Hallermann-Streiff-François (HSF) sendromu sporadik olarak ortaya çıkan mikrosefali, seyrek saç v... more Hallermann-Streiff-François (HSF) sendromu sporadik olarak ortaya çıkan mikrosefali, seyrek saç ve kaş, mikroftalmi, katarakt, ince cilt, ince ve sivri burun ve mikrognati gibi kraniofasiyal bulguların yanısıra trakeomalazi, sık pulmoner infeksiyon ve ince ve osteopenik kemik yapısı ile karakterize bir genetik bozukluktur. Bu anomaliler üst hava yolu obstrüksiyonu ve zor entübasyona neden olabilmektedir. Bu makalede konjenital bilateral katarakt nedeniyle toplam 6 kez genel anestezi almış 4 yaşındaki HSF sendromlu bir hastada ameliyat odası ve ameliyat odası dışındaki anestezi yönetimimiz anlatılmaktadır.
GİRİŞ ve AMAÇ: Postoperatif bulantı kusma, genel anestezi sonrası görülen en sık ikinci komplikas... more GİRİŞ ve AMAÇ: Postoperatif bulantı kusma, genel anestezi sonrası görülen en sık ikinci komplikasyondur. Laparoskopik kolesistektomi vakalarında sık görülmekle birlikte postoperatif dönemde hasta memnuniyetini etkileyen önemli bir morbidite sebebidir. Çalışmamızda laparoskopik kolesistektomi vakalarında el bileğinde P6 akupunktur bölgesine akubasınç uygulama zamanının postoperatif bulantı kusma üzerine etkilerini prospektif olarak araştırmayı planladık. YÖNTEM ve GEREÇLER: 18 yaş üstü elektif laparoskopik kolesistektomi uygulanacak 150 hasta çalışmaya dahil edildi. Hastalar 50 hasta indüksiyon öncesi (grup 1), 50 hasta indüksiyon sonrası (grup 2), 50 hasta cerrahi sonrası (grup 3) olmak üzere randomize olarak 3 gruba ayrıldı. Grup 1' de hastalara anestezi indüksiyonundan önce P6 akubasınç bilekliği uygulanırken, aynı işlem grup 2' de indüksiyondan sonra, grup 3' te ise cerrahi bitiminde uygulandı. Postoperatif 24 saat boyunca postoperatif bulantı kusma sıklığı, şiddeti ve antiemetik ihtiyacı olup olmadığı kaydedildi. BULGULAR: Gruplar, bulantı skoru ve kurtarıcı antiemetik ihtiyacı yönünden değerlendirildiğinde, grup 2' de en düşük bulantı skoru olduğu gözlemlendi ve grup 3' e göre daha düşük değerler bulunmakla birlikte (p = 0,046, p = 0,021), grup 1' den farklı olmadığı gözlemlendi. Diğer saatlerde gruplar arasında bulantı skoru ve antiemetik ihtiyacı açısından farklılık gözlemlenmedi. Kusma, öğürme açısından gruplar arası farklılık gözlemlenmedi. TARTIŞMA ve SONUÇ: P6 akubasınç yönteminin ameliyat öncesinde uygulanmasının özellikle erken dönem postoperatif bulantı kusma kontrolünde daha etkin olduğu ve antiemetik tedavi ihtiyacını azaltmada etkili olduğu sonucuna varılmıştır. Anahtar Kelimeler: postoperatif bulantı kusma, sea band, laparoskopik kolesistektomi, akubasınç, akupunktur INTRODUCTION: Postoperative nausea and vomiting (PONV) are the second most common complications following general anesthesia. PONV has a high incidence rate in laparoscopic cholecystectomy cases and is an important cause of morbidity that significantly decreases patient satisfaction in the postoperative period. We prospectively investigated the effects of the ti ming of acupressure application to the P6 acupuncture point on the wrist for the prevention of PONV. METHODS: This study included 150 adults who were aged 18 years or older, who were scheduled for elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly assigned to three groups of 50 patients: pre-induction (group 1), post-induction (group 2), and post-operative (group 3). While the acupressure wristband was applied to the patients in Group 1 before anesthesia induction, the wristbands were applied to Group 2 and Group 3 after anesthesia induction and at the end of the surgery, respectively. During postoperative 24 hours, the incidence and severity of nausea/vomiting and the need for antiemetic therapy were recorded. RESULTS: The lowest median nausea score was found in group 2, which significantly differed from group 3 (p= 0.046), but not from group 1. This was also the case for the need for antiemetic therapy (p= 0.021). There were no differences among the groups at other specified time points. The incidence of retching or vomiting was similar across the groups. DISCUSSION AND CONCLUSION: Acupressure applied before surgery on the P6 point seems to be effe
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.
Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi
Objective: Postoperative Chronic Pain (POCP) affects the quality of patients' lives. Machine lear... more Objective: Postoperative Chronic Pain (POCP) affects the quality of patients' lives. Machine learning and its applications provide significant contributions to pain research. The aim of this study is to predict the POCP status of patients based on perioperative data by developing an "Intelligent POCP Prediction System (I-POCPP)" using the best performing machine learning algorithm.
Circulation was stablein all 3 groups. The idea for epidural administration of NM sprang up in th... more Circulation was stablein all 3 groups. The idea for epidural administration of NM sprang up in the process of research due to the high frequency of the sideeffects with 0.05 mg spinal NM. It was only logicalto choose a greater dose. Conclusions: NM addition of spinal anesthesia with L1docaln prolongs considerably theanalgetic period. Epidural wayof NMadministration keeps this advantage with lack of side effects. References
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2018
Purpose: Laparoscopic appendectomy has become more popular compared with the open appendectomy in... more Purpose: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. Methods: The children underwent laparoscopic (LAP Group, n = 22) or open appendectomy (OPEN Group, n = 22). Right and left cerebral oxygenation (RScO 2-LScO 2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO 2 pressure (PETCO 2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). Results: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO 2 , and LScO 2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO 2 of the LAP group. Conclusions: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.
What is already known • Several animal and clinical studies have shown that the anesthetic agents... more What is already known • Several animal and clinical studies have shown that the anesthetic agents, ketamine and propofol, have conflicting effects on otoacoustic emission measurements. What this article adds • Distortion-product otoacoustic emissions were reduced similarly by propofol and ketamine anesthesia. Lower false outcome ratio in transient evoked otoacoustic emissions made propofol a better option than ketamine.
Journal of Dr. Behcet Uz Children s Hospital, 2020
Objective: Ensuring airway security carries the utmost importance in anesthesia. Specific predict... more Objective: Ensuring airway security carries the utmost importance in anesthesia. Specific predictive tests or findings for difficult airway are not defined for children under 3 years old. This study is aimed at finding out the value of anthropometric measurements in the prediction of difficult laryngoscopy and intubation in children by comparing them to direct laryngoscopic evaluation of Cormack-Lehane test and intubation evaluation of Intubation Difficulty Scale." Method: A total of 108 patients (aged 0-3 years), undergoing elective surgery were included in this study. Patients with known syndrome, facial anomaly, Anesthesiologists Physical Status Classification Class >2, and laryngeal mask airway were excluded from the study. Demographic data, head circumference, weight, height measurements, body mass index and percentile values were recorded by a pediatric surgeon in the preoperative period. During laryngoscopy and intubation evaluations were made using Cormack-Lehane Score and Intubation Difficulty Scale and recorded by a blinded resient. All recorded parameters were compared with Cormack-Lehane and Intubation Difficulty Scale scores. Results: When all parameters were compared with CL Grade I-II-III, IDS scores; a statistically significant difference was found between age and head circumference and CL Grade I, II (p<0.05, p<0.05). When all parameters were compared in terms of difficult and easy direct laryngoscopy, relations between difficult direct laryngoscopy and male gender and low weight percentile were observed (p<0.05). Difficult intubation was not found according to Intubation Difficulty Scale. Conclusion: Anthropometric measurements are not predictive for difficult direct laryngoscopy and difficult intubation in pediatric patients. The potentiality of difficult direct laryngoscopy could be higher in boys than girls and in children with low weight percentile.
Hallermann-Streiff-François (HSF) sendromu sporadik olarak ortaya çıkan mikrosefali, seyrek saç v... more Hallermann-Streiff-François (HSF) sendromu sporadik olarak ortaya çıkan mikrosefali, seyrek saç ve kaş, mikroftalmi, katarakt, ince cilt, ince ve sivri burun ve mikrognati gibi kraniofasiyal bulguların yanısıra trakeomalazi, sık pulmoner infeksiyon ve ince ve osteopenik kemik yapısı ile karakterize bir genetik bozukluktur. Bu anomaliler üst hava yolu obstrüksiyonu ve zor entübasyona neden olabilmektedir. Bu makalede konjenital bilateral katarakt nedeniyle toplam 6 kez genel anestezi almış 4 yaşındaki HSF sendromlu bir hastada ameliyat odası ve ameliyat odası dışındaki anestezi yönetimimiz anlatılmaktadır.
GİRİŞ ve AMAÇ: Postoperatif bulantı kusma, genel anestezi sonrası görülen en sık ikinci komplikas... more GİRİŞ ve AMAÇ: Postoperatif bulantı kusma, genel anestezi sonrası görülen en sık ikinci komplikasyondur. Laparoskopik kolesistektomi vakalarında sık görülmekle birlikte postoperatif dönemde hasta memnuniyetini etkileyen önemli bir morbidite sebebidir. Çalışmamızda laparoskopik kolesistektomi vakalarında el bileğinde P6 akupunktur bölgesine akubasınç uygulama zamanının postoperatif bulantı kusma üzerine etkilerini prospektif olarak araştırmayı planladık. YÖNTEM ve GEREÇLER: 18 yaş üstü elektif laparoskopik kolesistektomi uygulanacak 150 hasta çalışmaya dahil edildi. Hastalar 50 hasta indüksiyon öncesi (grup 1), 50 hasta indüksiyon sonrası (grup 2), 50 hasta cerrahi sonrası (grup 3) olmak üzere randomize olarak 3 gruba ayrıldı. Grup 1' de hastalara anestezi indüksiyonundan önce P6 akubasınç bilekliği uygulanırken, aynı işlem grup 2' de indüksiyondan sonra, grup 3' te ise cerrahi bitiminde uygulandı. Postoperatif 24 saat boyunca postoperatif bulantı kusma sıklığı, şiddeti ve antiemetik ihtiyacı olup olmadığı kaydedildi. BULGULAR: Gruplar, bulantı skoru ve kurtarıcı antiemetik ihtiyacı yönünden değerlendirildiğinde, grup 2' de en düşük bulantı skoru olduğu gözlemlendi ve grup 3' e göre daha düşük değerler bulunmakla birlikte (p = 0,046, p = 0,021), grup 1' den farklı olmadığı gözlemlendi. Diğer saatlerde gruplar arasında bulantı skoru ve antiemetik ihtiyacı açısından farklılık gözlemlenmedi. Kusma, öğürme açısından gruplar arası farklılık gözlemlenmedi. TARTIŞMA ve SONUÇ: P6 akubasınç yönteminin ameliyat öncesinde uygulanmasının özellikle erken dönem postoperatif bulantı kusma kontrolünde daha etkin olduğu ve antiemetik tedavi ihtiyacını azaltmada etkili olduğu sonucuna varılmıştır. Anahtar Kelimeler: postoperatif bulantı kusma, sea band, laparoskopik kolesistektomi, akubasınç, akupunktur INTRODUCTION: Postoperative nausea and vomiting (PONV) are the second most common complications following general anesthesia. PONV has a high incidence rate in laparoscopic cholecystectomy cases and is an important cause of morbidity that significantly decreases patient satisfaction in the postoperative period. We prospectively investigated the effects of the ti ming of acupressure application to the P6 acupuncture point on the wrist for the prevention of PONV. METHODS: This study included 150 adults who were aged 18 years or older, who were scheduled for elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly assigned to three groups of 50 patients: pre-induction (group 1), post-induction (group 2), and post-operative (group 3). While the acupressure wristband was applied to the patients in Group 1 before anesthesia induction, the wristbands were applied to Group 2 and Group 3 after anesthesia induction and at the end of the surgery, respectively. During postoperative 24 hours, the incidence and severity of nausea/vomiting and the need for antiemetic therapy were recorded. RESULTS: The lowest median nausea score was found in group 2, which significantly differed from group 3 (p= 0.046), but not from group 1. This was also the case for the need for antiemetic therapy (p= 0.021). There were no differences among the groups at other specified time points. The incidence of retching or vomiting was similar across the groups. DISCUSSION AND CONCLUSION: Acupressure applied before surgery on the P6 point seems to be effe
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.
Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi
Objective: Postoperative Chronic Pain (POCP) affects the quality of patients' lives. Machine lear... more Objective: Postoperative Chronic Pain (POCP) affects the quality of patients' lives. Machine learning and its applications provide significant contributions to pain research. The aim of this study is to predict the POCP status of patients based on perioperative data by developing an "Intelligent POCP Prediction System (I-POCPP)" using the best performing machine learning algorithm.
Circulation was stablein all 3 groups. The idea for epidural administration of NM sprang up in th... more Circulation was stablein all 3 groups. The idea for epidural administration of NM sprang up in the process of research due to the high frequency of the sideeffects with 0.05 mg spinal NM. It was only logicalto choose a greater dose. Conclusions: NM addition of spinal anesthesia with L1docaln prolongs considerably theanalgetic period. Epidural wayof NMadministration keeps this advantage with lack of side effects. References
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2018
Purpose: Laparoscopic appendectomy has become more popular compared with the open appendectomy in... more Purpose: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. Methods: The children underwent laparoscopic (LAP Group, n = 22) or open appendectomy (OPEN Group, n = 22). Right and left cerebral oxygenation (RScO 2-LScO 2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO 2 pressure (PETCO 2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). Results: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO 2 , and LScO 2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO 2 of the LAP group. Conclusions: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.
What is already known • Several animal and clinical studies have shown that the anesthetic agents... more What is already known • Several animal and clinical studies have shown that the anesthetic agents, ketamine and propofol, have conflicting effects on otoacoustic emission measurements. What this article adds • Distortion-product otoacoustic emissions were reduced similarly by propofol and ketamine anesthesia. Lower false outcome ratio in transient evoked otoacoustic emissions made propofol a better option than ketamine.
Journal of Dr. Behcet Uz Children s Hospital, 2020
Objective: Ensuring airway security carries the utmost importance in anesthesia. Specific predict... more Objective: Ensuring airway security carries the utmost importance in anesthesia. Specific predictive tests or findings for difficult airway are not defined for children under 3 years old. This study is aimed at finding out the value of anthropometric measurements in the prediction of difficult laryngoscopy and intubation in children by comparing them to direct laryngoscopic evaluation of Cormack-Lehane test and intubation evaluation of Intubation Difficulty Scale." Method: A total of 108 patients (aged 0-3 years), undergoing elective surgery were included in this study. Patients with known syndrome, facial anomaly, Anesthesiologists Physical Status Classification Class >2, and laryngeal mask airway were excluded from the study. Demographic data, head circumference, weight, height measurements, body mass index and percentile values were recorded by a pediatric surgeon in the preoperative period. During laryngoscopy and intubation evaluations were made using Cormack-Lehane Score and Intubation Difficulty Scale and recorded by a blinded resient. All recorded parameters were compared with Cormack-Lehane and Intubation Difficulty Scale scores. Results: When all parameters were compared with CL Grade I-II-III, IDS scores; a statistically significant difference was found between age and head circumference and CL Grade I, II (p<0.05, p<0.05). When all parameters were compared in terms of difficult and easy direct laryngoscopy, relations between difficult direct laryngoscopy and male gender and low weight percentile were observed (p<0.05). Difficult intubation was not found according to Intubation Difficulty Scale. Conclusion: Anthropometric measurements are not predictive for difficult direct laryngoscopy and difficult intubation in pediatric patients. The potentiality of difficult direct laryngoscopy could be higher in boys than girls and in children with low weight percentile.
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Papers by Pervin Bozkurt