We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituit... more We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituitary dwarfism. In addition to supportive treatment, we offered a postoperative epidural analgesia pump. The patient recovered well without any complications.
Purpose. We aimed to establish the basic data for the improvement of the weak points by determini... more Purpose. We aimed to establish the basic data for the improvement of the weak points by determining the knowledge and attitude of professionals in anesthesiology and reanimation or/and intensive care, who are 50% responsible for the diagnosis of brain death. Methods. After the approval of the ethics committee, questionnaires were sent to participants. The data were collected electronically. The questionnaire consists of 89 questions. Results. A total of 564 (22.56%) completed questionnaires were returned. The sex distribution of the respondents was 207 (36.7%) female and 357 (63.3%) male; the mean age was 37 (SD, 7) years. Among participants, 87.2% reported needing ancillary testing for the diagnosis of brain death. Nevertheless, the rate of those who never needed ancillary testing was high among the participants who were specialized and working in hospitals covered by Erzurum RCC (31.2% and 26.7%, respectively) (P < .05). A total of 55.3% of respondents reported considering brain death and 41.9% reported considering circulatory arrest at the time of death. Participants' religious beliefs are not against to organ donation (93.4%). However, the percentage of respondents who thought that families refuse organ donation because of their religion was 84.1%. Suggestions for increasing organ transplants from deceased donors include education (54.1%), religious support (21.4%), use of media resources (25%), government support and legislative changes (10.1% and 7.6%, respectively), and education of health workers (9.4%). The most important way to solve this problem is to give adequate education to main stakeholders. This is the most effective method to improve the public's behavior.
Journal of Anesthesia & Critical Care: Open Access, Feb 17, 2017
Aim: The aim is to compare microbiological examination of samples, which were taken by fiberoptic... more Aim: The aim is to compare microbiological examination of samples, which were taken by fiberoptic BAL and protected mini-BAL methods from patients with diagnosis of pneumonia in the intensive care unit. Methods: Study population included all adult critically ill mechanically ventilated patients, who were admitted to Intensive Care Units of Cerrahpaşa Medical School between July 2013 and November 2014, and diagnosed as pneumonia either on admission or during their stay. Patients were assessed by APACHE II, SOFA and CPIS. The patients were randomly allocated in to two groups using computer generated random numbers. In the first group FOB and BAL was applied first followed by protected mini-BAL, in the second group protected mini-BAL was the first sampling method. The samples were then transferred to the microbiology laboratory for microbiologic examination. The materials were evaluated by gram-staining and quantitative cultures. The compability of fiberoptic BAL and protected mini-BAL results for all cases was evaluated with kappa statistics. A two tailed p value of <0.05 was considered statistically significant. Results: Sixty-six patients were included in to the study. Fiberoptic BAL followed by protected mini-BAL was performed in 32 (48.5%) patients, protected mini-BAL followed by fiberoptic BAL in 34 (51.5%) patients. No significant difference was found between two groups about demographic features, severity scores, laboratory values, use of antibiotics, comorbidities and prognosis. When the types of pathogens were compared between two groups no significant differences were found. When the results of samples were evaluated for compatibility all together, the Kappa coefficient was found as 0.476 (p=0.0001), which is not high value, and this kappa coefficient is considered to be moderate value. Conclusion: Protected mini-BAL procedure is effective, less invasive and easier to apply compared to FOB. But it cannot be used as an alternative to fiberoptic BAL to determine the causative organism of pneumonia in ICU patients according to this study results.
Page 1. 158 Entübasyon Tüpü Disseksiyonuna Bağlı Akut Hava Yolu Tıkanması ÖZET Genel anestezi uyg... more Page 1. 158 Entübasyon Tüpü Disseksiyonuna Bağlı Akut Hava Yolu Tıkanması ÖZET Genel anestezi uygulamaları sırasında entübasyon ile ilgili sorunlar olabilmektedir. Bunlar sıklıkla güç entübasyon, bronş entübasyonu, özofagus ...
Türk Anesteziyoloji ve Reanimasyon Derneği dergisi, Oct 11, 2013
Introduction H ypothermia is defined as the lowering of the core body temperature below 36°C. The... more Introduction H ypothermia is defined as the lowering of the core body temperature below 36°C. The frequency of perioperative hypothermia is 50-90% (1). Perioperative hypothermia, especially in operations exceeding half an hour and those occurring in patients in the high risk group lead to important complications. It causes prolongation of the effects of anaesthetic drugs and the duration of patient recovery, and increases the risk for complications like coagulophaty, respiratory and cardiovascular system depression, and surgical site infections. (1, 2). Risk of perioperative hypothermia is increased in patients with an ASA score higher than II, in those over 70 years of age, the newborns, and the patients with a concomitant disease (3, 4). The nature and duration of the surgical procedure, ambient temperature, the amount of intravenous fluids, blood and blood products used, the duration of mechanical ventilation and body temperature of the patient before anaesthesia induction, are the determinants of risk for perioperative hypothermia (2-5). Perioperative hypothermia, which underlie numerous complications that increase the morbidity and mortality, and that increase the duration of hospital stay and costs, is a condition that needs to be prevented, but has not been completely solved yet. When the articles published until now has been reviewed, it was observed that approximately only 10 to 13 of 800 articles published were randomized, clinical, prospective trials. There are no common guidelines for the prevention of management of perioperative hypothermia that is used worldwide. Countries such as England and Germany use their national guidelines.
... Tuğhan Utku*, Yusuf Tunalı*, Eren Fatma Akçıl*, Özlem Korkmaz Dilmen*, Egemen Eken** * İstanb... more ... Tuğhan Utku*, Yusuf Tunalı*, Eren Fatma Akçıl*, Özlem Korkmaz Dilmen*, Egemen Eken** * İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, ** Bilim Üniversitesi ... Postoperatif analjezinin uzun sürmesi için uzun etkili bir ajan seçtik. ...
Aim:Noninvasive mechanical ventilation (NIMV) is associated with a large number of failures, and ... more Aim:Noninvasive mechanical ventilation (NIMV) is associated with a large number of failures, and patient refusal. The purpose of the study was to assess the feasibilty and safety of dexmedetomidine during NIMV. Methods:The patients allocated randomly in to two groups; Dexmedetomidine (D) group and control (C) group. In D group, Dexmedetomidine infusion rate was set between 0,2-0,7 µgr/kg/hour to reach a Ramsey sedation score (RSS) between 3-4. Mean arterial pressure, heart rate, respiratory rate, blood gas analysis, PaO2/FIO2 and RSS documented at 1 min, 10 min, 30 min,1 hour, 4 hour, 24 hours after Dexmedetomidine infusion started and after the end of infusion and at non invasive mechanical ventilation support cessation in any reason. Result: Thirty patients under NIMV support with agitation and ventilatory dyssynchrony were included in this study. In D group mean arterial pressure, heart rate, respiratory rate measurements were significantly lower than C group. RSS shown significant rises (1 to 3) at the period between 1th min to 10th min to the cessation time in D group (p<0.01) and PaO2/FIO2 values were significantly higher than control group. Conclusion: Dexmedetomidine is safe and effective agent for the sedation of the patients under NIMV support. Sonuç: Lale uçlu fiber ile endovenöz lazer ablasyon kronik venöz yetmezlik tedavisinde güvenli ve etkin bir yöntemdir.
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2002
Bacteremia is one of the most frequently diagnosed hospital infections in Intensive Care Units (I... more Bacteremia is one of the most frequently diagnosed hospital infections in Intensive Care Units (ICU). To determine agents causing bacteremia in our ICU, a total of 1090 hemocultures from 402 febrile episodes of 331 patients in one year were evaluated. Bacteremia was detected in 216 (53.7%) of the episodes of which 58 (26.8%) were found to be polymicrobial. The most frequent agents were; coagulase-negative staphylococci, Acinetobacter baumannii and Pseudomonas spp. Rate of methicilline resistance were 96.8% and 91.6% in the coagulase-negative staphylococci and Staphylococcus aureus species respectively. The diversity of causative agents and their resistance patterns shows the difficulty of empirical antibiotic therapy in ICU and the necessity of an active screening and acceleration of precautions.
Journal of Anesthesiology and Reanimation Specialists’ Society, 2020
Covid-19 pandemisi olarak adlandırılan virüs salgını, 2019 yılı Aralık ayında Çin'in Wuhan kentin... more Covid-19 pandemisi olarak adlandırılan virüs salgını, 2019 yılı Aralık ayında Çin'in Wuhan kentinden tüm dünyaya yayılmıştır. Hastalar ve hastalığı taşıyan asemptomatik vakalar nedeniyle, sağlık çalışanları açısından risk oluşturmaktadır. Özellikle ameliyathaneler, aerosol oluşturan işlemler ve olası temas açısından en riskli çalışma alanlarındandır. Bu nedenle perioperatif dönem işleyiş protokollerinin oluşturulması önem göstermektedir. Bu derlemede, pandemi döneminde özellik arzeden; preoperatif hasta hazırlığı, ameliyathane organizasyonu ve kişisel korunma ekipmanlarını içeren "preoperatif hasta hazırlığı ve ameliyathane işleyiş protokolümüz" sunulmuştur. Yöntem: Bu amaçla mevcut protokoller ve literatür taraması yapılmış ve güncel bilgiler ışığında oluşturulan protokol; preoperatif hasta hazırlığı, ameliyathane işleyişinin düzenlenmesi, ameliyat bitiminde ameliyathane temizliği olmak üzere 3 alt başlık içermektedir. Bulgular: Oluşturulan protokol 15 Mart-10 Mayıs 2020 tarihleri arasında kullanılmıştır. Kurumumuzun iç işleyişine uygun olarak oluşturulan protokollerimiz eşliğinde perioperatif yönetim titizlikle uygulandığında, hasta ve çalışan güvenliği yanında, işleyişin aksamadığı görülmüştür. Sonuç: Klinik protokoller ışığında preoperatif dönemde COVID-19 şüpheli-enfekte hastalar belirlenerek, perioperatif riskler azaltılabilir ve hastanın, sağlık çalışanlarının ve diğer hastaların güvenliği arttırılabilir.
We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituit... more We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituitary dwarfism. In addition to supportive treatment, we offered a postoperative epidural analgesia pump. The patient recovered well without any complications.
Purpose. We aimed to establish the basic data for the improvement of the weak points by determini... more Purpose. We aimed to establish the basic data for the improvement of the weak points by determining the knowledge and attitude of professionals in anesthesiology and reanimation or/and intensive care, who are 50% responsible for the diagnosis of brain death. Methods. After the approval of the ethics committee, questionnaires were sent to participants. The data were collected electronically. The questionnaire consists of 89 questions. Results. A total of 564 (22.56%) completed questionnaires were returned. The sex distribution of the respondents was 207 (36.7%) female and 357 (63.3%) male; the mean age was 37 (SD, 7) years. Among participants, 87.2% reported needing ancillary testing for the diagnosis of brain death. Nevertheless, the rate of those who never needed ancillary testing was high among the participants who were specialized and working in hospitals covered by Erzurum RCC (31.2% and 26.7%, respectively) (P < .05). A total of 55.3% of respondents reported considering brain death and 41.9% reported considering circulatory arrest at the time of death. Participants' religious beliefs are not against to organ donation (93.4%). However, the percentage of respondents who thought that families refuse organ donation because of their religion was 84.1%. Suggestions for increasing organ transplants from deceased donors include education (54.1%), religious support (21.4%), use of media resources (25%), government support and legislative changes (10.1% and 7.6%, respectively), and education of health workers (9.4%). The most important way to solve this problem is to give adequate education to main stakeholders. This is the most effective method to improve the public's behavior.
Journal of Anesthesia & Critical Care: Open Access, Feb 17, 2017
Aim: The aim is to compare microbiological examination of samples, which were taken by fiberoptic... more Aim: The aim is to compare microbiological examination of samples, which were taken by fiberoptic BAL and protected mini-BAL methods from patients with diagnosis of pneumonia in the intensive care unit. Methods: Study population included all adult critically ill mechanically ventilated patients, who were admitted to Intensive Care Units of Cerrahpaşa Medical School between July 2013 and November 2014, and diagnosed as pneumonia either on admission or during their stay. Patients were assessed by APACHE II, SOFA and CPIS. The patients were randomly allocated in to two groups using computer generated random numbers. In the first group FOB and BAL was applied first followed by protected mini-BAL, in the second group protected mini-BAL was the first sampling method. The samples were then transferred to the microbiology laboratory for microbiologic examination. The materials were evaluated by gram-staining and quantitative cultures. The compability of fiberoptic BAL and protected mini-BAL results for all cases was evaluated with kappa statistics. A two tailed p value of <0.05 was considered statistically significant. Results: Sixty-six patients were included in to the study. Fiberoptic BAL followed by protected mini-BAL was performed in 32 (48.5%) patients, protected mini-BAL followed by fiberoptic BAL in 34 (51.5%) patients. No significant difference was found between two groups about demographic features, severity scores, laboratory values, use of antibiotics, comorbidities and prognosis. When the types of pathogens were compared between two groups no significant differences were found. When the results of samples were evaluated for compatibility all together, the Kappa coefficient was found as 0.476 (p=0.0001), which is not high value, and this kappa coefficient is considered to be moderate value. Conclusion: Protected mini-BAL procedure is effective, less invasive and easier to apply compared to FOB. But it cannot be used as an alternative to fiberoptic BAL to determine the causative organism of pneumonia in ICU patients according to this study results.
Page 1. 158 Entübasyon Tüpü Disseksiyonuna Bağlı Akut Hava Yolu Tıkanması ÖZET Genel anestezi uyg... more Page 1. 158 Entübasyon Tüpü Disseksiyonuna Bağlı Akut Hava Yolu Tıkanması ÖZET Genel anestezi uygulamaları sırasında entübasyon ile ilgili sorunlar olabilmektedir. Bunlar sıklıkla güç entübasyon, bronş entübasyonu, özofagus ...
Türk Anesteziyoloji ve Reanimasyon Derneği dergisi, Oct 11, 2013
Introduction H ypothermia is defined as the lowering of the core body temperature below 36°C. The... more Introduction H ypothermia is defined as the lowering of the core body temperature below 36°C. The frequency of perioperative hypothermia is 50-90% (1). Perioperative hypothermia, especially in operations exceeding half an hour and those occurring in patients in the high risk group lead to important complications. It causes prolongation of the effects of anaesthetic drugs and the duration of patient recovery, and increases the risk for complications like coagulophaty, respiratory and cardiovascular system depression, and surgical site infections. (1, 2). Risk of perioperative hypothermia is increased in patients with an ASA score higher than II, in those over 70 years of age, the newborns, and the patients with a concomitant disease (3, 4). The nature and duration of the surgical procedure, ambient temperature, the amount of intravenous fluids, blood and blood products used, the duration of mechanical ventilation and body temperature of the patient before anaesthesia induction, are the determinants of risk for perioperative hypothermia (2-5). Perioperative hypothermia, which underlie numerous complications that increase the morbidity and mortality, and that increase the duration of hospital stay and costs, is a condition that needs to be prevented, but has not been completely solved yet. When the articles published until now has been reviewed, it was observed that approximately only 10 to 13 of 800 articles published were randomized, clinical, prospective trials. There are no common guidelines for the prevention of management of perioperative hypothermia that is used worldwide. Countries such as England and Germany use their national guidelines.
... Tuğhan Utku*, Yusuf Tunalı*, Eren Fatma Akçıl*, Özlem Korkmaz Dilmen*, Egemen Eken** * İstanb... more ... Tuğhan Utku*, Yusuf Tunalı*, Eren Fatma Akçıl*, Özlem Korkmaz Dilmen*, Egemen Eken** * İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, ** Bilim Üniversitesi ... Postoperatif analjezinin uzun sürmesi için uzun etkili bir ajan seçtik. ...
Aim:Noninvasive mechanical ventilation (NIMV) is associated with a large number of failures, and ... more Aim:Noninvasive mechanical ventilation (NIMV) is associated with a large number of failures, and patient refusal. The purpose of the study was to assess the feasibilty and safety of dexmedetomidine during NIMV. Methods:The patients allocated randomly in to two groups; Dexmedetomidine (D) group and control (C) group. In D group, Dexmedetomidine infusion rate was set between 0,2-0,7 µgr/kg/hour to reach a Ramsey sedation score (RSS) between 3-4. Mean arterial pressure, heart rate, respiratory rate, blood gas analysis, PaO2/FIO2 and RSS documented at 1 min, 10 min, 30 min,1 hour, 4 hour, 24 hours after Dexmedetomidine infusion started and after the end of infusion and at non invasive mechanical ventilation support cessation in any reason. Result: Thirty patients under NIMV support with agitation and ventilatory dyssynchrony were included in this study. In D group mean arterial pressure, heart rate, respiratory rate measurements were significantly lower than C group. RSS shown significant rises (1 to 3) at the period between 1th min to 10th min to the cessation time in D group (p<0.01) and PaO2/FIO2 values were significantly higher than control group. Conclusion: Dexmedetomidine is safe and effective agent for the sedation of the patients under NIMV support. Sonuç: Lale uçlu fiber ile endovenöz lazer ablasyon kronik venöz yetmezlik tedavisinde güvenli ve etkin bir yöntemdir.
Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 2002
Bacteremia is one of the most frequently diagnosed hospital infections in Intensive Care Units (I... more Bacteremia is one of the most frequently diagnosed hospital infections in Intensive Care Units (ICU). To determine agents causing bacteremia in our ICU, a total of 1090 hemocultures from 402 febrile episodes of 331 patients in one year were evaluated. Bacteremia was detected in 216 (53.7%) of the episodes of which 58 (26.8%) were found to be polymicrobial. The most frequent agents were; coagulase-negative staphylococci, Acinetobacter baumannii and Pseudomonas spp. Rate of methicilline resistance were 96.8% and 91.6% in the coagulase-negative staphylococci and Staphylococcus aureus species respectively. The diversity of causative agents and their resistance patterns shows the difficulty of empirical antibiotic therapy in ICU and the necessity of an active screening and acceleration of precautions.
Journal of Anesthesiology and Reanimation Specialists’ Society, 2020
Covid-19 pandemisi olarak adlandırılan virüs salgını, 2019 yılı Aralık ayında Çin'in Wuhan kentin... more Covid-19 pandemisi olarak adlandırılan virüs salgını, 2019 yılı Aralık ayında Çin'in Wuhan kentinden tüm dünyaya yayılmıştır. Hastalar ve hastalığı taşıyan asemptomatik vakalar nedeniyle, sağlık çalışanları açısından risk oluşturmaktadır. Özellikle ameliyathaneler, aerosol oluşturan işlemler ve olası temas açısından en riskli çalışma alanlarındandır. Bu nedenle perioperatif dönem işleyiş protokollerinin oluşturulması önem göstermektedir. Bu derlemede, pandemi döneminde özellik arzeden; preoperatif hasta hazırlığı, ameliyathane organizasyonu ve kişisel korunma ekipmanlarını içeren "preoperatif hasta hazırlığı ve ameliyathane işleyiş protokolümüz" sunulmuştur. Yöntem: Bu amaçla mevcut protokoller ve literatür taraması yapılmış ve güncel bilgiler ışığında oluşturulan protokol; preoperatif hasta hazırlığı, ameliyathane işleyişinin düzenlenmesi, ameliyat bitiminde ameliyathane temizliği olmak üzere 3 alt başlık içermektedir. Bulgular: Oluşturulan protokol 15 Mart-10 Mayıs 2020 tarihleri arasında kullanılmıştır. Kurumumuzun iç işleyişine uygun olarak oluşturulan protokollerimiz eşliğinde perioperatif yönetim titizlikle uygulandığında, hasta ve çalışan güvenliği yanında, işleyişin aksamadığı görülmüştür. Sonuç: Klinik protokoller ışığında preoperatif dönemde COVID-19 şüpheli-enfekte hastalar belirlenerek, perioperatif riskler azaltılabilir ve hastanın, sağlık çalışanlarının ve diğer hastaların güvenliği arttırılabilir.
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