanoglu, Selim; Kaya, Sedat; Erdogan, HulyaSpinal anesthesia for cesarean section is associated with a high incidence of maternal hypotension. The aim of this study was to assess the efficacy of low-dose bupivacaine with fentanyl to reduce the incidence of hypotension in spinal anesthesia for cesarean section. Forty pregnant women undergoing elective cesarean section were randomly allocated to two groups; those receiving 10 mg bupivacaine to group B (n = 20) and those receiving 4 mg bupivacaine plus 25 mu g fentanyl to group BF (n = 20); the agents were given intrathecally with patients in the sitting position, with a combined spinal-epidural technique. Sensory block was adequate for surgery in all patients. Hypotension occurred in all patients in group B (100%) and in 15 patients in group BF (75%). The incidence of hypotension, number of ephedrine treatments, and need for ephedrine were significantly greater in group B than group BF. Three patients in group BF required i.v. fentanyl supplementation after delivery. In 1 of these patients, i.v. fentanyl was not adequate, and epidural supplementation of 1% lidocaine was required. The development of hypotension after spinal block in subjects undergoing cesarean section was not prevented despite low-dose (4 mg) bupivacaine plus 25 mu g fentanyl, but the severity of maternal hypotension, and the number of ephedrine treatments and the total dose of ephedrine were decreased.Öğe Lidocaine for prevention of propofol injection-induced pain(Elsevier Science Inc, 2008) Kaya, Sedat; Turhanoglu, Selim; Karaman, Haktan; Ozgun, Sule; Basak, NihalBACKGROUND: Many patients experience pain on injection of propofol. The use of lidocaine to prevent propofol injection pain is common. The analgesic effect of preinjected lidocaine has been found to increase when a tourniquet is used. OBJECTIVE: The aim of this study was to compare the effectiveness of various venous occlusion times with lidocaine analgesia to prevent pain during propofol injection. METHODS: In this prospective, randomized, double-blind, controlled study, women aged 18 to 45 years,, classified as American Society of Anesthesiologists physical status I or II, who were scheduled to undergo elective surgery under general anesthesia induced with propofol, were randomly assigned to 1 of 5 groups: group 1, 2% lidocaine 20 mg in saline in a total volume of 10 mL and no venous occlusion; group 2, 2% lidocaine 20 mg in saline in a total volume of 10 mL plus venous occlusion for 15 seconds; group 3, 296 lidocaine plus venous occlusion for 30 seconds; group 4, 2% lidocaine plus venous occlusion for 60 seconds; and group 5, saline 10 mL and no venous occlusion. When the first 25% of the calculated propofol dose was administered, patients were asked about propofol-induced pain using a verbal pain scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). All patients and the anesthesiologist who evaluated pain severity were blinded to the study preparation being used. RESULTS: The study comprised 100 women who were randomly divided into 5 groups of 20 patients each. Significantly more patients in group 5 (18 [90%] patients; P < 0.05) reported pain compared with the other treatment groups. In groups 2, 3, and 4, in which venous occlusion was applied, pain was reported during propofol injection in 6 (3096), 7 (35%), and 2 (10%) patients, respectively. The incidence of reported pain was significantly greater in group 1 (lidocaine without venous occlusion) than in group 4 (P < 0.05); however, the incidence of pain was similar in group I compared with groups 2 and 3. CONCLUSIONS: The present study found that pretreatment with lidocaine 20 mg with or without venous occlusion significantly reduced the incidence and the severity of pain during the injection of propofol when compared with the group with no venous occlusion administered saline. In addition, pretreatment with lidocaine 20 mg plus venous occlusion for 60 seconds significantly reduced the incidence of propofol-induced pain compared with lidocaine without venous occlusion.Öğe Perioperative Effects of Induction with High-dose Rocuronium during Laparoscopic Cholecystectomy(Aves, 2020) Turhanoglu, Selim; Tunc, Mehmet; Oksar, Menekse; Temiz, MuhyittinObjective: We aimed to investigate the effects of high-dose rocuronium administration on intra-abdominal pressure (IAP) and surgical conditions during anaesthesia induction and laparoscopic cholecystectomy anaesthesia induction, respectively. Further, we aimed to determine postoperative nausea and vomiting (PONV) and pain scores following the laparoscopic cholecystectomy. Methods: Patients with American Society of Anesthesiologists (ASA) score of I-III, aged 18 to 75 years and who were scheduled for surgery under general anaesthesia were included in the study. Patients were randomised and a high-dose of 1.2 mg kg(-1) rocuronium was given to Group A and 0.6 mg kg(-1) rocuronium to Group B. The intraoperative train of four (TOF) ratio and post-tetanic count (PTC) were measured. Surgery was initiated with a low IAP of 7 mmHg. The surgeon evaluated surgical conditions with a 4-step surgical field scale and increased the IAP when necessary. PONV at 4, 12 and 24 hours and postoperative pain at 2 and 24 hours and 3 days were evaluated. Results: There were no significant differences in the demographic and haemodynamic parameters between the groups. In high-dose rocuronium Group A, IAP values were significantly lower in the first 20 minutes compared to Group B. The duration of operations was significantly shorter in Group A (29.00 +/- 7.39 minute vs. 34.63 +/- 12.00 minute, p=0.044). PONV in the first 12 hours was significantly lower in Group A (p<0.05). Conclusion: High-dose rocuronium-induced deep neuromuscular block helped perform laparoscopic cholecystectomy operations with lower values of IAP compared to a normal dose rocuronium. It also shortened duration of operation and reduced PONV and pain.Öğe Predictors of Difficult Intubation in Patients With Ankylosing Spondylitis: Do Disease Activity and Spinal Mobility Indices Matter?(Turkish League Against Rheumatism, 2014) Ustun, Nilgun; Tok, Fatih; Davarci, Isil; Yagiz, Erman; Guler, Hayal; Turhanoglu, Selim; Turhanoglu, AyseObjectives: This study aims to determine the predictors of difficult intubation and their possible correlations with disease activity and spinal mobility indices in patients with ankylosing spondylitis. Patients and methods: Forty-five ankylosing spondylitis patients were included in the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI). The predictors of difficult intubation were evaluated by using the modified Mallampati test, upper lip bite test, thyromental distance, sternomental distance, interincisor distance and neck extension. Results: There was no correlation between Bath Ankylosing Spondylitis Disease Activity Index and predictive test values (all p>0.05). There were significant correlations between BASMI with modified Mallampati test, sternomental distance, neck extension, and inter-incisor distance values (all p<0.05). The BASMI scores in patients with two or more predictors were significantly higher than BASMI scores in patients with none or one predictor (5.28 +/- 2.12 vs. 1.58 +/- 1.50; p<0.001). Among the patients with moderate to severe BASMI, the number of patients with two or more predictors was higher than in those patients with none or one predictor (p=0.001). Conclusion: Neck extension, inter-incisor distance, sternomental distance and modified Mallampati test are significant predictors for difficult intubation in patients with ankylosing spondylitis. These predictors were found to be correlated with spinal mobility index, but not with disease activity index. Clinicians should be aware of difficult intubation in ankylosing spondylitis patients with moderate to severe spinal mobility limitation.Öğe Severe hypoxemia follows hypoxic pulmonary vasoconstriction and/or hypoxic pulmonary vasoconstriction inhibition by inhaled anesthetics: prognostic potential of 100% shunt fractions(Elsevier Science Inc, 2017) Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim[Abstract Not Available]
