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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 Ameliorating effects of CAPE on oxidative damage caused by pneumoperitoneum in rat lung tissue(E-Century Publishing Corp, 2014) Davarci, Isil; Alp, Harun; Ozgur, Tumay; Karcioglu, Murat; Tuzcu, Kasim; Evliyaoglu, Osman; Motor, SedatWe investigated the biochemical and histopathological effects of caffeic acid phenethyl ester (CAPE) against oxidative stress causing lung injury induced by pneumoperitoneum. Twenty-eight rats were selected at random and seven rats were assigned to each of the following groups. The control group (S) was subjected to a sham operation without pneumoperitoneum. The other groups were subjected to CO2 pneumoperitoneum 15 mmHg for 60 min. The laparoscopy group (L) had no additional drugs administered, the laparoscopy + alcohol (LA) group had 1 ml of 70% ethyl alcohol administered 1 h before the desufflation period, and the laparoscopy + CAPE (LC) group had CAPE administered at 10 mu mol/kg 1 h before the desufflation period. The total oxidative status levels of lung and plasma were significantly increased in the LA group as compared with the LC and S group. When the LC group was compared with the L group, there was a decrease in the level of total oxidant status and increase in the levels of total antioxidant status and paraoxonase in lung tissue. The level of total antioxidative status in the S group was increased compared with the L group in lung tissue and bronchoalveolar lavage fluid. TNF-alpha and IL-6 were found significantly elevated in the L group compared with the LC and S groups in bronchoalveolar lavage fluid. There was a similar increase in plasma levels of IL-6. These results were supported by histopathological examination. CAPE was found to considerably reduce oxidative stress and inflammation induced by pneumoperitoneum.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 Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches(Sage Publications Inc, 2014) Karakus, Ali; Celik, Muhammet Murat; Karcioglu, Murat; Tuzcu, Kasim; Erden, Ersin Sukru; Zeren, CemOrganophosphate poisoning is a life-threatening condition, which is being responsible for the symptoms due to cholinergic effects. Clinical status and blood levels of cholinesterase are used its diagnosis. While atropine and pralidoxime (PAM) appear as essential medications, hemofiltration treatments and lipid solutions have been widely studied in recent years. In this study, the importance of high-dose atropine therapy and early intervention and novel treatment approaches are discussed. Records of a total of 25 patients treated for organophosphate poisoning in the intensive care unit (ICU) between April 2007 and December 2011 were evaluated retrospectively. Of the 25 patients, 14 (56%) were male and 11 (44%) were female with a mean age of 34.8 +/- 17.66 years (range: 14-77 years). The patients were most frequently admitted in June (n = 4) and July (n = 4) (16%). Of the 25 patients, 22 patients (88%) were poisoned by oral intake, two (8%) by inhalation, and one (4%) by dermal route. Of them, 20 patients (80%) took organophosphates intentionally for suicidal purposes, while five (20%) cases poisoned due to accidental exposure. The scores of Glasgow Coma Scale of nine patients (36%) were below 8 point upon admission to hospital. The highest dose of atropine given was 100 mg intravenously on admission and 100 mg/h/day during follow-up. The total dose given was 11.6 g/12 days. A total of 11 patients (44%) were on mechanical ventilation for a mean duration of 5.73 +/- 4.83 days. The mean duration of ICU stay was 6.52 +/- 4.80 days. Of all, 23 patients (92%) were discharged in good clinical condition and one patient (4%) was referred to another hospital. This study suggests that atropine can be administered until secretions disappear and intensive care should be exerted in follow-up of these patients. In addition, in case of necessity for high doses, sufficient amounts of atropine and PAM should be available in hospitals.Öğe Chemotherapy Related Angioedema Reply(Aves, 2015) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Kurt, Raziye; Dikey, Ismail[Abstract Not Available]Öğe Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy(Sage Publications Ltd, 2013) Davarci, Isil; Tuzcu, Kasim; Karcioglu, Murat; Hakimoglu, Sedat; Ozden, Raif; Yengil, Erhan; Akkurt, Cagla OzbakisObjective To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic-femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). Methods Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2ml (10mg) of 0.5% levobupivacaine and the USFB group received a 25ml mixture consisting of 10ml of 2.0% lidocaine, 10ml of 0.5% levobupivacaine and 5ml of saline (15ml for the femoral and 10ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. Results A total of 40 patients were enrolled in the study (n=20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. Conclusions USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.Öğe Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects(Elsevier Taiwan, 2016) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Tuzcu, Esra Ayhan; Hanci, Volkan; Aydin, SuzanDuring surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 mu g/kg) plus atropine (15 mu g/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine -atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.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 Effectiveness of sub-Tenon's block in pediatric strabismus surgery(Elsevier Science Inc, 2015) Tuzcu, Kasim; Coskun, Mesut; Tuzcu, Esra Ayhan; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Aydin, SuzanBackground and objectives: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. Methods: Forty patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. Results: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p> 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p< 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p< 0.05). Conclusions: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery. (c) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe The Effects of Remifentanil and Esmolol on Increase in Intraocular Pressure Due to Laryngoscopy and Tracheal Intubation: A Double-Blind, Randomized Clinical Trial(Lippincott Williams & Wilkins, 2015) Tuzcu, Kasim; Tuzcu, Esra A.; Karcioglu, Murat; Davarci, Isil; Coskun, Mesut; Ilhan, Ozgur; Daglioglu, Mutlu C.Purpose:This study aimed to compare the effects of remifentanil and esmolol on the elevation of intraocular pressure (IOP) and hemodynamic response.Methods:After approval of the institutional Ethics Committee and obtaining informed consent, 60 adult patients with American Society of Anesthesiologists I-II status undergoing elective, nonophthalmic surgery were included in the study. Exclusion criteria were preexisting eye disease, neuromuscular disease, esophageal reflux, hiatus hernia, allergy to any of the study drugs, and the use of -blockers, diuretics, or other antihypertensive agents. The patients were randomized into 2 groups by using the sealed-envelope method, as follows: group E (esmolol) and group R (remifentanil). A single intravenous dose of esmolol (0.5 mg/kg) or remifentanil (1 g/kg) just before induction agents were given to patients in groups E and R, respectively. IOP, heart rate (HR), and mean arterial pressure (MAP) values were recorded before intubation and at 1, 3, 5, and 10 minutes after intubation.Results:The IOP decrease in group R was statistically significant compared with group E (P<0.01). HR values at 10 minutes after intubation were significantly decreased in group E compared with group R (P<0.05). There was no significant difference in MAP values between the groups.Conclusions:It was concluded that remifentanil is more effective than esmolol in preventing IOP elevation related to laryngoscopy and tracheal intubation, while there is no significant difference between the 2 agents in terms of HR and MAP.Öğe The impact of different antiepileptic drugs on the sedation of children during magnetic resonance imaging(Elsevier Science Inc, 2014) Davarci, Isil; Karcioglu, Murat; Tuzcu, Kasim; Basarslan, Fatmagul; Davran, Ramazan; Yengil, Erhan; Yilmaz, CahideBackground and objectives: The induction and inhibition of cytochrome P450 isoenzymes by antiepileptic drugs lead to changes in the clearance of anesthetic drugs eliminated via hepatic metabolism. We investigated the duration of the sedation and additional anesthetic needs during magnetic resonance imaging in epileptic children receiving antiepileptic drugs that cause either enzyme induction or inhibition. Methods: In American Society of Anesthesiology I-II, 120 children aged 3-10 years were included. Group 1: children using antiepileptic drugs that cause cytochrome P450 enzyme induction; Group 2: those using antiepileptic drugs that cause inhibition; and Group 3: those that did not use antiepileptic drugs. Sedation was induced with the use of 0.05 mg kg(-1) midazolam and 1 mg kg(-1) propofol. An additional 0.05 mg kg(-1) of midazolam and rescue propofol (0.5 mg kg(-1)) were administered and repeated to maintain sedation. The duration of sedation and the additional sedation needed were compared. Results: The duration of the initial dose was significantly shorter in Group I compared with groups II and III (p = 0.001, p = 0.003, respectively). It was significantly longer in Group II compared with groups I and III (p = 0.001, p = 0.029, respectively). The additional midazolam needed for adequate sedation was increased in Group I when compared with groups II and III (p = 0.010, p = 0.001, respectively). In addition, the rescue propofol dose was significantly higher only in Group I when compared with Group III (p = 0.002). Conclusion: In epileptic children, the response variability to the initial sedative agents during the magnetic resonance imaging procedure resulting from the inhibition or induction of the cytochrome P450 isoenzymes by the antiepileptic drugs mandated the titration of anesthetic agents. Copyright (C) 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.Öğe Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions(Aves, 2015) Hakimoglu, Sedat; Tuzcu, Kasim; Davarci, Isil; Karcioglu, Murat; Kurt, Raziye; Dikey, IsmailAnaesthesia represents a specific set-up in respect to pharmacology, and during this time, early hypersensitivity reactions or anaphylaxis may occur in patients who are exposed to a great number of foreign substances. Intravenous ephedrine (5 mg) was applied to a 37-year-old patient due to the development of intraoperative hypotension in a total abdominal hysterectomy operation. After application, hyperaemia was seen in the track of the intravenous catheter of that extremity. Approximately 15 minutes later, urticarial plaques were observed extensively in the abdomen and in both extremities. Methylprednisolone (100 mg+ 100 mg) and pheniramine (45.5 mg) were given with an increasing infusion rate of intravenous crystalloid. The patient was extubated without any problem and removed to the recovery unit for observation. After the total disappearance of lesions at postoperative 60 minutes and because of the stability of vital signs, the patient was removed to the service. In the follow-up of surgery, no complication developed, and the patient was discharged on postoperative day 2.Öğe Oral intralipid emulsion use: a novel therapeutic approach to pancreatic ?-cell injury caused by malathion toxicity in rats(Taylor & Francis Ltd, 2014) Tuzcu, Kasim; Alp, Harun; Ozgur, Tumay; Karcioglu, Murat; Davarci, Isil; Evliyaoglu, Osman; Karakus, AliWe aimed to investigate whether oral intralipid emulsion (OIE) reduces pancreatic beta-cell injury (P beta CI) by chelating with malathion (M), or increases P beta CI by increasing M absorption in the stomach. Fifty rats were randomly divided into six groups: control group (C); OIE administered group (L); M-treated group (M); OIE-administered group immediately after given M (M0L); OIE-administered group 6 hours after being given M (M6L) and OIE administered group 12 hours after being given M (M12L). M induced P beta CI, hyperglycemia, temporary hyperinsulinemia and oxidative stress (OS). However, there was no significant difference in serum levels of glucose, insulin, total oxidants (TOS) and liver TOS between the M0L group and groups C and L. Also, insulin levels of M12L significantly increased, compared to the M6L group. Biochemical results, which were confirmed by histopathology, indicate that administering OIE after 6 hours and immediately after taking M may markedly prevent P beta CI, hyperglycemia and OS. In addition, OIE's effectiveness decreased after 6 hours and was totally ineffective after 12 hours. We concluded that OIE may help to achieve a better prognosis and reduce mortality rate in cases presented to the emergency department, particularly within the first 6 hours, resulting from organophosphate pesticide poisoning by oral ingestion.Öğe Perioperative Anaesthetic Approach in a Homozygous Sickle Cell Anaemia Patient with Frequent Pain Crises(Aves, 2014) Tuzcu, Kasim; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Akkucuk, SeckinSickle cell disease (HbS) is a haemolytic anaemia characterized by the formation of abnormal haemoglobin. In patients with sickle cell disease, high rates of erythrocyte generation, degradation, and hyperbilirubinemia increase the risk for cholelithiasis. Previous studies have found that the incidence of cholelithiasis is 70% in adult patients. In sickle cell disease, decreased oxygen concentration leads to the sickling of erythrocytes by causing aggregation and polymerization. Sickle erythrocytes can have devastating effects on many vital organs by causing microvascular occlusion. In patients with sickle cell anaemia, anaesthetic technique, anaesthetic agents, and surgical trauma may cause additional risk. In this case report, we present a perioperative anaesthetic approach in the laparoscopic cholecystectomy of a patient with HbS, elevated liver function tests, and frequent pain crises.Öğe Protective effects of N-acetylcysteine on triamcinolone acetonide-induced lens damage in rats(Taylor & Francis Ltd, 2014) Tuzcu, Esra Ayhan; Tuzcu, Kasim; Basarslan, Fatmagul; Motor, Sedat; Coskun, Mesut; Keskin, Ugurcan; Ayintap, EmreObjective: To examine the relationship of cataract forming effect of intravitreal triamcinolone acetonide (IVTA) injection with oxidative status and the effect of N-acetylcysteine (NAC) on these alterations. Materials and methods: Twenty-six Wistar-Albino rats were included in the study. Rats were assigned into four groups as follows: intravitreal saline injection group (controls); IVTA injection group; IVTA + intraperitoneal NAC injection group (IVTA + NAC); and intraperitoneal NAC injection group (NAC). Triamcinolone acetonide was intravitreally injected at a dose of 1 mg. NAC was intraperitoneally injected at a dose of 150 mg/g body weight. Animals were sacrificed and lens specimens were analyzed for levels of malondialdehyde (MDA) and protein carbonyl (PC) and activities of glutathione (GSH) and glutathione peroxidase (GSH-Px). Results: We found that the MDA and PC levels of lenses were increased in the IVTA group (p < 0.01). It was seen that GSH and GSH-Px in lenses were decreased in the IVTA group (p < 0.01). NAC administration significantly ameliorated these changes in the IVTA + NAC group (p<0.05). Conclusion: These results indicate that the NAC produces a protective mechanism against IVTA-induced cataract and suggest a role of oxidative stress in pathogenesis.Öğe A successful administration of anesthesia in an urgent spinal surgery of a patient with a high risk of coronary artery and degenerative cardiac valvular diseases(2011) Karcio?lu, Murat; Tuzcu, Kasim; Davarci, Işil; Bozdo?an, Yusuf Bolkan; Turhano?lu, Selim; Akçay, Adnan Burak; Altaş, MuratIn noncardiac surgery of cardiac patients, all efforts during the preoperative assessment are to predict, and prevent potential complications An urgent operation was decided to be performed on a 80-year-old female patient with the diagnosis of depression fracture of L1. During assessment of the patient before anesthesia, we learned that patient had coronary artery disease. During the physical examination, pulmonary edema was detected secondary to the congestive heart failure. The patient was sent to coronary intensive care unit after talking with patient's relatives and the attending surgeon. After aggressive treatment about a week, blood gas values were improved and hemodynamic values were stabilized. In this condition, we decided operation for the patient. Invasive monitorization was performed in the operation room. For induction of anesthesia, midazolam, fentanyl, rocuronium, and lidocaine were given. The maintenance of anesthesia provided with sevoflurane plus 50% of air and 50% of oxygen. The patient remained stable during the operation. A three-hour operation was completed without any problem, and she was remained at a steady state up to the discharge. As a conclusion, each patient should be questioned and examined carefully about cardiac manifestations during the preoperative assessment. In the presence of any sign or symptom of congestive heart failure (CHF), non-cardiac surgeries should be postponed if it is not urgent. Such patients should be treated aggressively during the perioperative period according to the functional degree of CHF. In case of emergency, consultation with cardiologists should arrive at a consensus, and patients should be operated under optimal conditions.Öğe Successful Management of Aluminium Phosphide Poisoning Resulting in Cardiac Arrest(Aves, 2015) Hakimoglu, Sedat; Dikey, Ismail; Sari, Ali; Kekec, Leyla; Tuzcu, Kasim; Karcioglu, MuratAluminum phosphide has high toxicity when it is ingested, and in case of contact with moisture, phosphine gas is released. Aluminum phosphide poisoning causes metabolic acidosis, arrhythmia, acute respiratory distress syndrome and shock, and there is no specific antidote. A 17-year-old male patient was referred to our hospital because of aluminum phosphide poisoning with 1500 mg of aluminum phosphide tablets. The patient's consciousness was clear but he was somnolent. Vital parameters were as follows: blood pressure: 85/56 mmHg, pulse: 88 beats/min, SpO(2) : 94%, temperature: 36.4 degrees C. Because of hypotension, noradrenaline and dopamine infusions were started. The patient was intubated because of respiratory distress and loss of consciousness. Severe metabolic acidosis was determined in the arterial blood gas, and metabolic acidosis was corrected by sodium bicarbonate treatment. In addition to supportive therapy of the poisoning, haemodialysis was performed. Cardiac arrest occurred during follow-ups in the intensive care unit, and sinus rhythm was achieved after 10 min of cardiopulmonary resuscitation. The patient was discharged after three sessions of haemodialysis on the ninth day. As a result, haemodialysis contributed to symptomatic treatment of aluminum phosphide poisoning in this case report.
