Taner Çiftçi

The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in rats.

AIMnTo investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury.nnnMETHODSnForty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 μg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups.nnnRESULTSnAccording to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs.nnnCONCLUSIONnThis study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver.

Zinc Phosphide Poisoning

Zinc phosphide has been used widely as a rodenticide. Upon ingestion, it gets converted to phosphine gas in the body, which is subsequently absorbed into the bloodstream through the stomach and the intestines and gets captured by the liver and the lungs. Phosphine gas produces various metabolic and nonmetabolic toxic effects. Clinical symptoms are circulatory collapse, hypotension, shock symptoms, myocarditis, pericarditis, acute pulmonary edema, and congestive heart failure. In this case presentation, we aim to present the intensive care process and treatment resistance of a patient who ingested zinc phosphide for suicide purposes.

Inhalation Anesthesia with Sevoflurane during Intravitreal Bevacizumab Injection in Infants with Retinopathy of Prematurity

Bacground. To investigate the anesthetic management in premature infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) injections. Methods. A retrospective chart review was performed for the patients with ROP who had IVB injection. Clinical characteristics, demographic variables, anesthetic medications, operation techniques, time intervals, and complications were recorded. Results. Sixty-six eyes of 33u2009patients (23u2009males, 10u2009females) with type 1 ROP who were treated with IVB were included. A total of 66 anesthetic applications were performed. Mean gestational age at birth was 28.3u2009weeks (range 25–33). Mean birth weight was 1300u2009g (range 600–1850). Serious ocular and systemic complications were not observed in any infant. Conclusion. Inhalation anesthesia with sevoflurane during IVB treatment in premature infants with ROP may be appropriate for anesthetic management.

A minimally painful, comfortable, and safe technique for hemodialysis catheter placement in children: Superficial cervical plexus block

The superficial cervical plexus block (SCPB) is utilized in pediatric patients to perform certain surgical procedures, but there is no evidence supporting its use in hemodialysis catheter placement. We evaluated the analgesic effectiveness, intraoperative complications, and patient satisfaction associated with SCPB for pediatric patients in renal failure undergoing emergent dialysis catheterization. A total of 52 patients ranging from 1 to 17 years old that required emergent dialysis catheter placement and received SCPB were included in this study. During the catheterization, intraoperative pain scores, requirement for additional analgesia, catheterization access site, and intraoperative complications were recorded. The Childrens Hospital of Eastern Ontario Pain Scale (mCHEOPS) was used to determine pain ratings during skin puncture with the needle, skin dilatation, and securing the catheter with stitches. The patients had an average age of 8.46u2009±u20095.3 years. The preferred catheterization entry site was through right internal jugular vein, which was achieved in 80.7% of patients. However, 19.3% of patients required access through the right subclavian vein. The average mCHEOPS score during skin puncture was 1.4u2009±u20090.5, and the mean mCHEOPS score was 2.3u2009±u20090.6 for skin dilatation. Finally, the average mCHEOPS score while securing the catheter with stitches was 1.3u2009±u20090.4. No patient required fentanyl for additional analgesia. No intraoperative complications occurred. The benefits gained from using SCPB performed by an experienced anesthesiologist for hemodialysis catheter placement include providing sufficient analgesia and optimal surgical conditions while avoiding the complications associated with general anesthesia for pediatric patients with renal failure.

Use of the gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography cases under sedation/analgesia.

BACKGROUND/AIMSnIn this study, we aimed to analyze the effects of Gastro-Laryngeal Tube (GLT) use on intraoperative and postoperative hemodynamic parameters, comfort of the procedure, and patients satisfaction in endoscopic retrograde cholangiopancreatography (ERCP).nnnMATERIALS AND METHODSnA total of 80 patients between the ages of 20 and 75 years who were scheduled for elective ERCP were enrolled. The patients were randomly assigned to two groups: groups N and G. Those in group N underwent the procedure with sedation without any airway instruments and those in group G underwent procedure after sedation and airway management with GLT. Intraoperative and postoperative vital signs as well as the satisfaction of the patients were recorded.nnnRESULTSnThe duration to esophageal visualization was found to be significantly higher in group N (16 s) than in group G (7 s) (p=0.001). The mean Visual Analogue Scale for Pain (VAS) was significantly higher in group G (1.85) than in group N (0.45) (p=0.016). Group G had higher endoscopist satisfaction scores than group N. The incidence of desaturation during ERCP was significantly higher in group N (60%) than in group G (0%) (p=0.000).nnnCONCLUSIONnIn conclusion, ERCP should be performed under optimal conditions to avoid the occurrence of unwanted complications, such as aspiration-related disorders. Therefore, according to the structural properties of GLT, sedation anesthesia application with GLT in ERCP will be safer, more comfortable, and more effective.

Yanık sonrası boyun kontraktürlü çocuk hastada i-gel kullanarak hava yolu yönetimi

I-gel is a supraglottic airway device that has been used for emergency airway management. In this report, we present a case in which airway management is facilitated using I-gel. Scar revision was planned in a 12-year-old male patient with limited ability to extend the neck and restricted oral opening because of post-burn contracture. The patient was ventilated successfully achieved using the supraglottic I-gel method. This new airway device may appropriate in cases with asymmetric airways in which airway management is difficult. J Clin Exp Invest 2014; 5 (2): 301-303

Comparing spinal blockade effectiveness and maternal hemodynamics using 25 gauge and 29 gauge spinal needles with the same volumetric flow rate in patients undergoing caesarean section

Abstract Spinal needles with different diameters can be used to prevent side effects in patients undergoing spinal anaesthesia. However, the velocity of local anaesthetic changes through the spinal needle depending on the diameter of it. Local anaesthetic injection velocity has been reported to be associated with the spinal block level. We aimed to compare spinal needles of different diameters with the same local anaesthetic volumetric flow rate in terms of spinal blockade and hemodynamics in obstetric patients. Eighty-four patients received spinal anaesthesia by either a 25G needle or 29G with the same volumetric flow rate. Block levels, adverse effects, ephedrine given and a success rate of spinal anaesthesia were significantly higher in 25G than in 29G (pu2009<u2009.05). Athough the use of 29G was associated with a low level of block, a sufficient block level was generated for caesarean section. Furthermore, in spite of the technical difficulty, use of 29G was accompanied by a decreased incidence of maternal hypotension, bradycardia and a lowered ephedrine administration. Impact statement Local spinal anaesthetic injections at faster flows cause turbulent flow leading to lower anaesthesia concentrations. The control of spinal anaesthesia levels has some difficulties due to anatomical repositioning, especially in pregnant patients. Also, it can cause frequent hemodynamic complications including hypotension and bradycardia, complications that may also have inadvertent effects on foetus. In this study, we showed that smaller diameter spinal needles provided safer spinal anaesthesia levels and a lower incidence of hemodynamic complications.

The Levels and Duration of Sensory and Motor Blockades of Spinal Anesthesia in Obese Patients That Underwent Urological Operations in the Lithotomy Position

Obesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TUR-P) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI < 25u2009kg/m2, Group N) or obese (BMI ≥ 30u2009kg/m2, Group O) group. SB assessments were recorded afterthe LP. SB at 6 and 120u2009min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120u2009min SB levels were significantly higher for Group O (P < 0.05). Blood pressure (BP) after the LP was significantly higher for Group N (P < 0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients.

Patient specific or routine preoperative workup in septoplasty: which one is cost-effective?

This study aimed at determining the limits of preoperative investigation and calculate estimated cost analysis in septoplasty with and without turbinate surgery. A retrospective chart review. The study was conducted at secondary referral center. A retrospective chart review of patients who have undergone septoplasty over a 1-year period was performed. The need for routine (battery testing) versus patient specific preoperative workup of 380 septoplasty patients was evaluated. Mean age of the patients was 31.5xa0±xa04.6. The patients were classified into three groups according to preoperative routine laboratory testing results: (1) normal group (2) abnormal group and (3) abnormal out of action limit group. Medical records were revaluated by an anesthesiologist and ear nose throat doctor according to preoperative American Society of Anesthesiologists guidelines to calculate estimated possible costs in case of patient specific preoperative workup. Three hundred seventy-seven patients were within ASA 1 group and three patients were within ASA 2. According to preoperative battery testing results, 5.8xa0% of the patients (nxa0=xa022) were in group 1, 93.4xa0% (nxa0=xa0355) were in group 2, 0.8xa0% (nxa0=xa03) were in group 3. Surgery was postponed due to concomitant pathologies for about 44xa0days (10–180xa0days) in four patients (1.1xa0%). Preoperative routine laboratory testing costs were calculated as

Kifoskolyotik bir hastada akut apandisit operasyonu için genel anestezi uygulaması

41.08xa0±xa06.69 (40.25–128.78) per patient. When medical records were reevaluated retrospectively, estimated cost per patient would be