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Öğe Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications(Marmara Univ, Fac Medicine, 2020) Kilicaslan, Alper; Gok, Funda; Korucu, Ismail Hakki; Ozkan, Asiye; Yilmaz, ResulObjective: Our aim was to evaluate the anatomic variations detected during ultrasound-guided interscalene brachial plexus block (US-ISB) and present their clinical implications. Materials and Methods: After the ethical approval for the study was obtained from the local ethics committee, the files and US records of patients who underwent US-ISB for anesthesia of the shoulder surgery were retrospectively analyzed. Results: Anatomical variations which were considered to affect the block technique were detected in 13 (11.8%) of 110 patients. C5 cervical root pierced the anterior scalene muscle (ASM) in 4.5%, and ventral rami of C5 and/or C6 were located in ASM in 3.6% of patients. There was a muscle bridge between C5 to C6 and C5 to C7 roots in 1.8% of the patients. The brachial plexus was located medial to ASM and missing from interscalene groove in 1.8% of patients. In one case (C5 root was located in ASM), US-ISB resulted in incomplete brachial plexus anesthesia, and so general anesthesia (GA) was performed. Conclusion: Some of the brachial plexus variations in the interscalene area may be associated with further needle manipulation/redirection and block failure. We consider that prospective studies including more populations are needed to elucidate the effects of these variations on block parameters.Öğe Bispectral Index Guided Sedation in Congenital Pain Insensitivity Syndrome(Aves, 2014) Kilicaslan, Alper; Gok, Funda; Yasar, Eray; Basdemirci, Ali; Otelcioglu, Seref[Abstract Not Availabe]Öğe Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients(E-Century Publishing Corp, 2015) Gok, Funda; Sarkilar, Gamze; Kilicaslan, Alper; Yosunkaya, Alper; Uzun, Sema TuncerCentral vein catheterization is a common procedure performed on patients under intensive care. The safe and successful placement of the central venous catheter depends on vein size. Although used for this purpose, the Trendelenburg position can be hazardous in some patients. The aim of this study was to compare the effects of the Trendelenburg and passive leg raising (PLR) positions on the size of the right internal jugular vein (IJV) in mechanically ventilated patients under intensive care. Seventy-eight mechanically ventilated patients under intensive care were included into the study. Sonographic images of the right IJV were recorded in supine (control), 10 degrees Trendelenburg and 40 degrees PLR positions. Anterior-posterior and transverse diameter, cross-sectional area (CSA), and depth were calculated from the recorded images. The size of the right IJV (CSA, transverse and vertical diameters) was significantly larger in the Trendelenburg and PLR positions than in supine position. An increase of 26% in the IJV CSA was obtained in the Trendelenburg position and 23% in the PLR position, compared to the supine position. There was no significant difference between the measurements obtained from the Trendelenburg and PLR positions. The study shows that the Trendelenburg and PLR positions increase the size of the IJV to a similar extent in mechanically ventilated patients under intensive care.Öğe Continuous monitoring of ventilation by diaphragm ultrasonography using a new tool during procedural sedation(Elsevier Science Inc, 2018) Kilicaslan, Alper; Gok, Funda; Gunuc, Hilmi[Abstract Not Availabe]Öğe Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam(Wiley-Blackwell, 2014) Kilicaslan, Alper; Gok, Funda; Erol, Atilla; Okesli, Selmin; Sarkilar, Gamze; Otelcioglu, SerefBackgroundIt has been shown that early placement of an intravenous line in children administered sevoflurane anesthesia increased the incidence of laryngospasm and movement. However, the optimal time for safe cannulation after the loss of the eyelash reflex during the administration of sevoflurane and nitrous oxide is not known. AimThe aim of the study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane and nitrous oxide in children premedicated with oral midazolam. MethodWe performed a prospective, observer-blinded, up-down sequential, allocation study, and children, aged 2-6years, ASA physical status I, scheduled for an elective procedure undergoing inhalational induction were included in the study. Anesthesia was induced with sevoflurane and nitrous oxide after premedication with oral midazolam. For the first child, 4min after the loss of the eyelash reflex, the intravenous cannulation was attempted by an experienced anesthesiologist. The time for intravenous cannulation was considered adequate if movement, coughing, or laryngospasm did not occur. The time for cannulation was increased by 15s if the time was inadequate in the previous patient, and conversely, the time for cannulation was decreased by 15s if the time was adequate in the previous patient. The probit test was used in the analysis of up-down sequences. ResultsA total of 32 children were enrolled sequentially during the study period. The adequate time for effective intravenous cannulation after induction with sevoflurane and nitrous oxide in 50% and 95% of patients were 1.29min (95% confidence interval, 0.96-1.54min) and 1.86min (95% confidence interval 1.58-4.35min), respectively. ConclusionWe recommend waiting 2min for attempting intravenous placement following the loss of the eyelash reflex in children sedated with midazolam and receiving an inhalation induction with sevoflurane and nitrous oxide.Öğe Diaphragm and Lung Ultrasonography During Weaning From Mechanical Ventilation in Critically Ill Patients(Springernature, 2021) Gok, Funda; Mercan, Aysel; Kilicaslan, Alper; Sarkilar, Gamze; Yosunkaya, AlperAim: Optimum Liming is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters. Methods: Patients undergoing mechanical ventilation for >48 hours were included in the study. In patients planned for extubation, sonographic evaluations of the diaphragm and lung were performed at the T-tube stage. RSBI was achieved in the pressure support (PS) ventilation stage. Predictive values of DTF, DE, and anterolateral LUS scores were compared with RSBI in extubation success. Results: Sixty-two patients were enrolled in the study. The study population consisted mostly of trauma patients (77%). A cut-off value of 64 was obtained for RSBI. The positive predictive value (PPV) was found at 97% in extubation success. Cut-off values of 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained al the T-tube stage, respectively. PPVs of all sonographic parameters were found over 90%. At the first stage, weaning and extubation failures were determined as 35 and 9.6%, respectively. RSBI was found as a powerful parameter in determining extubation success (r=0.774, p <= 0.001) and moderately correlated with sonographic parameters. Conclusion: Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.Öğe THE EFFECT OF ULTRASOUND GUIDANCE ON CENTRAL VENOUS CATHETER-ASSOCIATED BLOODSTREAM INFECTION IN CRITICAL CARE PATIENTS(Carbone Editore, 2013) Gok, Funda; Kilicaslan, Alper; Sarkilar, Gamze; Kandemir, Bahar; Yosunkaya, AlperBackground and aims: The central venous catheterization can be performed according to anatomical references points or by using ultrasound guidance. In this study, our aim was to perform a comparison between the application of these two methods for internal vein catheterization, especially with regards to the incidence of catheter-related bloodstream infections. Materials and methods: 97 critical care patients who underwent real-time USG-guided cannulation (Grup 1) of the internal jugular vein were prospectively compared with 97 critical care patients in whom the landmark technique (Grup 2) was used. The parameters studied included average access time, time for insertion, attempts required, mechanical complications and catheter-related bloodstream infections. Results: There was no difference between the two groups with regards to demographic data (p>0.05). The mean skin-vein period, the total period of insertion, the number of attempts, the rate of mechanical complications, and the incidence of catheter-related bloodstream infections were significantly lower in Group 1 in comparison to Group 2 (p<0.0.5). Conclusions: USG-guided internal jugular vein catheterization reduced the number of attempts, and was more advantageous than the conventional method in terms of allowing a lower incidence of mechanical complications and catheter-related bloodstream infections.Öğe Fulminant Liver Failure Due to Amanita Phalloides Toxicity Treated with Emergent Liver Transplantation(Modestum Ltd, 2015) Gok, Funda; Topal, Ahmet; Hacibeyoglu, Gulcin; Erol, Atilla; Biyik, Murat; Kucukkartallar, Tevfik; Yosunkaya, AlperThe clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.Öğe Fulminant Liver Failure Due to Amanita Phalloides Toxicity Treated with Emergent Liver Transplantation(Modestum Ltd, 2015) Gok, Funda; Topal, Ahmet; Hacibeyoglu, Gulcin; Erol, Atilla; Biyik, Murat; Kucukkartallar, Tevfik; Yosunkaya, AlperThe clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.Öğe Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery(E-Century Publishing Corp, 2015) Sarkilar, Gamze; Sargin, Mehmet; Saritas, Tuba Berra; Borazan, Hale; Gok, Funda; Kilicaslan, Alper; Otelcioglu, SerefThis study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance <6 cm, upper lip bite test class 3, Wilson risk sum score >= 2, Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.Öğe Management of a patient with Opalski's syndrome in intensive care unit(Wiley, 2017) Aynaci, Ozer; Gok, Funda; Yosunkaya, AlperKey Clinical Message Opalski syndrome is a rare vascular brainstem syndrome which is accepted as a variant of Wallenberg syndrome. Opalski syndrome should be considered in acute conditions in which typical symptoms of lateral medullary infarct are accompanied by ipsilateral hemiparesis. Other brain stem syndromes are distinguished from Opalski syndrome by the presence of contralateral hemiparesis.Öğe Morphometric Analysis of the Sacral Canal and Hiatus Using Multidetector Computed Tomography for Interventional Procedures(Turkish Neurosurgical Soc, 2015) Kilicaslan, Alper; Keskin, Fatih; Babaoglu, Ozan; Gok, Funda; Erdi, Mehmet Fatih; Kaya, Bulent; Ozbiner, HuseyinAIM:The sacral canal has been frequently used asa passagefor minimally invasive diagnostic and therapeutic procedures for spinal diseases. The aim of the present study was to investigate morphometric analyses of the sacral canal, hiatus, and surrounding structures according to different age groups and gender by using themultidetector computed tomography method. MATERIAL and METHODS: Multiplanar-reconstructed images from 300 adult (150 females and 150 males, between 20 and 80 years old) were divided into three groups according to age and retrospectively examined. Various anatomic measurements of the sacral hiatus, surrounding structures, and sacral canal were performed. Sacral curvature angle and lumbosacral lordotic angle were noted. RESULTS: Bony anatomic abnormalities such as absent hiatus (0.3%), complete agenesis (1%), and bony septum (2.6%) were detected in some cases. The anteroposterior (AP) diameter of the hiatus was less than 2 mm in 5% of cases. In all groups, the mean values of the hiatus AP diameter and area, and the shortest distance of the sacral canal AP diameter were shorter in the 60-80 years age group when compared with those in 20-39 years age group (p=0.01). The shortest sacral canal AP diameter was commonly located at the S2 and S3 levels in 59.2% and 33.9% of cases, respectively. The levels of maximum curvature were at S3 and S2 in 63.3% and 26.7% of cases, respectively. Median sacral curvature angles and lumbosacral lordotic angles were measured as 164 degrees and 134 degrees, respectively. CONCLUSION: Sacral structures have morphometric variations. Understanding of the detailed anatomy may improve the reliability of interventional procedures.Öğe Post-Spinal a Rare Complication and Treatment: Tinnitus and Epidural Blood Patch(Aves, 2015) Sarkilar, Gamze; Reisli, Ruhiye; Saritas, Tuba Berra; Gok, Funda; Sarigul, Ali; Otelcioglu, Seref[Abstract Not Availabe]Öğe Response to Makkar and Singh's comment on our article 'Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam'(Wiley, 2015) Kilicaslan, Alper; Gok, Funda; Erol, Atilla; Okesli, Sermin; Sarkilar, Gamze; Otelcioglu, Seref[Abstract Not Availabe]Öğe Ultrasonography in the Diagnosis of Pneumothorax Not Detected by Chest Radiography: Case Report(Galenos Yayincilik, 2019) Gok, Funda; Kilicaslan, Alper; Yosunkaya, AlperIn patients with acute respiratory distress syndrome (ARDS), many factors, especially barotrauma may cause pneumothorax. Early detection of pneumothorax is critical in ARDS patients. When pneumothorax is suspected, chest radiography is usually preferred as the first line imaging modality. Recently, ultrasonography has been used by intensive care physicians in many fields, even in imaging of pneumothorax. We present a 75-year-old female patient with ARDS complicated by pneumothorax, in whom chest radiography was not diagnostic but ultrasound was used for diagnosis and follow-up.Öğe ULTRASOUND GUIDED NASOGASTRIC FEEDING TUBE PLACEMENT IN CRITICAL CARE PATIENTS(Lippincott Williams & Wilkins, 2014) Gok, Funda; Kilicaslan, Alper; Yosunkaya, Alper[Abstract Not Availabe]Öğe Ultrasound-Guided Nasogastric Feeding Tube Placement in Critical Care Patients(Wiley, 2015) Gok, Funda; Kilicaslan, Alper; Yosunkaya, AlperBackground: Nasogastric feeding tube (NGT) placement is a common practice performed in intensive care units (ICUs). Complications due to the improper placement of NGT are well known. In this prospective descriptive study, the effectiveness of ultrasound (US)-guided NGT placement was investigated. Materials and Methods: Fifty-six mechanically ventilated patients monitored in the ICU were included. A linear US probe was transversely placed just cranial to the suprasternal notch, and the concentric layers of the esophagus were attempted to be viewed on the posterolateral side of the trachea (generally left) by shifting the probe. If the esophagus can be seen, an attempt was made to insert the NGT under real-time visualization of ultrasonography. Furthermore, gastric placement of the NGT tip was confirmed with abdominal radiograph. Results: A total of 56 patients were included in the study. For 52 (92.8%), the NGT image was obtained during placement within the esophagus. For 3 (5.3%), the esophagus could not be seen by US, and NGT was placed blindly. For 1 patient, we could not detect passing of the NGT into the stomach despite the successful visualization of esophagus. In this patient, NGT was radiographically detected in the trachea after the procedure. Conclusion: This study revealed that passing of the NGT through the esophagus could be visualized at a high rate in real-time US among ICU patients. These data suggest that ultrasonographic visualization of the upper esophagus during NGT insertion can be used as an adjuvant method for confirmation of correct placement.
