Anesteziyoloji ve Reanimasyon/Makale Koleksiyonu
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Öğe Opinions of Physicians and Nurses on the Postoperative Pain of Pediatric Patients Undergoing General Anesthesia: A Qualitative Study(Selçuk Üniversitesi, 2023 Haziran) Akkoyun, Sevinç; Arslan, Fatma Taş; Kara, İnciAim: It is aimed to determine the opinions of physicians and nurses on the evaluation of pain in the postoperative period of pediatric patients undergoing general anesthesia. Materials and Methods: Qualitative research method was used in the study. The study was carried out with a total of 13 physicians and nurses working voluntarily in the anesthesia and pediatric surgery clinic of Selçuk University Medical Faculty Hospital. Data were collected through individual in-depth interviews through a semi-structured questionnaire in October 2022. Individual interviews were held in a suitable meeting room within the hospital with the participation of two researchers. Note-taking technique was used in the interviews and a voice recorder was used. The qualitative data obtained were analyzed by the researchers with the content analysis method. Results: Qualitative findings were determined as four main themes: thoughts about pain, beliefs about pain management, the role of health professionals in pain management, and the role of family/parent in pain management. Conclusion: As a result of the study, it was determined that pain was followed, pharmacological methods were used, non-pharmacological methods were not in the clinical routine, teamwork was important in pain management, and the family/parent were with the child.Öğe Measuring Medical Students’ Awareness of Rational Drug Use and Assessing Associated Factors(Selçuk Üniversitesi, 2023 Haziran) Çiçekçi, Faruk; Poçan, Berna; Ayyıldız, Burak; Koyuncu, Dilara Aylin; İnan, Hatice Beyza; Kakat, Aleyna Betül; Kamış, Ayşe; Kurağ, Mustafa; Tavlı, Yusuf Emre; Poçan, BüşraAim: To measure Selcuk University Medical Faculty (SUMF) students’ levels of awareness of rational drug use (RDU) in adults and to assess related factors. Material and Methods: The data for this descriptive, cross-sectional study were derived from an online questionnaire completed by SUMF students; the questionnaire employed a sociodemographic survey and the Rational Drug Use Scale. Statistical analysis was conducted using the SPSS software, and a p-value of <.05 was considered statistically significant. Results: Four hundred and forty-six students (51.1% women, 48.9% men) participated in this study. The results showed that awareness of correct drug use was higher in women than in men (p=.01) and that awareness of correct drugs (p=.007), correct use (p=.003), and RDU (p=.002) were higher in clinical students than in preclinical students. Awareness of correct information (p=.008), correct drugs (p=.03), correct use (p=.009), and RDU (p=.002) were higher in students who took RDU education than in those who did not. Awareness of correct information (p=.018), correct use (p=.002), and RDU (p=.015) were also higher in students who considered RDU education necessary than in those who did not. Conclusion: The results of this research indicate that students’ RDU awareness levels should be improved. Effective, formal and non-formal education opportunities should continue to be used and developed to create and spread awareness of RDU.Öğe Topikal Lidokainin Bilateral Otoplasti Sütür Alınması Klinik Modelinde Ağrıyı Azaltmada Etkinliğinin Değerlendirilmesi(Selçuk Üniversitesi, 2017 Aralık) Aksoy, Hasan Mete; Aksoy, Berna; Öç, BaharAmaç: Topikal anestezik maddelerin küçük kutanöz cerrahi girişimler öncesi invazif olmayan yöntemle analjezi sağlamada etkili oldukları gösterilmiştir. Sunulan bu pilot gözlemsel çalışmada topikal lidokain uygulamasının bilateral otoplasti modelinde sütürlerin alınması sırasında hasta ağrısını gidermedeki etkisi araştırılmıştır. Gereç ve Yöntem: Bilateral otoplasti operasyonu yapılan hastaların sütür alınması öncesinde bir kulağa topikal lidokain diğer kulağa saf vazelin uygulanmıştır. Sütür alınması sırasında oluşan ağrıyı karşılaştırmaları istenmiştir. Bulgular: Tüm otoplasti hastaları topikal lidokain uygulamasının saf vazelin ile karşılaştırıldığında sütür alınması sırasında oluşan ağrı hissini azalttığını belirtmişlerdir. Herhangi bir yan etki gelişimi gözlenmemiştir. Sonuç: Erişkin otoplasti sütür alınması modelinin topikal anestezik etkinliğini değerlendirmede etkili bir klinik model olduğu gözlenmiştir. Ayrıca, topikal lidokain pomad kutanöz cerrahi sütür alınması sırasında düşük ağrı eşiği olan hastalarda kullanılmaya uygundur.Öğe Yoğun Bakımdaki Kritik Hastalarda Akut Böbrek Hasarında Renal Replasman Tedavisi Kararı ve Zamanlaması(Selçuk Üniversitesi, 2019 Ocak) Kara, İskender; Yıldırım, Fatma; Türkoğlu, Melda; Aygencel, GülbinYoğun bakım ünitelerinde (YBÜ) takip edilen kritik hastalarda gelişen akut böbrek hasarı (ABH) önemli bir morbidite ve mortalite nedenidir. Bu hastalarda yapılan renal replasman tedavilerinin (RRT) başlatılmasında hangi kriterlerin kullanılacağı ve tedavinin ne zaman başlatılacağı soruları net olarak cevaplanmış değildir. Bu derlemede YBÜ’de RRT başlangıcını belirleyen faktörler incelendi. Ayrıca hastaların üre-kreatinin seviyeleri, idrar çıkışı-sıvı yükü, YBÜ yatışı ile RRT başlangıcı arasında geçen süre, prognostik faktörler ve bazı belirteçlere göre başlatılan erken ve geç RRT çalışmaları incelendi. Sonuçta YBÜ’de kritik hastalarda RRT başlangıcını belirleyen kriterler ve bu kriterlerin eşik değerlerinin kişiselleştirilmesi gerektiği düşünüldü.Öğe Geriatrik ve Non-geriatrik Yoğun Bakım Hastalarında Kolistin İlişkili Nefrotoksisite: Retrospektif Kohort Çalışması(Selçuk Üniversitesi, 2018 Aralık) Duman, İpek; Bayraktar, Yeşim Şerife; Duman, AteşAmaç: Kolistin (kolistimetat sodyum) son yıllarda çoklu ilaç direnci gösteren gram negatif bakterilerin oluşturduğu nozokomiyal enfeksiyonların tedavisinde kullanılmaktadır. Kolistin kullanımı sonucu gelişen ciddi advers etkiler arasında nefrotoksisite önemli bir yer tutar. Geriatrik hastalarda kolistin ve nefrotoksisite ilişkisine yönelik çalışmalar kısıtlıdır. Amacımız Yoğun Bakım Ünitesinde Acinetobacter baumannii enfeksiyonu nedeniyle kolistin tedavisi alan geriatrik (?65 yaş) ve nongeriatrik (<65yaş) hastalar arasında akut böbrek yetmezliği (ABY) gelişimi ile demografik veriler, laboratuvar ve klinik fizyolojik parametreler açısından farklılıkları değerlendirmekti. Gereç ve Yöntem: Hastaların akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE II) skorları, diyabetes mellitus, vücut kitle indeksi (VKİ), yatış süresi ve nedenleri kaydedildi. Başlangıç ve tedavi sırasındaki en yüksek üre, kreatinin, albümin değerleri ile glomerüler filtrasyon hızları (GFR) değerlendirmeye alındı. Nefrotoksisite riski taşıyan ek ajan alıp almadığı da araştırıldı. Akut böbrek yetmezliği kriteri olarak renal replasman ihtiyacı alındı. Renal replasman tedavisi, vazopresör ilaç kullanımı ve mortalite sıklığı da kaydedildi. Gruplar arasındaki klinik ve laboratuvar verilere ilişkin farklılıklar istatistiksel olarak değerlendirildi. p<0,05 anlamlı kabul edildi. Bulgular: Geriatrik hastalarda ABY görülme sıklığı, diyabetes mellitus tanısı, APACHE II skoru, VKİ, başlangıç GFR değerleri ve kolistin sonrası en düşük GFR değerleri ile en düşük albümin değerleri nongeriatrik hastalara göre anlamlıydı. Gruplar arasında mortalite, hipertansiyon, septik şok, vazopresör kullanımı ve potasyum seviyelerinde fark yoktu. Sonuç: Acinetobacter baumannii enfeksiyonunda kolistin kullanılan geriatrik yoğun bakım hastalarında ABY sık gelişmektedir. Geriatrik hastalarda APACHE II skorlarının, VKİ’lerinin, diyabet, ABY ve renal replasman sıklığının nongeriatrik hastalara oranla daha yüksek olmasına karşın yaş grupları arasında mortalite farkı yoktur.Öğe Transüretral Mesane Tümörü Rezeksiyonu Sonrası Bacillus Calmette-guérin (Bcg) İmmünoterapisine Bağlı Nadir Bir Komplikasyon: Akut Solunum Yetmezliği ve Sepsis(Selçuk Üniversitesi, 2018 Aralık) Çiçekci, Faruk; Büyükcavlak, Mustafa; Bayraktar, Yeşim Şerife; Çelik, Jale BengiYüzeyel mesane kanserinde intravezikal BCG tedavisi güvenli ve etkili olarak kabul edilir. Sistemik komplikasyonlar nadir de olsa fark edilmediğinde yaşamı tehdit edici olabilir. Bu olgu sunumunda, intravezikal BCG tedavisinden sonra sistemik enfeksiyonun erken ve etkili tedavisinin önemini vurgulamak istedik. Olgu: 52 yaşında yüzeyel mesane kanseri teşhisi konulan ve 4 kez Trans Uretral Rezeksiyon-Mesane Tümörü(TUR-MT) operasyonu uygulanan erkek hastaya BCG tedavisi planlanmış. BCG'nin üçüncü kür tedavisinden 2 hafta sonra, hasta yüksek ateş, kırıklık, solunum sıkıntısı nedeniyle yoğun bakım ünitesine yatırıldı. Hastayahemen anti-tüberküloz tedavisi başlandı. Yoğun bakım ünitesinde genel durumu bozulan hasta mekanik ventilatöre bağlandı. Hastada pozitif inotropik tedaviye cevap vermeyen hipotansiyon ile birlikte akut böbrek yetmezliği gelişti ve hemodiyaliz tedavisi başlandı. Ancak 23. günde, kardiyak arrest geçiren hasta tüm müdahalelerecevap vermedi ve eksitus oldu. Sonuç: BCG tedavisinin sistemik yan etkileri nadirdir, ancak hızlı ve etkin bir şekilde tedavi edilmezse yaşamı tehdit eder. Bu nedenle, BCG tedavisinden sonra ateş, taşikardi gibi sistemik bulgular görüldüğünde, anti-tüberküloz tedavisi hızla başlatılmalıdır. Kortikosteroidlerin tedaviye eklenmesi yapılan çalışmalarda önerilmektedir.Öğe Beyin Ölümü Tanısı Sonrasında Hasta Yakını Davranışlarının İncelenmesi: Bir Tıp Fakültesi Hastanesi Uygulaması(Selçuk Üniversitesi, 2021) Kara, İnci; Uluer, Mehmet Selçuk; Uludağ, AyhanAmaç: Çalışmamızda; hasta yakınlarının beyin ölümüne bakışları, buna paralel olarak organ bağışı konusu ve hastadan yaşam desteğini kesme konularında verdikleri kararların incelenmesi amaçlanmıştır. Materyal ve Metod: Selçuk Üniversitesi Tıp Fakültesi Hastanesinde 2017- 2019 yılları arasındaki beyin ölümü tanısı almış vakaların arşiv kayıtları taranarak yaş, cinsiyet, medeni durum, eğitim düzeyi, ikamet yeri gibi sosyo demografik özellikler kaydedildi. Arşiv kayıtlarından organ nakli izni verilen, aile isteği ile yaşam desteği kesilen, kendiliğinden kalp durması beklenen ve beyin ölümü deklerasyonu yapıldığı sırada kalbin durması şeklinde hasta yakını davranışları sınıflandırılarak yıllara göre vaka sayıları kaydedildi. Bulgular : Çalışmamız da arşiv taraması sonucunda toplamda 60 beyin ölümü tanısı konulmuştur. Hastaların yaş ortalaması 31.12 (std;24.7) dir. Erkek cinsiyet 37 (%61.7) kadın cinsiyet 23 (%38,3) olup erkeklerin oranı kadınlara göre daha yüksektir. Hasta yakını davranışlarında ise yaşam desteğinin kesilmesi en yüksek (%40) tercihtir. Bunu kalbin kendiliğinden durmasını bekleme (%38.3) ve organ bağışı (%18.3) takip etmektedir. Asıl dikkat çeken konu ise 2017-2019 yıllarında yaşam desteğinin kesilmesi kararını verenlerin oranı yüzde 20’den yüzde 50’ye çıkar iken, organ bağışı ise yüzde 25’den yüzde 10’a düşmüştür. Hasta yakını davranışları ile değişkenlerin Ki-kare analizinde hiçbir anlamlı ilişki bulunamamıştır. Sonuç : Hasta yakınlarının beyin ölümünü giderek daha fazla gerçek ölüm olarak kabullendikleri görülmüştür. Ancak bu kabullenmenin organ bağışına (nakil iznine) yansımaması hâlâ önemli bir sorun olarak karşımızdadır.Öğe Beyin Ölümü Tanısı Sonrasında Hasta Yakını Davranışlarının İncelenmesi: Bir Tıp Fakültesi Hastanesi Uygulamas(Selçuk Üniversitesi, 2021) Uludağ, Ayhan; Kara, İnci; Uluer, Mehmet SelçukAmaç: Çalışmamızda; hasta yakınlarının beyin ölümüne bakışları, buna paralel olarak organ bağışı konusu ve hastadan yaşam desteğini kesme konularında verdikleri kararların incelenmesi amaçlanmıştır. Materyal ve Metod: Selçuk Üniversitesi Tıp Fakültesi Hastanesinde 2017- 2019 yılları arasındaki beyin ölümü tanısı almış vakaların arşiv kayıtları taranarak yaş, cinsiyet, medeni durum, eğitim düzeyi, ikamet yeri gibi sosyo demografik özellikler kaydedildi. Arşiv kayıtlarından organ nakli izni verilen, aile isteği ile yaşam desteği kesilen, kendiliğinden kalp durması beklenen ve beyin ölümü deklerasyonu yapıldığı sırada kalbin durması şeklinde hasta yakını davranışları sınıflandırılarak yıllara göre vaka sayıları kaydedildi. Bulgular : Çalışmamız da arşiv taraması sonucunda toplamda 60 beyin ölümü tanısı konulmuştur. Hastaların yaş ortalaması 31.12 (std;24.7) dir. Erkek cinsiyet 37 (%61.7) kadın cinsiyet 23 (%38,3) olup erkeklerin oranı kadınlara göre daha yüksektir. Hasta yakını davranışlarında ise yaşam desteğinin kesilmesi en yüksek (%40) tercihtir. Bunu kalbin kendiliğinden durmasını bekleme (%38.3) ve organ bağışı (%18.3) takip etmektedir. Asıl dikkat çeken konu ise 2017-2019 yıllarında yaşam desteğinin kesilmesi kararını verenlerin oranı yüzde 20’den yüzde 50’ye çıkar iken, organ bağışı ise yüzde 25’den yüzde 10’a düşmüştür. Hasta yakını davranışları ile değişkenlerin Ki-kare analizinde hiçbir anlamlı ilişki bulunamamıştır. Sonuç : Hasta yakınlarının beyin ölümünü giderek daha fazla gerçek ölüm olarak kabullendikleri görülmüştür. Ancak bu kabullenmenin organ bağışına (nakil iznine) yansımaması hâlâ önemli bir sorun olarak karşımızdadır.Öğe Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after total knee arthroplasty: A randomized clinical trial(ASSOCIACAO PAULISTA MEDICINA, 2019) Cicekci, Faruk.; Yildirim, Ahmet.; Onal, Ozkan.; Celik, Jale Bengi.; Kara, Inci.BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated with periarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability.Öğe Trisomy 18(AKTIV DRUCK & VERLAG GMBH, 2019) Arun, Oguzhan.Trisomy 18, the second most common autosomal chromosomal disorder after trisomy 21, is characteristic with the presence of an extra chromosome 18; either full, mosaic trisomy, or partial trisomy 18q. The clinical pattern is characterised by growth deficiency that starts in the prenatal period; specific craniofacial features and marked psychomotor and cognitive developmental delay. Typical craniofacial features include dolichocephaly, short palpebral fissures, micrognathia, external anomalies of the ears, and redundant skin at the back of the neck. The presence of major systemic malformations is common, and any organ and system can be affected. Cardiovascular, respiratory, ophthalmologic, musculoskeletal, genitourinary, neoplastic, neurologic, and developmental problems can occur. Prenatal and early postnatal infant mortality rates are high. The postnatal median survival of children is 3 to 4.5 days; approximately 50% of babies with trisomy 18 live longer than one week and only five to 10% of children survive beyond the first year. Central apnoea, cardiac failure due to cardiac malformations, respiratory insufficiency due to hypoventilation, aspiration, and/or upper airway obstruction are major causes of death. Due to the short life expectancy, there are ethical concerns regarding offering interventional surgical operation to the children with Edwards syndrome.Öğe The use of vasoactive-inotropic score in adult patients with septic shock in intensive care(TURKISH SOC MEDICAL & SURGICAL INTENSIVE CARE MEDICINE, 2019) Kara, Iskender; Sargin, Mehmet; Bayraktar, Yeşim Şerife; Eyiol, Hatice; Duman, Ipek; Celik, Jale BengiObjective: Sepsis and septic shock are significant causes of mortality and morbidity. In septic shock, vasopressors and inotropic support are given for the treatment of hypotension. This study was designed to investigate the relationship between the vasoactive-inotropic score (VIS) and the results of sepsis patients in ICU. Methods: The data of 392 patients who were followed up with the diagnosis of septic shock in adult ICU were recorded retrospectively. Vasopressors and inotropic support of the patients during the first 48 hours after the diagnosis of septic shock were recorded. Mean and peak VIS values were calculated according to these values. The patients were divided into groups according to the mean VlS >= 10, peak VIS >= 10 and intensive care results and statistical analysis was performed. Results: The median ages of the patients were 68 (54.25-79) years and 239 (61%) were male. Dopamine 188 (47.9%), noradrenaline 365 (93.1%), adrenaline 53 (13.5%) and dobutamine 15 (3.8%) were used in the patients. The mean VIS was 9 (4-15), while the number of mean VIS >= 10 patients were 192 (49%). Peak VIS values were 11 (5-20), and the number of peak VIS >= 10 patients were 220 (56.1%). The mortality rate of the patients included in the study was 42.1%. The mean VIS score(13 vs 6, p=0.000), mean VIS >= 10 patient ratio (71.5% vs 32.6%, p=0.000), peak VIS score (16 vs 8, p=0.000), and peak VIS >= 10 patient ratio (73.3% vs 43.6%, p=0.000) were higher in non-survivors. The parameters such as mean VIS [OR 1.123, 95% CI 1.027-1.229, p=0.011], mean VIS >= 10 [OR 3.455, 95% CI 1.625-7.345, p=0.001] and peak VIS score [OR 0.917, 95% CI 0.851-0.989, p=0.024] were determined as independent risk factors for mortality. Conclusion: We conclude that vasoactive-inotropic score may be useful in predicting the outcome of septic shock patients in intensive care units.Öğe The relationship between vasoactive-inotropic score and mortality in adult patients with traumatic brain injury(TURKISH NEUROSURGICAL SOC, 2019) Kara, Iskender; Sargin, Mehmet; Bayraktar, Yesim Serife; Sahinoglu, Mert; Ildarov, Gurban; Duman, Ipek; Celik, Jale Bengi; Karabaglı, HakanAIM: To assess the feasibility of the vasoactive-inotropic score (VIS) in determining the amount of vasoactive support and its relationship with the mortality rate and characteristics of the patients with traumatic brain injury (TBI). MATERIAL and METHODS: This study was conducted with a retrospective design involving the years 2013-2018 in a university hospital which provides tertiary intensive care service. A total of 102 patients who were admitted in the ICU with the diagnosis of severe TBI, and also were followed by neurosurgery service and who received vasoactive and inotropic support were analyzed concerning VIS value. RESULTS: The median age of the patients was 34 years, and 69.6% of the patients were male. Mortality rate was 43.1%. In the group with mean VIS >= 10, the admission duration in the ICU and hospital were shorter (p<0.0001) whereas mortality rates were higher (81.1% vs 21.5% and p<0.0001). Besides, the number of patients with a VIS score of >= 10, >= 15 and >= 20 were higher in the group of patients who died (p<0.0001). The results of the multivariate analysis such as VIS >= 10 were significant. CONCLUSION: We can conclude that VIS, which is used to determine the amount of vasoactive and inotropic medicines during cardiac surgery and in sepsis patients, may be useful in predicting mortality in TBI patients.Öğe The effects of intra-articular injection of ibuprofen on knee joint cartilage and synovium in rats(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2019) Kutahya, Emine Cepni; Oc, Bahar; Ugurluoglu, Ceyhan; Duman, Ipek; Arun, OguzhanObjective: The aim of this animal study was to investigate the short and long-term local histomorphologic effects and the utility of intra-articular application of ibuprofen. Methods: Forty-six Wistar Albino rats were used in the study. The rats were randomized into 5 groups of 8 and a sham group of 6. The 40 rats in the study groups were anaesthetised with 60 mg/kg of ketamine, then 0.25 ml ibuprofen (25 mg) was injected to the right knee joint of each rat (ibuprofen group) and 0.25 ml 0.9% saline to the left knee joint as the control group. To the 6 rats in the sham group, only puncture was applied to both knee joints. The rats in each of the 5 study groups were sacrificed on days 1, 2, 7, 14 and 21 respectively. The histomorphologic changes were graded on a 6-point scale regarding inflammation of the synovia, cartilage tissue, and subchondral bone. Inflammation scores were compared using the Mann Whitney U-test and comparisons of the sacrifice day and drug used were evaluated with the Kruskal Wallis test. The p values below 0.05 were considered as significant. Results: Statistically significant difference was found between the ibuprofen injected knees (10/40) and the saline injected (0/40) and sham knees (0/12) in respect of hematoma positivity (p = 0.002). Significantly higher inflammation scores were found in ibuprofen injected knees on the 1st, 2nd, 7th and 14th days compared to controls and sham (p < 0.05). Inflammation scores were similar in ibuprofen injected knees with and without hematoma (p > 0.05). Inflammation of the ibuprofen injected group was most severe on day one and the severity of inflammation reduced gradually throughout the 3 weeks. Conclusion: Our results show that intra-articular injection of ibuprofen can cause intra-articular hematoma. It also leads to transient inflammation of the synovia that is more severe in the early period, which gradually recovers. (C) 2019 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.Öğe The effects of dexmedetomidine on human internal mammary artery and saphenous vein grafts under hypothermia and normothermia(COMENIUS UNIV, 2019) Oc, B.; Arun, O.; Taylan, S. B.; Oc, M.; Bariskaner, H.; Duman, A.OBJECTIVES: The purpose of this study was to determine the effects of hypothermia and normothermia on the isolated human saphenous vein (SV) and internal mammary artery (IMA) responses to dexmedetomidine. METHODS: The response of human IMA and SV strips with (E+) and without (E-) endothelium subjected to cumulative concentrations of (10(-9), 0(-6) M) dexmedetomidine were recorded at 37 degrees C and at 28 degrees C. OnE-way ANOVA was used for analysis. A p < 0.05 was considered significant. RESULTS: At 37 degrees C dexmedetomidine resulted in similar signifi cant concentration-dependent contractions in both E+ and E-SV strips (p < 0.05). At 37 degrees C dexmedetomidine resulted in signifi cant concentration-dependent contractions in E+ IMA strips, these contractions were significantly lower at all concentrations of dexmedetomidine in E-compared to E+ IMA strips (p < 0.05). When results between similar groups of SV and IMA strips were compared, the contractions were significantly higher in the IMA strips in E+ and E-at 37 degrees C and also E-28 degrees C groups compared to SV (p < 0.05). CONCLUSION: In conclusion, dexmedetomidine causes in vitro vasoconstriction in human IMA and SV grafts. These contractions are greater in IMA compared to SV grafts. Endothelium-derived pathways are possibly involved in the contractile responses of IMA. Moderate hypothermia augments vasoconstriction in SV graftsÖğe The effect of bispectral index monitoring on cognitive performance following sedation for outpatient colonoscopy: a randomized controlled trial(ASSOCIACAO PAULISTA MEDICINA, 2019) Sargın, Mehmet; Uluer, Mehmet Selçuk; Şimşek, BarışBACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients' baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients' post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance.Öğe Sedation for colonoscopy: Comparison of remifentanil and alfentanil combined with Propofol/Midazolam(ISTANBUL TRAINING & RESEARCH HOSPITAL, 2019) Arıcan, Şule.; Çicekçi, Faruk.; Hacıbeyoğlu, Gülçin.; Sizer, Çiğdem.; Uzun, Sema Tuncer.; Dertli, Ramazan.; Keskin, Muharrem.Introduction: Different drug combinations are used in patients who underwent colonoscopy for safe sedation and early discharge. Remifentanil and alfentanil are short-acting narcotic analgesic agents. A short-acting anxiolytic agent, midazolam has a potent sedative efficiency when combined with narcotic analgesics. In this study, we aimed to compare the effectiveness of the two opioids that have not been previously compared in the literature, combined with propofol/midazolam in patients who underwent colonoscopy. Methods: One hundred eighty-nine patients aged over 18 years who underwent diagnostic and/or therapeutic colonoscopy were included in the study. 1 mg midazolam + 5 mu g kg-1 alfentanil + 1 mg kg-1 propofol were administered in the alfentanil group (group A), while 1 mg midazolam + 0.1 mu g kg-1 min-1 remifentanil + 1 mg kg-1 propofol were administered in the remifentanil group (group R). Hemodynamic data, Modified Steward scale (MSS), Visual Analog scale (VAS), additional propofol doses, total procedure time, awake time, recovery time, and side effects were recorded during the procedure. After the procedure, all patients were transferred to the recovery room, and the Modified Aldrete scale (MAS) values were recorded. Results: There was a statistically significant difference between the groups in terms of total propofol and additional propofol doses (p<0.05), with additional propofol dose being higher in group A compared to group R (p<0.05). Awake time was similar between the groups. Recovery time was longer in group A compared to group R (p<0.05). No significant difference was observed in the side effects between both groups. Conclusion: Although the low dose of midazolam combined with propofol/remifentanil and propofol/alfentanil provided adequate sedation and analgesia, we believe that remifentanil is an ideal choice for daily procedures like colonoscopy because of its advantages resulting from its pharmacological properties.Öğe Relationship between mortality and the laboratory values at admission to palliative care unit in geriatric patients with no diagnosis of malignancy(GUNES KITABEVI LTD STI, 2019) Sargın, Mehmet.; Demirel, Huzeyfe Feyyaz.Introduction: With a global rise in the elderly population, the need for palliative care units (PCU) is also increasing. Moreover, it is important to determine the prognosis in these patients. Thus, the present study aimed to evaluate the relationship between mortality and the biomarkers at admission to PCU, in the geriatric patients with no diagnosis of malignancy. Materials and Method: Medical records of the patients hospitalised in the Isparta City Hospital PCU, between 01.03.2017 and 31.03.2018, were retrospectively reviewed. Age, gender, neutrophil, lymphocyte and platelet counts, mean platelet volume and the C-reactive protein and albumin values, at admission to the PCU, were evaluated. Results: The median age of the patients was 81 years (interquartile range: 73-87 years), and 58.5% (n=76) of the patients were female. The mortality rate of the patients was 21.5% (n=28). An albumin value<3.5 g/dL (odds ratio 35.40, 95% confidence interval (CI)=4.86-257.65 and p<0.001) was determined as an independent risk factor. The cut-off for the mean albumin value according to the receiver operating characteristic analysis, performed to predict the mortality rate, was 3.5 g/dL, with sensitivity and specificity values as 89% and 92%, respectively. The positive and negative predictive values and the positive and negative likelihood ratio values were 0.75, 0.96, 11.38 and 0.12, respectively (area under the curve=0.937 and 95% CI=0.880-0.994, p<0.0001). Conclusion: Albumin values may effectively predict the prognosis of geriatric PCU patients, not diagnosed with malignancy.Öğe Neostigmine treatment protocols applied in acute colonic pseudo-obstruction disease: A retrospective comparative study(AVES, 2019) Ilban, Omur; Cicekci, Faruk; Celik, Jale Bengi; Bas, Mehmet Ali; Duman, AtesBackground/Aims: When conservative methods fail, neostigmine is recommended in the pharmacological treatment of acute colonic pseudo-obstruction (ACPO). The objective of this study was to analyze the response of patients to different neostigmine protocols. Materials and Methods: Patients diagnosed with ACPO in the intensive care unit between January 2015 and September 2017 were retrospectively studied. Either of the two neostigmine protocols, the bolus dose (BD) or continuous infusion (CI), was applied to the ACPO patients who were unresponsive to conservative treatments, and the results were analyzed. Results: In 79 of 122 (64%) patients, the resolution of symptoms was observed with conservative treatments. Of 43 patients who did not respond to conservative treatments, 20 were applied neostigmine as BD, and 23 were applied by CI. A total of 55% of patients in the BD group and 60.9% patients in the CI group responded to neostigmine therapy after the first dose. The group-specific protocols were reapplied in patients unresponsive to the first dose. A total of 25% in the BD group and 8.7% in the CI group responded to the second dose treatment. As a result, 80% of patients from the BD group and 69.6% from the CI group responded to neostigmine therapy. Although an overall response rate was higher in the BD group, there was no significant difference between groups (P=0.322). Colonic complications were observed in 2 patients, 1 from each group. There were no major side effects requiring treatment cessation. Conclusion: The safety and effectiveness of both neostigmine protocols applied to ACPO patients were similar. Clinical and radiological responses were obtained without serious side effects with CI.Öğe Myroides sp, a rare opportunistic infective agent, at a hospital in Turkey(SOUTHEAST ASIAN MINISTERS EDUC ORGANIZATION, 2019) Kara, Iskender.; Kalem, Fatma.; Unaldi, Ozlem.; Arslan, Ugur.Myroides sp is a rare cause of infection, which can be fatal. Myroides spp isolates were obtained from urinal specimens of in- and out-patients attending a hospital in Turkey during July 2015 to November 2017. Myroides sp identification was based on colony morphology, biochemical properties and partial sequence of 16S rDNA, revealing the presence of M. odoratus. Antibiogram profiles showed almost all Myroides sp strains from in-patients (n = 11) were resistant to 13 antibiotics tested except for 50% that were intermediate resistant to tigecycline, whereas strains from out-patients (n = 4) were susceptible or intermediate susceptible. However, all Myroides sp strains lacked the six carbapenem resistance genes examined. Pulse-field gel-electrophoresis demonstrated clonality among four strains from in-patients. Clinical features of five in-patients and two outpatients isolates were believed to be due to Myroides infection and were treated accordingly; however, two died. Two out-patients believed to be infected recovered completely upon treatment. Ten in-patients had renal problems and all outpatients had urological problems or chronic renal failure. Myroides spp caused infection in both immunocompromised and immunocompetent patients in our study. Although tigecycline was used as first line treatment for Myroides-infected in-patients at this hospital, antibiograms of Myroides spp cultured from both in-and out-patients at other hospitals should be maintained to assist in prescribing appropriate antibiotics. Although Myroides infection is rare, its innate multi-drug resistance and propensity among patients with renal and urological problems warrants microbiological attention.Öğe In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries(COMENIUS UNIV, 2019) Arun, O.; Taylan, S. B.; Duman, I; Oc, B.; Yilmaz, S. A.; Tekin, A.; Celik, C.; Bariskaner H.; Celik J. B.OBJECTIVE: We aimed to investigate the vasoactive effects of dexmedetomidine on isolated human umbilical arteries and possible mechanisms involved. METHODS: Human umbilical artery strips were suspended in Krebs-Henseleit solution and dose-response curves were obtained for cumulative dexmedetomidine before and after incubation with different agents; propranolol, atropine, yohimbine, prazosin, indomethacin, verapamil. Effects of calcium on cumulative dexmedetomidine-induced contractions were also studied. RESULTS: Cumulative dexmedetomidine resulted in dose dependent contraction responses. Incubation with propranolol (Emax: 93.3 +/- 3.26 %), atropine (Emax: 92.0 +/- 6.54 %), or indomethacin (Emax: 94.25 +/- 2.62 %), did not attenuate dexmedetomidine-elicited contractions (p > 0.05). There were significant decreases in the contraction responses of cumulative dexmedetomidine with yohimbine (Emax: 12.1 +/- 11.9 %), prazosin (Emax: 28.8 +/- 4.6 %) and verapamil (Emax: 11.2 +/- 13.6 %) (p < 0.05). In Ca+2 free medium contraction responses to cumulative dexmedetomidine was insignificant (Emax: 5.20 +/- 3.42 %). Addition of cumulative calcium to the Ca+2 free medium resulted in concentration dependent increase in contractions (Emax: 64.83 +/- 37.7 %) (p < 0.05). CONCLUSION: Dexmedetomidine induces vasoconstriction in endothelial-free umbilical arteries via both, alpha(1)- and alpha(2)-adrenergic receptors and also extracellular Ca+2 concentrations play a major role. beta-adrenergic receptors, muscarinic cholinergic receptors, and inhibition of cyclooxygenase enzyme are not involved in this vasoconstriction (Fig. 3, Ref. 36). Text in PDF www.elis.sk.
