Ahmet Selim Özkan

Colistin nephrotoxicity increases with age.

Abstract Background: Colistin (COL) has become the backbone of the treatment of infections due to extensively drug-resistant (XDR) Gram-negative bacteria. The most common restriction to its use is acute kidney injury (AKI). Methods: We conducted a retrospective cohort study to evaluate risk factors for new-onset AKI in patients receiving COL. The cohort consisted of 198 adults admitted to 9 referral hospitals between January 2010 and October 2012 and treated with intravenous COL for ≥ 72 h. Patients with no pre-existing kidney dysfunction were compared in terms of risk factors and outcomes of AKI graded according to the RIFLE criteria. Logistic regression analysis was used to identify associated risk factors. Results: A total of 198 patients met the inclusion criteria, of whom 167 had no pre-existing kidney dysfunction; the mean patient age was 58.77 (± 18.98) y. Bloodstream infections (34.8%) and ventilator-associated pneumonia (32.3%) were the 2 most common indications for COL use. New-onset AKI developed in 46.1% of the patients, graded as risk (10%), injury (15%), and failure (21%). Patients with high Charlson co-morbidity index (CCI) scores (p = 0.001) and comparatively low initial glomerular filtration rate (GFR) estimations (p < 0.001) were more likely to develop AKI, but older age (p = 0.001; odds ratio 5.199, 95% confidence interval 2.684–10.072) was the major predictor in the multivariate analysis. In-hospital recovery from AKI occurred in 58.1%, within a median of 7 days. Conclusions: COL-induced nephrotoxicity occurred significantly more often in patients older than 60 y of age and was related to low initial GFR estimations and high CCI scores, which were basically determined by age.

Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study

Study Design. A prospective, randomized, double-blinded study. Objective. The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis. Summary of Background Data. Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis. Methods. Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus. Results. Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group. Conclusion. The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid. Level of Evidence: 2

Effects of perineural administration of phenytoin in combination with levobupivacaine in a rat sciatic nerve block

Peripheral nerve blocks are commonly preferred worldwide for the purposes of anesthesia application and postoperative analgesia. In this study, we investigated the effects of phenytoin which has a similar mechanism to local anesthetics in terms of the duration of analgesia and quality. The study was performed on 32 Sprague-Dawley male rats. Rats were randomly grouped into 4 groups. Group S: Sham group (n: 8); 0,2 ml saline perineural unilateral sciatic nerve. Group L: Perineural levobupivacaine (0,2 ml 0,5% levobupivacaine, n: 8); Group Ph: Perineural phenytoin (0,2 ml 62,5 mg / kg, n: 8); Group L + PH: Perineural phenytoin and levobupivacaine (0,2 ml 0,5% levobupivacaine + 62,5 mg / kg phenytoin, n: 8). Hot-plate and tail- flick tests were performed to measure acute thermal pain and histological changes were evaluated. The latency time at 30 minute in Group L+Ph were significantly increased when compared to the other groups during evaluation of the hot plate test. There was a significant difference in terms of latency time at 30 minute in Group L+Ph in the Tail Flick test and the latency time in Group L+Ph was longer when compared to the other groups (p

The effects of endotracheal intubation via McGRATH Videolaryngoscope on intraocular pressure: A randomized clinical trial -

In this study; we aimed to compare the effects of endotracheal intubation via direct laryngoscope and McGRATH videolaryngoscope (VL) on intraocular pressure. Total of 50 ASA (American Society of Anesthesiologist) Grade 1-2, Mallampati score 1 or 2, age between 18 to 65 patients planned to undergo nonophthalmic surgery were included to study. Patients were divided randomly into 2 groups as direct laryngoscopic (Macintosh)(n=25) and videolaryngoscopic (McGRATH)(n=25) intubation group. The mean arterial blood pressure (MAP) and heart rate (HR) recorded by anesthesiologist and intraocular pressure (IOP) measured by ophthalmologist with tonopen device were recorded pre-induction (basal), pre-intubation, 1th,3rd,5th minutes of intubation, respectively. Study terminated after 5th minute values taken. There were no statistically significant differences in distirubiton of sex, weight, age, height, and ASA between groups. Duration of intubation in McGRATH group was 32 ± 2 s and statistically significantly longer than Macintosh group (23.8 ± 2.9 s)(p

Anesthesia management in pediatric patients undergoing percutaneous closure of atrial and ventricular septal defects in catheter laboratory: Retrospective clinical study

Along with technological and medical advances, diagnostic and therapeutic cardiac catheterization commonly used in pediatric patients; it is frequently preferred the percutaneous closure of ASD/VSD. In this study, it was aimed to evaluate anesthesia management of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory. This was a retrospective review of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory between 2012–2017. Demographic and clinical characteristics were recorded, and all results of anesthesia management were evaluated. Thirty-eight patients (18 males, 20 females) with a mean age of 7,71 ± 3,57 years underwent percutaneous closure of ASD/VSD. Of the cases; 78,4% diagnosed ASD, 21,6% diagnosed VSD were operated. The most common presenting symptoms were murmur (55,3%), chest pain (21,1%) and palpitation (10,5%), Mean defect size was 11.60 ± 6.27 mm for ASD and 6.00 ± 4.64 mm for VSD. Mean anesthesia time was 71.33 ± 22.77 minutes for ASD and 85.83 ± 26.91 minutes for VSD. Mean procedure time was 56.00 ± 20.56 minutes for ASD and 69.16 ± 28.70 minutes for VSD. Premedication was performed for 94,7%, anesthesia induction was performed with propofol (94,7%), fentanyl (63,2%), rocuronium (65,8%). Sevoflurane was used for anesthesia maintenance. TEE was used in 86,8% of the cases. Complications developed for 3 cases. IV paracetamol was preferred in 84,2%. Anesthetist must consider carefully premedication, anesthetic agent preferences, general anesthesia or sedation, complications by catheterization, discomforts of transesophageal echocardiography, hemodynamic instability, requirement of immobility and adequate analgesia.

Successful nasotracheal intubation in a pediatric patient with Goldenhar's Syndrome using McGRATHTM videolaryngoscope

Goldenhar Syndrome (GS) (oculo-auriculo-vertebral syndrome) is a rare congenital hemicraniofacial disorder and it occurs one in every 3000 to 5000 live births (1). GS is characterized by external ear malformations, hypoplastic zygomatic arch, micrognathia, facial asymmetry and hypoplasia. Difficult or impossible laryngoscopy of cases with GS due to micrognathia and jaw joint problems have been reported in the literature as case reports. Firstly in the literature, we report airway management of 5-year-old child with GS for jaw surgery at our university hospital and succesfully using of McGRATH videolaryngoscope (VL) for the management of airway via nasal intubation.

The Effects of Secondhand Smoke Exposure on Postoperative Pain and Ventilation Values During One-Lung Ventilation: A Prospective Clinical Trial

OBJECTIVES To investigate the relationships between secondhand smoke (SHS) exposure and oxygenation during one-lung ventilation (OLV) in lobectomy surgery and between SHS exposure and postoperative analgesic consumption. DESIGN Prospective study. SETTING University, Faculty of Medicine, operating room. PARTICIPANTS Sixty adult patients with American Society of Anesthesiologists score II to III, aged 18 to 65 years, with a body mass index (BMI) <35 kg/m2 scheduled for lobectomy surgery by open thoracotomy. INTERVENTIONS Patients were divided into 2 groups: the SHS group (n = 30) (urine cotinine level ≥6.0 ng/mL) and the NS (nonsmoker) group (n = 30) (urine cotinine level <6.0 ng/mL and no smoking history). SHS exposure was defined according to a previously published algorithm. MEASUREMENTS AND MAIN RESULTS Noninvasive blood pressure, electrocardiography, capnography, and peripheral oxygen saturation were monitored, and intra- and postoperative arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), and intraoperative peak airway pressure were compared between the 2 groups. Postoperative analgesic consumption was calculated. No significant differences in demographics or preoperative data were noted between the 2 groups. PaO2 values 10 minutes after OLV onset and 10 minutes after the end of OLV were increased significantly in the NS group compared with those in the SHS group (p < 0.05). PaO2 values after 10 minutes of OLV in the NS and SHS groups were 285.5 ± 90 mmHg and 186.7 ± 66 mmHg, respectively. PaO2 values after OLV termination in the NS and SHS groups were 365.8 ± 58 mmHg and 283.6 ± 64 mmHg (p < 0.05), respectively. PaCO2 values 10 minutes after OLV onset, 10 minutes after the end of OLV, at the end of surgery, and upon arrival in the intermediate care unit were significantly different between the 2 groups (p < 0.05). CONCLUSION The present study demonstrated that during OLV, patients exposed to SHS exhibited significantly lower arterial oxygen pressure compared with nonsmokers. Arterial carbon dioxide values were increased significantly in SHS-exposed patients. Morphine consumption for postoperative analgesia also was increased in patients exposed to SHS compared with that in nonsmokers.

Regional versus general anesthesia in patients underwent hip fracture surgery over 80 years old: A retrospective cohort study

Aim: To determine the optimum anesthetic technique, namely general or regional anesthesia, for elderly patients over 80 years old with hip fracture surgery with respect to demographic characteristics, hemodynamics, length of hospital stay, and mortality. Material and Methods: Patients with the American Society of Anesthesiology (ASA) scores of II–IV aged over 80 years old were included in our study. The patients were retrospectively allocated to two cohort study groups: regional anesthesia (Group GA, n=41) and general anesthesia (Group RA, n=19). The demographic characteristics, hemodynamics, length of hospital stay, and mortality were recorded. Results: The two groups were similar with respect to age, sex, height, weight, body mass index, ideal body weight, ASA scores, and smoking. The number of patients using drugs in Group RA was significantly more than Group GA. The need for invasive arterial monitorization, central venous catheter, and nasogastric tube in Group RA were significantly less. The duration of anesthesia and surgery in Group RA were significantly shorter than Group GA. The length of ICU and hospital stays in Group RA were significantly shorter than Group GA. Hospital mortality of Group GA was significantly higher than that in Group RA. Conclusion: The present retrospective cohort study showed that perioperative complications, duration of anesthesia and surgery, admission to the postoperative ICU, length of ICU and hospital stay, and also mortality in regional anesthesia were significantly lower in comparison with general anesthesia. We therefore conclude that regional anesthesia can be used safely with patients during hip fracture surgery.

Sedação com dexmedetomidina em paciente pediátrico com síndrome de Klippel‐Feil

Klippel Feil Syndrome (KFS) is a congenital malformation which has a failure of segmantation of cervical somites in the 8th weeks of gestation and fusion at least two cervical segments.1 It is described as the triad of short neck, low posterior hairline and decreased range of neck motions.2 Especially decreased range of neck motions lead many anesthesiologists to difficult airway management. Dexmedetomidine is used for sedation especially without respiratory depression and for use in very early age group pediatric patients was not observed in reported cases.3 In this case; we aimed to present successful sedation by dexmedetomidine to infant patient who is 65 days aged, diagnosed KFS, limited neck motions and known difficult airway. Infant patient, who is 65 days aged, 4 kg weight, 81 cm height and diagnosed KFS, was scheduled for a neck MRI. On evaluation of patient; short neck, low posterior hairline, thorax deformity and floating finger was found. The mouth opening of patient was normal but the extension of neck was particularly restricted. Systemic examination revealed no other abnormalities. The chest X-ray showed hypoplastic ribs. In medical history of patient; there was

General anesthesia management in carotid endarterectomy surgery: a single center experience

Carotid endarterectomy (CEA) is an effective surgery which is applied in order to reduce the risk of stroke associated with severe stenosis of the carotid artery. Anesthesia management is important in these patients due to high incidence of cardiovascular disease and studies are in progress for ideal anesthesia management. In this study, we aimed to share our experience in carotis endarterectomy and evaluate the clinical outcomes and review retrospectively. Patients informations were obtained from the patients and anesthesia records. Age, ASA physical status, Mallampati score (MP), anesthesia and surgery duration, ICU and discharge time, blood transfusion rate, anesthetic and analgesic drugs, invasive procedures, complications, smoking, stenosis side and ratio, comorbid conditions of patients and drugs were recorded. The mean age of patients was 67.19±1.07 (33-98). It was evaluated that 44 patients (61.2%) were ASA II, 28 patients (38.8%) were ASA III. It was recorded that mean duration of anesthesia was 226.25 ± 37.99 min, duration of surgery was 195.83±38 min, ICU stay was 2.45 ± 2.52 days and hospital stay time was 5.23 ± 2.77 days. 29 of patients (40.3%) were smokers and 7 of patients (9.7%) were identified as secondary smokers. The mortality rate was 6.9% (5 patients). Clinical experience and outcome data from our study are consistent with the literature. In CEA surgery, anesthetic technique that is safe enough to guide the evidence is not there yet. Experience of the anesthesiologist and the surgeon as surgical anesthetic management of CEA is an important point to be noted that the current developments in the patients characteristics and monitoring.