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Açık kalp cerrahisinde malnütrisyon oranları ve ilişkili risk faktörlerinin araştırılması
(Turkish Anaesthesiology and Intensive Care Society, 2014) Bayır, Hakan; Tekelioğlu, Ümit Yaşar; Koçoğlu, Hasan; Akkaya, Akcan; Demirhan, Abdullah; Bilgi, Murat; Erdem, Kemalettin; Dağlar, Bahadır; Yıldız, İsa
Objective: Rates of malnutrition in hospitalized patients may vary depending on the type of the hospital and patient population. Malnourished patients have higher mortality and morbidity rates, longer length of hospital stay (LOS) and much more drug use than patients without malnutrition. We aimed to investigate rates of malnutrition in hospitalized patients undergoing open heart surgery and the associated risk factors. Material and Methods: We studied 50 ASA II-III patients aged between 40-85 years undergoing elective open heart surgery. Patients whose NRS-2002 score ? 3 and/or, Body Mass Index (BMI) <18.5 kg/m2, and/or serum albumin level <3 g/dl were evaluated as malnourished. Preoperatively patients' demographic data, preoperatwe left ventricular ejection fraction (LVEF), pulmonary function test results (FVC, FEV1, FEV1/FVC), hemoglobin, hematocrit, lymphocyte count, albumin, CRP, and cholesterol values were recorded. LOS in intensive care unit and service, type of complications that occurred during hospitalization were recorded. Pulmonary function test results were also obtained on the day patients discharged. Results: Malnutrition rate was 20 % in patients with open-heart surgery. Patients at risk of malnutrition had longer postoperative intubated time, LOS in ICU and in service, higher rates of postoperative complications and louer preoperative and postoperative FEV1, FVC, and FEV1/FVC values than those without risk of malnutrition. But these findings were not statistically significant. In addition, LOS in the ICU and service were found to be relatively longer in overweight and obese patients. Conclusion: In summary, a high rate of malnutrition can be observed in patients with open-heart surgery. Malnutrition has negative postoperative effects in these patients.
Ameliyathane ve servis çalışanlarında hepatit B, hepatit C ve HIV seroprevlalansının karşılaştırılması
(2012) Tekelioğlu, Ümit Yaşar; Koçoğlu, Mücahide Esra; Akkaya, Akcan; Demirhan, Abdullah; Hakyemez, İsmail Necati; Taş, Tekin; Bayır, Hakan
Amaç: Ameliyathane ve servislerde çalışan hekimler, yardımcı sağlık personelleri (anestezi teknisyenleri ve hemşireler) ve temizlik personelleri sıklıkla kan ve vücut sıvıları ile temas edebilmektedir. Bu sıvılar ve kontamine aletler Hepatit B, Hepatit C veya HIV virüs enfeksiyonu bulaşmasına neden olabilecek önemli sebeplerdendir. Bu çalışmanın amacı Abant ‹zzet Baysal Üniversitesi Tıp Fakültesi Ameliyathane’sinde ve dahili servislerinde çalışan personelin Hepatit B virüsü (HBV), Hepatit C virüsü (HCV) ve Kazanılmış ‹mmün Yetmezlik virus (HIV) seroprevalansını ve immünizasyon durumunu saptamaktır. Ayrıca aşılanma ve alınabilecek tedbirlerin güncel literatür eşliğinde tartışılması hedeşenmiştir. Yöntem: Ameliyathane ve servis ortamında çalışmaya katılan toplam 122 kişinin bilgilendirilmiş onam formları alındıktan sonra, kan örnekleri toplandı. Katılımcılar sunulan anket formunu doldurarak, demografik bilgilerini, klinikte çalışma sürelerini, hepatit enfeksiyon hikâyesini ve immünizasyon durumlarını bildirdiler. Hepatit B yüzey antijeni, yüzey antikoru (anti-HBs), çekirdek antikoru (anti-HBc), anti-HCV ve anti-HIV durumu "enzyme linked immunosorbent assay" metodu kullanılarak araştırıldı. Verilerin istatistiksel incelemesinde "Ki- kare testi" ve "Ki- kare kökenli Phi-Cromer’s V, Contingency Coefficient, Goodman and Kruskal tau ve Uncertainly Coefficient testi" kullanıldı. p< 0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya 43 kadın %35,2 ve 79 erkek %64,8 toplam 122 gönüllü katıldı. Gönüllülerin 62’ si ameliyathane çalışanı, 60’ ı servis çalışanı idi. 30’ u doktor (%24,6), 60’ ı yardımcı sağlık personeli (hemşire ve anestezi teknisyeni) (%49,2) ve 32’ si yardımcı personel (%26,2) idi. 108 katılımcı (%88,5) 5 yıldan az, 12 katılımcı (%9.8) 10 yıldan az, 2 katılımcı da (%1,6) 10 yıldan fazla çalışmıştı. Servis ve ameliyathane çalışanlarında, hepatit belirteçlerinde istatistiksel açıdan fark olmadığı görüldü. Hepatit hikayesi olmayan ameliyathane çalışanlarından, 6’sında (%5), servis çalışanlarından ise 2’sinde (%1,6) anti-HBc’ nin (+) olduğu saptandı. Ameliyathane çalışanlarının 52’sinde (%42,6), servis çalışanlarının ise 50’sinde (%40,9) anti-HBs (+) bulundu. Katılımcıların tümünde anti-HCV ve anti-HIV negatifti. Sonuç: Bu çalışma rutin aralıklarla yapılan labaratuvar tetkiklerin ve hastane ortamında alınan standart önlem ve tedbirlerin, risk altında bulunan sağlık çalışanlarında önemini bir kez daha ortaya koymuştur.
Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia
(Makerere Univ, Fac Med, 2013) Demirhan, Abdullah; Tekelioğlu, Yaşar Ümit; Akkaya, Akcan; Özlü, Tülay; Yıldız, İsa; Bayır, Hakan; Koçoğlu, Hasan; Duran, Bülent
Background: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. Objective: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. Methods: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. Results: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups(p>0.05). Conclusion: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.
Atropa Belladonna (Güzel Avrat Otu) meyvesi ile ilişkili antikolinerjik toksik sendrom: Bir olgu sunumu
(2013) Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Yıldız, İsa; Korkmaz, Tanzer; Bilgi, Murat; Akkaya, Akcan; Koçakoğlu, Hasan
Atropa Belladonna (güzel avrat otu) ile gelişen zehirlenmeler antikolinerjik sendroma yol açabilmektedir. Bitkinin yüksek miktarda alınması letarji, koma ve hatta ölümle sonuçlanabilen ciddi klinik tabloya neden olabiir. Bu olgu sunumunda ülkemizde güzel avrat otu olarak bilinen bitkinin meyvesinin bol miktarda yenmesi sonucu gelişen ciddi antikolinerjik sendromu literatür eşliğinde paylaşmayı amaçladık.
Atropa bellodonna fruit (Deadly Nightshade) related anticholinergic toxic syndrome: A case report
(2013) Demirhan, Abdullah; Tekelio?lu, Ümit Yaşar; Yildiz, Isa; Korkmaz, Tanzer; Bilgi, Murat; Akkaya, Akcan; Koço?lu, Hasan
Atropa Belladonna related poisoning may lead to anticholinergic syndrome. Ingestion of high amounts of the plant may cause lethargy, coma, and even a serious clinical picture that could lead to death. In this case report, we aim to share a case of anticholinergic syndrome that developed after ingestion of the fruit called "Deadly Nightshade" in our country. © 2013 by Turkish Anaesthesiology and Intensive Care Society.
Awake fibre-optic intubation in a patient with cervico-occipital fixator
(2013) Akkaya, Akcan; Yildiz, Isa; Demirhan, Abdullah; Tekelio?lu, Ümit Yaşar; Koço?lu, Hasan
A 23-year-old male patient with cervico-occipital fixator was scheduled for surgery due to injuries to the right forearm. The patient's thyromental distance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. The loss of extension of the neck in particular indicated difficult intubation. Anaesthetic procedures are almost always difficult in patients with cervico-occipital fixators; the limited cervical extension complicates both intubation and ventilation. In this report, application of general anaesthesia using awake fibre-optic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedication, hypopharyngeal topical anaesthesia was applied with 10% lidocaine sprayed twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following completion of local anaesthesia, the patient, who was oxygenated with 5 L min-1 of 100% O2, was intubated using the awake FOB technique. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of cervico-occipital fixation, which causes severe limitation of neck movements, the use of awake fibre-optic intubation should be considered. © 2013 by Turkish Anaesthesiology and Intensive Care Societ.
Bilateral orofasiyal yarıklı bir infantın anestezi yönetimi (Tessier Tip 3): Olgu sunumu
(2014) Demirhan, Abdullah; Akkaya, Akcan; Tekelioğlu, Ümit Yaşar; Karabekmez, Furkan Erol; Bilgi, Murat; Yıldız, İsa; Koçoğlu, Hasan
Tessier yüz yarıkları çok nadir görülmekte olup konjenital olarak birçok anomaliyi de içinde barındırmaktadır. Özelikle Tessier tip 3 de bulunan oblik yüz yarığı, yarık dudak ve damak bu hastaların havayolu yönetimini oldukça güçleştirmektedir. Uygulanacak olan anestezisi için multidisipliner bir yaklaşım gerekmektedir. Bu olguda Tessier tip 3 yüz yarıklı bir hastanın anestezi uygulaması ve anestezi yönetimi tartışılmıştır.
A case of anesthesia mumps after general anesthesia
(Springer Tokyo, 2012) Tekelioğlu, Ümit Yaşar; Akkaya, Akcan; Apuhan, Tayfun; Demirhan, Abdullah; Bayır, Hakan; Koçoğlu, Hasan
The comparison of hepatitis B, hepatitis C and HIV seroprevalence in operating room and clinical staff
(2012) Tekelio?lu, Ümit Yaşar; Koço?lu, Esra; Akkaya, Akcan; Demirhan, Abdullah; Hakyemez, Ismail; Taş, Tekin; Bayir, Hakan
Objective: Physicians, allied health staff (anaesthesia technicians and nurses) and medical ward staff in operating rooms and in the clinics may often contact with blood or body fluids. These fluids and contaminated instruments are important causes of infection transmission including hepatitis B, hepatitis C or HIV. The objective of this study was to determine the immunization status and seroprevelance of Abant Izzet Baysal University Medical School Hospital operation room personnel and medical ward staff for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV). In addition to this, we aimed to discuss vaccination and measures that can be taken with the aid of current literature. Method: After obtaining informed consent from 122 operating room personnel and service staff, blood samples were collected. A self-assessment questionnaire was used to obtain the informations including demographic information, duration of clinical practice, previously diagnosed hepatitis infection and the immunization status. Serum samples were tested for hepatitis B surface antigen, surface antibody (anti-HBs), core antibody, anti-HCV, and anti-HIV using the enzyme linked immunosorbent assay method. For statistical analysis, Chi-square tests and Phi- Cramer's V, Contingency Coefficient, Goodman and Kruskal tau and Uncertainly Coefficient tests were used. P values <0.05 were considered statistically significant. Results: 43 women (35.2%) and 79 men (64.8%) participated in a total of 122 volunteers in this study. Sixty-two volunteers were operating room personnel and sixty participants were medical ward staff. A total of 30 (24.6%) physicians, 60 (49.2%) allied health staff (anaesthesia technicians and nurses) and 32 (26.2%) medical ward staff were included in the study. One hundred and eight participants have been working less than 5 years (88.5%), 12 participants have been working less than 10 years (9.8%) and 2 participants have been working more than 10 years (1.6%). Hepatitis markers of operating room personnel and medical ward staff were not statistically different. Eight of 120 participants without a history of hepatitis, had positive anti-HBc (6.6%). All were negative for anti-HCV and anti-HIV. Conclusion: This study shows once again that the importance of laboratory examinations made by routine intervals and standard precautions taken in the hospital for health care workers at risk.
Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy
(Univ Catholique Louvain-Ucl, 2015) Bilgi, Murat; Tekelioğlu, Ümit Yaşar; Şit, Mustafa; Demirhan, Abdullah; Akkaya, Akcan; Yıldız, İsa; Koçoğlu, Hasan
Background and study aims : In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption. Materials and methods : A totally 60 patients were enrolled in the study. Propofol group (Group 1) : A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index-value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 7075 was achieved. Results : In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed. Conclusion : The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.
A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension
(ARSMB-KVBMG, 2014) Kıracı, Gökhan; Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Akkaya, Akcan; Bilgi, Murat; Erdem, Alim; Bayır, Hakan; Koçoğlu, Hasan; Yıldız, İsa
Background: The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine.Methods: Patients with essential hypertension who were under ? 65 years old, scheduled for elective surgery with a Mallampati score of I-II were included in the study. Patients were randomly divided into three groups; group M (n=20) received magnesium sulfate, group L was prescribed lidocaine, and group C (control group) received saline. Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation.Results: There were no statistically significant differences between the groups in terms of age, sex and demographic characteristics. There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups. In group M, QTd values were significantly lower at the first and fifth minutes than before induction. There were no statistically significant differences in QTd values at different times in group L and group C.Conclusion: QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.
Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery : randomized clinical study
(Elsevier Science Inc, 2014) Akkaya, Akcan; Tekelioğlu, Ümit Yaşar; Demirhan, Abdullah; Bilgi, Murat; Yıldız, İsa; Apuhan, Tayfun; Koçoğlu, Hasan
Background and objectives: Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. Method: 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50 mg kg(-1) over 10 min and maintained at 15 mg kg(-1) h(-1); in Group D, dexmedetomidine was given at 1 mcg kg(-1) 10 min before induction and maintained at 0.6 mcg kg(-1) h(-1). Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. Results: Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. Conclusions: Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy
(Wiley, 2013) Tekelioğlu, Ümit Yaşar; Apuhan, Tayfun; Akkaya, Akcan; Demirhan, Abdullah; Yıldız, İsa; Şimşek, Tuğçe; Gök, Üzeyir; Koçoğlu, Hasan
Objectives/Aim The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients. Background Tonsillectomy surgery is frequently associated with postoperative pain, which usually requires substantial consumption of analgesics including opioids. Safe and effective post-tonsillectomy pain control is still a clinical dilemma, in spite of the use of various surgical and anesthetic techniques. Methods A total of 60 children, aged between 4 and 10years, scheduled for tonsillectomy, were randomly assigned to one of three groups. Study drugs were administered to both tonsillar fossae for 5min. In 5ml artificial saliva, Group K (n=20) received 0.4ml (20mg) ketamine and Group T (n=20) received 0.8ml tramadol HCl solution. Group C (n=20) received only 5ml saline as a control. Ramsay Sedation Scale and FACES PRS Score, nausea, vomiting, difficulty in swallowing, and sore throat were evaluated. Results There was no difference among the groups in terms of baseline characteristics, including age, sex, and ASA profile (0.05 for all). Systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen (SpO2) values were not significantly different among the groups in all time points (0.05 for all). There was a statistically significant difference among the groups according to Ramsay Sedation Scales in 40th minute (P<0.001). There were statistically significant differences among the groups in terms of Wong-Baker FACES Pain Rating Scale Score in all time points (P<0.004 for all). There was a statistically significant difference among the groups in terms of rescue analgesia necessity in 5th and 10th minute (P<0.001 and P=0.003). There was a statistically significant difference among the groups in terms of sore throat in 5th and 10th minute (P<0.001 for both). Neither rescue analgesia necessity nor sore throat characteristics was different between the Group T and Group K in all time points. Conclusion Topical tramadol and ketamine seem to be safe, effective, and easy analgesic approach for decreasing tonsillectomy pain.
Consciousness disturbance associated with severe hyponatremia : a case report
(Ondokuz Mayıs Üniversitesi, 2013) Duran, Arif; Ocak, Tarık; Tekelioğlu, Ümit Yaşar; Tekçe, Hikmet; Akkaya, Akcan; Demirhan, Abdullah; Aktaş, Gülali
Hyponatremia; a serious electrolyte disorder, frequently develops in the elderly and hospitalized patients with heart failure. Hyponatremia in patients with heart failure is usually in hypervolemic form characterized by increased total body sodium and water. However, rarely, hypovolemic hyponatremia associated with actual sodium loss may occur in the clinical course. We present an extremely hypovolemic hyponatremia case in a patient with severe heart failure. Serum sodium value of the patient was 101mEq/L; which is exceptionally compatible with life. © 2013 OMU.
Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section : a randomized, double blind, controlled trial
(Verduci Publisher, 2014) Akkaya, Akcan; Yıldız, İsa; Tekelioğlu, Ümit Yaşar; Demirhan, Abdullah; Bayır, Hakan; Özlü, Tülay; Bilgi, Murat
OBJECTIVES: When added to local anaesthetics, dexamethasone can prolong the duration of peripheral blocks. Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. The aim of this study was to determine the effect of dexamethasone on the block duration added to levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. PATIENTS AND METHODS: Forty-two patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I-II risk group were included in the study and divided into two groups. Bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl for the levobupivacaine group and bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone (8 mg) for the dexamethasone group were administered in a TAP block performed with ultrasonography. The time need for the first analgesic in the postoperative period was recorded. The numeric evaluation scale, and the total additional analgesic amounts were recorded. RESULTS: The time before the administration of the first additional analgesic dose was prolonged significantly in the dexamethasone group compared to the levobupivacaine group (p = 0.004). The pain scores were lower in the dexamethasone group for superficial pain. A significant difference for the dexamethasone group was observed in the evaluation of deep pain. The total consumption of tramadol was significantly lower in the dexamethasone group (p = 0.001). CONCLUSIONS: The utilization of dexamethasone, which has a prolonging effect on the transversus abdominis plane block, may be an alternative to epidural opioid analgesia in caesarean section. We observed that dexamethasone added to levobupivacaine in a TAP block applied for analgesia following a caesarean section procedure prolonged the time required for analgesia.
Digoksin intoksikasyonu
(2011) Tekelioğlu, Ümit Yaşar; Ayhan, Selim Suzi; Demirhan, Abdullah; Öztürk, Serkan; Akkaya, Akcan; Yıldız, İsa; Koçoğlu, Hasan
Digoxin is one of the most commonly used cardiac positive inotropic agents. The therapeutic and toxic dose ranges of digoxin are narrow. Therefore, digoxin intoxication may develop easily. Serum digoxin levels of 2 ngmL -1 or higher cause toxic signs. We aimed to share treatment and management of a patient who swallowed 3 boxes of digoxin for suicidal purposes and presented with life-threatening arrhythmias, in the light of current literature.
Does the kidney injury molecule-1 predict cisplatin-induced kidney injury in early stage?
(Sage Publications Inc, 2015) Tekçe, Buket Kin; Üyetürk, Ümmügül; Tekçe, Hikmet; Üyetürk, Uğur; Aktaş, Gülali; Akkaya, Akcan
Background It is not possible to diagnose acute kidney injury (AKI) in early stages with traditional biomarkers. Kidney injury molecule-1 (KIM-1) is a novel biomarker promising the diagnosis of AKI in early stages. We studied whether urinary and serum KIM-1 (KIM-1(U) and KIM-1(S)) concentrations were useful in predicting cisplatin-induced AKI in early stages. Methods We prospectively analysed 22 patients on cisplatin treatment. KIM-1(S) and KIM-1(U) concentrations were assessed in the samples of the patients on four different time periods (before treatment [BT], first [AT(1)], third [AT(3)] and fifth [AT(5)] day after treatment). Results KIM-1(U) concentrations on the first day after cisplatin treatment in patients with AKI were significantly increased compared to both KIM-1(U) concentrations of the same patients BT (P=0.009) and to AT(1)-KIM-1(U) concentrations of the patients without AKI (P=0.008). A receiver operating characteristic analysis revealed that AT(1)-KIM-1(U) concentrations may predict AKI with an 87.5% sensitivity and 93.3% specificity (area under the curve=0.94). KIM-1(S) concentrations were not significantly changed between BT and AT periods. Conclusions KIM-1(U) concentrations may predict cisplatin-induced AKI in early stages with high sensitivity and specificity.
Effect of pregabalin and dexamethasone addition to multimodal analgesia on postoperative analgesia following rhinoplasty surgery
(Springer, 2013) Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Akkaya, Akcan; Bilgi, Murat; Apuhan, Tayfun; Karabekmez, Furkan Erol; Bayır, Hakan; Kurt, Adem Deniz; Koçoğlu, Hasan
We investigated the effect of a combination of pregabalin and dexamethasone, when used as part of a multimodal analgesic regimen, on pain control after rhinoplasty operations. Sixty patients were enrolled in this study. They were randomly assigned into three groups: Group C (placebo + placebo), Group P (pregabalin + placebo), and Group PD (pregabalin + dexamethasone). Patients received either pregabalin 300 mg orally 1 h before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain was treated with intravenous patient-controlled analgesia (tramadol, 20-mg bolus dose, 45-min lockout time). The numeric rating scale (NRS), side effects, and consumption of tramadol, pethidine, and ondansetron were assessed. The median NRS scores at 0, 1, and 6 h after surgery were significantly higher in Group C than in Group PD (p < 0.001 for all). The 24-h consumption of tramadol and pethidine was significantly reduced in Groups P and PD compared to Group C (p < 0.01 and p < 0.01). The total tramadol consumption was decreased by 54.5 % in Group P and 81.9 % in Group PD compared to Group C (p < 0.001 for both). The incidence of nausea was higher in Group C than in Groups P and PD between the postoperative 0-2 and 0-24-h periods (p < 0.05 for both). The frequency of blurred vision was significantly higher in Groups P and PD than in Group C within the 0-24-h period (p < 0.05 for both). We found that the addition of a single dose of pregabalin and dexamethasone to multimodal analgesia in rhinoplasty surgeries provided efficient analgesia and thus decreased opioid consumption. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty
(Hindawi Publishing Corporation, 2014) Demirhan, Abdullah; Akkaya, Akcan; Tekelioğlu, Ümit Yaşar; Apuhan, Tayfun; Bilgi, Murat; Yurttaş, Veysel; Bayır, Hakan; Yıldız, İsa; Gök, Üzeyir; Koçoğlu, Hasan
Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P?0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P<0.001 and P<0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0-2 h and 0-24 h periods (P=0.002 and P<0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients.
Effect of sedation anesthesia on kinesiophobia and early outcomes after total knee arthroplasty
(Sage Publications Ltd, 2020) Değirmenci, Erdem; Özturan, Kutay Engin; Kaya, Yasin Emre; Akkaya, Akcan; YÜcel, Istemi
Background: Total knee arthroplasty (TKA) operation is an effective treatment method in severe osteoarthritis worldwide. However, the number of patients with chronic pain and functional limitations in the postoperative period will continue to increase. Kinesiphobia is an important factor that affects the functional outcomes postoperatively. The aim of this study is to investigate the effects of intraoperative consciousness of the patients during surgery on kinesiophobia development and early functional outcomes of TKA. Methods: Sixty patients with the diagnosis of primary knee osteoarthritis were enrolled in the study. Tampa Scale of Kinesiophabia (TSK) was obtained for each patient at multiple time periods. Regional anaesthesia and deep sedation were performed on group 1 (n = 30), while regional anaesthesia and light sedation were performed on group 2 (n = 30). The same surgical procedures were applied to all participants. Functional tests were performed on the patients at the postoperative 2nd and 5th days. Visual Analogue Scale (VAS) scores and knee flexion angles were also measured postoperatively. Results: The mean age of the participants (19 men (31.7%) and 41women (68.3%)) was 67.7 +/- 6.7 (54-82) years. TSK >= 40 was detected in 18 (30%) patients preoperatively and 33 patients (55%) postoperatively. The number of kinesiophobic patients showed statistically significant increase after operation (20/30 (66.7%)) according to preoperative period (9/30 (30%)) in group 2 (p = 0.003). Postoperative functional scores, knee flexion angles and VAS scores were better in non-kinesiophobic patients. Conclusion: Patient's consciousness during TKA operations is an important factor that interferes with the postoperative kinesiophobia development, which may play a pivotal role affecting the early mobility and functional outcomes.

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