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Öğe Anaesthetic Management with Thromboelastography in a Patient with Glanzmann Thrombasthenia(Aves, 2014) Topal, Ahmet; Kilicaslan, Alper; Erol, Atilla; Cankaya, Baris; Otelcioglu, SerefGlanzmann thrombastenia (GT) is a rare disease of an autosomal recessive inheritance characterized with fatal bleeding tendency. The anaesthesiologist should be cognizant of the risk involved and be prepared with necessary measures. In this paper, we present a GT case of a 9-year-old male with hypospadias, which was successfully repaired after platelet transfusions according to the thromboelastography tracings.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 Awake thoracic spine surgery under bilateral ultrasound guided multiple midpoint transverse process to pleura (MTP) blocks(Elsevier Science Inc, 2019) Kilicaslan, Alper; Kacira, Burkay Kutluhan[Abstract Not Availabe]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 The clavipectoral fascia plane block: Reply to Dr. Altinpulluk(Elsevier Science Inc, 2020) Ince, Ilker; Kilicaslan, Alper; Rogues, Vicente; Elsharkawy, Hesham; Valdes, Luis[Abstract Not Availabe]Öğe Combination of Lumbar Erector Spinae Plane Block (LESP) and Pericapsullar Nerve Group (PENG) block in hip surgery(Elsevier Science Inc, 2020) Ince, Ilker; Kilicaslan, Alper[Abstract Not Availabe]Öğe Combined erector spinae plane and interscalene brachial plexus block for surgical anesthesia of scapula fracture(Elsevier Science Inc, 2019) Kilicaslan, Alper; Hacibeyoglu, Gulcin; Goger, Esra; Uzun, Sema Tuncer; Ozer, Mustafa[Abstract Not Availabe]Öğe Combined pericapsular nerve block (PENG) and lumbar erector spinae plane (ESP) block for congenital hip dislocation surgery(Elsevier Science Inc, 2020) Ince, Ilker; Kilicaslan, Alper; Kutlu, Esra; Aydin, Ali[Abstract Not Availabe]Öğe Comparison of Hemodynamics Recovery Profile and Costs of Remifentanil Versus Fentanyl-Based Sevoflurane Anesthesia(Ortadogu Ad Pres & Publ Co, 2012) Uluer, Mehmet Selcuk; Topal, Ahmet; Tavlan, Aybars; Erol, Atilla; Kilicaslan, Alper; Otelcioglu, SerefObjective: This trial was designed to compare the effects of fentanyl and remifentanil on hemodynamic parameters, postoperative recovery, sevoflurane consumption and the cost of anesthetics. Material and Methods: Cases that were scheduled to undergo elective laparoscopic cholecystectomy surgery were assigned to two groups with simple random sampling method, as Group F (Fentanyl) and Group R (Remifentanil), each including 30 patients. The anesthetic induction was initiated by administering 1-2 mg/kg propofol bolus based on the bispectral index (BIS) value followed by 2 mu g/kg fentanyl in Group F patients and 1 mu g/kg remifentanil in Group R patients administered in 60 seconds as iv bolus; subsequently, 0.5 mg/kg iv atracurium was administered. For maintenance of anesthesia, 50% oxygen in-air was administered at 4 L/min; the end-tidal sevoflurane concentration was adjusted to achieve a BIS value of 45 to 55. In Group R, remifentanil 0.25 mu g/kg/min infusion was continued. The addition of 0.5 mu g/kg fentanyl was planned as required in Group F. Sevoflurane end-tidal concentration and the changing times were recorded. For each case, the sevoflurane consumption was calculated using the Dion formula. Results: In Group R, the hemodynamic control, particularly the suppression of response to intubation was more successful than in Group F. The eye opening times and Post Anesthesia Care Unit (PACU) transfer times were shorter in Group R relative to Group F (p=0.001 and p=0.001, respectively). Sevoflurane consumption was lower in the Group R (7.18 +/- 3.45 mL) compared to Group F (16.45 +/- 7.15 mL) (p=0.001). The total anesthetic drug cost was similar between the groups. Conclusion: Compared to fentanyl, remifentanil provided a better intraoperative hemodynamic control, faster postoperative recovery and a favorable effect on anesthetic drug cost by decreasing sevoflurane consumption, eliminating the disadvantages of its price.Öğe Comparison of the C-MAC D-Blade, Conventional C-MAC, and Macintosh Laryngoscopes in Simulated Easy and Difficult Airways(Aves, 2014) Kilicaslan, Alper; Topal, Ahmet; Erol, Atilla; Uzun, Sema TuncerObjective: Recently, to further enhance the potential in the management of difficult airways, the highly angulated D-Blade was added to the C-MAC system. The purpose of this study was to investigate the laryngoscopic view and intubation parameters using the new C-MAC D-Blade in comparison to the conventional C-MAC video laryngoscope and Macintosh direct laryngoscope in simulated easy and difficult airways. Methods: We recruited 26 experienced anaesthesia providers into a randomized trial. Each performed tracheal intubation of a Laerdal SimMan r manikin with each laryngoscope in the following laryngoscopy scenarios: (1) normal airway, (2) cervical spine immobilization, and (3) tongue edema. The intubation times, success rates, number of intubation attempts, laryngoscopic views, and severity of dental compression were recorded. Results: In all scenarios, video laryngoscopes provided better laryngeal exposure than the ML and appeared to produce less dental pressure. In the cervical spine immobilization scenario, D-Blade caused less dental pressure and showed better Cormack-Lehane (CL) classes than the other devices (p<0.001). There were no differences between video laryngoscopes in success of tracheal intubation (p>0.05). The CMAC provided the most rapid intubation. The rate of failure was 19% with ML. In the tongue edema scenario, the CMAC provided the most rapid and successful intubation (p<0.001). There were no differences between video laryngoscopes in laryngoscopic views according to CL classification and dental pressure (p>0.05). The rate of failure was 46% with the ML and 7% with the D-Blade. Conclusion: The CMAC D-Blade caused less dental pressure than the conventional C-MAC and ML in the cervical immobilization scenario. The conventional CMAC performed better than the D-Blade and ML in the tongue edema scenario. These two video laryngoscopes may complement each other in various difficult airway situations.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 A Comparison of the Effects of Postoperative CPAP and Nasal Oxygen Use on Arterial Blood Gas in Laparoscopic Cholecystectomy Performed in Obese Patients: A Prospective, Randomized Cinical Trial(Ortadogu Ad Pres & Publ Co, 2012) Kiziloz, Sema Peker; Tavlan, Aybars; Topal, Ahmet; Erol, Atilla; Kilicaslan, Alper; Otelcioglu, SerefObjective: This study was designed to compare the effects of continuous positive airway pressure (CPAP) and nasal oxygen use on postoperative blood gases in obese patients undergoing laparoscopic cholecystectomy. Material and Methods: A total of 40 patients with a body mass index (BMI) ranging between 30 and 40 were enrolled in this study. Patients were divided into two groups: Group C (n=20) = CPAP and Group N (n=20) = Nasal O-2. Baseline blood gas was sampled on spontaneous respiration (G(0)). The blood gas sampling was repeated before patients were admitted to the postoperative care unit (PACU) (G(1)). Following the operation, Group C received CPAP 5 cmH(2)O and Group N received 5 1/min O-2 via nasal cannula for 60 minutes. Blood gas sampling was repeated after 60 minutes in both groups (G(2)). Results: At the PACU, the SpO(2) values were higher in Group C relative to Group N at 30 minutes (p<0.05). In both groups, the in-group pH values at G(1) measurement time displayed a statistically significant reduction compared to those at the G(0) measurement time (p<0.05). At G(2), PaCO2 was higher in Group N compared to Group C (p<0.05). In both groups, the in-group PaCO2 values were significantly higher at G(1) relative to G(0) (p<0.01). In Group C, PaO2 was higher at G(2) compared to Group N (p<0.05). Conclusion: Postoperative CPAP use may increase the PaO2 more and provide a better CO2 elimination compared to nasal oxygen use in obese patients undergoing laparoscopic cholecystectomy.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 Differences in tip visibility and nerve block parameters between two echogenic needles during a simulation study with inexperienced anesthesia trainees(Springer Japan Kk, 2014) Kilicaslan, Alper; Topal, Ahmet; Tavlan, Aybars; Erol, Atilla; Otelcioglu, SerefNeedle tip visualization during ultrasound-guided regional anesthesia (UGRA) is necessary for safety and efficacy. However, disruption of the image of the needle tip driven toward the target is a general problem, especially for beginners. The purpose of this study was to compare performance parameters between using the Sonoplex and Stimuplex D-Plus echogenic needles in a simulated ultrasound-guided interventional task by inexperienced anaesthesia residents. After a standardized training session, 28 anesthesiology residents performed simulated nerve blocks in a beef phantom with each needle. All ultrasound images were digitally stored for analysis. The absolute time the needle tip was in view, total procedure time, and angle of needle insertion were subsequently measured objectively by two single investigators. The procedures that used the Sonoplex echogenic needle had significantly better tip visibility and shorter total procedure time at insertion angles between 42A degrees and 64A degrees relative to the phantom surface. We have demonstrated that inexperienced users who used the Sonoplex echogenic needle were able to complete the procedure more quickly. Needles with improved visibility would be a very useful addition to UGRA for inexperienced users.Öğe The Effect of Sevoflurane and Desflurane on the Early Postoperative Cognitive Functions In Geriatric Patients(Modestum Ltd, 2013) Cobanoglu, Halit; Tavlan, Aybars; Topal, Ahmet; Kilicaslan, Alper; Erol, Atilla; Otelcioglu, SerefOur aim was to compare the effects of desflurane and sevoflurane on cognitive functions of geriatric patients that were planned for elective surgery under general anestesia. After national ethical committee approval, 40 patients (aged 65-75 yr) were enrolled. Patients were allocated to either the desflurane (n= 20) or the sevoflurane (n= 20) group. In all patients anaesthesia will be induced with propofol and remifentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, and remifentanyl. Emergence times from anaesthesia and Aldrete scores were recorded. Cognitive function will be evaluated with two cognitive test; Blessed Short Orientation Memory Concentration Test (BOMC) and standardized mini mental test (SMMT) preoperatively and postoperatively at 60, and 180 minute after extubation. The mean extubation time, eye opening time and Aldrete scores were similar in the desflurane and sevoflurane groups (p> 0,05). There were no significant differences between the desflurane and the sevoflurane groups when the BOMC and MMST scores were compared preoperatively, and postoperatively at 60, and 180 min (p> 0,05). The result of this study indicate that there is no difference between effects of desflurane and sevoflurane anesthesia on postoperatif cognitive functions in the elderly.Öğe The Effect of Transversus Abdominis Plane Block in Inguinal Hernioplasty on Chronic Pain(Modestum Ltd, 2015) Topal, Ahmet; Sargin, Mehmet; Kilicaslan, Alper; Uzun, Sema TuncerThe aim of the current study was to retrospectively evaluate the efficacy of IV analgesia after general anesthesia, transversus abdominis plane (TAP) block after the induction of general anesthesia and before the surgery and spinal analgesia on development of chronic pain following inguinal hernia repair. Forty patients, who underwent hernioplasty for the first-time and for whom at least 6 months had passed since the operation date were included in the study, were included in each group as follows: Group G received IV analgesia with general anesthesia; Group T included patients who received TAP block with general anesthesia; and Group S received spinal anesthesia. The study evaluated early and chronic postoperative pain, as well as pain severity, nature of the pain, predisposing factors, and the effect on various activities. No difference was found in pain incidence among the groups in the early postoperative pain evaluation; whereas VAS scores were lower in Group T. Chronic pain incidence was found to be lower in Group T. However, there was no difference among the groups in terms of VAS scores, pain nature, frequency, its effect on daily activities and sleep for patients with chronic pain. The TAP block is an effective method to prevent chronic pain development after inguinal hernioplasty compared to the other two methods. Because of the retrospective nature of the study, further prospective clinical trials are required.Öğe The Effect of Transversus Abdominis Plane Block in Inguinal Hernioplasty on Chronic Pain(Modestum Ltd, 2015) Topal, Ahmet; Sargin, Mehmet; Kilicaslan, Alper; Uzun, Sema TuncerThe aim of the current study was to retrospectively evaluate the efficacy of IV analgesia after general anesthesia, transversus abdominis plane (TAP) block after the induction of general anesthesia and before the surgery and spinal analgesia on development of chronic pain following inguinal hernia repair. Forty patients, who underwent hernioplasty for the first-time and for whom at least 6 months had passed since the operation date were included in the study, were included in each group as follows: Group G received IV analgesia with general anesthesia; Group T included patients who received TAP block with general anesthesia; and Group S received spinal anesthesia. The study evaluated early and chronic postoperative pain, as well as pain severity, nature of the pain, predisposing factors, and the effect on various activities. No difference was found in pain incidence among the groups in the early postoperative pain evaluation; whereas VAS scores were lower in Group T. Chronic pain incidence was found to be lower in Group T. However, there was no difference among the groups in terms of VAS scores, pain nature, frequency, its effect on daily activities and sleep for patients with chronic pain. The TAP block is an effective method to prevent chronic pain development after inguinal hernioplasty compared to the other two methods. Because of the retrospective nature of the study, further prospective clinical trials are required.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.
