Studies, including fMRI, show that neurodegeneration or a decrease in neuron count occurs in cert... more Studies, including fMRI, show that neurodegeneration or a decrease in neuron count occurs in certain brain regions of patients with chronic itchy lesions. In these studies attention was also drawn to increased GABAA receptor sensitivity. In 3 patients suffering from chronic stress-induced non-histaminergic pruritus for more than 6 weeks, who underwent elective orthopedic surgery under total intravenous general anesthesia with bispectral index monitoring, it has been determined that total propofol consumption was 50, 78 and 58 micrograms/kg/min respectively. All three operations lasted more than 2 hours, were completed without any complications or awareness and all 3 patients were hemodynamically stable among the operation. From this point of view, we observed that GABA receptor sensitivity increased in patients with chronic itching. Also the need for propofol during general anesthesia, which acts on GABA receptors, decreased to doses equivalent to average sedation doses. We consider...
Respiratuar komplikasyonlar; postoperatif morbidite ve mortalitenin onemli bir nedenidir. Atelekt... more Respiratuar komplikasyonlar; postoperatif morbidite ve mortalitenin onemli bir nedenidir. Atelektazi gelisimi; perioperatif donemde en sik gorulen respiratuar komplikasyonlardan biridir, hastalarin yaklasik % 90’inda gorulur. Atelektazi, yalnizca intraoperatif periyodda ve anestezi induksiyonunun ilk birkac dakikasinda degil, postoperatif periyodda hatta derlenme odasinda dahi akut olarak gelisebilen, sistemik oksijenasyonu bozarak, havayolu yonetimini guclestiren bir sorundur. Postoperatif komplikasyonlarla ilgili risk faktorlerini tanimlayan calismalar mevcuttur. Ancak risk faktoru yoklugunda, genel anestezi rutininin kendisi de atelektazi gelisimine predispozisyon olusturabilir. Biz; risk faktoru tasimayan; 24 yasinda bayan hastada genel anestezi sonrasi derlenme unitesinde gelisen ve CPAP maske ile mekanik ventilator destegi sonrasi hizla duzelen bir postoperatif atelektazi olgusunu sunmayi amacladik.
We present our anesthetic approach to a patient with Pantotenat Kinase Associated Neurodegenerati... more We present our anesthetic approach to a patient with Pantotenat Kinase Associated Neurodegeneration (PKAN) (formerly called Hallervorden-Spatz disease) who underwent thyroidectomy under general anesthesia. A 46-year-old female patient was admitted to the general surgery department because of dysphagia and swallowing sensation. The patient was dystonic, aphonic, and she was only able to communicate with eye movements. High cortical functions were normal. The patient was operated under general anesthesia. Thiopental, rocuronium, and fentanyl were used for induction and no intubation difficulty was observed. Anesthesia was maintained with sevoflurane and fentanyl under Bispectral Index (BIS) monitoring. It was observed that the need for anesthetic agents decreased, so BIS levels of 38%-40% were obtained with inhalation of 0.6 minimum alveolar concentration sevoflurane. In the postoperative period after extubation using sugammadex, the patient was transferred to the intensive care unit. PKAN is an autosomal recessive syndrome characterized by dystonia, Parkinson disease-like symptoms, and iron deposition in the brain, which is caused by panthotenate kinase 2 enzyme mutation. The anesthetic approach is characterized by reduced mouth opening, atetoid posture, dystonic movements, and cervical pathologies. In our case, endotracheal intubation was easy and the need for anesthetic agents was considerably reduced. Our absolute recommendation is to involve neuromonitoring techniques in the anesthetic management of neurodegenerative diseases.
Total parenteral nutrition through a peripheral venous access is a good alternative in the manage... more Total parenteral nutrition through a peripheral venous access is a good alternative in the management of critically ill patients in the ICU who cannot be adequately fed. However, it carries an inherent risk of extravasation which results in skin and tissue necrosis. In the present report we discuss a case of accidental extravasation of peripheral parenteral nutrition solution causing serious skin necrosis. The importance of this case report lies on the high frequency of patients who need total parenteral nutrition in ICU units and that sterile dressings with Goulard's extract is a non-invasive alternative in the early period of skin lesions before needing invasive operations like debridement or/and amputation.
Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients t... more Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients. Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive-midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg −1 , and midazolam was administered at a concentration of 0.025 μg.kg −1 via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T beginning , T preop5 min , T preop 10 min , T induction , T intubation , T intubation 5 min , T initial surgery , T surgery 15 min , T surgery 30 min , T extubation , T extubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately. Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T preop 5 min , T preop 10 min , T induction , T intubation , T intubation 5 min and T initial surgery. MBP was significantly different in the hypertensive groups at T induction , T intubation , T intubation 5 min, T initial surgery , T surgery 15 min , T surgery 30 min, T extubation and T extubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM. Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.
We report a case of acute respiratory insuffi ciency due to peripartum cardiomyopathy after Caesa... more We report a case of acute respiratory insuffi ciency due to peripartum cardiomyopathy after Caesarean section in a term pregnancy with twins. The patient was a 30-year-old woman with a spontaneous twin pregnancy at 32 weeks of gestation who was admitted to our obstetrics department with preterm premature rupture of membranes. After 48 hours, the tocolysis was stopped and an uneventful Caesarean was performed under general anesthesia. As the patient was waking up, her SPO 2 decreased to 32%, and she became cyanotic and tachypneic. Auscultation revealed rales in her lower lung lobes bilaterally. Her oxygen saturation did not increase in the hours that followed, and her cyanosis persisted, so we decided to admit her to the Intensive Care Unit. She was mechanically ventilated. Her chest Xray showed an enlarged cardiac silhouette and pulmonary infi ltrates in the lower lobes. On the second postoperative day, transthoracic echocardiography was performed and revealed an EF of 45%, mild left ventricular systolic dysfunction and moderate mitral valve failure. Lisinopryl and furosemide were started. On postoperative day four, her symptoms and radiological signs had resolved. She was weaned from mechanical ventilation and discharged from the obstetric ward on postoperative day seven.
Working in extraordinary conditions as healthcare professionals is a situation where your standar... more Working in extraordinary conditions as healthcare professionals is a situation where your standard rules and working order disappear. In this process, the transfer of experiences facilitates adaptation to these extraordinary conditions. In the ongoing pandemic process, we, as Duzce University Department of Anesthesiology and Reanimation, have benefited from the experiences of clinicians who have experienced COVID-19 outbreak before us. In this article, we aimed to share a presentation about our working plan, the resources we took advantage of and the difficulties we experienced, with other clinicians. In our initial evaluations, when there is no official case in the region yet, based on the data of countries with similar region abroad, we encountered how many cases we have the capacity to support and how much we can increase this capacity in the worst conditions. During this discussions, we have planned material, equipment and our possible work order.We tried to provide protective equipment procurement, equipment use training in terms of employee health, we talked through case scenarios to create a safe working environment and for safe anesthesia practices. Our scenarios contained the questions like how many people and at what level of seniority should be and how the task should be done. We followed the Turkish Anesthesiology and Reanimation Association (TARD), the Turkish Intensive Care Association(TYBD), European Society of Anesthesiology (ESA) , European Society of Intensive Medicine (ESICM) guidelines for safe anesthesia and intensive care practices. In this process, the guides we used the most for Novel Coronavirus Disease follow-up and treatment were the Guide of Scientific Advisory Board of Turkish Ministry of Health , besides the Zhejiang University School of Medicine (FAHZU) COVID-19 Prevention and Treatment Handbook and Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19. While planning a pandemic ICU physically, it was decided to create a new area, it was seen that this area reduced the risk of transmission, but brought about the adaptation and placement problems to the working area. It should be taken into consideration that multidisciplinary approach may lead to problems in followup and orientation, although it has a positive contribution to the treatment process.
Journal of the Turkish German Gynecological Association, 2014
Breast milk has many features reinforcing newborn development, and as a nutrient, it is superior ... more Breast milk has many features reinforcing newborn development, and as a nutrient, it is superior to all artificial nutrients (1). Breastfeeding is given great value in the healthy development of a newborn (2). It is important that a mother ideally begins breastfeeding her newborn baby in the first hour after delivery. Cesarean section and primiparity are important risk factors for late onset of breastfeeding (3). Cesarean section is one of the most important operations in obstetrics, and its incidence is approximately 25% of all deliveries and is progressively increasing. General and regional anesthesia techniques are performed in the anesthetic management of cesarean sections (2). Consulting the relevant literature, articles about the effects of epidural anesthesia on lactation are common, but there is no article about the effects of general, spinal, and epidural anesthesia techniques and normal vaginal birth on lactation. We designed this study to test our clinical observations about the difference in lactation between patients who underwent cesarean section and vaginal birth. In our study, we aimed to compare the lactation process by mothers who underwent elective cesarean section under general anesthesia, spinal anesthesia, epidural anesthesia, and normal vaginal birth. Material and Methods The study was approved by the Ethical Committee of Clinical Research from the University of Duzce, Faculty of Medicine (date: 04.08.2011, number: 2011/173). The study was supported by the Committee on Scientific Research Projects from the Düzce University (date: 05.12.2011, number: 2011/350). A total of 84 patients were included into the study, and 6 patients were excluded (Figure 1); 63 of them were underwent elective cesarean section, and 21 patients had a normal vaginal delivery in the Clinic of Gynecology and Obstetrics. All patients were between 18-40 years of age and had a risk of ASA I-II. Before the procedure, informed consent was obtained from all patients (ClinicalTrial.gov ID: NCT02016937). Exclusion criteria were: non-elective cases, plural pregnancies, preterm pregnancies, fetal anomalies, retardation of fetal development, newborns with birth weight under 2500 grams, infants with a risk of aspiration of meconium or amnions, pathologies affecting acid-base balance, diabetes mellitus,
ÖZET: İkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği ... more ÖZET: İkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği gelişen bir olgu sunulmuştur. Bizim olgumuzda, 30 yaşında 32 haftalık ikiz gebeliği olan kadın hasta preterm membran rüptürü nedeniyle Kadın Hastalıkları ve ...
Studies, including fMRI, show that neurodegeneration or a decrease in neuron count occurs in cert... more Studies, including fMRI, show that neurodegeneration or a decrease in neuron count occurs in certain brain regions of patients with chronic itchy lesions. In these studies attention was also drawn to increased GABAA receptor sensitivity. In 3 patients suffering from chronic stress-induced non-histaminergic pruritus for more than 6 weeks, who underwent elective orthopedic surgery under total intravenous general anesthesia with bispectral index monitoring, it has been determined that total propofol consumption was 50, 78 and 58 micrograms/kg/min respectively. All three operations lasted more than 2 hours, were completed without any complications or awareness and all 3 patients were hemodynamically stable among the operation. From this point of view, we observed that GABA receptor sensitivity increased in patients with chronic itching. Also the need for propofol during general anesthesia, which acts on GABA receptors, decreased to doses equivalent to average sedation doses. We consider...
Respiratuar komplikasyonlar; postoperatif morbidite ve mortalitenin onemli bir nedenidir. Atelekt... more Respiratuar komplikasyonlar; postoperatif morbidite ve mortalitenin onemli bir nedenidir. Atelektazi gelisimi; perioperatif donemde en sik gorulen respiratuar komplikasyonlardan biridir, hastalarin yaklasik % 90’inda gorulur. Atelektazi, yalnizca intraoperatif periyodda ve anestezi induksiyonunun ilk birkac dakikasinda degil, postoperatif periyodda hatta derlenme odasinda dahi akut olarak gelisebilen, sistemik oksijenasyonu bozarak, havayolu yonetimini guclestiren bir sorundur. Postoperatif komplikasyonlarla ilgili risk faktorlerini tanimlayan calismalar mevcuttur. Ancak risk faktoru yoklugunda, genel anestezi rutininin kendisi de atelektazi gelisimine predispozisyon olusturabilir. Biz; risk faktoru tasimayan; 24 yasinda bayan hastada genel anestezi sonrasi derlenme unitesinde gelisen ve CPAP maske ile mekanik ventilator destegi sonrasi hizla duzelen bir postoperatif atelektazi olgusunu sunmayi amacladik.
We present our anesthetic approach to a patient with Pantotenat Kinase Associated Neurodegenerati... more We present our anesthetic approach to a patient with Pantotenat Kinase Associated Neurodegeneration (PKAN) (formerly called Hallervorden-Spatz disease) who underwent thyroidectomy under general anesthesia. A 46-year-old female patient was admitted to the general surgery department because of dysphagia and swallowing sensation. The patient was dystonic, aphonic, and she was only able to communicate with eye movements. High cortical functions were normal. The patient was operated under general anesthesia. Thiopental, rocuronium, and fentanyl were used for induction and no intubation difficulty was observed. Anesthesia was maintained with sevoflurane and fentanyl under Bispectral Index (BIS) monitoring. It was observed that the need for anesthetic agents decreased, so BIS levels of 38%-40% were obtained with inhalation of 0.6 minimum alveolar concentration sevoflurane. In the postoperative period after extubation using sugammadex, the patient was transferred to the intensive care unit. PKAN is an autosomal recessive syndrome characterized by dystonia, Parkinson disease-like symptoms, and iron deposition in the brain, which is caused by panthotenate kinase 2 enzyme mutation. The anesthetic approach is characterized by reduced mouth opening, atetoid posture, dystonic movements, and cervical pathologies. In our case, endotracheal intubation was easy and the need for anesthetic agents was considerably reduced. Our absolute recommendation is to involve neuromonitoring techniques in the anesthetic management of neurodegenerative diseases.
Total parenteral nutrition through a peripheral venous access is a good alternative in the manage... more Total parenteral nutrition through a peripheral venous access is a good alternative in the management of critically ill patients in the ICU who cannot be adequately fed. However, it carries an inherent risk of extravasation which results in skin and tissue necrosis. In the present report we discuss a case of accidental extravasation of peripheral parenteral nutrition solution causing serious skin necrosis. The importance of this case report lies on the high frequency of patients who need total parenteral nutrition in ICU units and that sterile dressings with Goulard's extract is a non-invasive alternative in the early period of skin lesions before needing invasive operations like debridement or/and amputation.
Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients t... more Background: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients. Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive-midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg −1 , and midazolam was administered at a concentration of 0.025 μg.kg −1 via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T beginning , T preop5 min , T preop 10 min , T induction , T intubation , T intubation 5 min , T initial surgery , T surgery 15 min , T surgery 30 min , T extubation , T extubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately. Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T preop 5 min , T preop 10 min , T induction , T intubation , T intubation 5 min and T initial surgery. MBP was significantly different in the hypertensive groups at T induction , T intubation , T intubation 5 min, T initial surgery , T surgery 15 min , T surgery 30 min, T extubation and T extubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM. Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.
We report a case of acute respiratory insuffi ciency due to peripartum cardiomyopathy after Caesa... more We report a case of acute respiratory insuffi ciency due to peripartum cardiomyopathy after Caesarean section in a term pregnancy with twins. The patient was a 30-year-old woman with a spontaneous twin pregnancy at 32 weeks of gestation who was admitted to our obstetrics department with preterm premature rupture of membranes. After 48 hours, the tocolysis was stopped and an uneventful Caesarean was performed under general anesthesia. As the patient was waking up, her SPO 2 decreased to 32%, and she became cyanotic and tachypneic. Auscultation revealed rales in her lower lung lobes bilaterally. Her oxygen saturation did not increase in the hours that followed, and her cyanosis persisted, so we decided to admit her to the Intensive Care Unit. She was mechanically ventilated. Her chest Xray showed an enlarged cardiac silhouette and pulmonary infi ltrates in the lower lobes. On the second postoperative day, transthoracic echocardiography was performed and revealed an EF of 45%, mild left ventricular systolic dysfunction and moderate mitral valve failure. Lisinopryl and furosemide were started. On postoperative day four, her symptoms and radiological signs had resolved. She was weaned from mechanical ventilation and discharged from the obstetric ward on postoperative day seven.
Working in extraordinary conditions as healthcare professionals is a situation where your standar... more Working in extraordinary conditions as healthcare professionals is a situation where your standard rules and working order disappear. In this process, the transfer of experiences facilitates adaptation to these extraordinary conditions. In the ongoing pandemic process, we, as Duzce University Department of Anesthesiology and Reanimation, have benefited from the experiences of clinicians who have experienced COVID-19 outbreak before us. In this article, we aimed to share a presentation about our working plan, the resources we took advantage of and the difficulties we experienced, with other clinicians. In our initial evaluations, when there is no official case in the region yet, based on the data of countries with similar region abroad, we encountered how many cases we have the capacity to support and how much we can increase this capacity in the worst conditions. During this discussions, we have planned material, equipment and our possible work order.We tried to provide protective equipment procurement, equipment use training in terms of employee health, we talked through case scenarios to create a safe working environment and for safe anesthesia practices. Our scenarios contained the questions like how many people and at what level of seniority should be and how the task should be done. We followed the Turkish Anesthesiology and Reanimation Association (TARD), the Turkish Intensive Care Association(TYBD), European Society of Anesthesiology (ESA) , European Society of Intensive Medicine (ESICM) guidelines for safe anesthesia and intensive care practices. In this process, the guides we used the most for Novel Coronavirus Disease follow-up and treatment were the Guide of Scientific Advisory Board of Turkish Ministry of Health , besides the Zhejiang University School of Medicine (FAHZU) COVID-19 Prevention and Treatment Handbook and Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19. While planning a pandemic ICU physically, it was decided to create a new area, it was seen that this area reduced the risk of transmission, but brought about the adaptation and placement problems to the working area. It should be taken into consideration that multidisciplinary approach may lead to problems in followup and orientation, although it has a positive contribution to the treatment process.
Journal of the Turkish German Gynecological Association, 2014
Breast milk has many features reinforcing newborn development, and as a nutrient, it is superior ... more Breast milk has many features reinforcing newborn development, and as a nutrient, it is superior to all artificial nutrients (1). Breastfeeding is given great value in the healthy development of a newborn (2). It is important that a mother ideally begins breastfeeding her newborn baby in the first hour after delivery. Cesarean section and primiparity are important risk factors for late onset of breastfeeding (3). Cesarean section is one of the most important operations in obstetrics, and its incidence is approximately 25% of all deliveries and is progressively increasing. General and regional anesthesia techniques are performed in the anesthetic management of cesarean sections (2). Consulting the relevant literature, articles about the effects of epidural anesthesia on lactation are common, but there is no article about the effects of general, spinal, and epidural anesthesia techniques and normal vaginal birth on lactation. We designed this study to test our clinical observations about the difference in lactation between patients who underwent cesarean section and vaginal birth. In our study, we aimed to compare the lactation process by mothers who underwent elective cesarean section under general anesthesia, spinal anesthesia, epidural anesthesia, and normal vaginal birth. Material and Methods The study was approved by the Ethical Committee of Clinical Research from the University of Duzce, Faculty of Medicine (date: 04.08.2011, number: 2011/173). The study was supported by the Committee on Scientific Research Projects from the Düzce University (date: 05.12.2011, number: 2011/350). A total of 84 patients were included into the study, and 6 patients were excluded (Figure 1); 63 of them were underwent elective cesarean section, and 21 patients had a normal vaginal delivery in the Clinic of Gynecology and Obstetrics. All patients were between 18-40 years of age and had a risk of ASA I-II. Before the procedure, informed consent was obtained from all patients (ClinicalTrial.gov ID: NCT02016937). Exclusion criteria were: non-elective cases, plural pregnancies, preterm pregnancies, fetal anomalies, retardation of fetal development, newborns with birth weight under 2500 grams, infants with a risk of aspiration of meconium or amnions, pathologies affecting acid-base balance, diabetes mellitus,
ÖZET: İkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği ... more ÖZET: İkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği gelişen bir olgu sunulmuştur. Bizim olgumuzda, 30 yaşında 32 haftalık ikiz gebeliği olan kadın hasta preterm membran rüptürü nedeniyle Kadın Hastalıkları ve ...
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