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Öğe Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant(Baskent Univ, 2016) Ucar, Muharrem; Erdil, Feray; Sanli, Mukadder; Aydogan, Mustafa Said; Durmus, MahmutKidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on exam-ination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardiopulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.Öğe Application of medical data mining on the prediction of apache ıı score(Medicine Science | International Medical Journal, 2015) Çolak, Cemil; Aydogan, Mustafa Said; Arslan, Ahmet Kadir; Yücel, AytaçThe Acute Physiology and Chronic Health Evaluation (APACHE II) is a beneficial tool for the estimation of risk and the comparison of the patients who received care with similar risk properties. Machine learning based systems can assist clinicians in the early diagnosis of diseases. This research aimed at predicting the APACHE II score using Support Vector Machine (SVM) from Medical Data Mining (MDM). The records of 280 patients from intensive care unit included the dataset containing the target variable (the APACHE II score), and 23 demographical/clinical predictor variables. Genetic algorithm based feature selection and 10-fold cross validation method were employed. SVM with radial basis (RBF) was constructed. The performance of the proposed approach was assessed using root mean squared error (RMSE), mean absolute error (MAE), correlation (R) and coefficient of determination (R2 ). Mean age of the individuals was 51±23 years. 153 (54.6%) were females, and 127 (45.4%) were males. The proposed approach yielded the values of 1.037 for RMSE, 0.727 for MAE, 0.993 for R and 0.986 for R2 , respectively. The results demonstrated that the proposed approach had an excellent predictive performance of the APACHE II score. Additionally, ensemble approaches such as bagging, boosting, voting etc. can improve markedly the performance of the prediction and classification tasks.Öğe Approach to Acute Iron Intoxication: A Case Report(Galenos Yayincilik, 2011) Ozgul, Ulku; Erdogan, Mehmet Ali; Gedik, Ender; Ucar, Muharrem; Aydogan, Mustafa Said; Togal, TurkanIn adults, the main causes of iron poisoning are intake suicide attempts and an overdose of iron during pregnancy. The severity of intoxication depends on the amount of iron. When serum iron level exceeds the iron binding capacity of the body, free radicals occurs, leading to lipid peroxidation and cellular membrane damage. In iron poisoning, especially the liver, heart, kidney, lung, and hematologic systems are affected negatively. Acute iron poisoning can cause serious complications resulting in death. Clinical, laboratory observation and early treatment are important. In this case report, we examined to approach the acute iron poisoning with the occasion of high-dose iron intake for suicide attempt.Öğe Approach to the Iron deficiency in liver transplant recipients in ıntensive care(2017) Aydogan, Mustafa SaidPreoperative anemia is a common condition in surgical patients, particularly those with end-stage liver failure. Liver transplant (LT) represents the last therapeutic option for end-stage liver failure patients. The procedure is often associated with major blood loss, requiring allogeneic blood product transfusions. The prevalence of anemia in LT recipients ranges from 2% to 28% and the prevalence of iron deficiency (ID) among LT recipients ranges from 45% to 60%. Several factors may contribute to anemia, including occult gastrointestinal bleeding, folate and vitamin B12 deficiency, autoimmune hemolysis, altered oxide-reductive balance, hypersplenism (in adults), and nutritional deficiency (in children). The intensive care unit (ICU) plays a vital role in the practice of LT recipients. A prolonged ICU stay consumes physical and financial resources. Among LT patients, it may be associated with an increased risk of complications and greater mortality. Preoperative ID may be able to identify patients who are likely to need a prolonged ICU stay after LT because of preoperative ID is associated with high intraoperative PRBC transfusion requirements in LT patients. Furthermore, the quantity of blood products administered intraoperatively is a well known independent risk factor for a prolonged ICU stay after LT. Improvements in preoperative evaluation, surgical techniques, and intraoperative anesthesia of LT recipients during the past decade have resulted in shorter ICU stay. We believe that to avoid prolonged ICU stay, transfusion is important during LT.Öğe Comparing 2% lidocaine gel (Dispogel and Cathejell) in cystoscopy(Sage Publications Ltd, 2019) Ucar, Muharrem; Oguz, Fatih; Gecit, Ilhan; Aydogan, Mustafa SaidObjective Cystoscopy is a common urologic procedure. Analgesics are often used to reduce any pain associated with this procedure. The aim of this study was to investigate the efficacy in reducing pain and the cost-effectiveness of two forms of lidocaine gel in patients undergoing cystoscopy. Methods In this double-blind, randomized clinical trial, 77 male patients who were referred for double J removal, urethral dilatation, or cystoscopy were enrolled. The patients were divided into two groups: Dispogel and Cathejell. All patients received 20 mL of intraurethral lidocaine gel 2% and cystoscopy was performed 5 minutes thereafter. The primary outcome was the pain score (visual analogue scale, VAS) during and 5 minutes after cystoscopy. Results There were no statistically significant differences between the VAS scores, blood pressure, and pulse rate in the groups in either observation period. No patient required additional anesthetic agents or sedatives for insufficient pain relief. Conclusion The results of this study show that the analgesic efficacy of Dispogel and Cathejell in the treatment of pain during and after elective cystoscopy was the same, but Dispogel was more cost-effective.Öğe Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial(Springer Japan Kk, 2013) Erdogan, Mehmet Ali; Begec, Zekine; Aydogan, Mustafa Said; Ozgul, Ulku; Yucel, Aytac; Colak, Cemil; Durmus, MahmutThe objective of this study was to compare the effects of ketamine-propofol mixture (ketofol) and propofol on ProSeal laryngeal mask airway (PLMA) insertion conditions and hemodynamics in elderly patients. Eighty elderly patients, American Society of Anesthesiologists (ASA) physical status I and II, were randomly divided into two groups to receive either propofol 0.15 ml/kg (n = 40), or ketofol (using a 1:1 single-syringe mixture of 5 mg/ml ketamine and 5 mg/ml propofol) (n = 40) before induction of anesthesia. Sixty seconds after induction, the PLMA was inserted. Heart rate and arterial blood pressure (systolic [S] BP) were recorded prior to the induction of anesthesia, immediately following induction, immediately after PLMA insertion, and 5 and 10 min after PLMA insertion. PLMA insertion conditions were scored according to mouth opening, swallowing, coughing, head and body motion, laryngospasm, and ease of PLMA insertion by the same experienced anesthesiologist, who did not know which agents were used. There were no differences in PLMA insertion conditions between the groups. The number of patients in need of ephedrine (P = 0.043) and the total dose of ephedrine (P = 0.022) were significantly lower, and apnea duration (P < 0.001) was significantly higher in the ketofol group compared with the propofol group. SBP was significantly higher in the ketofol group than in the propofol group immediately after PLMA insertion and 5 min after PLMA insertion. The same PLMA insertion conditions were found with ketofol and propofol. The number of patients in need of ephedrine and the total ephedrine dose were lower and apnea duration was increased in the ketofol group.Öğe Effective management of exposure keratopathy developed in intensive care units: The impact of an evidence based eye care education programme(Elsevier Sci Ltd, 2014) Demirel, Soner; Cumurcu, Tongabay; Firat, Penpegul; Aydogan, Mustafa Said; Doganay, SelimObjectives: To assess the impact of eye care education on the incidence of corneal exposure in intensive care units (ICU). Research methodology/design: Approximately 300 ICU personnel were educated about eye care to reduce the incidence of corneal exposure. The patients were divided into two groups: pretraining (Group 1: Between February 1, 2011 and March 31, 2011 [2 months]) and post-training periods (Group 2: Between April 1, 2011 and April 1 2012 [1 year]). We compared the groups for keratopathy incidence to evaluate the efficacy of this education. Results: The number of patients were 762 in Group 1 and 6196 in Group 2 (p=0.335). Medians of patients followed in pre training ICU and post training ICU for each month were found to be 476 (interquartile range, 433-539) and 515 (interquartile range, 490-528). Exposure keratopathy was identified in 8 eyes of 6 patients (3 males and 3 females) in pre training ICU with the mean age of 27.6 +/- 31.8 years and 5 eyes of 3 patients (1 male and 2 females) in post training ICU with the mean age of 41.3 +/- 32.1 years. No significant difference was noticed between two groups in terms of the medians of patients followed in ICUs for each month (p =0.335). The time of hospitalisation in ICU when the patients were consulted for the first ocular assessment in pre training ICU and post training ICU were found to be 13 +/- 8.7 days and 8 +/- 1.7 days, respectively. After the training, the decrease in incidence of exposure keratopathy was found to be highly significant (p<0.001). Conclusion: We observed a highly significant reduction in the incidence of corneal exposure, following the eye-care education programme. (C) 2013 Published by Elsevier Ltd.Öğe Effects of ?- Glucan Liver Ischemia/Reperfusion Injury in Rats(Wiley-Blackwell, 2012) Aydogan, Mustafa Said; Yucel, Aytac; Erdogan, Mehmet Ali; Polat, Alaadin; Cetin, Asli; Ucar, Muharrem; Duran, Zeynep Rumeysa[Abstract Not Available]Öğe The effects of iron deficiency on red blood cell transfusion requirements in non-bleeding critically ill patients(Allied Acad, 2016) Aydogan, Mustafa Said; Ucar, Muharrem; Yucel, Aytac; Karakas, Bugra; Gok, Abdullah; Togal, TurkanIntroduction: Critically ill patients often need blood transfusion, but no reliable predictors of transfusion requirements are available at Intensive Care Unit (ICU) admission. We hypothesized that ICU patients admitted with Iron Deficiency (ID) may be at higher risk for developing anemia, requiring blood transfusion. The aims of this study were to determine the frequency of ID in ICU patients admission and to investigate its relationship with transfusion requirements in ICU patients. Methods: Two hundred ninety-six patients admitted to the general ICU were enrolled in the prospective observational study. We studied 268 patients, after excluding those transfused on or before ICU admission. The patients recorded age, gender, diagnosis, severity scores, presence of sepsis, ICU complications, ICU treatments, and transfusion-free interval. ID was assessed on the basis of several parameters, including hemoglobin, hematocrit, levels of serum iron, transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein. Results: The mean age was 48 years. Of 268 patients (138 male/130 female), 114 (42.8%) had ID with outcomes of blood samples were used at ICU admission. The overall transfusion rate was 38.8%, being higher in ID patients than in normal iron profile patients (40.3 vs. 18.9%, P= 0.001). After adjusting for severity of illness and hemoglobin level, ID patients remained significantly associated with transfusion, with a hazard ratio of 5.3 (95% CI, 1.8-14.8; P= 0.001). Conclusion: ID is common at ICU admission and is associated with higher transfusion requirements. These findings have important implications for transfusion practices for in ICU patients.Öğe Effects of Ketamine-Propofol Mixture on Intraocular Pressure and Haemodynamics in Elderly Patients: A Randomised Double-Blind Trial(Aves, 2014) Aydogan, Mustafa Said; Demirel, Soner; Erdogan, Mehmet Ali; Firat, Penpegul; Colak, Cemil; Durmus, MahmutObjective: The aim of this study was to compare the effects of a ketamine-propofol mixture (ketofol) and propofol on intraocular pressure (IOP) and haemodynamics in elderly patients during anaesthetic management at each repeated measurement times. Methods: Forty elderly ASA I and II patients were divided into two random groups and received either propofol (1.5 mg kg(-1); group P, n=20) or ketofol (1:1 single syringe mixture of 5 mg mL(-1) ketamine and 5 mg mL(-1) propofol; group KP, n=20). A proseal laryngeal mask airway (PLMA) was inserted 60 seconds after induction of anaesthesia. IOP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) values were recorded at preinduction (t0), immediately following induction (t1), and at 1 (t2), 3 (t3), and 5 (t4) minutes after induction. Hemodynamic complications and the need for ephedrine were also recorded. Results: Patient characteristics at the beginning of the procedure were similar between the groups. SBP and HR were significantly increased in group KP compared to group P at t1 and t4 (p=0.044). Induction of both anaesthetic agents significantly decreased the IOP values from the t0 (p=0.026). A significant decrease in IOP was found at t1 and t4 in group P compared to group KP (p=0.018). The total dose of ephedrine was statistically different in group P (p=0.034). Conclusion: Ketofol can be an alternative agent to provide haemodynamic stability with a moderate decrease in IOP during anaesthesia induction in elderly patients.Öğe Effects of Melatonin and ?-Glucan Combination Hepatic Ischemia and Reperfusion in Rats(Wiley-Blackwell, 2012) Aydogan, Mustafa Said; Erdogan, Mehmet Ali; Polat, Alaadin; Yucel, Aytac; Ozgul, Ulku; Parlakpinar, Hakan; Duran, Zeynep Rumeysa[Abstract Not Available]Öğe Effects of sample temperature and storage time on arterial blood gases values(Drunpp-Sarajevo, 2012) Aydogan, Mustafa Said; Yucel, Aytac; Erdogan, Mehmet Ali; Sanli, Mukadder; Konur, Huseyin; Ozgul, Ulku; Togal, TurkanBackground: Arterial blood gas analysis is vital during diagnosis and treatment monitorization of mechanically ventilated patients. Work overload delays blood gas analysis lead to false results. Therefore syringes and the blood samples is recommended to kept cool or cold environment. The aim of this study is to investigate the effect of refrigerator-cooled syringes on blood gas analysis. Methods: We prepared 12 heparinized polypropylene plastic syringes for blood gas analysis for each patients before the study. Syringes divided in tree group as kept at room temperature (Group Room, n=4), or stored in the refrigerator for 30 minutes (Group Refrigerator, n=4), or stored in the refrigerator for 30 minutes but blood samples stored at room temperature (Group Refrigerator and Room, n=4). 40 for each patient's blood samples on mechanical ventilation were analyzed immediately as reference value (T-0). Samples analyzed at 15, 30, 45 and 60 minutes. Results: Patients characteristics and mechanical ventilation parameters were similar in the three groups. In terms of impact of sample temperature and storage time on arterial blood gas analysis; pH, pCO(2), and pO(2) values were not differ significantly among the groups (Table 2, P>0.05). There was significant difference in 60 minutes SpO(2) value among the groups (Table 2, P<0.05). Conclusion: Storage of syringes at room temperature or cooling in refrigerator was not affect arterial blood gas analysis results immediately before obtaining of blood samples. Blood gas analysis with plastic syringes at room temperature can provide safe results up to 60 minutes.Öğe The effects of secondhand smoke on postoperative pain and fentanyl consumption(Springer Japan Kk, 2013) Aydogan, Mustafa Said; Ozturk, Erdogan; Erdogan, Mehmet Ali; Yucel, Aytac; Durmus, Mahmut; Ersoy, Mehmet Ozcan; Colak, CemilAlthough the need for increased postoperative analgesia in smokers has been described, the effect of secondhand smoke on postoperative analgesia requirements has not been studied. We examined the effects of secondhand smoke on fentanyl consumption and postoperative pain. In this study, 101 patients (American Society of Anesthesiology physical status I and II) who underwent abdominal hysterectomy were divided into 3 groups according to history of exposure to cigarette smoke as per medical records which was retrospectively confirmed by measurement of serum cotinine: smokers (n = 28), nonsmokers (n = 31), and secondhand smokers (n = 32). All patients received propofol-remifentanil total intravenous anesthesia and used fentanyl patient controlled analgesia for postoperative pain. The fentanyl consumption visual analogue scale-pain intensity (VAS-PI) score and side effects were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 h after surgery. Fentanyl consumption at all the evaluation time points was significantly higher in secondhand smokers than in nonsmokers (P < 0.05). However, fentanyl consumption in secondhand smokers was lower than that in smokers in the PACU and at 24 h (P < 0.05). VAS-PI scores during movement and at rest in the PACU and at 4, 6, and 24 h after surgery were higher in secondhand smokers than in nonsmokers (P < 0.05). There were no statistically significant differences between the groups with regard to side effects such as nausea, vomiting, and dizziness (P > 0.05). Secondhand smoking was associated with increased postoperative fentanyl consumption, and increased VAS-PI scores. These findings may be beneficial for managing postoperative pain in secondhand smokers.Öğe Efficacy of Intravenous Ibuprofen and Intravenous Paracetamol in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy(Elsevier Science Inc, 2022) Ucar, Muharrem; Erdogan, Mehmet Ali; Sanli, Mukadder; Colak, Yusuf Ziya; Aydogan, Mustafa Said; Yucel, Aytac; Ozgul, UlkuPurpose: Many different techniques, including multimodal analgesia, have been used for the management of postoperative pain after Percutaneous nephrolithotomy (PCNL). Ketorolac, intravenous (IV) paracetamol, rofecoxib, and IV ibuprofen have been used as a part of a multimodal analgesic approach in different surgical procedures. However, the efficacy of IV ibuprofen has not been well elucidated in adult patients undergoing elective PCNL. The aim of the study was to examine the efficacy of IV ibuprofen compared to IV paracetamol after elective PCNL. Design: This was a prospective randomized clinic study. Methods: The study was conducted with 50 patients scheduled for PNCL between the ages of 18 and 65. IV ibuprofen 800 mg infusion was used for Group I, and 1 g IV paracetamol infusion Group P. IV tramadol infusion was administered with a Patient Controlled Analgesia device for postoperative analgesia. The primary outcome was 24-hour tramadol consumption. Secondary outcomes were pain intensity and side effects of the drugs. All outcomes were recorded in the 30th minute in the PACU and in 2, 4, 6, 12, 24 hours postoperatively. Findings: Total postoperative tramadol consumption was significantly lower in Group I compared with Group P (P = .031). There was also a significant decrease in the cumulative tramadol consumption between the two groups in the 2nd and 24th hours (P < .012). In all measurement periods, pain intensity, sedation score, nausea and vomiting, itching, additional analgesia, and satisfaction with pain management were similar between the two groups. Conclusion: IV ibuprofen, used as a part of multimodal tramadol-based analgesia reduced tramadol consumption compared with IV paracetamol in the first 24 hours postoperatively after elective PCNL. The IV ibuprofen-tramadol combination seems appeared superior to a paracetamol-tramadol combination. (C) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.Öğe Evaluation of pleth variability index as a predictor of fluid responsiveness during orthotopic liver transplantation(Wiley, 2016) Konur, Huseyin; Kayhan, Gulay Erdogan; Toprak, Huseyin Ilksen; Bucak, Nizamettin; Aydogan, Mustafa Said; Yologlu, Saim; Durmus, MahmutFluid management is challenging and still remains controversial in orthotopic liver transplantation (OLT). The pleth variability index (PVI) has been shown to be a reliable predictor of fluid responsiveness of perioperative and critically ill patients; however, it has not been evaluated in OLT. This study was designed to examine whether the PVI can reliably predict fluid responsiveness in OLT and to compare PVI with other hemodynamic indexes that are measured using the PiCCO(2) monitoring system. Twenty-five patients were enrolled in this study. Each patient was monitored using the noninvasive Masimo and PiCCO(2) monitoring system. PVI was obtained with a Masimo pulse oximeter. Cardiac index was obtained using a transpulmonary thermodilution technique (CITPTD). Stroke volume variation (SVV), pulse pressure variation, and systemic vascular resistance index were measured using the PiCCO(2) system. Fluid loading (10 mL/kg colloid) was performed at two different phases during the operation, and fluid responsiveness was defined as an increase in CITPTD >= 15%. During the dissection phase and the anhepatic phase, respectively, 14 patients (56%) and 18 patients (75%) were classified as responders. There were no differences between the baseline values of the PVI of responders and nonresponders. Area under the curve for PVI was 0.56 (sensitivity 35%, specificity 90%, p = 0.58) at dissection phase, and was 0.55 (sensitivity 55%, specificity 66%, p = 0.58) at anhepatic phase. Of the parameters, a higher area under the curve value was found for SVV. We conclude that PVI was unable to predict fluid responsiveness with sufficient accuracy in patients undergoing OLT, but the SVV parameter was reliable. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.Öğe The Hemodynamic Effects of Dexmedetomidine and Esmolol in Electroconvulsive Therapy A Retrospective Comparison(Lippincott Williams & Wilkins, 2013) Aydogan, Mustafa Said; Yucel, Aytac; Begec, Zekine; Colak, Yusuf Ziya; Durmus, MahmutAim: Acute hemodynamic responses, including transient hypertension and tachycardia, to electroconvulsive therapy (ECT) predispose vulnerable patients to significant cardiovascular complications. Many drugs have been used in an attempt to attenuate these responses. To date, no comparative study of the acute hemodynamic effects of dexmedetomidine and esmolol in ECT has been published. Hence, this retrospective study aimed to compare the effects of dexmedetomidine and esmolol on acute hemodynamic responses in patients undergoing ECT. Materials and Methods: The anesthesia records for 66 patients who underwent a total of 198 ECT treatments performed between July 2009 and January 2010 were analyzed retrospectively. For each case, 1 seizure with 1-mg/kg propofol as control (group C), 1 seizure with 1-mu g/kg dexmedetomidine combined with propofol (group D; total volume, 30 mL for 10 minutes), and 1 seizure with 1-mg/kg esmolol combined with propofol were compared (group E; total volume, 30 mL for 10 minutes). Anesthesia was induced with 1-mg/kg propofol, and then intravenous succinylcholine, 0.5-mg/kg, was administered. Heart rates and systolic and mean blood pressures were recorded at baseline (T-0) and 1, 3, and 10 minutes after the seizure (T-1, T-2, and T-3, respectively). The electroencephalographic (EEG) tracing motor seizure duration, and recovery times (spontaneous breathing, eye opening, and obeying commands) were recorded. Results: The baseline hemodynamic measurements were similar between the groups. Heart rates at T-1, T-2, and T-3 were lower in group D than those in groups E and C (P < 0.05). Systolic blood pressures at T-1, T-2, and T-3 were lower in group D than those in groups C (P < 0.05). In addition, systolic blood pressure at T-3 was lower in group D than that in group E (P < 0.05). The mean blood pressure at T3 was significantly lower in group D than those in groups E and C (P <0.05). The electroencephalographic tracing, motor seizure durations, and recovery times were similar between the groups. Conclusion: Dexmedetomidine administration before anesthesia induction reduced the acute hemodynamic response compared with esmolol administration in the early period of ECT. Therefore, dexmedetomidine may be effective in preventing acute hemodynamic responses to ECT.Öğe Long-term analysis of patients admitted to the emergency room as a result of occupational accidents(Allied Acad, 2016) Gurbuz, Sukru; Aydogan, Mustafa Said; Colak, Cemil; Turtay, Muhammet Gokhan; Oguzturk, Hakan; Gur, Ali; Ekmekyapar, MuhammedObjective: We aimed to describe the demographic and clinical features and healthcare costs associated with occupation related injuries between 2010 and 2015. Method: The patients of occupational accidents were evaluated according to age, gender, accident type, trauma localization, duration of hospitalization in the emergency department, prognosis, imperfection types causing to accidents and outcomes and cost spent. Results: 449 patients diagnosed with occupational accidents from January 2010 to December 2014 were included in the analysis. Of injury referring distribution the most common cause of occupational accidents (type of accidents) was extremities injury 141 (31.4%). About 50.1% of all estimated construction occupational accidents treated in the emergency department affected upper extremities. Remaining injuries primarily affected the head, lower extremities and thorax (45%). The mean cost of an inpatient admission following occupational accidents was $232, and the overall costs of patient care for the study sample during this time frame exceeded $26.142 annually. Conclusions: Occupational injuries, illnesses, and fatalities remain a major public health and economic concern around the world. The findings from this study may be beneficial in the development, implementation, and evaluation of injury prevention policies and prevention programs.Öğe Management of the crush syndrome in critical patients: 10 cases(2017) Karakas, Bugra; Aydogan, Mustafa Said; Yucel, Aytac; Yucel, Neslihan; Kacmaz, Osman; Sari, Mirac SefaAbstract Introduction: Crush trauma may be life threating in extremities. Crush syndrome leads to a systemic disorder through muscle cytolysis and the spread of metabolic substance into the circulatory system. In the present study, we summarized the follow-up and treatment of 10 cases with intensive care unit (ICU) crush injury. Meterials and Methods: We have analyzed the clinical data of 10 patients with crush injury who were under treatment in the intensive care unit of our clinic. Age, sex, diagnosis, APACHE II score, sepsis, intensive care complications, treatment parameters in intensive care and arterial blood gases parameters, routine blood biochemistry, alanine aminotransferase, lactate dehydrogenase, creatine kinase, creatinine, existence of blood urea nitrogen, urinary protein and severity score of the patients have been recorded. Patients have been closely monitored for symptoms of crush injury, changes, crush area, urination and dangerous complications. Results: The mean age of 10 patients (10 male) was 41.3 ± 8.7 years. APACHE II score was 21,7. 8 out of 10 patients had traumatic shock, one showed acute renal failure and one presented with multiple organ dysfunction syndrome (MODS). In 3 patients presenting the criteria for crush syndrome, the symptoms of extremity distension and sensory function disorder were regulated with rapid surgical operation and hemodialysis, and urination increased, even in some patients, it reached the normal level. Serologic parameters were regulated in most of the patients after application. Amputation was applied to 5 (50%) patients in our group for serious infection and crush. 2 (20%) patients died, one because of MODS and one because of acute renal failure. Conclusion: Early and aggressive resuscitation, emergency treatment and close monitoring of serious complications are of great importance for saving the lives of the patients with crush syndrome under intensive careÖğe Patient controlled ıntermittent epidural bolus versus epidural ınfusion for posterior spinal fusion after adolescent ıdiopathic scoliosis(SPINE Volume 42, Number 12, pp 882–886., 2016) Erdoğan, Mehmet Ali; Özgül, Ülkü; Ucar, Muharrem; Korkmaz, Mehmet Fatih; Aydogan, Mustafa Said; Özkan, Ahmet Selim; Çolak, Cemil; Durmuş, MahmutStudy Design. A prospective, randomized, double-blinded study. Objective. The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis. Summary of Background Data. Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis. Methods. Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/ mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus. Results. Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group. Conclusion. The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid.Öğe Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis(Lippincott Williams & Wilkins, 2017) Erdogan, Mehmet Ali; Ozgul, Ulku; Ucar, Muharrem; Korkmaz, Mehmet Fatih; Aydogan, Mustafa Said; Ozkan, Ahmet Selim; Colak, CemilStudy Design. A prospective, randomized, double-blinded study. Objective. The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis. Summary of Background Data. Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis. Methods. Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus. Results. Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group. Conclusion. The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid.
