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A comparision of the effect of sugammadex on the recovery period and postoperative residual block in young elderly and middle-aged elderly patients
(Galenos Yayıncılık, 2015-10-20) Yazar, Emine; Yılmaz, Canan; Karasu, Derya; Apaydın, Yılmaz; Sayan, Halil Erkan; Bilgin, Hülya; Bayraktar, Selcan; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0001-6639-5533; A-7338-2016; 6701663354; 34879358300
Background: The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and >= 75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF >= 0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T-2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged >= 75 years compared to patients aged between 65-74 years.
The effect of nursing-implemented sedation on the duration of mechanical ventilation in the ICU
(Ulusal Travma ve Acil Cerrahi Derneği, 2010-11-01) Yılmaz, Canan; Girgin, Nermin Kelebek; Özdemir, Nurdan; Kutlay, Oya; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0002-1510-0667; N-3608-2019; AAH-7250-2019; 56526391600; 55663009300; 57212543974; 6602199747
BACKGROUND We aimed to compare the effects of nursing-implemented sedation protocol and daily interruption of sedative infusion on the duration of mechanical ventilation. METHODS Fifty patients receiving mechanical ventilation and requiring sedation in the intensive care unit (ICU) were randomly selected to receive either daily interruption of sedative infusion (Group P, n=25) or nursing-implemented sedation protocol (Group N, n=25). In Group P, daily interruption of sedative infusions without any sedation protocol was performed by physicians. In Group N, nursing-implemented sedation protocol prepared by physicians was applied. In this group, if the ideal level of sedation was not achieved, information was given by nurses to physicians. Patients in each group were compared according to demographic variables, duration of mechanical ventilation and sedation, length of stay in the ICU, and mortality. RESULTS Demographic variables, length of stay in the ICU and mortality were similar between the two groups. In Group P, duration of sedation and mechanical ventilation were significantly shorter than in Group N. Light sedation was seen more frequently in Group P and deep sedation in Group N. CONCLUSION Daily interruption of sedative infusions provided shorter duration of sedation and mechanical ventilation than nursing-implemented sedation with protocol. Although nurse-implemented sedation protocol has been found acceptable, if the number of nurses is lacking, we believe the nurse-implemented sedation protocol should not be applied.
Functional results of conservative therapy accompanied by interscalane brachial plexus block and patient-controlled analgesia in cases with frozen shoulder
(Türk Ortopedi ve Travmatoloji Derneği, 2010) Yılmazlar, Aysun; Türker, Gürkan; Atıcı, Teoman; Bilgen, Sadık; Bilgen, Ömer Faruk; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0002-3019-581X; AAI-1638-2021; AAI-6642-2021; A-5095-2018; 55899579900; 7003400116; 7801647288; 15061239900; 16933501900
Objectives: We evaluated the efficacy of simultaneous interscalene block and catheter analgesia applied as an aid to conservative treatment in improving shoulder functions in patients with frozen shoulder. Methods: Three patients (2 women, I man; mean age 47 years) with frozen shoulder underwent conservative treatment including manipulation under interscalene brachial plexus block and subsequent rehabilitation under catheter analgesia to improve shoulder range of motion and function. Following manipulation under interscalene block, the patients were hospitalized for 15 to 28 days (mean 21 days) for an exercise program performed by a physiotherapist and orthopedist at least twice a day under interscalene catheter analgesia. Thirty minutes before each rehabilitation session, patient-controlled analgesia was administered via a pain relief pump. Active and passive range of motion (ROM) were measured and the severity of pain was rated using a visual analog scale (VAS) prior to and following interscalene block, during the exercise program, and at the end of the treatment. Functional assessments were made before and after treatment using the University of California in Los Angeles (UCLA) Shoulder Scale. The exercise program under interscalene analgesia was performed until pain-free and sufficient active movements were obtained, with at least 80% improvement in active and passive motion, a VAS score of 0-2, and an UCLA score of >27. Results: Compared to pretreatment values, the ROM values showed remarkable increases at the end of the treatment. Active ROM reached at least 30 degrees external rotation, 40 degrees internal rotation, 150 degrees flexion, 45 degrees extension, and 100 degrees abduction in all cases. On presentation, the VAS scores of all cases were 10 for both active and passive movements, whereas they ranged from 0 to 2 on discharge. The mean UCLA score increased from 12.3 to 30.3 after treatment. Immediately after the interscalene block, two patients exhibited signs of Horner's syndrome which resolved spontaneously within an hour without the need for treatment. No complications or catheter-related problems such as infection, break-off, or displacement developed throughout the treatment period. There was no requirement for additional analgesia. Conclusion: In patients with frozen shoulder, interscalene block and continuous patient-controlled analgesia via an interscalene catheter provided sufficient analgesia and contributed to the recovery of shoulder functions through an effective and safe exercise program, with no side effects or complications. However, further studies are needed to assess the feasibility of home applications of interscalene patient-controlled analgesia to increase cost-effectiveness and patient satisfaction.
Ogilvie's syndrome following bilateral knee arthroplasty: A case report
(Türk Ortopedi ve Travmatoloji Derneği, 2012) Yılmazlar, Aysun; İşçimen, Remzi; Bilgen, Ömer Faruk; Özgüç, Halil; Tıp Fakültesi; Genel Cerrahi Ana Bilim Dalı; 0000-0001-8111-5958; AAI-8104-2021; 55899579900; 16645821200; 16933501900; 6603867989
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is an uncommon but severe postoperative complication of total hip and knee arthroplasty. This syndrome should be borne in mind after arthroplasty surgery. We present a case of this serious postoperative complication and aim to identify the risk factors and alert surgeons to the possibility and appropriate management of Ogilvie's syndrome.
Total diz artroplastisi sonras intravenöz ve epidural hasta kontrollü analjezi tekniklerinin ameliyat sonrasi aǧrı ve diz rehabilitasyonu üzerine etkilerinin karşılaştırılması
(Türk Eklem Hastalıkları Derneği, 2009) Bozkurt, Merlin; Yılmazlar, Aysun; Bilgen, Ömer Faruk; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 16202046200; 55899579900; 16933501900
Objectives: We aimed to compare the effects of controlled intravenous (iv.) and epidural analgesia techniques on postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA). Patients and methods: After the approval of the ethical committee, both i.v. (group I.V; n=20) and epidural (group E; n=22) postoperative analgesia (PCA) were applied in 42 patients (range 18 to 75 years) undergoing TKA. Because of dislocation of epidural catheters in the postoperative period, two cases were excluded from the study and 20 patients in each group were evaluated. Postoperative pain was assessed with the visual analog scale (VAS) and it was recorded in the recovery unite and then at the 01, 8(th), 12(th), 16(th), 24(th), 48(th) and 72(nd), hours. The knee flexion angles of patients were daily measured with a goniometer. The data were analyzed using Mann Whitney U-test, two-samples independent t-test, Fisher exact-chi squared and Pierson chi squared tests. Results: Demographic variables were similar in two groups. In group E, VAS scores at rest and motion were found to be significantly lower and knee flexion angles were significantly higher than that of the group I.V. Conclusion: We determined that epidural PCA provided better pain relief and rehabilitation than iv. PCA in postoperative period after TKA.

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