Handan Güleç

Hemodiafiltration: A novel approach for treating severe amitriptyline intoxication

Tricyclic antidepressant overdose is one of the most common cause of serious drug poisonings. Sometimes amitriptyline intoxication can be difficult to treat with standard treatments. At that case hemodiafiltration (HD) can be an eligible choice. We report a successful treatment of severe case using hemodiafiltration in addition to the supportive measures. Management with gastric lavage, activated charcoal, alkalinization and supportive care is the common approach and not enough for patients in deep coma. We satisfied that HD may have a beneficial role in lethal doses of amitriptyline as an additional therapy.

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.

Folliculitis following greater occipital nerve block.

Among headache syndromes cervicogenic headache is a common problem which originates from region of the neck. When wide range of pharmacological treatment options are inadequate, interventional procedures are applied.[1] After trigger point injections, greater occipital nerve block (GONB) which is the most frequently applied technique among interventional methods has an important role in the treatment of cervicogenic headaches.[2] Although the possibility of complication after GONB is very low, some side effects e.g. bleeding, infection, and allergic reactions can be seen after the application. [3] Folliculitis is a skin condition which occurs with inflammation of the hair follicles.[4] No report was obtained about association of GONB and folliculitis after an extensive database search. We report a case of folliculitis as a rare complication of GONB.

Sedação com cetamina‐propofol em circuncisão

BACKGROUND AND OBJECTIVE to compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation. METHODS 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II. RESULTS in the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p>0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p<0.050). CONCLUSION propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

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

.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.

Tiroidektomi Operasyonlarında Menstruel Siklusla Postoperatif Bulantı-Kusma İlişkisi

Amac: Tiroidektomi operasyonlarindan sonra yaklasik %63-84 oraninda bulanti-kusmaya rastlanir. Kadinlarda, bulanti-kusma insidansi erkeklerden 2-3 kat fazladir. Yontemler: On sekiz kirk dokuz yas arasi 150 kadin hasta calisma kapsamina alindi. Hastalarin son menstruel periyodunun ilk gunu 1. gun sayilarak operasyona alindigi gune gore hastanin periyodu hesaplandiktan sonra, periyodunun 1-8. gunleri arasinda olan 50 hasta follikuler donem (Grup F), 9-16. gunler arasindaki 50 hasta ovulatuar donem (Grup O), 17.gun ile menstruasyon arasindaki 50 hasta luteal donem (Grup L), olarak gruplandirildi. Tum gruplara ayni standartta genel anestezi uygulandi. Ekstubasyon aninda ve ekstubasyonun ardindan 5, 15, 30. dakikalarda, 1.,3.,6. ve 24.saatlerde Aldrete derlenme ve Abromowitz emezis skorlari calisma gruplarindan haberdar olmayan anestezi asistani tarafindan not edildi. Bulgular: Her grupta toplam 50 hasta olacak sekilde toplam 150 hasta calisma kapsamina alinmistir. Calisma gruplari yas, cinsiyet, VKI gibi hasta ozellikleri acisindan benzerdiler.Abramowitz Emezis skorlamasina gore bulanti-kusma ciddiyeti degerlendirildiginde, toplam kusma atagi gozlenen hasta sayisi Grup M’de (n=47, %97) Grup O (n=33, %66) ve Grup L’ye (n=22, %44) gore daha fazla bulunmustur. Sonuc: Sonuc olarak, tiroidektomi operasyonu geciren fertil cagdaki kadinlarda menstrual siklusun follikuler doneminde daha fazla bulanti ile kusma atagi gozlendi.