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Bilateral high-level percutaneous cervical cordotomy in cancer pain due to lung cancer: A case report
(Elsevier Science, 2006-07-11) Bekar, Ahmet; Kocaeli, Hasan; Abaş, Faruk; Bozkurt, Merlin; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim Dalı; 6603677218; 6603500567; 8546184300; 16202046200
Background: Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description: A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast- enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion: The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.
Combination of a psoas compartment, sciatic nerve, and T12-L1 paravertebral blocks for femoropopliteal bypass surgery in a high-risk patient
(W. B. Saunders Company-Elsevier, 2008-04) Moǧol, Elif Başaǧan; Türker, Gürkan; Yılmaz, Mert; Gören, Suna; Tıp Fakültesi; Kalp Damar Cerrahisi Ana Bilim Dalı; 0000-0002-1190-6831; 0000-0002-3019-581X; EMB-1552-2022; AAI-6642-2021; KCJ-0506-2024; AAI-3551-2021; 23982134100; 7003400116; 57220839864; 7006563257
A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation
(Lippincott Williams & Wilkins, 2008-06) Yavaşçaoǧlu, Belgin; Kaya, Fatma Nur; Baykara, Mehmet; Bozkurt, Merlin; Korkmaz, Serdar; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; AAG-9356-2021; AAI-8213-2021; AAI-8213-2021; 6602742300; 7003619647; 23093006700; 16202046200; 24171259800
Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial
(Sage Publications, 2008-02) Kırdak, Türkay; Yılmazlar, Aysun; Kavun, Sinan; Ercan, İlker; Yılmazlar, Tuncay; Tıp Fakültesi; Farmakoloji ve Klinik Farmakoloji Ana Bilim Dalı; 0000-0002-2382-290X; AAC-9702-2019; 8704181100; 55899579900; 6507468595; 6603789069; 6701800362
Preoperative single, high-dose methylprednisolone administration improves postoperative outcomes after colonic surgery. Several randomized studies, including major surgeries, assessed various high-dose steroid regimens; however, evidence about the effect of administration of lower doses on postoperative outcomes in colorectal surgery is not available. The aim of the present study is to determine whether the administration of a single, low dose of dexamethasone before surgery would confer an outcome advantage after colorectal surgery. Thirty patients undergoing colorectal surgery were included in this randomized, double-blind study. Patients received 8 mg dexamethasone or serum physiologic preoperatively. Levels of Interleukin-6 and C-reactive protein, pain scores, postoperative nausea and vomiting, mobilization, complications, hospital stay, and readmissions were compared. Age, sex, indications, and operations were similar in both groups (P > 0.05). C-reactive protein and Interleukin-6 levels increased significantly postoperatively in each group (P < 0.05), but there were no differences between groups when compared (P > 0.05). There were also no significant differences between pain scores, bowel functions, mobilization, hospital stay, complication rates, and readmission rates between the two groups (P > 0.05). Preoperative 8 mg dexamethasone administration has no significant effect on reducing postoperative inflammatory response and also does not improve outcomes of colorectal. surgery.
Early identification of patients at risk of acute lung injury: Evaluation of lung injury prediction score in a multicenter cohort study
(American Thoracic Society, 2011-02) Gajic, Ognien; Dabbagh, Ousama; Park, Pauline K.; Adesanya, Adebola; Chang, Steven Y.; Hou, Peter; Anderson, Harry, III; Hoth, J. Jason; Mikkelsen, Mark E.; Gentile, Nina T.; Gong, Michelle N.; Talmor, Daniel; Bajwa, Ednan; Watkins, Timothy R.; Festic, Emir; Yılmaz, Murat; Kaufman, David A.; Esper, Annette M.; Sadikot, Ruxana; Douglas, Ivor; Sevransky, Jonathan; Malinchoc, Michael; İşçimen, Remzi; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0001-8111-5958; AAI-8104-2021; 16645821200
Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk All developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80(95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7). Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies.
The effectiveness of local anesthetics in preventing postoperative adhesions in rat models
(Springer-Verlag Italia SRL, 2010-12) Öztürk, Ersin; Yılmazlar, Aysun; Berhuni, Sait; Yılmazlar, Tuncay; Tıp Fakültesi; Genel Cerrahi Ana Bilim Dalı; 35070171400; 55899579900; 37076610600; 6701800362
Intra-abdominal adhesions are fibrous bands that develop after abdominal surgery or inflammation and cause significant surgical morbidity and mortality. In this study, the effectiveness of lidocaine, prilocaine and bupivacaine in preventing experimental intra-abdominal adhesions in rats was studied. After obtaining the approval of our local institutional review board, 50 female Wistar-Albino rats weighing 250-320 g underwent laparotomy via a standard 5-cm midline incision under intramuscular anesthesia with ketamine (40 mg/kg) and xylazine (10 mg/kg). The cecal serosa and adjacent abdominal wall were superficially injured using sterile gauze. The laparotomy incision was closed after irrigation of the peritoneal cavity with the following: 5 ml saline in Group II, (the sham group), 7 mg/kg prilocaine in Group III, 3 mg/kg lidocaine in Group IV or 2 mg/kg bupivacaine in Group V. No irrigation was performed in Group I rats (the control group). After laparotomy closure, all rats were allowed to wake spontaneously. Two weeks after the initial experimental procedure, all rats underwent a second laparotomy, and adhesions were scored using the Linsky scale. The adhesion quantity and quality were comparable among all groups (P > 0.05); however, adhesion severity scores were significantly lower in the prilocaine and bupivacaine groups vs. the other groups (P < 0.05). Prilocaine and bupivacaine were found to decrease the severity of intra-peritoneal adhesions.
Outcomes of patients presenting with mild acute respiratory distress syndrome insights from the lung safe Study
(Lippincott Williams & Wilkins, 2018-10-05) Ceylan, İlkay; Girgin, Nermin Kelebek; Tıp Fakültesi; Cerrahi Tıp Bilimleri; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; AAH-7250-2019; 57200337923; 55663009300
Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: " worsening" if moderate or severe acute respiratory distress syndrome criteria were met, " persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and " improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.
Perioperative statin therapy and renal outcomes after major vascular surgery: A propensity-based analysis
(W B Saunders Co-Elsevier, 2008-04) Kor, Daryl Jon; Brown, Michael John; Brown, Daniel Ross; Whalen, Francis; Roy, Tuhin; Keegan, Mark; İşçimen, Remzi; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0001-8111-5958; AAI-8104-2021; 16645821200
Objective: To evaluate how the presence and timing of statin therapy affect perioperative renal outcomes after major vascular surgery. Design: Retrospective cohort study. Setting: Surgical intensive care unit at a single academic medical center. Participants: Patients undergoing major vascular surgery between July 2004 and October 2005. Measurements and Main Results: The presence and timing of perioperative statin administration and the propensity for receiving such therapy were noted. Renal outcomes, lengths of stay, and mortality were reviewed. One hundred fifty-one procedures were performed. Eighty-nine patients (59%) received statin therapy. There was no evidence for renal protection with perioperative statin therapy (A creatinine 0.2 mg/dL v 0.2 mg/dL, p = 0.41; acute renal injury/acute renal failure 8% v 6%, p = 1.00; renal replacement therapy 3% v 3%, p = 1.00; all statin v no statin, respectively). With the possible exception of early reinstitution of statin therapy in chronic statin users, subgroup analyses failed to confirm an association between statin timing and prevention of postoperative renal dysfunction. Conclusions: In the present investigation, neither the presence nor timing of perioperative statin therapy was associated with improved renal outcomes in patients undergoing a range of major vascular procedures. A possible exception is early postoperative reinitiation of statin therapy in chronic statin users. The discrepant results of available literature preclude a definitive statement on the use of statin therapy as a means of preventing postoperative renal dysfunction. An adequately powered prospective trial is needed before advocating the routine use of statin therapy for perioperative renal protection. (C) 2008 Elsevier Inc. All rights reserved.
Predictive factors for postoperative intensive care unit admission in pediatric patients undergoing scoliosis correction surgery
(e-Century Publishing Corporation, 2021) Akesen, Selcan; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0002-9518-541X; ELR-9087-2022; 57221719031
Objective: Postoperative intensive care unit (ICU) admission might be required in adolescent patients following posterior fusion and instrumentation surgery for the treatment of scoliosis. We aimed to evaluate the predictive factors for mechanical ventilation and the characteristics of the patients who required an ICU stay following spinal surgery. Methods: We retrospectively reviewed the records of 85 children undergoing primary scoliosis surgery at a university-affiliated general hospital from January 2010 and June 2020 by the same spinal surgeon. The demographic data, pre- and peritoperative variables were collected and recorded. All patients underwent surgery with a combined anesthesia protocol of fentanyl and remifentanil. Results: There were 31 males (36.5%) and 54 females (63.5%). In the postoperative period, 13 patients (15.3%) were admitted to the ICU, and six of them required mechanical ventilation. Among these, three patients (50%) were extubated within the postoperative 0-12 hours, two (33.3%) within postoperative 12-24 hours, and one (16.7) after postoperative 24 hours. The major complications included acidosis (4.7%), hemodynamic instability (1.2%), hypercapnia (1.2%), hypoxemia (1.2%), and delayed extubation (1.2%). Conclusions: A smaller bodyweight percentile, neuromuscular etiology, abnormal findings in preoperative chest X-ray, additional comorbidities, and preoperative estimated risk for postoperative mechanical ventilation were among the risk factors for postoperative ICU stay. The age, height, weight, degree of the curvature, and the number of operated segments did not have an association with the postoperative outcomes.
Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study
(Wiley, 2020-12) Sayan, Halil Erkan; Asan, Ali; Girgin, Nermin Kelebek; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; DTU-3148-2022; 55663009300
Rationale, aims, and objectives: Pressure ulcers (PUs), which are preventable complications, increase the cost of health care and the risk of prolonged hospital stay, as well as morbidity and mortality. In this study, we aimed to describe the prevalence, clinical features, and risk factors for PUs among hospitalized patients. Method: This study was cross-sectional and conducted over a single day in all the care units. Data were recorded on a patient observation form that included demographic data, diagnosis of admission to the hospital or intensive care unit (ICU), comorbidity and chronic diseases, location, stage of PU, and Braden Scale score. Acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma score (GCS), PaO2/FiO2 ratio, and albumin level were recorded for ICU patients. Results: A total of 1548 adult patients participated in the study. Of these patients, 177 (11.43%) had PU. The patients with PU had more advanced age, lower body mass index (BMI), and longer duration of hospital and ICU stay (for all P =.001). Evaluation of PU in the first 24 hours after hospital admission and the last PU evaluation time also showed a significant effect (both P =.001). Braden Scale score less than or equal to 13 in the first evaluation after hospital admission increased the risk of PU. Albumin was 2.78 ± 0.57 gm/dL in ICU patients, and albumin level was significantly lower in patients with PU (P =.001). PUs were located mainly in the sacrum (47.59%) and were classified as stage II (42.76%) for all patients. Conclusions: The prevalence of PU is related to the age and severity of patient clinical status, as predicted by the Braden Scale score and APACHE II score, and length of hospital and ICU stay. Low albumin level is also related to development of PUs in ICU patients.
Prognostic risk factors in ventilator-associated pneumonia
(International Scientific Information, 2018-03-05) Karakuzu, Ziyaettin; İşçimen, Remzi; Akalın, Halis; Girgin, Nermin Kelebek; Kahveci, Ferda; Sınırtaş, Melda; Tıp Fakültesi; Mikrobiyoloji ve Enfeksiyon Hastalıkları Ana Bilim Dalı; 0000-0001-8111-5958; FAL-0396-2022; HKP-2533-2023; AAU-8952-2020; AAH-7250-2019; CYR-2043-2022; DSE-4824-2022; 56088206300; 16645821200; 57207553671; 55663009300; 6602405968; 6505818048
Background: Ventilator-associated pneumonia (VAP) is a nosocomial infection commonly seen in patients in intensive care units (ICU). This study aimed to analyze factors affecting prognosis of patients diagnosed with VAP. Material/Methods: Critically ill patients with VAP were retrospectively evaluated between June 2002 and June 2011 in the ICU. VAP diagnosis was made according to 2005 ATS/IDSA (Infectious Diseases Society of America/American Thoracic Society) criteria. First pneumonia attacks of patients were analyzed. Results: When early-and late-onset pneumonia causes were compared according to ICU and hospital admittance, resistant bacteria were found to be more common in pneumonias classified as early-onset according to ICU admittance. APACHE II score of >21 (p=0.016), SOFA score of >6 (p<0.001) on admission to ICU and SOFA score of >6 (p<0.001) on day of diagnosis are risk factors affecting mortality. Additionally, low PaO2/FIO2 ratio at onset of VAP had a negative effect on prognosis (p<0.001). SOFA score of >6 on the day of VAP diagnosis was an independent risk factor for mortality [(p<0.001; OR (95% CI): 1.4 (1.2-1.6)]. Conclusions: Resistant bacteria might be present in early-onset VAP. Especially, taking LOS into consideration may better estimate the presence of resistant bacteria. Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent causative microorganisms for VAP. SOFA score might be more valuable than APACHE II score. Frequently surveilling SOFA scores may improve predictive performance over time.
Retrospective investigation of difficult airway cases encountered in Bursa Uludağ University Medical Faculty operating room
(AVES, 2023-04) Alemdar, Didem; Akesen, Selcan; Bilgin, Hülya; AKESEN, SELCAN; BİLGİN, HÜLYA; Uludağ Üniverstesi; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0001-7332-5568; ELR-9087-2022; R-8285-2017
Objective: Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in prevent-ing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management.Methods: In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operat-ing room of Bursa Uludag. University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over).Results: The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in pae-diatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P =.001, P <.001, P <.001, and P <.001, respec-tively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P <.001, P <.001, and P <.001, respectively).Conclusion: In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of <6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.
Thoracic paravertebral block for video-assisted thoracoscopic surgery: Single injection versus multiple injections
(W. B. Saunders - Elsevier, 2012-02) Kaya, Fatma Nur; Türker, Gürkan; Moğol, Elif Başağan; Bayraktar, Selcan; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0002-3019-581X; AAI-8213-2021; AAI-6642-2021; 7003619647; 7003400116; 23982134100; 34879358300
Objective: Thoracic paravertebral blocks (PVBs) have been shown to be effective for analgesia after video-assisted thoracoscopic surgery (VATS) with single- and multiple-injection techniques. The efficacy of single-injection PVB was compared with multiple-injection PVB on postoperative analgesia in VATS was studied. Design: Prospective, randomized study. Setting: Single university hospital. Participants: Fifty patients undergoing VATS. Interventions: A nerve stimulator-guided PVB was performed in the sitting position before surgery using a solution of 20 mL 0.5% bupivacaine with 1:200,000 epinephrine by a single injection at T6 (group S, n = 25) or by 5 injections of 4 mL each at T4 to T8 (group M, n = 25). Measurements and Main Results: A successful PVB was achieved in all patients. The times to perform the blocks were 6.8 +/- 1.9 minutes in the S group and 17.9 +/- 3.0 minutes in the M group (p < 0.001). The times to block onset were 8.3 +/- 1.8 minutes in the S group and 7.2 +/- 0.9 minutes in the M group (p = 0.014). The numbers of anesthetized dermatomes were 5.8 +/- 0.8 for the S group and 6.6 +/- 1.1 for the M group (p = 0.009). The postoperative pain scores and morphine consumption with patient-controlled analgesia were comparable in the two groups. There were no significant differences in times to the first mobilization and hospital discharge for two groups. Patient satisfaction with the analgesic procedure was greater in the S group (p < 0.05). No complications were attributed to the blocks. Conclusions: The two techniques provided comparable postoperative analgesia. However, single-injection PVB may represent an advantage over multiple-injection PVB in patients undergoing VATS, with greater patient satisfaction associated with a shorter procedure and the likelihood of decreased complications.

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