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Application of prilocaine-lidocaine cream for the internal jugular venous cannulation and comparison with prilocaine HCI infiltration
(2005) Köro?lu A.; Çiçek M.; But A.K.; Toprak H.I.; Ersoy M.Ö.
In this study, it was aimed to evaluate the effects of prilocaine-lidocaine cream applied at different durations on the quality analgesia and procedure and to compare them with those of prilocaine HCI infiltration for internal jugular venous (IJV) cannulation. Seventy-five cases performing IJV cannulation before operations were included in the study. Prilocaine-lidocaine cream was applied before IJV cannulation in Groups I, II, III, and IV during 60, 90, 120 and 180 min, respectively. Prilocaine HCI infiltration was applied in cases of Group V. The level of pain was evaluated with the visual analogue scale during infiltration of prilocaine HCI and IJV cannulation. In addition, the depth of skin-İJV, the quality of analgesia and procedure were recorded. Adequate skin analgesia was obtained in all cases. Number of cases obtained adequate analgesia at different depths in cases in which prilocaine-lidocaine cream was applied were higher in Groups III and IV than in Groups I and II at 0.5 cm depth, higher in Group IV than in Groups I and II, and in Group III than in Group I at 1 cm depth, and higher in Group IV than in Group I at 1.5 cm depth. The quality of analgesia was better in group IV than in Groups I and II. Total number of cases obtained adequate analgesia was significantly higher, the requirement of additional 2% prilokain HCI infiltration was lower in Group IV than in Groups I and II, and also in Group V than in Groups I, II, and III, during IJV cannulation. As a result, we hold the opinion that prilocaine-lidocaine cream applied for 3 h provided more effective analgesia than the shorter duration of application. Also, since when it was applied during 90, 120, and 180 min it provided clinically better the quality of procedure it could be a better alternative to the prilocaine HCI infiltration.
Comparison of haemodynamic profile and recovery characteristics of total intravenous anaesthesia and desflurane anaesthesia in paediatric outpatient surgery
(2005) Özpolat Z.; To?al T.; Toprak H.I.; Öztürk E.; Çiçek M.; Ülger H.; Ersoy M.O.
Aim: We aimed to compare the intraoperative haemodynamic profile and recovery characteristics of total intravenous anaesthesia (TIVA) with remifentanilpropofol and inhalation anaesthesia with desflurane-N2O in paediatric patients. Materials and Methods: Fifty children, ASA I, aged 4-12 years undergoing tonsillectomy, adenoidectomy or insertion of ventilation tubes, were included into the study. After premedication with midazolam orally, induction was performed intravenously with lidoeaine 1 mg kg-1, remifentanil 1 ?g kg-1, propofol 3 mg kg-1 and vecuronium 0.1 mg kg-1. Patients were divided into two groups: In Group I, remifentanil 0.5 ?g kg-1 min-1 and propofol 50 ug kg-1 min-1 were given; in Group II, desflurane 8.3 % and N2O 50 % in O2 were given. The heart rate (HR), mean arterial pressure (MAP), SpO2, PETCO2 and body temperature were monitorized. Emergence and recovery times, side effects like hypoxia, laryngospasm, nausea-vomiting, pain, and agitation were recorded. Results: In Group I, MAP increased at all times except after induction when compared with baseline, and decreased at all times except after intubation and surgical incision in Group II. HR decreased at surgical incision, 10, 20 and 30 minutes after incision in Group I when compared with baseline, and at all times except after intubation and surgical incision in Group II (p<0.05). In Group II, MAP was lower and HR was higher when compared with Group I. Eve-opening time and time to reach Aldrete score >8 in Group II was longer than in Group I. The time of spontaneous ventilation and extubation, and side effects were similar between groups. The incidence of postoperative pain and agitation was high in both groups. Conclusion: We concluded that both TIVA with propofol-remifentanil and desflurane-N2O based anaesthesia are suitable methods with short postoperative recovery for outpatient paediatric cases. However haemodynamic instability, postoperative agitation and pain are serious problems with both methods that should be solved.
Comparison of the Effects of Ketamine and Propofol Combined with Remifentanil 1 ?g kg-1 Bolus on Hemodynamic Changes and Intubating Conditions during Anesthetic Induction
(2003) Demirbilek S.; To?al T.; Gülhaş N.; Çiçek M.; Do?an Z.; Ersoy M.O.
Aim of this study was to compare the effects of ketamine and propofol combined with remifentanil 1 ?g kg-1 bolus on hemodynamic changes and intubating conditions during anesthetic induction. After obtaining approval from the Ethics Committee and patient informed consent, 44 patients, ASA physical status I, aged 20-56 years, who scheduled for elective surgery, were divided into two groups randomly. After administration of a bolus dose of remifentanil 1 ?g kg-1, patients in group K (n=22) received ketamine 1-1.5 mg kg-1, group P (n=22) received propofol 1.5-2 mg kg-1. The trachea was intubated 3 minutes after administration of vecuronium 0.1 mg kg-1 in all patients. The quality of intubation was scored as perfect, good and poor. Anesthesia was maintained with sevoflurane 1-1.5 % and 50 % nitrous oxide in oxygen, and if necessary remifentanil 0.5 pg kg-1 was administered. Systolic blood pressure (SAP), diastolic blood pressure (DAP), mean arterial pressure (MAP) and heart rate (HR) were recorded before (control) and after induction, before and 1, 3 and 5 min after placement of the tracheal tube, 1 min after surgical incision and every 5 min up to 30 minutes. Until surgical incision, SAP, DAP, MAP and HR were higher in group K than group P. There were no significance between groups regarding intubation scores and additional remifentanil requirements. As a result, we concluded that 1 pg kg-1 bolus of remifentanil combined with ketamine during induction provides better hemodynamic stability, and similar intubating conditions, when comparing those of propofol-remifentanil induction.
Effect of malnutrition on total intravenous anaesthesia in patients undergoing elective gastrointestinal surgery
(2007) Çiçek M.; Turan Y.B.; Toprak H.I.; Köro?lu A.; Ersoy M.Ö.
Aim: The effects of malnutrition on anesthesia induction, hemodynamics, recovery criteria, propofol consumption and complications were evaluated in patients undergoing elective gastrointestinal surgery. Material and method: Fifty adult patients (ASA I-III) were divided as well-nourished (n=24) and malnourished (n=26) after preanesthetic evaluation. For anesthesia induction, all patients recieved remifentanil (1 ?gr kg-1), 1 % propofol (until loss of consciousness and release of the object from the hand) and cisatracurium (0.1 mg kg-1). Patients were intubated 3 minutes afterwards. For maintenance, remifentanil 0.15 ?g kg-1 min -1, propofol 75 ?g kg-1 min-1 and cisatracurium 0.08 mg kg-1 h-1 were administered. Propofol dosage was adjusted according to hemodynamic changes. Age, weight loss in last 6 months, body weight, serum albumin level, intubation conditions, mean arterial pressure, heart rate, recovery criteria (spontaneous breathing, eye opening and extubation times), amount of propofol used and complications were recorded. Results: Mean age and weight loss were higher in malnourished patients when compared to well-nourished patients while body weight and albumin levels were lower (p<0.05). Mean arterial pressure at 20 and 30 minutes during the operation were higher in well-nourished patients (p<0.05). Heart rate was lower in well-nourished patients at 1 and 5 minutes during intubation and at 10 minutes during operation (p<0.05). The incidence of hypotension was higher in malnourished patients during anesthesia induction (p<0.05). Time to recovery of spontaneous breathing was shorter in well nourished patients (p<0.05), while eye opening and extubation times were similar. Conclusion: We propose that malnutrition might cause negative effects on blood pressure during anaesthesia induction. However, it does not alter intubation conditions, propofol consumption and recovery criteria.
Effects of intrathecal fentanyl or meperidine addition to bupivacaine on hemodynamic variables, postoperative analgesic requirements, levels of histamine, IgE, basophiles and eosinophiles
(2003) Köro?lu A.; Erdem S.; Çiçek M.; Do?an Z.; Sezgin N.; Ersoy M.O.
The aim of our study is to compare the effects of intrathecal fentanyl and meperidine with bupivacaine on hemodynamics, postoperative analgesic requirement, side effects and levels of histamine, IgE, basophiles, eosinophiles and to investigate a possible relationship between itching and levels of basophiles and eosinophiles. Heart rate, mean arterial pressure, SpO2 values, respiration rates of 45 cases were recorded before and after spinal anesthesia. Intrathecal 10mg bupivacaine heavy was used in combination with 0.5 mL 0.9% NaCl in group B, 25 ?g fentanyl in group F, 25 mg meperidine in group M were given. Blood samples were collected to determine the plasma levels of histamine, IgE, basophiles and eosinophiles 30 min before spinal anaesthesia, and at the 8th, 60th minutes of spinal anaesthesia. Analgesic requirement was evaluated for postoperative 24 hours by using VAS. Although plasma levels of histamine and basophiles were significantly higher in group M and F at the 8th, 60th min of spinal anaesthesia, levels of histamine were significantly higher in group M than other two groups at the 8th min of spinal anaesthesia. VAS scores and analgesic requirements were significantly lower in group M than the other two groups at late postoperative period. Itching and vomiting incidences were higher in group F and there was no relationship between itching and levels of eosinophiles and basophiles. In conclusion, we determined that intrathecal fentanyl and meperidine did not effect hemodynamics, and meperidine provided better analgesia in the postoperative period. Although, histamine release increased with both opioids, it was more in meperidine than fentanyl, however fentanyl caused more vomiting and itching. There was no relationship between levels of eosinophiles, basophiles and itching.
The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy
(2003) Köro?lu A.; To?al T.; Çiçek M.; Kiliç S.; Ayas A.; Özcan M.
Objective: to determine fluid-electrolyte and hemodynamics changes and complications associated with irrigation fluid volume and time in percutaneous nephrolithotripsy in that 0.9% NaCI was used as irrigant. Methods: Standard anaesthetic procedures were performed to 6 women and 16 men. Mean arterial pressure, heart rate, central venous pressure, Na+, K+, osmolality, haemoglobin, haematocrit were recorded before, during and after irrigation every 10 minutes. Creatinine and blood urea nitrogen were determined before and after irrigation. Moreover, the operation and irrigation times, irrigation fluid volume, total fluid output versus input, blood transfusions and complications were recorded. Results: Mean arterial pressure, heart rate, central venous pressure, Na+, K+, osmolality did not change significantly during and after irrigation and no relationship was observed between those with irrigation volume and time. Creatinine and blood urea nitrogen values during and after irrigation did not change significantly versus those before irrigation. Although no blood transfusion was needed for any case during the procedure, it was necessary for two cases after the procedure. One case with pneumothorax that developed during procedure was treated by inserting a thoracic tube. Conclusion: There were no significant changes in fluid-electrolyte balance and hemodynamics related to both irrigation fluid volume and irrigation time when 0.9% NaCI was used in PNL.
Effects of Irrigation Fluid Volume and Irrigation Time on Fluid Electrolyte Balance and Hemodynamics in Percutaneous Nephrolithotripsy
(2003) Köro?lu A.; To?al T.; Çiçek M.; Kiliç S.; Ayas A.; Ersoy M.Ö.
This study was performed to determine fluid-electrolyte and hemodynamics changes and complications associated with irrigation fluid volume and irrigation time in percutaneous nephrolithotripsy (PNL) in which 0.9 % NaCl was used. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), Na+, K+, osmolality (Osm), haemoglobin, haematocrit values of 22 cases that were included into the study were recorded before, during and after irrigation every 10 minutes. Creatinine (Cre), blood urea nitrogen (BUN) were determined before and after irrigation. Moreover, operation and irrigation time, irrigation fluid volume, and complications were recorded. Mean time of operation and irrigation, irrigation fluid volume were determined 125.45 min, 69.40 min, 24.22 L, respectively. MAP, HR, CVP, Na +, K+, Osm did not significantly change during and after irrigation when compared to before irrigation. Fair degree of positive relationship was determined between irrigation fluid volume and Na+, CVP values after irrigation. Also significant positive relationship was determined between irrigation fluid volume and CVP during irrigation. Only significant positive relationship was determined between irrigation time and Na+ after irrigation. One case who developed pneumothorax developed during procedure was treated by inserting a thoracal tube. As a result, we established that there were no clinically significant changes in both fluid-electrolyte balance and hemodynamics related to irrigation fluid volume and irrigation time when 0.9 % NaCl was used in PNL. However we suggested that MAP, CVP, Na+ and Osm should be monitored closely when extensive amount of irrigation fluid volume and irrigation time were used.
Emergent Anesthesia Management of a Premature Case with Asplenia Syndrome and Complex Congenital Heart Disease
(2003) Çiçek M.; Köro?lu A.; To?al T.; Özpolat S.; Ersoy M.O.; Karada? N.
A premature case with asplenia syndrome and complex congenital heart disease underwent an urgent laparotomy. After general anesthesia induction with fentanyl, atracurium and sevoflurane, single shot caudal anesthesia with bupivacaine was performed. There was no complication during the operation. The case was not extubated and transported to paediatric intensive care unit. He died at the postoperative fourth day because of heart failure and sepsis.
Identifying malnutrition with subjective global assessment in hospitalized elective surgical patients
(2007) Çiçek M.; Gedik E.; Gülhaş N.; Do?an Z.; Ersoy M.Ö.
Aim: Malnourished patients have longer hospitalization time, increased drug usage, less functional capacity and higher morbidity and mortality rates compared to well-nourished patients. It has been reported that American Society of Anesthesiologists physical status (ASA) evaluation is not suitable in 'estimating nutritional status and this should be evaluated seperately. In this study, the aim was to determine nutritional status of adult hospitalized elective surgical patients with Subjective Global Assessment during preanesthetic evaluation. In addition, patients' age and hospitalization time was evaluated before preanesthetic evaluation with regard to their nutritional status. Material and Method: A total of 450 adult patients from 9 departments were included in this study. Following preanesthetic evaluation, patients' nutritional evaluation were performed in accordance with Subjective Global Assessment. Results: Overall prevalence of malnutrition in adult hospitalized elective surgical patients was determined as 24.22 %. Highest risk of malnutrition was determined in cardiovascular (50.00 %), orthopedic (36.17 %) and general surgery (31.70 %) patients. Mean age and hospitalization time were significantly higher in malnourished patients when compared to well-nourished patients as determined in the preanesthesic evaluation (p<0.05). Conclusion: Overall prevalence of malnutrition in adult elective surgical patients was 24.22 %. The departments with highest rates of patients with malnutrition were Cardiovascular Surgery, Orthopedic Surgery and General Surgery. In addition, it was concluded that malnourished patients tended to have higher mean age and a longer mean hospitalization time before preanesthesic evaluation.
Pregnancy and lightning strike (case report)
(2006) Borazan H.; Gedik E.; Çiçek M.; Ülger H.; Ersoy Ö.
It is estimated that lightning strikes kill nearly 1000 people per year worldwide, but 70% of these injuries have good survival rates and are not fatal. There are three mechanisms in lightning strikes: a direct strike, (most often fatal of causing severe injuries), current deflection from a tree or other tall object, or current transfer from the ground to the lower extremity of the body. In this case report, the clinical diagnosis and subsequent management of a 29 year-old 28 week pregnant woman who had been exposed to a lightning strike while working in the open field are described.
The prevalence of malnutrition in elective surgical patients
(2006) Çiçek M.; Gedik E.; Gülhas N.; Do?an Z.; Ersoy M.O.
Aim: Malnourished patients have longer hospital stays, more drug usage, poorer functional capacity and higher morbidity and mortality rates compared to well-nourished patients. To prevent malnutrition in hospitalized patients, physicians should be aware of the fact that every hospitalized patient may be in risk, so that early diagnosis and treatment can be undertaken. The aim of this study was to determine the prevalence of malnutrition with Subjective Global Assessment in elective surgical patients. Materials and Methods: A total of 1355 adult patients from 9 departments were included in this study. Preanesthetic evaluation and Subjective Global Assessment were performed in that order. Results: The departments with highest rates of malnutrition were cardiovascular surgery (28.8%), neurosurgery (24.4%), and general surgery (21.9%). Overall prevalence of malnutrition was 12.8%. The average duration of Subjective Global Assessment was 2.42 min. Conclusion: It was concluded that Subjective Global Assessment is an readily employable after preanaesthetic evaluation.
A severe botulism outbreak from homemade canned portulaca olearacea (5 cases)
(2007) Çiçek M.; Gedik E.; Kayabaş Ü.; Bulut S.; Bayindir Y.; Ersoy M.Ö.
Five cases of serious botulism resulting from homemade canned portulaca olearacea and the applied therapy are presented. All cases were evaluated at the Emergency Department 35 hours after the meal except one who was admitted 31 hours after the event. They were diagnosed as botulism depending on anamnesis and clinical data. They were supported by mechanical ventilation due to progression in muscle paralysis in the Intensive Care Unit. Botulinum antitoxin was applied to all cases 49 hours after the meal. They were performed percutaneous tracheostomi at 5 to 6 days of admittance. Nosocomial infections were treated with antibiotics. They were required by mechanical ventilation for 13 to 25 days. They were interned by infection disease ward after detracheostomised. All cases discharged with no morbidity after adequate therapy in the ward.
Simultaneous use of continuous veno-venous hemodiafiltration and activated protein C for treatment of septic shock and acute renal failure (case report)
(2006) Çiçek M.; Gedik E.; Do?an Z.; Gülhaş N.; Ersoy M.Ö.
Objective: The mortality of severe sepsis and septic shock is extremely high. We aimed to present a case to which we applicated continuous veno-venous hemodiafiltration and activated protein C for treatment of septic shock and acute renal failure. Case report: Assessment of the 42 -year old male with gun-shot wound in the emergency service revealed that Glasgow Coma Scale 3, isochoric pupils, bilateral positive light reflex, cold and pale skin, spontaneous ventilation rate (38 min-1), blood pressure (64/42 mmHg), and heart rate (174 min-1). In urgent operation, primary repair of liver laceration and diaphragm rupture, cholecystectomy, caecum resection and ileocolostomy, greft to femoral artery, thorax drainage with bilateral tubes, orchiectomy and debridment of tibia fracture were performed. After the operation, he was mechanically ventilated in intensive care unit. In first day, APACHE II score was determined as 34. In the 9th day, septic shock and acute renal failure developed in spite of antibacterial and supportive treatments. In another operation, subhepatic abscess drainage, repair of ileocolic anastomosis and ileostomy were performed. Activated protein C and continuous veno-venous hemodiafiltration were started following the operation. Activated protein C treatment was stopped for 2 hours and than percutaneous tracheotomy was performed. Activated protein C was started again one hour after the tracheotomy and than administered totally 96 hours. Patient was discharged with tibia fracture sequel in the 47th day. Conclusion: In a case with septic shock and acute renal failure due to abdominal infection, in addition to standard care and treatment of cause of sepsis, simultaneous continuous veno-venous hemodiafiltration application and activated protein C administration may be life-saving.

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