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Öğe Adequacy of anesthesıa monitörizasyonu eşliğinde menstruel siklus fazlarının anestezi derinliği üzerine etkisi(2021) Yusifov, Merve; Erol, AtillaÖstrojen ve progesteronun siklik dalgalanmalarına bağlı olarak anksiyete düzeylerinin, anestezik ihtiyacın, ağrı duyarlılığının ve buna bağlı olarak analjezik ihtiyacın değişebileceği çeşitli çalışmalarla gösterilmiştir. Bu çalışmamızda, genel anestezi altında rinoplasti yapılan kadın hastalarda, Adequacy of Anesthesia monitörizasyonu eşliğinde, menstruel siklusun farklı fazlarının anestezi ve analjezi üzerine etkilerini incelemeyi amaçladık. YÖNTEM: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi etik kurul onayı (22 Mayıs 2019 tarihli, 14567952-050/868 sayılı karar) alındı. Genel anestezi altında rinoplasti yapılması planlanan, 18-49 yaş arası, düzenli menstruel siklusları bulunan, ASA I-II olarak değerlendirilen 80 kadın hasta çalışmaya dahil edildi. Menstruel siklusun 6-12. günleri arasında olan hastalar foliküler (Grup F) ve 18-24. günleri arasında olan hastalar luteal (Grup L) grup olarak adlandırıldı. Progesteron, Estradiol, FSH (Folikül Stimulan Hormon), LH (Luteinizan Hormon) düzeyleri çalışıldı. Demografik özellikleri kaydedildi. Amsterdam Preoperatif Anksiyete ve Bilgi Skalası (APAIS) uygulandı. Tüm olgulara EKG (elektrokardiyogram), NIBP (noninvaziv kan basıncı) ölçümü, pulsoksimetre (SpO2) takibi, Adequacy of Anesthesia (AoA; entropi, SPI, NMT) monitörizasyonu uygulandı. Cerrahi işlem boyunca Entropi indeks değeri 40-60 olacak şekilde end-tidal desfluran dozu, SPI değeri 50 nin altında olacak şekilde remifentanil infüzyon dozu ayarlandı. İşlem sonunda toplam cerrahi süre, toplam remifentanil dozu (mcg), toplam desfluran dozu (ml) , ekstübasyon süresi, uyanıklık ve derlenme zamanları kaydedildi. BULGULAR: Grupların demografik özellikleri, hemodinamik verileri, APAIS skorları, cerrahi işlem süreleri, tüketilen desfluran ve remifentanil miktarları, ekstübasyon süreleri, uyanıklık ve derlenme zamanları arasında istatistiksel anlamlı fark saptanmamıştır. SONUÇ: Biz çalışmamızda menstruel siklus fazlarının, uygun monitörizasyon yöntemleri kullanarak, anestezik ve analjezik ihtiyacı etkilemediği kanısına vardık.Öğe Anesthesia Management in Charcot-Marie-Tooth Disease(2017) Yusifov, Merve; Yılmaz, Resul; Bilge, Ayşegül; Kaya, Ercan; Topal, Ahmet…Öğe Comparison of Patient Haemodynamics and Cost Analysis between Ketamine and Dexmedetomidine Used for Endoscopic Retrograde Cholangiopancreatography(Istanbul Training & Research Hospital, 2020) Arican, Sule; Yusifov, Merve; Hacibeyoglu, Gulcin; Yilmaz, ResulIntroduction: This study aimed to compare the ketamine-propofol and dexmedetomidine-propofol combinations used for endoscopic retrograde cholangiopancreatography (ERCP) performed under sedation. Primary outcomes were total propofol consumption, recovery and haemodynamic profiles of patients in each study group. Secondary outcomes were sedation-related complications and cost profiles of patients in each study group. Methods: Patients with American Society of Anaesthesiologists class I-III, aged 18-80 years, who underwent ERCP under sedation, were included in the study. Patients were randomly divided into two groups, namely the ketamine group (group KP) and the dexmedetomidine group (group DP). Group KP received 1 mg/kg ketamine plus 1 mg/kg propofol. Group DP received a loading dose of 1 mu g/kg of dexmedetomidine for 10 min and a maintenance dose of 0.5 mu g/kg plus 1 mg/kg of propofol. Moreover, propofol (10-20 mg) was added to keep the Ramsay Sedation scale at >= 3. Cardiopulmonary side effects, nausea, vomiting, hiccups, straining or retching were recorded in all patients. The ERCP procedure duration, as well as the awakening and recovery times, were recorded. Doses and costs of the drugs used were recorded. Patients were discharged when their Modified Alderete score was 10. Results: This study included 80 patients. The duration of ERCP in the groups KP and DP was 23.1 +/- 9.7 min and 24.4 +/- 15.2 min, respectively, and the duration of awakening was 6.0 +/- 3.2 min and 7.3 +/- 2.9 min, respectively. No statistically significant difference was noted. The recovery time was 18.6 +/- 10.6 min and 9.6 +/- 4.0 min in groups KP and DP, respectively, with a statistically significant difference noted. No statistically significant intergroup difference was noted regarding additional propofol doses; however, the total cost was $0.58 +/- 0.16 and $3.03 +/- 0.60 in groups KP and DP, respectively. Conclusion: Both ketamine-propofol and dexmedetomidine-propofol combinations provide safe and effective anaesthesia for ERCP performed under sedation. Even though the recovery time was significantly shorter in group DP, it had a significantly higher cost factor on analysis.Öğe Comparison of pre-operative platelet functions by thromboelastogram in patients selective serotonin reuptake inhibitors user and non-user(Turkish Assoc Trauma Emergency Surgery, 2022) Yilmaz, Resul; Yusifov, Merve; Hacibeyoglu, Gulcin; Arican, Sule; Topal, AhmetBACKGROUND: The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases. METHODS: The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I-II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed. RESULTS: R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year. CONCLUSION: When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.Öğe Comparison of pre-operative platelet functions by thromboelastogram in patients selective serotonin reuptake inhibitors user and non-user(Turkish Assoc Trauma Emergency Surgery, 2022) Yilmaz, Resul; Yusifov, Merve; Hacibeyoglu, Gulcin; Arican, Sule; Topal, AhmetBACKGROUND: The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases. METHODS: The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I-II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed. RESULTS: R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year. CONCLUSION: When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.Öğe The Impact of Surgical Procedures During Septorhinoplasty on the Intraoperative Pain Response(Oxford Univ Press Inc, 2021) Ince, Bilsev; Zuhour, Moath; Yusifov, Merve; Erol, Atilla; Dadaci, MehmetBackground: During septorhinoplasty, many different surgical procedures are employed to bring the nose to the desired shape and solve breathing complaints. As a matter of course, intraoperative pain response occurs due to these procedures. Objectives: With this study, the authors aimed to evaluate the intraoperative pain formed during septorhinoplasty surgery with numerical values and to determine which stage of surgery is more painful. Methods: Between April 2019 and March 2020, a total of 30 female patients who were planned to undergo septorhinoplasty were included in this prospective study. Standard anesthesia and analgesia were applied to all patients. During surgery, state entropy measure was utilized to evaluate the depth of anesthesia, and Surgical Pleth Index was employed to evaluate the response of the central nervous system to pain nociception. Results: The age of the patients ranged from 18 to 42 years (average, 25.3+/-6.1 years). The average value of state entropy recorded during the surgery for all patients was found to be 45.43+/-5.37. The mean beginning Surgical Pleth Index value recoded from all of the patients was 23.4 +/- 8.84 compared with the beginning value; the values recorded during periost dissection, lateral osteotomy, and lower turbinate lateralization were statistically significantly higher (P<0.005). Conclusions: Although sufficient depth of anesthesia and standard protocol of analgesia were applied, pain response was found to be significantly higher at some procedures during septorhinoplasty. The authors think that increasing the depth of anesthesia during these procedures will increase the comfort of this operation by inhibiting pain response. Level of Evidence: 4Öğe The place of ultrasonography in confirming the position of the laryngeal mask airway in pediatric patients: an observational study(Elsevier Science Inc, 2021) Arican, Sule; Pekcan, Sevgi; Hacibeyoglu, Gulcin; Yusifov, Merve; Yuce, Sait; Uzun, Sema TuncerBackground and objectives: Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging. Methods: A prospective observational study was conducted on 82 patients aged 3-15 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope. Results: The average age of the patients was 6.27 +/- 4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (p < 0.001; r = 0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (OR = 2.961; p = 0.046; 95% Cl 2.850-30.745). Conclusion: The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective. (c) 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
