Eyüp Horasanlı

Effect of Uterine Fundal Pressure on Maternal Intraocular Pressure in Cesarean Delivery: Comparison of Regional and General Anesthesia

Purpose: To evaluate the intraocular pressure (IOP) changes accompanying fundal pressure during a cesarean-section procedure under both regional and general anesthesia. Methods: In total, 60 women scheduled for elective cesarean section, none of them diagnosed with ocular problems, were enrolled in the study. Patients underwent cesarean section under either general (group G, n=30) or regional anesthesia (group S, n=30) according to their choice. IOP was measured with a Tono-Pen before (T1) and after (T2) application of anesthesia, during fundal pressure (T3), and after the birth of the baby (T4). Heart rate as well as systolic, diastolic, and mean arterial pressure were recorded during the procedure. Results: There was no significant difference in IOP between the groups (P>0.05). In group S, IOP at T3 was significantly higher than at all other timepoints (P<0.001). In group G, IOP at T3 was significantly higher than at T2 and T4. Mean arterial pressure was significantly lower in group S at all timepoints except T1. Conclusions: In conclusion, fundal pressure may significantly increase the IOP, but the choice of anesthetic technique may not have any effect on IOP.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy: From the View of an Anesthesiologist

PURPOSE To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. PATIENTS AND METHODS Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO2) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. RESULTS SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). CONCLUSION Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery

BACKGROUND the aim of this study was to investigate the effects of spinal anesthesia using two different doses of fentanyl combined with low-dose levobupivacaine in anorectal surgery. METHODS in this prospective, double-blind study, 52 American Society of Anaesthesiologists I-II patients scheduled for elective anorectal surgery were randomized into two groups. The patients in group I received intrathecal 2.5mg hyperbaric levobupivacaine plus 12.5 μg fentanyl and in group II received intrathecal 2.5mg hyperbaric levobupivacaine plus 25 μg fentanyl. All the patients remained in the seated position for 5 min after completion of the spinal anesthesia. Sensory block was evaluated with pin-prick test and motor block was evaluated with a modified Bromage scale. RESULTS motor block was not observed in both of the groups. The sensory block was limited to the S2 level in group I, and S1 level in group II. None of the patients required additional analgesics during the operation. Time to two-segment regression was shorter in group I compared with group II (p<0.01). One patient in group I and 5 patients in group II had pruritus. Hemodynamic parameters were stable during the operation in both of the groups. CONCLUSION spinal saddle block using hyperbaric levobupivacaine with both 12.5 μg and 25 μg fentanyl provided good quality of anesthesia without motor block for anorectal surgery in the prone position.

A Prospective, Randomized Evaluation of the Effects of Unilateral Epidural Anesthesiaand Different Baricities of Bupivacaine

A Prospective, Randomized Evaluation of the Effects of Unilateral Epidural Anesthesia and Different Baricities of Bupivacaine In this study, it was aimed to assess the efficacy of intentional ipsilateral epidural catheterization for unilateral epidural anesthesia with different baricities of bupivacaine.

Hypothermia Frequency of Patients in the Postoperative Period

In this study, we aimed to investigate the frequency of postoperative hypothermia in our hospital.In Kecioren Training and Research Hospital, 165 ASA I-III patients between the ages of 18 and 81, whose operation times were longer than 30 minutes were included in this study. In addition to recording the demographic data of the patients, the body temperatures were also measured twice in the preoperative preparation room, and in the postoperative care unit in the forehead with infrared thermometers. The operation types, the durations, the anesthesia types, and the patients’ heating status in the perioperative period were recorded. If the body temperature was 35oC or below, it was accepted as hypothermia; and if it was 34oC and below, it was accepted as deep hypothermia. We compared the data of normothermic, hypothermic and deep hypothermic patients. 79 women (47.9%) and 86 men (52.1%), totally 165 patients were included in this study. It was detected that 7 patients (4.2%) were heated preoperatively. It was determined that 16 patients (9.7%) were hypothermic in the postoperative period, and 3 of them were deep hypothermic. There were no statistically meaningful differences between the hypothermic and non-hypothermic patients in terms of age, gender, ASA, type of anesthesia, and operation time (p>0.05). Although postoperative hypothermia has not been found as a common problem in our operating theaters, we observed that most of the postoperative hypothermia cases were in percutaneous urological operations. In order to reduce the frequency of postoperative hypothermia, specific precautions for this type of operations should be taken.

İntraoperatif Malign Hipertansiyon ile ortaya çıkan feokromasitoma olgusunda anestezi yönetimi

Feokromositoma nadir gorulen katekolamin ureten hipertansiyon, tasikardi, terleme, carpinti, bas agrisi ve anksiyete ataklarina neden olan noroendokrin bir tumordur. Genellikle anestezi induksiyonu ve cerrahi manuplasyonlar sirasinda katekolaminlerin kontrolsuz yuksek miktarda salinimi olmakta ve kardiyovaskuler instabilite gorulmektedir. Ozellikle bu durum tumor rezeksiyonu sirasinda artmaktadir (1). Bu hastalarda yogun bir preoperatif hazirlik ve yakin takip gerektiren intraoperatif ve postoperatif bakim hayati onem tasimaktadir (2). Onceden tanisi olmayan bu tur hastalarla surrenal cerrahi disindaki cerrahilerde de karsilasmak mumkundur. Intraoperatif malign hipertan¬siyon feokromasitomayi akillara getirmeli ve postoperatif gerekli tetkik¬ler yapilmalidir. Biz de bu olgumuzda ortopedik cerrahi sirasinda intra- operatif malign hipertansiyon ataklari olan ve postoperatif donemde feokromasitoma tanisi alan bir olgumuzu paylasmayi amacladik

Comparison of Two Different Doses of Fentanyl Combined With Levobupivacaine For Elective Cesarean Section

Objectives: In this prospective, randomized, double-blind, controlled study, we compared the effects of two different doses of fentanyl (10 μg or 25 μg) given intrathecally in addition to 0.5% levobupivacaine for cesarean section. Methods: Eight hundred, ASA I-II parturients, who were scheduled for elective cesarean section, were enrolled in the study. They were randomly allocated into three groups. Group I received 0.5% levobupivacaine; Group II received 0.5% levobupivacaine plus 15 μg fentanyl; Group III received 0.5% levobupivacaine plus 25 μg fentanyl intrathecally. Ephedrine was administered as a bolus dose (0.1 mg/kg), and then the continuous infusion was initiated. The rate of infusion was maintained with respect to baseline systolic blood pressure until umbilical cord clamping. We recorded maternal sistolic blood pressure, heart rate, total ephedrine dose, fetal Apgar scores (at 1st and 5th min), and umbilical cord blood parameters. Other side effects, such as hypotension, nausea/vomiting, bradycardia, etc. were also noted. Results: Bolus, infusion and total ephedrine doses were significantly lower in Group III when compared with the other groups (P<0.05). The incidences of hypotension in the I, II, and III groups were 17.30%, 13.38%, and 11.63%, respectively. There was no significant difference between the three groups regarding the Apgar scores at the 1st or 5th min, umbilical arterial or venous pH. There was no difference in the incidence of other side effects among the three groups. Conclusion: We conclude that the addition of 25 μg fentanyl to adjusting the dose of levobupivacaine to a patients height decreases the ephedrine requirement without additional side effects and adverse neonatal outcomes when compared with the other groups. The levobupivacaine doses as determined by the length of the patients’ and the use of the appropriate fluid resuscitation therapy with an infusion of ephedrine can be used effective methods.

.Which Guidance Method during Tracheotomy Procedure in Patients with Short Neck in the ICU:A Prospective Randomized Study

Purpose: Utilization of fiber optic video bronchoscope (F) alone vs. in combination with ultrasound (U + F) during tracheotomy procedures for patients with remarkable short necks. Materials and methods: Nineteen patients with short neck who required tracheotomy were enrolled to study. Tracheotomies were performed with Grigg’s technique. There was 9 patient in U + F group and 10 in F group. We gathered ICU admission diagnosis, demographic variables, guidance method (U + F or F), thyromental, sternomental and cricosternal distances, neck circumference, neck extension range, procedure duration and complications. Results: Mean thyromental distance, sternomental distance, neck extension range and neck circumference was similar between groups. There was no major complication in both groups. Minor bleeding occurred in 1 patient in-group U + F and 2 in group F. One of the patients in U + F group had an aberrant enlarged venous anomaly over tracheal rings and he underwent surgical tracheotomy, therefore he was excluded from this study. Duration of the procedures was 7, 4 min and 7 min in U + F and F group respectively. Conclusion: Using ultrasound and fiber optic bronchoscope together enhance the safety of the tracheotomy procedure and should be considered in patients with short necks who display limited extension.

A 5-Year Evaluation of Invasive Device-Associated Infections Rates in Intensive Care Unit of a Training Hospital in Turkey -

Objective: This study aimed to determine invasive instrument-related infections in the general intensive care unit by comparative evaluation of the annual infection control measures. Methods: A surveillance study was made based on the data of 1494 patients treated for 48 hours in the general intensive care unit (GICU) between January 2008 and December 2012. Results: The hospital infection (HI) rates of the GICU for each year of the study period were calculated as 29.15%, 28.85%, 16.62%, 18.05% and 8.30% respectively. For each 1000 patient days, the infection rates for each year were calculated as ventilator-related pneumonia (VRP) 2.31, 4.32, 2.77, 11.49 9.62, central venous catheter-related bloodstream infections (CVCRBI) 1.57, 2.23, 8.58, 0.56, 1.03, and catheter-related urinary system infections (CRUSI) 6.00, 7.09, 4.35, 4.57, 3.17. When the infection agents were isolated and evaluated, the infection rates were determined as 61.92% Gr(-) bacteria infections, 20.89% fungal infections and 17.16% Gr(+) bacteria infections. Conclusions: Although the infection control precautions which were taken improved urinary and central catheter infection rates, no significant fall was obtained in rates of ventilator-related pneumonia. It can be concluded that it is necessary to increase the infection control precautions in this area to reduce infection rates.

Antipsikotik ve Antiparkinson İlaçlarla Oluşan Antikolinerjik Zehirlenme

Anticholinergic poisoning with antipsychotic and antiparkinson drugs: case report. Tricyclic antidepressants, antipsychotics, antiparkinsonian and antihistamines are the drugs capable of producing anticholinergic toxicity. Anticholinergic poisoning causes tachycardia, hypertension, hyperthermia, mydriasis and altered mental status. Also life threatening complications such as ventricular arrythmias, rhabdomyolysis and seizures can occur. It can be difficult to distinquish from the sympathomimetic syndrome. Paliperidone or 9 hydroxy risperidone, is one of the newest atypical antipsychotics on the market and acts as a serotonin and dopamine antagonist. Biperidene is an anticholinergic drug and it is used to improve extrapyramidal side effects induced by neuroleptic agents. After an overdose it causes toxic effects of rapid onset to several organ systems. In this case report, we aimed to present anticholinergic toxicity resulting from the overdose ingestion of biperidene and paliperidone and physostigmine therapy in a patient with schizophrenia.