Mustafa Cengiz

The effect of music on preoperative sedation and the bispectral index.

We assessed the effect of music on the level of sedation and the electroencephalograph bispectral index (BIS) during the preoperative period. Fifty-four ASA physical status I–II patients, scheduled for elective septo-rhinoplastic surgery, were included in the study. Subjects were assigned to receive either music (music group; n = 28) or no music (control group; n = 26) during the preoperative period. Sedative premedication was provided with midazolam 0.08 mg/kg IM. Observer’s Assessment of Alertness/Sedation Scales (OAAS) scores and BIS values were recorded at specific time intervals. In the control group, there were more patients with an OAAS score of 1 than in the music group at 30 min after midazolam injection. In addition, there were more patients with an OAAS score of 2 in the control group than in the music group at 30–50 min. However, there were significantly more patients with an OAAS score of 3 in the music group than in the control group at 20–50 min. BIS values of the music group were also smaller than the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10–50 min in the music group, whereas BIS values decreased at 30–50 min in the control group. In conclusion, listening to music during midazolam premedication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

BackgroundCentral line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.MethodsWe conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.ResultsDuring baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.ConclusionsThe implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

Oxidative status and DNA damage in operating room personnel.

OBJECTIVES The aim of this study was to investigate the effects of occupational exposure to anesthetic gases on peripheral mononuclear leukocyte DNA damage and oxidative status in operating room personnel. DESIGN AND METHODS The population of study includes 30 operating room personnel (Group I) and 30 non-operating room personnel for control groups (Group II). DNA damage was assessed by alkaline comet assay in peripheral lymphocyte. Plasma levels of total antioxidant status (TAS), total oxidative status (TOS) were determined by using a novel automated measurement method and oxidative stress index (OSI) was calculated (OSI was calculated as: OSI=(TOS/TAS)x100). RESULTS Mononuclear leukocyte DNA damage, plasma TOS and OSI were significantly higher in Group I than Group II [p<0.01, p<0.05, p<0.05 respectively]. There was also significantly decrease in plasma TAS in Group I than Group II [p<0.05]. There were positive significant correlations between DNA damage and TOS and OSI in Group I [r=0.84, p<0.001, r=0.89, p<0.001 respectively]. CONCLUSIONS Our findings demonstrate that, mononuclear leukocyte DNA damage was significantly higher in operating room personnel. The increase of DNA damage might depend on oxidative effects of anesthetics.

Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging

Background:  The purpose of this study was to compare the safety and efficacy of oral midazolam and midazolam–diphenhydramine combination to sedate children undergoing magnetic resonance imaging (MRI).

Remifentanil vs alfentanil in the total intravenous anaesthesia for paediatric abdominal surgery

Summary Backgrounds: Our aim was to investigate whether total intravenous anaesthesia (TIVA) with remifentanil and alfentanil would ensure appropriate analgesia and recovery conditions in anaesthesia for children undergoing abdominal surgery.

Evaluation of total oxidative and antioxidative status in pediatric patients undergoing laparoscopic surgery

OBJECTIVE Reactive oxygen species (ROS) induced by several diseases can trigger oxidative stress. During laparoscopy, increased intraabdominal pressure caused by pneumoperitoneum may lead to splanchnic ischemia followed by reperfusion because of deflation. Because ischemia reperfusion creates oxidative stress, in this study, we aimed to investigate the oxidative-antioxidative status of the pediatric patients with laparoscopic surgery. METHODS The children underwent laparoscopic procedures under general anesthesia, and they were mechanically ventilated. Blood samples were obtained after induction of anesthesia, at the end of the surgery, and were centrifuged at 3000 revolutions per minute for 10 minutes to separate plasma. The plasma total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined. RESULTS Plasma TOS and OSI levels were significantly higher at the end of the surgery than after induction of anesthesia (P < .05 and P < .01, respectively). On the other hand, plasma TAS levels were lower in the end of the surgery than after induction of anesthesia (P < .05). CONCLUSIONS These results suggest that ROS are generated during the laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum, which causes oxidative stress and consume plasma antioxidants.

Effect of ephedrine on the onset time of succinylcholine

Background:  The aim of this study was to evaluate the effect of ephedrine administered prior to induction of anaesthesia on the onset time of succinylcholine for endotracheal intubation.

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach, over 8 years, in 11 cities of Turkey

Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6–93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79–0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73–0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54–0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

A Magnificent Circumcision Carnival in the Early 18th Century Ottoman Period

Circumcision has always been regarded as both an important social event and a milestone of a young man’s life in Turkish culture, especially in the Ottoman period. Herein we study an exceptional circumcision festivity which lasted 15 days in the early autumn of the year 1720, for the 4 princes of Sultan III Ahmed, some sons of two high-ranking Ottoman officials and thousands of male children of poor citizens of Istanbul as representing the beneficent of the Sultan. All the organizations of the Empire participated in this huge event, including many shows and a feast, and the preparations were initiated months before. Traditionally, this kind of important social event of Ottoman culture had been described in a literary manner, and Surname-i Vehbi was the special name for the book of this circumcision festivity with 137 colored paintings and a total of 175 pages. The original of this work, which is in the library of Topkapi Palace Museum in Istanbul, was written by Vehbi and illustrated by Levni. The importance of this antique book is that it is the last important example of the illustrated festivity books of Ottoman literature.

A dose–response study of intravenous regional analgesia with lidocaine in rabbits

Abstract The objective of this study was to compare the analgesic and side effects of three different doses of lidocaine for intravenous regional analgesia (IVRA). Thirty-six New Zealand white rabbits were used for the study. Rabbits were randomly divided into three groups. Group I received 0.5% lidocaine (3 mg/kg), Group II received 1% lidocaine (6 mg/kg), Group III received 1.5% lidocaine (9 mg/kg). Onset time of analgesia in Group III was significantly shorter than in Groups I and II. The durations of motor blockade and analgesia increased significantly in a dose dependent manner. In all the groups, there were statistical significance increases of sedation scores after tourniquet removal. Significant dose dependent reductions of heart and respiratory rates after tourniquet release were observed. In conclusion, 6 and 9 mg/kg lidocaine given intravenously produced a shorter onset time of IVRA, and a longer analgesia and motor blockade than 3 mg/kg without life threatening complications.