The aim of this study was to compare the effects of fentanyl, dexmedetomidine, and remifentanil o... more The aim of this study was to compare the effects of fentanyl, dexmedetomidine, and remifentanil on serum pentraxin 3 levels in patients undergoing on-pump coronary artery bypass surgery. Materials and Methods: In this retrospectively designed study, 36 patients who underwent elective on-pump coronary artery bypass surgery for coronary artery disease in the Cardiovascular Surgery Clinic of our hospital between 01.01.2020 and 31.12.2021 and whose serum pentraxin 3 levels were studied in the pre-operative and post-operative period were included. Patients were divided into 3 groups as fentanyl (Group F), dexmedetomidine (Group D), and remifentanil (Group R) based on the analgesic agent used during the intraoperative period. The data of the patients were obtained by scanning their files and information in the hospital automation system. Results: Demographic characteristics, duration of anesthesia, cardiopulmonary bypass duration, and aortic cross-clamp duration were similar. When serum pentraxin 3 levels were evaluated within groups, the difference between pre-operative and post-operative results was significant. In the intergroup evaluation, only the results obtained from Group F in the pre-operative period were significant compared to the other groups, but there was no significant difference between the results obtained in the post-operative period. Conclusion: When the data of this study were evaluated, it was determined that the analgesic agent used in the intraoperative period of on-pump coronary artery bypass surgery did not significantly affect post-operative serum pentraxin 3 levels.
Objective: It is established that the balance of serum thiols is disrupted in favor of oxidants i... more Objective: It is established that the balance of serum thiols is disrupted in favor of oxidants in coronary artery disease, and the cardiopulmonary bypass pump used during coronary artery bypass surgery disrupts this balance in favor of oxidants. In this study, we investigated the antioxidant effects of remifentanil or dexmedetomidine on thiol-disulfide balance and paraoxonase-1 (PON-1) levels during on-pump coronary artery bypass surgery. Patients and methods: A total of 100 patients who underwent on-pump coronary artery bypass grafting surgery between May 2018 and December 2018 were included in the study. Patients were divided into two groups: the remifentanil group (Group R) and the dexmedetomidine group (Group D). Venous blood samples were obtained from the patients after induction of anesthesia [Time 1 (T-1)], then after cross-clamping of the aorta (T-2), after removal of the cross-clamp (T-3), 10 minutes after the end of protamine infusion (T-4), and 24 hours postoperatively (T-5). Serum total thiol, native thiol, disulfide, and PON-1 levels were evaluated. Results: Total thiol, disulfide, PON-1, native thiol/total thiol, total thiol/disulfide, and native thiol/disulfide levels were similar between the two groups. Native thiol levels were statistically significantly higher in group D compared to group R at T-3 and T-5 (p = 0.017 and p = 0.027, respectively). When T-1 and T-5 times were compared in intragroup measurements, disulfide levels were significantly lower, and native thiol/total thiol ratios were significantly higher at T-5 (p < 0.001). Conclusions: In conclusion, in light of the data obtained from this study, it can be concluded that dexmedetomidine used during surgery has a better contribution to oxidant-antioxidant balance than remifentanil in patients undergoing coronary artery bypass surgery with the on-pump method.
This study aimed to evaluate the effect of the beach-chair position on intraoperative cerebral ox... more This study aimed to evaluate the effect of the beach-chair position on intraoperative cerebral oxygenation and postoperative cognitive functions in different age groups by comparing the data of patients who were under 65 years of age with those ≥65 years of age.
Case Report/Olgu Sunumu 69 went surgery in prone position under general anesthesia and developed ... more Case Report/Olgu Sunumu 69 went surgery in prone position under general anesthesia and developed hypoglossal nerve palsy following surgery. Possible causes are discussed. CASE REPORT A lumbar disc herniation operation was performed on a 50-year-old male patient who weighed 90 kg and was an American Society of Anesthesiology (ASA) score I patient, with a Mallampati score of III. Propofol (2 mg kg-1), fentanyl (1
Abstract
This study aims to determine the possible embryotoxic effects of propofol on the cerebel... more Abstract This study aims to determine the possible embryotoxic effects of propofol on the cerebellum and spinal cord using fertile chicken eggs. Materials and methods: A total of 430 fertile eggs were divided into 5 groups: control, saline, 2.5 mg.kg–1, 12.5 mg.kg–1, and 37.5 mg.kg–1 propofol. Injections were made immediately before incubation via the air chamber. On the 15th, 18th, and 21st day of incubation, 6 embryos from each group were evaluated. Serial paraffin sections taken from the cerebellum and spinal cord were stained with hematoxylin–eosin, Kluver–Barrera, toluidine blue, and periodic acid-Schiff ’s reaction. The outer granular layer and total cortex thickness were measured, and the linear density of the Purkinje cells was determined. The ratios of the substantia grisea surface area to the total surface area of the spinal cord were calculated. The transverse and longitudinal diameters of the canalis centralis were also assessed.Results: No structural malformation was observed in any embryos examined macroscopically. No significant difference was observed between the groups in terms of development and histologic organization of the cerebellum and spinal cord. However, on the 15th, 18th, and 21st day, the outer granular layer (p < 0.001 for all days) and the total cortex thickness (p < 0.01, p < 0.001, and p < 0.001, respectively) decreased significantly in different propofol dose groups in varying degrees in the cerebellum. Similarly, in the spinal cord, there were significant changes in the ratios of the substantia grisea surface area to the total surface area (p < 0.01 and p < 0.001, respectively). Conclusion: It was concluded that the in-ovo-administered propofol given immediately before incubation has adverse effects on the developing cerebellum and spinal cord. Therefore, it is important for anesthesiologists always to remain vigilant when treating female patients of childbearing age.
Keywords Central nervous system, CHEST, chicken embryo, embryotoxicity, propofol
Turkish Journal of Anaesthesiology and Reanimation, 2023
Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgic... more Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA).
Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.
Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly
higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.
Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.
Objective: The aim of this study is to determine the possible embryotoxic effects of propofol, a ... more Objective: The aim of this study is to determine the possible embryotoxic effects of propofol, a general anaesthetic agent that is commonly used in clinical practice, on peripheral blood lymphocytes using enzyme histochemical techniques. Methods: For this purpose, 430 laying hen fertile eggs were used for this study. The eggs were divided into 5 groups as control, solvent-control (saline), 2.5 mg kg −1 propofol, 12.5 mg kg −1 propofol, and 37.5 mg kg −1 propofol, and injections were performed via the air sac just before the incubation. The peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios were determined on the hatching day. Results: No statistically significant difference was found between both alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the control and solvent-control groups. However, when compared with the control and solvent-control groups, statistically significant decreases were observed in the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the chicks from the propofol-injected groups. Besides, the difference between 2.5 mg kg −1 and 12.5 mg kg −1 propofol groups is not significant, whereas the difference between these 2 groups and the 37.5 mg kg −1 propofol group was statistically significant (P < .05). Conclusions: It was concluded that propofol given to fertilised chicken eggs just before incubation caused significant decreases in both the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios.
Patau syndrome was the first described by Patau et al. and associated with trisomy 13. The syndro... more Patau syndrome was the first described by Patau et al. and associated with trisomy 13. The syndrome is characterized by microphthalmia, polydactyly, and cleft lip-palate. In this case report, we discuss the anesthesiology approach and management in a 2-year-old girl with Patau syndrome undergoing bilateral vitrectomy surgery. A 2-year-old girl weighing 12.5 kg was undergoing bilateral vitrectomy surgery. There was no additional pathology related to the cardiovascular, central nervous, and respiratory systems. Following anesthesia induction, the patient was intubated using a # 4.5 uncuffed endotracheal tube. At the end of the operation, 3 mg/kg sugammadex was given to the patient and she was transferred to the remission unit without any problems. During her follow-up in the unit, nurses called for help after her oxygen saturation level dropped to 90%. Mask ventilation support was supplied with a chin lift maneuver. As re-curarization was thought to be associated with the situation, an additional sugammadex dose was given to the patient. After 20 minutes of follow up, she was transferred to the pediatric ward in a steady state. The doses of anesthetic and analgesic drugs should be titrated carefully because intraoperative opioid and neuromuscular blocker use can lead to postoperative respiratory problems. Therefore, close follow-up of patients is essential in the postoperative period, as in the intraoperative period.
Awake craniotomy is a procedure of choice when the area to be resected is close to the eloquent r... more Awake craniotomy is a procedure of choice when the area to be resected is close to the eloquent regions of the cerebral cortex. In this case report, the anesthetic technique in the awake craniotomy case presented. Case Presentation: A 62 years old female was scheduled for awake craniotomy procedure. Anatomically, the tumor involved the motor tracts of the right hand. Following the intravenous access and monitorization of the patient, 4.5 mg midazolam and 50 mcg of fentanyl used for sedation of the patient and dexmedetomidine was used for maintenance. We used Bispectral Electroencephalogram Index in order to measure the deepness of sedation during the surgery. Desaturation and hypercapnia on the arterial blood gas analysis seen following the addition of 3 mg of midazolam to deeper the sedation after hemostasis. The dose of dexmedetomidine increased and flumazenil administered to reverse the midazolam. Discussion: Dexmedetomidine belongs to alpha-2 adrenergic agonist group, which acts through its sedative effects at the locus coeruleus. Different from GABA, alpha-2 adrenoreceptors produce sedation without the entire spectrum of stupor letting patients stay somnolent and easily awakened with verbal stimuli becoming compatible to be tested. In conclusion, dexmedetomidine is one of the possible choices of medication for awake craniotomy as it maintains the patient's convenience, reduces analgesic needs, and level of deliberateness without any confusion and agitation.
Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di i... more Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di iğ ği i Ö Ön ng gö ör rü ül le en n Y Ya aş şl lı ı H Ha as st ta al la ar rd da a P Pe er rk kü üt ta an n N Ne ef fr ro ol li it to ot to om mi i v ve e Y Yo oğ ğu un n B Ba ak kı ım m İ İh ht ti iy ya ac cı ın nı ın n D De eğ ğe er rl le en nd di ir ri il lm me es si i E Ev va al lu ua at ti io on n o of f P Pe er rc cu ut ta an ne eo ou us s N Ne ep ph hr ro ol li it th ho ot to om my y w wi it th h I In nt te en ns si iv ve e C Ca ar re e U Un ni it t i in n O Ol ld de er r P Pa at ti ie en nt ts s a an nd d P Po os st to op pe er ra at ti iv ve e I In nt te en ns si iv ve e C Ca ar re e R Re eq qu ui ir re em me en nt ts s
Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-mor... more Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-morbidity if it is not treated early and appropriately. Although there are lots of causes and risks of bladder tumor and it is known that tobacco smoking is the main contributor to bladder tumor, etiology of tumor is not clear. At diagnosis, it is generally seen as a superficial tumor. Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. In this procedure, different complications may occur, especially bleeding, and the most important complication is bladder perforation. Additional therapies are needed depending on location and size of perforation. An intraperitoneal perforation can lead to laparotomy, bladder repair and open drainage of the abdominal cavity. Sudden adductor muscle spasm can occur when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope, especially when the surgeon is operating at the lateral wall of the bladder, where the obturator nerve runs in close proximity during its intrapelvic course. Therefore, the type of anesthesia is important in the lateral wall tumors of the bladder. Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. We aimed to form a review to reduce difficult situations and to minimize the adverse consequences caused by this reflex that becomes a nightmare in many surgical cases.
of Anaesthesiology. Unauthorized reproduction of this article is prohibited. investigated, such a... more of Anaesthesiology. Unauthorized reproduction of this article is prohibited. investigated, such as continuous noninvasive BP monitoring, which has been shown to be useful even in patients suffering from arteriolar disease. 9 Acknowledgements relating to this article Assistance with the letter: the authors would like to thank the medical and nursing teams of the Brugmann Hospital Operating Theatre. Financial support and sponsorship: none.
References 1 Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated wit... more References 1 Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery. Eur J Anaesthesiol 2018; 4:273–279. 2 Association of Anaesthetists. Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia 2016; 71:85–93. 3 Kiers HD, Hofstra JM, Wetzels JF. Oscillometric blood pressure measurements: differences between measured and calculated mean arterial pressure. Neth J Med 2008; 66:474–479. 4 Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126:2890–2909. 5 Block F, Schulte T. Ankle blood pressure measurement, an acceptable alternative to arm measurements. Int J Clin Monit Comput 1996; 13: 167–171. 6 Drake M, Hill J. Observational study comparing noninvasive blood pressure measurement at the arm and ankle during caesarean section. Anaesthesia 2013; 68:461–466. 7 Columb MO. Clinical measurement and assessing agreement. Curr Anaesth Crit Care 2008; 19:328–329. 8 Zou GY. Confidence interval estimation for the Bland–Altman limits of agreement with multiple observations per individual. Stat Methods Med Res 2013; 22:630–642. 9 Noto A, Sanfilippo F, De Salvo G, et al. Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy: a prospective observational study. Eur J Anaesthesiol 2019; 36:144–152.
Journal of Anesthesiology and Reanimation Specialists' Society, 2022
Objective: This study was carried out in order to create the Turkish version of the Anaesthesia C... more Objective: This study was carried out in order to create the Turkish version of the Anaesthesia Case Report (ACRE) criteria, to increase the quality of perioperative case reports in the field of anaesthesiology and reanimation and to establish a standard in this field.
Methods: These criterias were translated into Turkish independently by authors and then a draft was determined. In order to ensure language equivalence, the adapted checklist was checked by an expert translator and the final version was created by making necessary corrections. Then, 20 case reports published between 2016 and 2021, indexed in the Turkish Medical Index, were examined by two independent specialists in the field of anaesthesiology and reanimation. Finally, inter-rater agreement was evaluated using the Bland-Altman method by calculating the intra-class correlation coefficient (CCT) and agreement percentages.
Results: The case report studies analyzed as a result of the evaluations made differed in the reporting frequency of the criteria. Although CCT values varied between 0.484 and 0.905, the agreement between anaesthesiology and reanimation specialists was statistically significant (p<0.05). According to the Bland-Altman chart, agreement was found between the raters.
Conclusion: Although ACRE criteria are rarely required for the review of perioperative case reports, there is solid evidence that standardized reporting guidelines improve the reporting quality of studies. It is thought that ACRE will bring a measurable standard status to case reports, and it will be beneficial and guide for researchers who will work in the field of anaesthesiology and reanimation in our country.
Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di i... more Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di iğ ği i Ö Ön ng gö ör rü ül le en n Y Ya aş şl lı ı H Ha as st ta al la ar rd da a P Pe er rk kü üt ta an n N Ne ef fr ro ol li it to ot to om mi i v ve e Y Yo oğ ğu un n B Ba ak kı ım m İ İh ht ti iy ya ac cı ın nı ın n D De eğ ğe er rl le en nd di ir ri il lm me es si i E Ev va al lu ua at ti io on n o of f P Pe er rc cu ut ta an ne eo ou us s N Ne ep ph hr ro ol li it th ho ot to om my y w wi it th h I In nt te en ns si iv ve e C Ca ar re e U Un ni it t i in n O Ol ld de er r P Pa at ti ie en nt ts s a an nd d P Po os st to op pe er ra at ti iv ve e I In nt te en ns si iv ve e C Ca ar re e R Re eq qu ui ir re em me en nt ts s
The aim of this study was to compare the effects of fentanyl, dexmedetomidine, and remifentanil o... more The aim of this study was to compare the effects of fentanyl, dexmedetomidine, and remifentanil on serum pentraxin 3 levels in patients undergoing on-pump coronary artery bypass surgery. Materials and Methods: In this retrospectively designed study, 36 patients who underwent elective on-pump coronary artery bypass surgery for coronary artery disease in the Cardiovascular Surgery Clinic of our hospital between 01.01.2020 and 31.12.2021 and whose serum pentraxin 3 levels were studied in the pre-operative and post-operative period were included. Patients were divided into 3 groups as fentanyl (Group F), dexmedetomidine (Group D), and remifentanil (Group R) based on the analgesic agent used during the intraoperative period. The data of the patients were obtained by scanning their files and information in the hospital automation system. Results: Demographic characteristics, duration of anesthesia, cardiopulmonary bypass duration, and aortic cross-clamp duration were similar. When serum pentraxin 3 levels were evaluated within groups, the difference between pre-operative and post-operative results was significant. In the intergroup evaluation, only the results obtained from Group F in the pre-operative period were significant compared to the other groups, but there was no significant difference between the results obtained in the post-operative period. Conclusion: When the data of this study were evaluated, it was determined that the analgesic agent used in the intraoperative period of on-pump coronary artery bypass surgery did not significantly affect post-operative serum pentraxin 3 levels.
Objective: It is established that the balance of serum thiols is disrupted in favor of oxidants i... more Objective: It is established that the balance of serum thiols is disrupted in favor of oxidants in coronary artery disease, and the cardiopulmonary bypass pump used during coronary artery bypass surgery disrupts this balance in favor of oxidants. In this study, we investigated the antioxidant effects of remifentanil or dexmedetomidine on thiol-disulfide balance and paraoxonase-1 (PON-1) levels during on-pump coronary artery bypass surgery. Patients and methods: A total of 100 patients who underwent on-pump coronary artery bypass grafting surgery between May 2018 and December 2018 were included in the study. Patients were divided into two groups: the remifentanil group (Group R) and the dexmedetomidine group (Group D). Venous blood samples were obtained from the patients after induction of anesthesia [Time 1 (T-1)], then after cross-clamping of the aorta (T-2), after removal of the cross-clamp (T-3), 10 minutes after the end of protamine infusion (T-4), and 24 hours postoperatively (T-5). Serum total thiol, native thiol, disulfide, and PON-1 levels were evaluated. Results: Total thiol, disulfide, PON-1, native thiol/total thiol, total thiol/disulfide, and native thiol/disulfide levels were similar between the two groups. Native thiol levels were statistically significantly higher in group D compared to group R at T-3 and T-5 (p = 0.017 and p = 0.027, respectively). When T-1 and T-5 times were compared in intragroup measurements, disulfide levels were significantly lower, and native thiol/total thiol ratios were significantly higher at T-5 (p < 0.001). Conclusions: In conclusion, in light of the data obtained from this study, it can be concluded that dexmedetomidine used during surgery has a better contribution to oxidant-antioxidant balance than remifentanil in patients undergoing coronary artery bypass surgery with the on-pump method.
This study aimed to evaluate the effect of the beach-chair position on intraoperative cerebral ox... more This study aimed to evaluate the effect of the beach-chair position on intraoperative cerebral oxygenation and postoperative cognitive functions in different age groups by comparing the data of patients who were under 65 years of age with those ≥65 years of age.
Case Report/Olgu Sunumu 69 went surgery in prone position under general anesthesia and developed ... more Case Report/Olgu Sunumu 69 went surgery in prone position under general anesthesia and developed hypoglossal nerve palsy following surgery. Possible causes are discussed. CASE REPORT A lumbar disc herniation operation was performed on a 50-year-old male patient who weighed 90 kg and was an American Society of Anesthesiology (ASA) score I patient, with a Mallampati score of III. Propofol (2 mg kg-1), fentanyl (1
Abstract
This study aims to determine the possible embryotoxic effects of propofol on the cerebel... more Abstract This study aims to determine the possible embryotoxic effects of propofol on the cerebellum and spinal cord using fertile chicken eggs. Materials and methods: A total of 430 fertile eggs were divided into 5 groups: control, saline, 2.5 mg.kg–1, 12.5 mg.kg–1, and 37.5 mg.kg–1 propofol. Injections were made immediately before incubation via the air chamber. On the 15th, 18th, and 21st day of incubation, 6 embryos from each group were evaluated. Serial paraffin sections taken from the cerebellum and spinal cord were stained with hematoxylin–eosin, Kluver–Barrera, toluidine blue, and periodic acid-Schiff ’s reaction. The outer granular layer and total cortex thickness were measured, and the linear density of the Purkinje cells was determined. The ratios of the substantia grisea surface area to the total surface area of the spinal cord were calculated. The transverse and longitudinal diameters of the canalis centralis were also assessed.Results: No structural malformation was observed in any embryos examined macroscopically. No significant difference was observed between the groups in terms of development and histologic organization of the cerebellum and spinal cord. However, on the 15th, 18th, and 21st day, the outer granular layer (p < 0.001 for all days) and the total cortex thickness (p < 0.01, p < 0.001, and p < 0.001, respectively) decreased significantly in different propofol dose groups in varying degrees in the cerebellum. Similarly, in the spinal cord, there were significant changes in the ratios of the substantia grisea surface area to the total surface area (p < 0.01 and p < 0.001, respectively). Conclusion: It was concluded that the in-ovo-administered propofol given immediately before incubation has adverse effects on the developing cerebellum and spinal cord. Therefore, it is important for anesthesiologists always to remain vigilant when treating female patients of childbearing age.
Keywords Central nervous system, CHEST, chicken embryo, embryotoxicity, propofol
Turkish Journal of Anaesthesiology and Reanimation, 2023
Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgic... more Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA).
Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.
Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly
higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.
Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.
Objective: The aim of this study is to determine the possible embryotoxic effects of propofol, a ... more Objective: The aim of this study is to determine the possible embryotoxic effects of propofol, a general anaesthetic agent that is commonly used in clinical practice, on peripheral blood lymphocytes using enzyme histochemical techniques. Methods: For this purpose, 430 laying hen fertile eggs were used for this study. The eggs were divided into 5 groups as control, solvent-control (saline), 2.5 mg kg −1 propofol, 12.5 mg kg −1 propofol, and 37.5 mg kg −1 propofol, and injections were performed via the air sac just before the incubation. The peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios were determined on the hatching day. Results: No statistically significant difference was found between both alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the control and solvent-control groups. However, when compared with the control and solvent-control groups, statistically significant decreases were observed in the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios of the chicks from the propofol-injected groups. Besides, the difference between 2.5 mg kg −1 and 12.5 mg kg −1 propofol groups is not significant, whereas the difference between these 2 groups and the 37.5 mg kg −1 propofol group was statistically significant (P < .05). Conclusions: It was concluded that propofol given to fertilised chicken eggs just before incubation caused significant decreases in both the peripheral blood alpha naphthyl acetate esterase and acid phosphatase-positive lymphocyte ratios.
Patau syndrome was the first described by Patau et al. and associated with trisomy 13. The syndro... more Patau syndrome was the first described by Patau et al. and associated with trisomy 13. The syndrome is characterized by microphthalmia, polydactyly, and cleft lip-palate. In this case report, we discuss the anesthesiology approach and management in a 2-year-old girl with Patau syndrome undergoing bilateral vitrectomy surgery. A 2-year-old girl weighing 12.5 kg was undergoing bilateral vitrectomy surgery. There was no additional pathology related to the cardiovascular, central nervous, and respiratory systems. Following anesthesia induction, the patient was intubated using a # 4.5 uncuffed endotracheal tube. At the end of the operation, 3 mg/kg sugammadex was given to the patient and she was transferred to the remission unit without any problems. During her follow-up in the unit, nurses called for help after her oxygen saturation level dropped to 90%. Mask ventilation support was supplied with a chin lift maneuver. As re-curarization was thought to be associated with the situation, an additional sugammadex dose was given to the patient. After 20 minutes of follow up, she was transferred to the pediatric ward in a steady state. The doses of anesthetic and analgesic drugs should be titrated carefully because intraoperative opioid and neuromuscular blocker use can lead to postoperative respiratory problems. Therefore, close follow-up of patients is essential in the postoperative period, as in the intraoperative period.
Awake craniotomy is a procedure of choice when the area to be resected is close to the eloquent r... more Awake craniotomy is a procedure of choice when the area to be resected is close to the eloquent regions of the cerebral cortex. In this case report, the anesthetic technique in the awake craniotomy case presented. Case Presentation: A 62 years old female was scheduled for awake craniotomy procedure. Anatomically, the tumor involved the motor tracts of the right hand. Following the intravenous access and monitorization of the patient, 4.5 mg midazolam and 50 mcg of fentanyl used for sedation of the patient and dexmedetomidine was used for maintenance. We used Bispectral Electroencephalogram Index in order to measure the deepness of sedation during the surgery. Desaturation and hypercapnia on the arterial blood gas analysis seen following the addition of 3 mg of midazolam to deeper the sedation after hemostasis. The dose of dexmedetomidine increased and flumazenil administered to reverse the midazolam. Discussion: Dexmedetomidine belongs to alpha-2 adrenergic agonist group, which acts through its sedative effects at the locus coeruleus. Different from GABA, alpha-2 adrenoreceptors produce sedation without the entire spectrum of stupor letting patients stay somnolent and easily awakened with verbal stimuli becoming compatible to be tested. In conclusion, dexmedetomidine is one of the possible choices of medication for awake craniotomy as it maintains the patient's convenience, reduces analgesic needs, and level of deliberateness without any confusion and agitation.
Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di i... more Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di iğ ği i Ö Ön ng gö ör rü ül le en n Y Ya aş şl lı ı H Ha as st ta al la ar rd da a P Pe er rk kü üt ta an n N Ne ef fr ro ol li it to ot to om mi i v ve e Y Yo oğ ğu un n B Ba ak kı ım m İ İh ht ti iy ya ac cı ın nı ın n D De eğ ğe er rl le en nd di ir ri il lm me es si i E Ev va al lu ua at ti io on n o of f P Pe er rc cu ut ta an ne eo ou us s N Ne ep ph hr ro ol li it th ho ot to om my y w wi it th h I In nt te en ns si iv ve e C Ca ar re e U Un ni it t i in n O Ol ld de er r P Pa at ti ie en nt ts s a an nd d P Po os st to op pe er ra at ti iv ve e I In nt te en ns si iv ve e C Ca ar re e R Re eq qu ui ir re em me en nt ts s
Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-mor... more Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-morbidity if it is not treated early and appropriately. Although there are lots of causes and risks of bladder tumor and it is known that tobacco smoking is the main contributor to bladder tumor, etiology of tumor is not clear. At diagnosis, it is generally seen as a superficial tumor. Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. In this procedure, different complications may occur, especially bleeding, and the most important complication is bladder perforation. Additional therapies are needed depending on location and size of perforation. An intraperitoneal perforation can lead to laparotomy, bladder repair and open drainage of the abdominal cavity. Sudden adductor muscle spasm can occur when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope, especially when the surgeon is operating at the lateral wall of the bladder, where the obturator nerve runs in close proximity during its intrapelvic course. Therefore, the type of anesthesia is important in the lateral wall tumors of the bladder. Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. We aimed to form a review to reduce difficult situations and to minimize the adverse consequences caused by this reflex that becomes a nightmare in many surgical cases.
of Anaesthesiology. Unauthorized reproduction of this article is prohibited. investigated, such a... more of Anaesthesiology. Unauthorized reproduction of this article is prohibited. investigated, such as continuous noninvasive BP monitoring, which has been shown to be useful even in patients suffering from arteriolar disease. 9 Acknowledgements relating to this article Assistance with the letter: the authors would like to thank the medical and nursing teams of the Brugmann Hospital Operating Theatre. Financial support and sponsorship: none.
References 1 Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated wit... more References 1 Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery. Eur J Anaesthesiol 2018; 4:273–279. 2 Association of Anaesthetists. Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia 2016; 71:85–93. 3 Kiers HD, Hofstra JM, Wetzels JF. Oscillometric blood pressure measurements: differences between measured and calculated mean arterial pressure. Neth J Med 2008; 66:474–479. 4 Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126:2890–2909. 5 Block F, Schulte T. Ankle blood pressure measurement, an acceptable alternative to arm measurements. Int J Clin Monit Comput 1996; 13: 167–171. 6 Drake M, Hill J. Observational study comparing noninvasive blood pressure measurement at the arm and ankle during caesarean section. Anaesthesia 2013; 68:461–466. 7 Columb MO. Clinical measurement and assessing agreement. Curr Anaesth Crit Care 2008; 19:328–329. 8 Zou GY. Confidence interval estimation for the Bland–Altman limits of agreement with multiple observations per individual. Stat Methods Med Res 2013; 22:630–642. 9 Noto A, Sanfilippo F, De Salvo G, et al. Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy: a prospective observational study. Eur J Anaesthesiol 2019; 36:144–152.
Journal of Anesthesiology and Reanimation Specialists' Society, 2022
Objective: This study was carried out in order to create the Turkish version of the Anaesthesia C... more Objective: This study was carried out in order to create the Turkish version of the Anaesthesia Case Report (ACRE) criteria, to increase the quality of perioperative case reports in the field of anaesthesiology and reanimation and to establish a standard in this field.
Methods: These criterias were translated into Turkish independently by authors and then a draft was determined. In order to ensure language equivalence, the adapted checklist was checked by an expert translator and the final version was created by making necessary corrections. Then, 20 case reports published between 2016 and 2021, indexed in the Turkish Medical Index, were examined by two independent specialists in the field of anaesthesiology and reanimation. Finally, inter-rater agreement was evaluated using the Bland-Altman method by calculating the intra-class correlation coefficient (CCT) and agreement percentages.
Results: The case report studies analyzed as a result of the evaluations made differed in the reporting frequency of the criteria. Although CCT values varied between 0.484 and 0.905, the agreement between anaesthesiology and reanimation specialists was statistically significant (p<0.05). According to the Bland-Altman chart, agreement was found between the raters.
Conclusion: Although ACRE criteria are rarely required for the review of perioperative case reports, there is solid evidence that standardized reporting guidelines improve the reporting quality of studies. It is thought that ACRE will bring a measurable standard status to case reports, and it will be beneficial and guide for researchers who will work in the field of anaesthesiology and reanimation in our country.
Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di i... more Po os st to op pe er ra at ti if f Y Yo oğ ğu un n B Ba ak kı ım m G Ge er re ek kt ti ir rd di iğ ği i Ö Ön ng gö ör rü ül le en n Y Ya aş şl lı ı H Ha as st ta al la ar rd da a P Pe er rk kü üt ta an n N Ne ef fr ro ol li it to ot to om mi i v ve e Y Yo oğ ğu un n B Ba ak kı ım m İ İh ht ti iy ya ac cı ın nı ın n D De eğ ğe er rl le en nd di ir ri il lm me es si i E Ev va al lu ua at ti io on n o of f P Pe er rc cu ut ta an ne eo ou us s N Ne ep ph hr ro ol li it th ho ot to om my y w wi it th h I In nt te en ns si iv ve e C Ca ar re e U Un ni it t i in n O Ol ld de er r P Pa at ti ie en nt ts s a an nd d P Po os st to op pe er ra at ti iv ve e I In nt te en ns si iv ve e C Ca ar re e R Re eq qu ui ir re em me en nt ts s
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Papers by Murat İzgi
This study aims to determine the possible embryotoxic effects of propofol on the cerebellum and spinal cord using fertile chicken eggs. Materials and methods: A total of 430 fertile eggs were divided into 5 groups: control, saline, 2.5 mg.kg–1, 12.5 mg.kg–1, and 37.5 mg.kg–1 propofol. Injections were made immediately before incubation via the air chamber. On the 15th, 18th, and 21st day of incubation, 6 embryos from each group were evaluated. Serial paraffin sections taken from the cerebellum and spinal cord were stained with hematoxylin–eosin, Kluver–Barrera, toluidine blue, and periodic acid-Schiff ’s reaction. The outer granular layer and total cortex thickness were measured, and the linear density of the Purkinje cells was determined. The ratios of the substantia grisea surface area to the total surface area of the spinal cord were calculated. The transverse and longitudinal diameters of the canalis centralis were also assessed.Results: No structural malformation was observed in any embryos examined macroscopically. No significant difference was observed between the groups in terms of development and histologic organization of the cerebellum and spinal cord. However, on the 15th, 18th, and 21st day, the outer granular layer (p < 0.001 for all days) and the total cortex thickness (p < 0.01, p < 0.001, and p < 0.001, respectively) decreased significantly in different propofol dose groups in varying degrees in the cerebellum. Similarly, in the spinal cord, there were significant changes in the ratios of the substantia grisea surface area to the total surface area (p < 0.01 and p < 0.001, respectively). Conclusion: It was concluded that the in-ovo-administered propofol given immediately before incubation has adverse effects on the developing cerebellum and spinal cord. Therefore, it is important for anesthesiologists always to remain vigilant when treating female patients of childbearing age.
Keywords
Central nervous system, CHEST, chicken embryo, embryotoxicity, propofol
Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.
Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly
higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.
Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.
Methods: These criterias were translated into Turkish independently by authors and then a draft was determined. In order to ensure language equivalence, the adapted checklist was checked by an expert translator and the final version was created by making necessary corrections. Then, 20 case reports published between 2016 and 2021, indexed in the Turkish Medical Index, were examined by two independent specialists in the field of anaesthesiology and reanimation. Finally, inter-rater agreement was evaluated using the Bland-Altman method by calculating the intra-class correlation coefficient (CCT) and agreement percentages.
Results: The case report studies analyzed as a result of the evaluations made differed in the reporting frequency of the criteria. Although CCT values varied between 0.484 and 0.905, the agreement between anaesthesiology and reanimation specialists was statistically significant (p<0.05). According to the Bland-Altman chart, agreement was found between the raters.
Conclusion: Although ACRE criteria are rarely required for the review of perioperative case reports, there is solid evidence that standardized reporting guidelines improve the reporting quality of studies. It is thought that ACRE will bring a measurable standard status to case reports, and it will be beneficial and guide for researchers who will work in the field of anaesthesiology and reanimation in our country.
This study aims to determine the possible embryotoxic effects of propofol on the cerebellum and spinal cord using fertile chicken eggs. Materials and methods: A total of 430 fertile eggs were divided into 5 groups: control, saline, 2.5 mg.kg–1, 12.5 mg.kg–1, and 37.5 mg.kg–1 propofol. Injections were made immediately before incubation via the air chamber. On the 15th, 18th, and 21st day of incubation, 6 embryos from each group were evaluated. Serial paraffin sections taken from the cerebellum and spinal cord were stained with hematoxylin–eosin, Kluver–Barrera, toluidine blue, and periodic acid-Schiff ’s reaction. The outer granular layer and total cortex thickness were measured, and the linear density of the Purkinje cells was determined. The ratios of the substantia grisea surface area to the total surface area of the spinal cord were calculated. The transverse and longitudinal diameters of the canalis centralis were also assessed.Results: No structural malformation was observed in any embryos examined macroscopically. No significant difference was observed between the groups in terms of development and histologic organization of the cerebellum and spinal cord. However, on the 15th, 18th, and 21st day, the outer granular layer (p < 0.001 for all days) and the total cortex thickness (p < 0.01, p < 0.001, and p < 0.001, respectively) decreased significantly in different propofol dose groups in varying degrees in the cerebellum. Similarly, in the spinal cord, there were significant changes in the ratios of the substantia grisea surface area to the total surface area (p < 0.01 and p < 0.001, respectively). Conclusion: It was concluded that the in-ovo-administered propofol given immediately before incubation has adverse effects on the developing cerebellum and spinal cord. Therefore, it is important for anesthesiologists always to remain vigilant when treating female patients of childbearing age.
Keywords
Central nervous system, CHEST, chicken embryo, embryotoxicity, propofol
Methods: One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.
Results: The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly
higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.
Conclusion: GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.
Methods: These criterias were translated into Turkish independently by authors and then a draft was determined. In order to ensure language equivalence, the adapted checklist was checked by an expert translator and the final version was created by making necessary corrections. Then, 20 case reports published between 2016 and 2021, indexed in the Turkish Medical Index, were examined by two independent specialists in the field of anaesthesiology and reanimation. Finally, inter-rater agreement was evaluated using the Bland-Altman method by calculating the intra-class correlation coefficient (CCT) and agreement percentages.
Results: The case report studies analyzed as a result of the evaluations made differed in the reporting frequency of the criteria. Although CCT values varied between 0.484 and 0.905, the agreement between anaesthesiology and reanimation specialists was statistically significant (p<0.05). According to the Bland-Altman chart, agreement was found between the raters.
Conclusion: Although ACRE criteria are rarely required for the review of perioperative case reports, there is solid evidence that standardized reporting guidelines improve the reporting quality of studies. It is thought that ACRE will bring a measurable standard status to case reports, and it will be beneficial and guide for researchers who will work in the field of anaesthesiology and reanimation in our country.