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    The Effects of Positive End-Expiratory Pressure on Cross-Sectional Area of Internal Jugular Vein in Obese Patients
    (Mary Ann Liebert, Inc, 2016) Kozanhan, Betul; Apiliogullari, Seza; Basaran, Betul; Iyisoy, Mehmet Sinan; Ozmen, Sadik
    Introduction: Obesity is one of the most important risk factors for complications of internal jugular vein (IJV) cannulation. The efficacy and safety of positive end-expiratory pressure (PEEP) are still under debate in obese patients. The aim of this prospective randomized ultrasound study was to investigate effects of different PEEP levels on the cross-sectional area (CSA) of right IJV and overlap with carotid artery (CA) in anesthetized obese patients. Materials and Methods: Seventy-two obese patients undergoing various elective surgeries under general endotracheal anesthesia were enrolled. We measured CSA of right IJV, margin of safety (MOS), and degree of overlap between CA and IJV at PEEP 0 (P0), 5 (P5), and 12 (P12) cm H2O levels. We defined a 20% increase in CSA as clinically relevant. Results: Data were collected for all the 72 patients enrolled in the study. Application of 12, but not 5cm H2O PEEP, resulted in a clinically significant increase in CSA of right IJV. When compared to P0, application of P5 and P12 increased both degree of overlap (p<0.001 each) and MOS (p<0.001 each). None of the patients experienced severe hypotension or bradycardia. Conclusions: Application of 12cm H2O PEEP provides a clinically significant increase in CSA of right IJV without relevant reduction of MOS in anesthetized obese patients.
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    Psychiatric Disorders and Association with Quality of Sleep and Quality of Life in Patients with Chronic Pain: A SCID-Based Study
    (Wiley-Blackwell, 2014) Annagur, Bilge B.; Uguz, Faruk; Apiliogullari, Seza; Kara, Inci; Gunduz, Sule
    ObjectiveWe aimed to determine Axis-I psychiatric disorders in patients with chronic pain (CP) and compare control subjects determined by a structured clinical interview. Another objective of the study was to examine whether there is an association between psychiatric disorders and quality of sleep, quality of life, and demographic and clinical characteristics in patients with CP. DesignThe study sample was comprised of 108 patients with CP and 54 control subjects without pain. Psychiatric interviews were conducted with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (SCID). Also used were the Hospital Anxiety and Depression Scale, Hamilton Depression Inventory, Short Form-36, and Pittsburgh Sleep Quality Index (PSQI). ResultsThe rate of any Axis-I psychiatric disorder stood at 66.7% (any mood disorder, 50%; any anxiety disorder, 33.3%; any somatoform disorder, 20.4%; any substance use disorder, 16.6%), significantly more common in the patients' group compared with the control group. The most common psychiatric disorder was major depression (49.1%) in subjects with CP. Female gender, numbers of localization, and neck and back localizations were significantly higher in the SCID (+) group than the SCID (-) group. A statistically significant difference was observed between the SCID (+) and SCID (-) groups regarding visual analogue scale, depression and anxiety scores, mental component summary score, and global PSQI scores. ConclusionResults of this study suggest that psychiatric morbidity in patients with CP is frequently seen and may adversely affect quality of sleep and quality of life of the patients. Therefore, the patients with CP should be examined with respect to their mental status.