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  • Küçük Resim Yok
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    Acil servisden akut koroner sendrom nedeniyle yatırılan hastaların birinci derece yakınlarının kalp hastalığı bilirlilik düzeyleri: Anket çalışması
    (2013) Ocak, Tarık; Duran, Arif; Öztürk, Serkan; Tekelioğlu, Ümit Yaşar; Erdem, Alim; Ayhan, Selim S.
    Amaç: Çalışmamızda, sağlık sektörü dışındaki genel popüla syonun miyokart enfarktüsü (MI) geçiren hastaların tanınması ve yapılması gereken ilk müdahale konusunda bilgi düzeyi ve yaklaşımlarını incelemeyi amaçladık. Yöntem: Araştırmacılar tarafından, MI geçiren kişilerdeki klinik bulgular ile ilk müdahalede yapılması gerekenleri sorgulayan bir anket oluşturuldu ve 250 gönüllü kişi tarafı ndan doldurulması sağlandı. Gönüllüler özellikle sağlık sektörü dışından seçildi. Bulgular : Katılımcılara sorulan "Sizce hastalıklara bağlı en sık ölüm nedir " sorusuna kadınların %45.1’i kalp krizi, %47.2’si kanser derken aynı soruya erkeklerin ise % 63.9’u kalp krizi, %22.2’si kanser cevabı verdiler. Katılımcıl a ra sorulan "Yalnız başınıza çevrenizde MI geçirdiğini düşü n düğünüz biri ile karşılaşırsanız ne yaparsınız? " sorusuna %92.4’ü acil servisi arayacağını (ka dınlarda %57, erkeklerde %40.7), %31,2’si hastanın bulu n duğu odayı havalandıracağını (kadınlarda %31.7, erkeklerde %30.6), %20.4’ü hastaya aspirin vereceğ ini (kadınlarda %21.8, erkeklerde %18.5), %7.6’sı ise ne yap acağı konusunda bilgisi olmadığını ifade etti (kadınlarda %7.2, erkeklerde %4.3). Sonuç : Bu çalışmanın sonucunda MI yaygınlığı ve mortalitesi konusunda özellikle kadınlarda farkındalığın daha az olduğu görülmüştür. MI’daki tipik bulgular konusunda göğüs ağrısı dışında diğer bulguların yeterince bilinmediği kanısına varılmıştır. MI ile karşılaşılacak bir durumda ise popülasyonun acil servisi arama dışında yapılması gerekenler konusunda yeterli bilgi seviyesine sahip olmadığı anlaşılmıştır. MI’ne müdahalede en önemli kısmı oluşturan tanı ve ilk müdahale konusunda toplum çapında yaygın eğitim programlarının uygulanması gerekli olduğunu düşünmekteyiz.
  • Küçük Resim
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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.
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    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.
  • Küçük Resim
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    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.
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    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.
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    A case of anesthesia mumps after general anesthesia
    (Springer Tokyo, 2012) Tekelioğlu, Ümit Yaşar; Akkaya, Akcan; Apuhan, Tayfun; Demirhan, Abdullah; Bayır, Hakan; Koçoğlu, Hasan
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    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.
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    Combinations of fentanyl and levobupivacaine for post-thoracotomy pain
    (Elsevier Taiwan LLC, 2012) Tekelioğlu, Ümit Yaşar; Gürses, Ercan Lütfi; Serin, Simay; Sungurtekin, Hülya
    The aim of the present study is to evaluate the analgesic activity, patient satisfaction, and side effect profile of different concentrations of levobupivacaine plus fentanyl administered through thoracic epidural patient-controlled analgesia in patients undergoing thoracotomy. The study included 60 patients who were randomly divided into three groups. At the end of the surgery, group I (n = 20) received 0.125% levobupivacaine plus 3 mg fentanyl, group II received 0.1% levobupivacaine plus 3 mg fentanyl, and group III received 0.05% levobupivacaine plus 3 mg fentanyl via an epidural catheter placed at the level of T10-11 or T11-12. For all groups, the patient-controlled analgesia device was programmed to deliver a loading dose of 14 ?l at an infusion rate of 4 ?l/h, and a bolus dose of 2 ?l/h, with a locked out interval of 15 minutes and 60 ?l of a 4-hour limit. The following parameters were evaluated at 5, 10, 15, 20, 30, and 40 minutes and at 1, 2, 4, 8, 16, and 24 hours after admission to the intensive care unit, at which nausea and vomiting scales, Visual Analog Scale I-II, Ramsay sedation scale, Bromage scale, pupil diameter, arterial blood pressure, heart rate, respiratory rate, and SpO2 were measured and recorded. Any side effect was also documented. As the result of the evaluation, visual Analog Scale I-II scores, patient satisfaction scores, mean arterial blood pressure, and heart rate significantly differed in group I as compared with groups II and III. No side effects were encountered except mild nausea, which was seen in group III and did not require treatment. Motor blockage, pupil size, respiratory rate, and SpO2 were not monitored in any of the patients in all groups. In conclusion, our study suggested that the use of 0.125% levobupivacaine, together with 3 mg/mL fentanyl, constitutes a good combination, and can be used safely without causing hemodynamic change and motor block.
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    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.
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    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.
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    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.
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    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.
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    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.
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    Delftia acidovorans’ın neden olduğu nozokomiyal pnömoni ve arteriyel kateter ilişkili bakteriyemi
    (2012) Taş, Tekin; Küçükbayrak, Abdülkadir; Koçoğlu, Mücahide Esra; Özsoy, Şeyda; Bucak, Özlem; Tekelioğlu, Ümit Yaşar; Hakyemez, İsmail Necati
    Delftia acidovorans, önceden Comamonas acidovorans olarak isimlendirilen non-ermentatif, gram negatif bakteridir. Kronik obstrüktif akciğer hastalığı tanısıyla yoğun bakım ünitesine yatırılan 79 yaşında erkek hastanın her iki akciğerinde solunum sesleri azalmış ve kaba ronküsleri mevcuttu. Sulbaktam/ampisilin başlanan hastadan yatışının yedinci gününde beyaz küre artışı ve sol akciğerde infiltrasyon olması üzerine kan kültürleri ve derin trakeal aspirat kültürü gönderildi. Hastanın sulbaktam-ampisilin tedavisi kesilerek seftriakson başlandı. Hastanın tüm kültürlerinde D. acidovorans üredi. Yatışın 11. günü D. acidovorans’a bağlı septisemi tanısıyla meropenem başlandı. Hasta takibinin 17. gününde kaybedildi.
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    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.
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    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.
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    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.
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    Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection
    (Verduci Publisher, 2016) Bayır, Hakan; Yıldız, İsa; Erdem, Fatma; Tekelioğlu, Ümit Yaşar; Özyalvaçlı, Mehmet Emin; Bilgi, Murat
    OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 degrees C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36 degrees C) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46 +/- 0.39; postop 35.68 +/- 0.59, paired sample t-test, p<0.001). Also in all patients, postoperative QTc dispersions were found to be significantly longer than the preoperative QTc dispersions (preop 59.66 +/- 32.69; postop 74.57 +/- 37.47 ms, p<0.05). When we divided the patients; hypothermic and normothermic, postoperative QTc dispersions were significantly different between two groups (68.23 +/- 33.43 ms, and 83.20 +/- 41.50 ms; p=0.009). CONCLUSIONS: The prevalence of inadvertent intraoperative hypothermia in patients undergoing transurethral resection is relatively high. QTc dispersion of mild hypothermic patients was significantly longer than normothermic patients'.
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    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.
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    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.