Tülay Özkan Seyhan

Writing references and using citation management software

The correct citation of references is obligatory to gain scientific credibility, to honor the original ideas of previous authors and to avoid plagiarism. Currently, researchers can easily find, cite and store references using citation management software. In this review, two popular citation management software programs (EndNote and Mendeley) are summarized.

Analysis of brain connectivity changes after propofol injection by generalized partial directed coherence

In this paper we present a method for the analysis of multichannel EEG by using Generalized Partial Directed Coherence (gPDC) to extract cortical connectivity changes under anesthesia. 15 channel EEG data were recorded from female subjects undergoing general anesthesia for gynecological surgery. Multivariate Autoregressive (MAR) modeling was applied to multichannel, bipolar EEG segments of awake and anesthetized states. gPDCs were calculated using the derived MAR model and averaged through EEG @a frequency band (8-14 Hz) and through a number of data segments. The gPDC calculation was performed for three different sets of bipolar EEG channel pairs each of which mainly represent a specific scalp area. To derive consistency levels of gPDC values, surrogate analysis is also performed. Using paired t-test for 12 patients, we extracted significant gPDC changes between awake and anesthetized stages for each set. Analysis revealed that during transition from awake to anesthetized stage, gPDCs of central to parietal directions were suppressed whereas gPDCs of parietal to central directions were increased. The results indicate that the proposed gPDC analysis method can be used to track the changes in brain connectivity and hence to estimate the depth of anesthesia.

Magnesium therapy in pre-eclampsia prolongs analgesia following spinal anaesthesia with fentanyl and bupivacaine: An observational study.

BACKGROUND Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV) magnesium sulphate (MgSO4) therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. AIMS The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. STUDY DESIGN Case-control Study. METHODS Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C) and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg). Following blood and cerebrospinal fluid (CSF) sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 μg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. RESULTS Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015). Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p<0.001; with a mean difference of 108.6 min and 95% CI between 81.6 and 135.7). Side effects were similar in both groups. Group C required significantly more fluids. CONCLUSION Treatment with IV MgSO4 in severe pre-eclamptic parturients significantly prolonged the time to first analgesic request compared to healthy preterm parturients, which might be attributed to the opioid potentiation of magnesium.

Topographic and temporal spectral analysis of EEG signals during anaesthesia

In this study, we present the spatial and temporal evolution of EEG signal spectrum under anaesthesia. Studied features include SEF-90, α-β power ratios, spectral entropy that are known to be used in commercially available depth of anaesthesia monitors. As an additional and comparing feature, we also present Higuchi fractal dimension that is used for analysis of non-linear systems. By means of spatial analysis, we verified the shift of occipitally dominant alpha activity to frontal regions and demonstrated corresponding topographic plots.

Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report

OBJECTIVE The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. METHODS Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway pressure of >25 cm H2O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. RESULTS The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. CONCLUSION Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size.

Can the Endotracheal Tube Become a Threat to Airway Patency

Address for Correspondence/Yazisma Adresi: Dr. Tulay Ozkan Seyhan, Istanbul Universitesi Istanbul Tip Fakultesi Anesteziyoloji ve Reanimasyon Anabilim Dali, 34093 Capa, Istanbul, Turkiye E-mail: tulay2000@gmail.com ©Telif Hakki 2015 Turk Anesteziyoloji ve Reanimasyon Dernegi Makale metnine www.jtaics.org web sayfasindan ulasilabilir. ©Copyright 2015 by Turkish Anaesthesiology and Intensive Care Society Available online at www.jtaics.org Received / Gelis Tarihi : 26.01.2015 Accepted / Kabul Tarihi : 04.05.2015 440 Dear Editor,

Combined Spinal Epidural Anaesthesia for Caesarean Section and Hysterectomy in a Parturient with Placenta Accreta

Placenta accreta complicates the anaesthetic and surgical approach in caesarean section. In this report, a parturient with placenta accreta and multiple drug allergies who was managed using combined spinal epidural anaesthesia for caesarean hysterectomy is discussed.

E-Learning Materials are not yet Subject to Peer Review.

Dear Editor, We have read the review entitled “Anaesthesiology and e-learning” (1), which has been published in your journal, with great interest. Education materials in electronic media are distributed in a wide spectrum ranging from texts to interactive education. Types of e-learning such as simulation, e-class, and e-conference allow interaction and active involvement. Positive aspect of web-based education for the trainer includes easy implementation of changes or updates in electronic media, whereas the negative aspect includes necessity of long preparation period and technological support (2). Positive aspect for the learner includes the fact that it promotes education and provides opportunity for the learner to realize and fill the gaps. The most important issue is the assessment of appropriateness of e-learning material before use by means of peer reviewing in three categories (scientific content, eligibility for teaching/learning, ease of use), which are the minimum standards (3, 4). In Turkey, professional organizations are recently interested in e-learning for continuing medical education. Continuing Medical Education-Continuing Professional Development Accreditation-Credit Designation Council of the Turkish Medical Association is currently working on the accreditation of e-learning. However, besides this, there is yet no peer review in Turkey, similar to that implemented for medical papers, in accordance with the standards recommended for e-learning. This brings the value of e-learning into disrepute. We are utilizing e-learning in our anaesthesiology residency training program for six years (5). For this purpose, we use Moodle (modular object-oriented dynamic learning environment) software among open-source code softwares because of availability of its Turkish translation (6). This software allows creation of not only lesson modules, calendar, dictionary, and case archive, but also many sections such as questionnaire, discussion platform, homework, and tests, which the users can share ideas, ask questions, and assess their knowledge and are supported with visual materials. It also enables detailed inventory and statistical analysis of duration of benefiting from lessons, homework, and tests in order to provide feedback for trainers and allows archiving. The system has been structured in the way that our students could benefit throughout their residency and is open only to the registered users excluding a sample section (laparoscopic surgery). Since the education material has not been peer reviewed, it is not open for general use. We believe that filling the gap in this area in the shortest time under the leadership of Turkish Society of Anaesthesiology and Reanimation would enhance Turkish e-learning sources and make substantial contribution to education.

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul This study aimed to investigate cardiopulmonary resuscitations (CPR) performed within the last year at Istanbul Medical Faculty and to determine success rates, to evaluate the factors affecting success rates and to compare outcomes to those previously performed.