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Abant İzzet Baysal Üniversitesi Sağlık Araştırma ve Uygulama Merkezi'nde çalışan hekimlerin kardiyopulmoner resusitasyon konusundaki yaklaşımları
(Aves, 2016) Yoldaş, Hamit; Koçoğlu, Hasan; Bayır, Hakan; Yıldız, İsa; Akkaya, Akçan; Demirhan, Abdullah
Objective: We aimed to evaluate the attitudes of doctors about cardiopulmonary resuscitation (CPR) in this research. Methods: Overall, 234 doctors who were working in Abant Izzet Baysal University Health Research and Application Center and who accepted to participate in this research were included. Research data were obtained by a questionnaire containing questions about demographic characteristics of doctors and their knowledge about CPR. Questionnaires were applied between 27.02.2012 and 04.06.2012. The chi-square test was used for categorical variables. A value of p< 0.05 was considered statistically significant. Results: It was determined that 90% of the participants included in the study applied and/or observed CPR, and 62% of participants did not attend any CPR course. In addition, 64.1% of the doctors were found to be aware of guidelines prepared every 5 years. Although 65.2% of the doctors who attended a course previously gave a correct answer for the question about the number of cardiac compressions during adult CPR, 47.6% of the doctors who did not attend a course gave the correct answer (p= 0.014). Additionally, 71.9% of participants who attended a course previously and 51.7% of participants who did not replied correctly to the question 'What should be done immediately after defibrillation during CPR?' And also the results for the question about how many joules is necessary to begin defibrillation with a monophasic defibrillator were statistically significant according to the attendance for a CPR course (p< 0.005). Conclusion: In this study, we have identified the lack of knowledge of the doctors about resuscitation.
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.
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.
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
Colostomy with transversus abdominis plane block
(Aves, 2015) Tekelioğlu, Ümit Yaşar; Demirhan, Abdullah; Şit, Mustafa; Kurt, Adem Deniz; Bilgi, Murat; Koçoğlu, Hasan
Transversus abdominis plane (TAP) block is one of the abdominal field block. The TAP block is used for both anaesthetic management and post-operative pain therapy in lower abdominal surgery. TAP block is a procedure in which local anaesthetic agents are applied to the anatomic neurofacial space between the internal oblique and the transversus abdominis muscle. TAP block is a good method for post-operative pain control as well as allows for short operations involving the abdominal area. In this article, a case of colostomy under TAP block is presented.
Comparison of BIPAP and SIMV+PEEP modes during weaning from mechanical ventilation after coronary artery bypass; effects on pulmonary function, ventilatory parameters and gas exchange
(2007) Karaaslan, Kazım; Talay, Fahrettin; Gülcü, Nebahat; Dağlar, Bahadır; Çolak, Cemil; Gümüş, Esra; Koçoğlu, Hasan
We aimed to compare the effects of biphasic intermittant positive airway pressure (BIPAP) and synchorised intermittant mondatory ventilation (SIMV) + PEEP (positive end expiratory pressure) on pulmonary functions, gas exchange and ventilatory parameters during weaning procedure after coronary artery bypass surgery. Twenty four patients aged 30-70 years scheduling for elective cardiopulmonary bypass grefting (CABG) were included in the study. Patients were ventilated with the mode of either BIPAP (GI, n: 12) or SIMV (G2, n: 12) randomly. Five cmH2O PEEP were applied in SIMV+PEEP group. Ventilation support decreased to 4-6 min-1 according to the adequacy of spontaneous respiration, and all patients in both, groups were extubated after waiting 30 min. The spirometric measurements were performed 1 day before operation (t0), 6 hrs (t1) and 24 hrs (t2) after extubation. The decrease during t1 and t2 in FEV1 were 62 % and 58 % in G1, 56 % and 61 % in G2 respectively. During the same period of time, FVC decreased 48 % and 42 % in G1, 58 % and 52 % in G2. These differences were not statistically significant between groups. FEV1/FVC ratio was similar within and between groups. We conclude that the rise of BIPAP or SIMV+PEEP have not affected the extubation time, gas exchange and pulmonary functions during weaning after CABG.
Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study
(Elsevier, 2007) Karaaslan, Kazım; Yılmaz, Fahrettin; Gülcü, Nebahat; Çolak, Cemil; Şereflican, Murat; Koçoğlu, Hasan
Background: Monitored anesthesia care (MAC) may be applied for septoplasty or endoscopic sinus surgery in which an adequate sedation and analgesia without respiratory depression are desired for comfort of both the patient and the surgeon. Several combinations with different agents have been used for this purpose in these patients. However, analgesic properties for these agents have not been reported. Objective: The aim of this study was to investigate the analgesic and sedative effects of dexmedetomidine or midazolam infusion combined with tramadol that was used via patient-controlled analgesia (PCA), and to document the effects of these drugs on early cognitive functions. Methods: This prospective, randomized, double-blind, clinical study enrolled patients undergoing septoplasty or endoscopic sinus surgery at the Abant Izzet Baysal University Hospital, Bolu, Turkey, between February and September 2006. Patients were randomly allocated in a 1: 1 ratio into I of 2 groups: the dexmedetomidine group (group D) patients received IV dexmedetomidine I mu g/kg for 10 minutes followed by continuous infusion of 0.5 mu g/kg center dot h(-1); and the midazolam group (group M) patients were administered a loading dose of IV midazolam 40 mu g/kg for 10 minutes followed by infusion at the rate of 50 mu g/kg center dot h-1. A I-minute bolus dose of IV tramadol (1.5 mg/kg) was administered in both groups 10 minutes after the administration of the primary drug, and continued via infusion using a PCA device. After baseline measurements, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and rate of respiration were recorded after the loading dose of study drug, after the bolus tramadol dose, at 10-minute intervals during the operation, and twice in the recovery rooms; 5 minutes after arrival and 5 minutes before discharge. Verbal rating score (VRS) and Ramsay sedation score were determined at baseline (after surgery was started), every 10 minutes thereafter until the end of the operation, and 2 times during recovery. All patients were assessed with the Wechsler Memory Scale-Revised at baseline (preoperatively) and 4 hours after the operation. Results: Seventy patients were enrolled in the study and randomly assigned to I of 2 groups: group D (sex, male/fernale, 23/12; mean [SEM] age, 32.53 [2.07] years; mean [SEM] weight, 73.03 [2.41] kg) or group M (sex, male/female, 21/14; mean [SEM] age, 34.43 [1.83] years; mean [SEM] weight, 67.90 [2.32] kg). All hemodynamic parameters (SAP, DAP, MAP, HR) were significantly higher in group M compared with group D from the onset of the surgery to discharge time (P < 0.05). Pain and sedation scores were similar in both groups, but the amount of PCA-administered rescue tramadol was significantly higher in group M (P = 0.001). A higher, though not statistically significant, prevalence of adverse events (ie, hypotension, bradycardia, and perioperative nausea and vomiting) were observed in group D. Postoperative logical verbal memory and digit span values were significantly higher in group D when compared with group M (P < 0.05). Postoperative digit span and visual reproduction scores were significantly higher than preoperative values in group D (P < 0.05). Postoperative personality functioning scores were significantly higher than preoperative values in group M (P < 0.05). Conclusions: Based on VRS, Ramsay sedation scores, and surgeon and anesthesiologist satisfaction scores, dexmedetomidine or midazolam combined with tramadol PCA provided adequate analgesia and sedation in these adult patients undergoing septoplasty or endoscopic sinus surgery with MAC. A significantly larger amount of rescue tramadol was used by group M, suggesting that a better analgesic effect was achieved with dexmedetomidine. (Curr Ther Res Clin Exp. 2007;68:69-81) Copyright (C) 2007 Excerpta Medica, Inc.
Comparison of lidocaine and levobupivacaine in transnasal fiberoptic laryngoscopy
(Sage Publications Inc, 2012) Apuhan, Tayfun; Koçoğlu, Hasan; Gülcü, Nebahat
Background: The anatomy of the nasal passages, pharynx, and larynx and evaluation of mucous membranes and laryngeal function is well observed by transnasal fiberoptic laryngoscopy (TFL). In this procedure, to provide good local infiltrative analgesia, medication such as anesthetics is important for the otolaryngologist. The aim of this study was to evaluate the efficacy of lidocaine (L) spray, compared with levobupivacaine solution, used for local anesthetic in patients undergoing TFL for complete examination. Methods: Sixty-two subjects (39 men and 23 women; mean age, 36 +/- 7 years) were enrolled in the study. Patients were randomly classified into two groups as levobupivacaine hydroclorur (LB) and L groups. A standard flexible transnasal fiberoptic 4.2-mm-diameter laryngoscope was passed through the nasal cavity and into the aerodigestive tract. Patients were asked to evaluate the intensity of the pain they experienced during the TFL, using a visual analog scale (VAS) and Ramsay sedation scale. Results: Demographic data were similar in both groups. There was no difference in VAS and Ramsay scores between both groups (p > 0.05). Conclusion: Our findings indicated that topical levobupivacaine seems to be an effective medication for anesthesia of the nasal mucosa and may be used to allow complete examinations involving TFL. (Am J Rhinol Allergy 26, e104-e106, 2012; doi: 10.2500/ajra.2012.26.3757)
Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecological surgery
(I R O G Canada, Inc, 2006) Karaca, Mehmet; Koçoğlu, Hasan; Göçmen, Ahmet
Background: The aim of this study was to compare the effects of lornoxicam and tramadol in patient-controlled analgesia (PCA) after gynecological surgery. Methods: Forty-four patients were randomly allocated to one of two groups after elective gynecological surgery. Patients in group I (n = 22) received IV tramadol, and group 11 patients (n = 2) received IV lornoxicarn with a PCA pump. A visual analogue scale (VAS) (0 = no pain, 10 = worst pain), hemodynamic parameters and side-effects were assessed before starting the infusion (baseline), at the 15(th) and 30(th) min, 1(st), 2(nd), 3(rd), 4(th), 6(th), 8(th), 12(th), 18(th), 24(th), 36(th) and 48(th) hour thereafter, and results were compared. Results: Adequate analgesia was achieved in both groups. VAS values in the tramadol group were lower than those of lornoxiacam at the 15(th) and 30(th) minute, 1(st), 2(nd), 4(th), 6 h, 8(th) and 12(th) hour measurements (p < 0.05). Eight patients (36.3%) in group I and six patients (27.2%) in group 11 suffered from nausea (p > 0.05). Conclusions: Tramadol and lornoxicarn may be used for pain control after gynecological surgery via PCA. However, we conclude that tramadol has better analgesic efficacy than lornoxicam during the first 12 hours postoperatively.
The comparison of the effects of bispectral index controlled minimal, low and high flow desfluran anesthesia on hemodynamics and recovery in patients undergoing lower abdominal surgery
(2016) Genç, Selçuk; Bozkurt, Hüseyin; Eke, Hakan; Şeren, Temel Deniz; Koçoğlu, Hasan
Amaç: Düşük akımlı anestezi, yarı kapalı yeniden solutmalı bir sistemle uygulanan ve yeniden solutma oranının en az %50 olduğu anestezisi tekniğidir. Modern yeniden solutmalı sistemler kullanıldığında, taze gaz akım hızı 2 L/dk'nın altına indirilirse düşük akımlı anesteziden söz edilebilir. Yöntem: Bu çalışmada BIS kontrolünde uygulanan desfluran anestezisinin hemodinami ve maliyet üzerindeki etkilerinin minimal akımlı, düşük akımlı ve yüksek akımlı anestezi uygulamaları arasında karşılaştırılması amaçlandı. Randomize olarak üç gruba ayrılan olgulardan Grup Y'de anestezi idamesinde taze gaz akımı 4.0 L/dk olarak devam edildi, Grup D'de 10. dakikadan sonra akım hızı 1 L/dk'ya indirildi, Grup M'de ise 10. dakikadan sonra 0.5 L/dk'ya indirildi ve her üç grupta da desfluran ile anestezi idamesine devam edildi. Bulgular: Yüksek, düşük ve minimal akım uygulanan üç grup arasında yapılan karşılaştırmada, her üç grupta da; kalp atım hızı, ortalama arteriyel basınçlar, oksijen saturasyonu, end-tidal karbondioksit değerlerinde anlamlı bir farklılık saptanmadı. Düşük akımlı ve minimal akımlı grupta derlenmenin daha erken olduğu belirlendi (p< 0.05). Düşük akım ve minimal akım gruplarında volatil anestezik tüketimi ve maliyet açısından önemli azalma sağlandı (p< 0.05). Sonuç: İntraoperatif süreçte, yeterli anestezi derinliği, hemodinamik stabilite ve respirasyon parametrelerini sağlayan düşük ve yüksek akımlı desfluran anestezisinin, yeterli koşullar altında postoperatif iyileşme üzerine pozitif etkileri vardır.
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 lornoxicam versus diclofenac in pain management after cardiac surgery: a single-blind, randomized, active-controlled study
(Elsevier Science Inc, 2005) Dağlar, Bahadır; Koçoğlu, Hasan; Celkan, M. Adnan; Göksu, Sıtkı; Kazaz, Hakkı; Kayıran, Celalettin
Background: Inadequate pain management after cardiac surgery may result in increased morbidity and length of hospital stay. Although opioids are the mainstay of postoperative analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used instead to avoid the adverse effects (AEs) associated with opioids. Lornoxicam is a newly developed NSAID, the use of which is increasing. However, lornoxicam has not been studied for use in pain management after cardiac surgery. Objective: The objective of this study was to compare the efficacy and tolerability of lornoxicam and diclofenac sodium, an NSAID well established for use in pain management after major surgery, in pain management after coronary artery bypass grafting (CABG). Methods: This single-blind, randomized, active-controlled study was conducted at the Gaziantep University Hospital, Gaziantep, Turkey. Adult patients scheduled to undergo valve or CABG surgery for the first time were included. Patients were premedicated with diazepam 10 mg PO at 10 PM on the evening before surgery. General anesthesia was induced using fentanyl, midazolam, and propofol, and maintained using fentanyl and isoflurane in pure oxygen. After extubation and when they stated that they felt pain, patients were randomly assigned to 1 of 2 treatment groups: lornoxicam 8 mg IM q8h or diclofenac 75 mg IM q12h, for 48 hours. Meperidine 1 mg/kg IM was given for additional analgesia when needed (rescue medication). Pain relief was assessed using an 11-point visual analog scale (0 = no pain to 10 = worst pain imaginable) immediately before the first injection (baseline), and at 15 and 30 minutes and 1, 2, 3, 4, 6, 12, 18, 24, and 48 hours after the first injection. Sedation was assessed using a 5-point scale (0 = awake and alert to 4 = deep sedation) at the same time points. Tolerability was assessed by monitoring of AEs using patient interview and laboratory analyses. Results: Forty patients were enrolled in the study (30 men, 10 women; mean [SD] age, 54.4 [11.1] years; 20 patients per treatment group). The demographic and clinical characteristics and mean baseline pain relief scores were statistically similar between the 2 treatment groups. The mean pain relief scores at 15 and 30 minutes were statistically similar to baseline values in the 2 treatment groups. However, the mean pain relief scores at >= 1 hour after the first injection were significantly lower compared with baseline values (both groups, P < 0.05 at time points >= 1 hour). No significant between-group differences in mean pain relief scores were found at any time point. The overall mean pain relief scores were statistically similar between the 2 treatment groups. The mean sedation scores were significantly higher at 30 minutes, 1 hour, and 2 hours after the first injection in the diclofenac group compared with the lornoxicam group (all, P < 0.05). No AEs were observed. The need for rescue medication was statistically similar between the 2 treatment groups (lornoxicam, 2 patients; diclofenac, 3 patients). Conclusions: In this study of adult patients who underwent CABG, the efficacy of lornoxicam and diclofenac were similar in postoperative pain management. Both study drugs were well tolerated.
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.
The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations
(Hospital Clinicas, Univ Sao Paulo, 2013) Ocak, Tarık; Erdem, Alim; Duran, Arif; Tekelioğlu, Ümit Yaşar; Öztürk, Serkan; Ayhan, Suzi Selim; Özlü, Mehmet Fatih; Tosun, Mehmet; Koçoğlu, Hasan; Yazıcı, Mehmet
OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74 +/- 197.11 in supraventricular tachyarrhythmia group and 39.99 +/- 32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels >= 61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17 +/- 0.56 and 0.01 +/- 0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels >= 0.01:2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non-supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.
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.
The effect of desflurane on postoperative olfactory memory
(Verduci Publisher, 2016) Yıldız, İsa; Bayır, Hakan; Sağlam, İbrahim; Şereflican, Murat; Bilgi, Murat; Yurttaş, Veysel; Demirhan, Abdullah; Koçoğlu, Hasan
OBJECTIVE: In this study, we investigated the effects of desflurane 6%, on olfactory memory. PATIENTS AND METHODS: This is a prospective clinical study performed with 40 patients aged 18-60 who had elective surgery and American Society of Anesthesiologists (ASA) physical status I-III. The Brief Smell Identification Test (BSIT) was used for evaluating patients' olfactory memories before and after the surgery. Patients received standard general anesthesia protocol and routine monitoring. For induction, 1.5 mg/kg of fentanyl, 2 mg/kg of propofol, and 0.5 mg/kg of rocuronium bromide were administered. Anesthesia was maintained with the inhalational of anesthetic desflurane (6%). The scores are recorded 30 minutes before the surgery and when the Aldrete Recovery Score reached 10 in the postoperative period. Preoperative and postoperative results were compared and p-values <0.05 were considered statistically significant. RESULTS: The patients' mean age was 41.1 +/- 12.0. Preoperative total correct answer rate to odorous substances was 92.7%, and postoperative rate was 92.1%. Percentage of the odor substance identification by the patients revealed no statistically significant difference when pre and post-operative rates have been compared (p-value > 0.05). CONCLUSIONS: We have observed for the first time in the literature that general anesthesia using desflurane (6%) did not affect short-term olfactory memory. Further studies will be necessary to confirm our findings with larger sample size.
Effect of dexmedetomidine on ischemia-reperfusion injury in rat kidney: a histopathologic study
(Taylor & Francis Inc, 2009) Koçoğlu, Hasan; Öztürk, Hülya; Öztürk, Hayrettin; Yılmaz, Fahri; Gülcü, Nebahat
Ischemia-reperfusion (I-R) injury remains the leading cause of acute renal failure. The purpose of this experimental study was to determine the role of dexmedetomidine on histologic alterations induced by renal I-R in rats. In the present study, thirty male Sprague-Dawley rats weighing 200-220 g were randomly assigned into three groups: the sham-control group (group 1, n = 10), the R/untreated group (group 2, n = 10), and the I-R/dexmedetomidine-treated group (group 3, n = 10). For group one, we performed a sham operation. The abdomen was dissected, the right kidney was harvested, and then the left renal pedicle exposed. Renal clamping was not applied. For group 2, rats underwent left renal ischemia for 60 minutes followed by reperfusion for 45 minutes. For group 3, the same surgical procedure as in group 2 was performed, and dexmedetomidine (100 g/kg, intraperitoneal) was administrated at the starting time of reperfusion. The rats were sacrificed after reperfusion, and the kidney tissue was harvested. The histopathological score in the kidney of the I-R/dexmedetomidine-treated group rats was significantly lower than that of I-R/untreated group rats. This score in I-R/untreated group rats was higher than the other two groups, which was statistically significant. In the I-R/untreated group rats, kidneys of untreated ischemia rats showed tubular cell swelling, cellular vacuolization, pyknotic nuclei, medullary congestion, and moderate to severe necrosis. Treatment with dexmedetomidine shows normal glomeruli and slight edema of the tubular cells. These findings provide the first evidence that dexmedetomidine can reduce the renal injury caused by I-R of the kidney, and may be useful in enhancing the tolerance of the kidney against renal injury.

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