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Öğe Anaesthetic Management of a Child with Limb-Girdle Muscular Dystrophy(Aves, 2014) Sarkilar, Gamze; Mermer, Aydin; Yucekul, Melike; Ceken, Bedia Mine; Altun, Celalettin; Otelcioglu, SerefLimb-girdle muscular dystrophies are a group of disorders with wide genetic and clinical heterogeneity. These disorders may lead to an increase in life-threatening complications related to surgery and anaesthesia. In this case, the anaesthetic management of a child with limb-girdle muscular dystrophy is presented.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 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 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 A Comparison of Ketamine and Paracetamol for Preventing Remifentanil Induced Hyperalgesia in Patients Undergoing Total Abdominal Hysterectomy(Ivyspring Int Publ, 2012) Yalcin, Naime; Uzun, Sema Tuncer; Reisli, Ruhiye; Borazan, Hale; Otelcioglu, SerefBackground: The aim of this prospective, randomized, placebo-controlled study was to compare the effects of ketamine and paracetamol on preventing remifentanil induced hyperalgesia. Methods: Ninety patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups to receive (I) either saline infusion; (II) 0.5 mg/kg ketamine iv bolus or (III) 1000 mg iv paracetamol infusion before induction of anesthesia. Until the skin closure, anesthesia was maintained with 0.4 mu g/kg/min remifentanil infusion in all groups, additionally Group II received 5 mu g/kg/min ketamine infusion. Pressure pain thresholds were measured the day before surgery during the preoperative visit for baseline measurements and repeated postoperatively at 24 and 48 hours (hrs). Pressure pain thresholds were established by digital algometer on three different peri-incisional regions for calculating mean pressure pain threshold values. The visual analogue scale (VAS), sedation scores, total morphine consumption and side effects were assessed postoperatively. Results: Demographic characteristics, duration of surgery and anesthesia were similar in the three groups. Pain thresholds at the incision region were significantly lower at 24 and 48 hrs postoperatively in Group I than the other Groups (p<0.05). In Group., pain thresholds were lower compared with preoperative baseline values. Thresholds in Group II and Group III were higher compared with preoperative baseline values (p<0.05) The VAS scores at all evaluation times were significantly higher in Group. when compared to Group.. and at 2, 4, 6,12 hrs were higher in Group I than Group III (p<0.05). The morphine consumption was higher in Group III at 24 and 48 hrs postoperatively (p<0.05). Conclusion: It was shown that ketamine and paracetamol were both effective in preventing remifentanil induced hyperalgesia.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 Comparison the effects of prilocaine and the addition of dexketoprofen and dexamethasone to prilocaine for intravenous regional anesthesia(Kare Publ, 2014) Borazan, Hale; Sahin, Osman; Uluer, Mehmet Selcuk; Kececioglu, Ahmet; Saritas, Tuba Berra; Otelcioglu, SerefObjectives: The aim of this study was to compare the anesthetic and analgesic effects of prilocaine alone, prilocaine added dexketoprofen and dexamethasone during intravenous regional anesthesia (IVRA). Methods: Forty five patients undergoing forearm or hand surgery were randomly assigned to one of three groups to receive (Group P) 3 mg/kg 0.5% prilocaine; (Group PDK) 3 mg/kg 0.5% prilocaine plus 50 mg dexketoprofen; (Group PDM) 3 mg/kg 0.5% prilocaine plus 8 mg dexamethasone in total 40 ml volume for IVRA. The onset and duration of sensory and motor blocks, hemodynamic datas, duration of analgesia and tourniquet, time to first analgesic requirement, visual analog scale (VAS), total analgesic consumption in 24 hours and patient satisfaction score were assessed and recorded. Results: Time to onset of sensory block was found to be longer in Group P (p<0.05), though no significance was found according to sensory block recovery times amoung groups. Time to onset of motor block was found to be longer and recovery time of motor block was found to be shorter in Group P (p<0.05). Time to first analgesic requirement was found to be longer in Group PDK, and was found to be high in Group PDM than Group PDK(p<0.05). The VAS scores was found to be high and patient satisfaction scale was found to be low in Group P (p<0.05). Conclusion: The addition of dexketoprofen and dexamethasone to prilocaine during IVRA improves the quality of both anesthesia and analgesia moreover dexketoprofen provides beter postoperative analgesia during the first 24 hour after surgery.Öğe The determination of histopathological and biochemical effects of the rabbit knee joint injected dexketoprofen trometamol(Wiley, 2015) Hacibeyoglu, Gulcin; Saritas, Tuba Berra; Saritas, Zulfikar Kadir; Korkmaz, Musa; Sevimli, Alper; Mehmetoglu, Idris; Otelcioglu, SerefThis study was conducted to investigate possible histopathological effects and biochemical reflections of intra-articular dexketoprofen trometamol. A total of 24 New Zealand rabbits were included in the study. Blood sampling was carried out from all animals on the first day, then they were randomly allocated either to the control group (GroupC, n=9) or the dexketoprofen trometamol group (GroupD, n=15). GroupC underwent each two intra-articular injections of saline, 0.25mL into right and 0.50mL into left knee. Group D was injected 0.25mL (6.25mg) dexketoprofen trometamol into the right knee and 0.50mL (12.5mg) into the left. The groups were divided randomly into three. Tissue and blood samples were collected from Groups C1 and D1 on the first day, C2 and D2 on the second day and C3 and D3 on the 10th day of the study. Interleukin-1 (IL-1), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-) and C-reactive protein (CRP) levels were studied. The histopathological examination of C and D groups did not present any deterioration. IL-6 basal levels were significantly higher in Group D2 compared with C2 and C3 compared with D3. Basal TNF- levels were higher compared with day 1 in Group C1, and IL-6 and CRP levels were higher in Group D3. Also, none of the increases in these values are supported by histopathological evaluation results. Consequently, we suppose that dexketoprofen trometamol does not cause histopathological deterioration in articular cartilage of rabbits, and the increases in biochemical parameters exclusively are not clinically significant.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 Developing bone cement implantation syndrome under regional anesthesia: case report(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2017) Sargin, Mehmet; Borazan, Hale; Otelcioglu, SerefBone cement implantation syndrome is associated with hypoxia, hypotension, cardiac arrhythmias, increase in pulmonary vascular resistance and cardiac arrest and is a cause of mortality and morbidity in orthopedic patients when cement is used. Because it is rare and isn't well identified, literature is limited to case reports. In this article, bone cement implatation syndrome developed in a patient who had undergone surgery for hip replacement is reported with literature.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 Effectiveness of videolaringoscopy C-MAC in managing intubations that have failed unexpectedly(Elsevier Science Inc, 2014) Kilicaslan, Alper; Topal, Ahmet; Tavlan, Aybars; Erol, Atilla; Otelcioglu, Seref[Abstract Not Availabe]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 Infraclavicular block experience in a case of multiple trauma patient(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2017) Sargin, Mehmet; Saritas, Tuba Berra; Sarkilar, Gamze; Otelcioglu, SerefAnesthetic applications in trauma patients have special features because of patient's traumatic reasons, preexisting systemic diseases and inappropriate fasting period as in most of the emergent multi traumatic patients. Ultrasound guided peripheral nevre blocks simplify anesthetic applications in suitable patients. In this article an ultrasound guided infraclavicular block in a multi traumatic patient was reported.Öğe Is intra-articular magnesium effective for postoperative analgesia in arthroscopic shoulder surgery?(Pulsus Group Inc, 2015) Saritas, Tuba Berra; Borazan, Hale; Okesli, Selmin; Yel, Mustafa; Otelcioglu, SerefBACKGROUND: Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements. METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n= 33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores > 5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times). RESULDS: Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range. CONCLUSION: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.Öğe Limited-Form Wegener Granulomatosis Case: Anaesthetic Approach and Literature Review(Aves, 2014) Saritas, Tuba Berra; Sahin, Osman; Borazan, Hale; Otelcioglu, SerefWegener granulomatosis (WG) is a kind of vasculitis that affects small and medium-sized arteries. Necrotizing granulomatous vasculitis of the upper and lower respiratory tracts and necrotizing glomerulonephritis of the kidneys are present. WG affects mainly Caucasian individuals between 15-75 years old, with a mean age of onset of 41 years. It affects both males and females equally. Kidney involvement is not present in the limited form of WG. Peripheral nerve blocks are good alternatives when general anaesthesia is risky. Popliteal block is blockade of the sciatic nerve at the popliteal region. Popliteal block is a kind of peripheral block for surgeries below the knee level. In this article, we report on the anaesthesia management of a 61-year-old limited-form WG patient for whom general anaesthesia was risky because of lung involvement.Öğe Management of the Difficult Paediatric Airway with a Simple Fiberoptic-Assisted Laryngoscope: A Report of Two Cases with Pierre Robin and Patau's (Trisomy 13) Syndrome(Aves, 2014) Kilicaslan, Alper; Erol, Atilla; Topal, Ahmet; Et, Tayfun; Otelcioglu, SerefAirway management of children with congenital craniofacial anomalies is a challenge for paediatric anaesthesiologists. We do not have any video-assisted airway device in our department for difficult paediatric intubations. We decided to attach a regular fiberoptic (outer diameter; 3.7 mm, Karl Storz, Germany) scope to a conventional Macintosh Laryngoscope (size 1). We describe two cases of Pierre Robin and Patau's (Trisomy 13) syndrome successfully intubated with a fiberoptic-assisted laryngoscope (FOL). A fiberoptic scope and any size of a laryngoscope blade can be easily assembled in the operating room. The FOL may be a useful device in the setting of difficult paediatric intubation.Öğe Oral Magnesium Lozenge Reduces Postoperative Sore Throat A Randomized, Prospective, Placebo-controlled Study(Lippincott Williams & Wilkins, 2012) Borazan, Hale; Kececioglu, Ahmet; Okesli, Selmin; Otelcioglu, SerefBackground: Postoperative sore throat (POST) is an undesirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The present study aimed to investigate the effect of preoperative administration of oral magnesium lozenge on POST. Methods: Seventy patients undergoing orthopedic surgery were randomly allocated into two groups, to either receive placebo (control) or magnesium lozenges (magnesium) to be dissolved by sucking 30 min preoperatively. Patients were assessed for incidence and severity (four-point scale, 0-3) of POST at 0, 2, 4, and 24 h postoperatively. The primary outcome was sore throat at 4 h after surgery. The secondary outcome was the severity of POST at four evaluation time-points postoperatively. Results: The incidence of POST at 4 h was higher in control group than in magnesium group (95% CI: 26%, 14-42%; P = 0.032). The highest incidence of POST occurred at the second hour after surgery, with the rate of 23% in the magnesium group and 57% in the control group (95% CI: 34%, 20-51%; P = 0.007). The severity of POST was significantly lower in the magnesium group at 0 (P = 0.007) and 2 h (P = 0.002). The incidences of POST at 0 and 24 h and severity scores at 4 and 24 h were not significantly different between the groups. Conclusions: The administration of magnesium lozenge 30 min preoperatively is effective to reduce both incidence and severity of POST in the immediate postoperative period.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]
