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Öğe Accuracy of non-invasive hemoglobin monitoring by pulse CO-oximeter during liver transplantation(Edizioni Minerva Medica, 2017) Erdogan Kayhan, Gulay; Colak, Yusuf Z.; Sanli, Mukadder; Ucar, Muharrem; Toprak, Huseyin I.BACKGROUND: Hemoglobin level monitoring is essential during liver transplantation (LT) due to substantial blood loss. We evaluated the accuracy of non-invasive and continuous hemoglobin monitoring (SpHb) obtained by a transcutaneous spectrophotometry-based technology (Masimo Corporation, Irvine, CA) compared with conventional laboratory Hb measurement (Hb(L)) during LT. Additionally, we made subgroup analyses for distinct surgical phases that have special features and hemodynamic problems and thus may affect the accuracy of SpHb. METHODS: During LT, blood samples were obtained twice for each of the three phases of LT (pre-anhepatic, anhepatic, and neohepatic) and were analyzed by the central laboratory. The HbL measurements were compared with SpHb obtained at the time of the blood draws. RESULTS : A total of 282 data pairs obtained from 53 patients were analyzed. The SpHb values ranged from 6.9 to 17.7 g/dL, and the Hb(L) values ranged from 5.4 to 17.1 g/dL. The correlation coefficient between SpHb and HbL was 0.73 (P< 0.001), and change in SpHb versus change in HbL was 0.76 (P< 0.001). The sensitivity value determined using a 4-quadrant plot was 79%. The bias and precision of SpHb to HbL were 0.86 +/- 1.58 g/dL; the limits of agreement were -2.25 to 3.96 g/dL. The overall correlation between SpHb and Hb(L) remained stable in different phases of surgical procedure. CONCLUSIONS: SpHb was demonstrated to have a clinically acceptable accuracy of hemoglobin measurement in comparison with a standard laboratory device when used during LT. This technology can be useful as a trend monitor during all surgical phases of LT and can supplement HbL to optimize transfusion decisions or to detect occult bleeding.Öğe Comparison of Femoral and Radial Arterial Pressures for Goal Directed Fluid Therapy in Undergoing Liver Transplantation Recipients(Lippincott Williams & Wilkins, 2016) Ucar, Hacer; Colak, Yusuf Z.; Kitlik, Arzu; Ucar, Muharrem; Ince, Volkan; Toprak, Huseyin I.; Yilmaz, Sezai[Abstract Not Available]Öğe Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study(Wiley, 2017) Erdogan, Mehmet A.; Ozgul, Ulku; Ucar, Muharrem; Yalin, Mehmet R.; Colak, Yusuf Z.; Colak, Cemil; Toprak, Huseyin I.BackgroundTransversus abdominis plane (TAP) block provides effective postoperative analgesia after abdominal surgeries. It can be also a useful strategy to reduce perioperative opioid consumption, support intraoperative hemodynamic stability, and promote early recovery from anesthesia. The aim of this prospective randomized double-blind study was to assess the effect of subcostal TAP blocks on perioperative opioid consumption, hemodynamic, and recovery time in living liver donors. MethodsThe prospective, double-blinded, randomized controlled study was conducted with 49 living liver donors, aged 18-65years, who were scheduled to undergo right hepatectomy. Patients who received subcostal TAP block in combination with general anesthesia were allocated into Group 1, and patients who received general anesthesia alone were allocated into Group 2. The TAP blocks were performed bilaterally by obtaining an image with real-time ultrasound guidance using 0.5% bupivacaine diluted with saline to reach a total volume of 40mL. The primary outcome measure in our study was perioperative remifentanil consumption. Secondary outcomes were mean blood pressure (MBP), heart rate (HR), mean desflurane requirement, anesthesia recovery time, frequency of emergency vasopressor use, total morphine use, and length of hospital stay. ResultsTotal remifentanil consumption and the anesthesia recovery time were significantly lower in Group 1 compared with Group 2. Postoperative total morphine use and length of hospital stay were also reduced. Changes in the MAP and HR were similar in the both groups. There were no significant differences in HR and MBP between groups at any time. ConclusionsCombining subcostal TAP blocks with general anesthesia significantly reduced perioperative and postoperative opioid consumption, provided shorter anesthesia recovery time, and length of hospital stay in living liver donors.Öğe Feasibility, safety, and economic consequences of using low flow anesthesia according to body weight(Springer Japan Kk, 2020) Colak, Yusuf Z.; Toprak, Huseyin I.Background Low flow anesthesia (LFA) provides a saving up to 75% and improves the dynamics of inhaled anesthesia gas, increases mucociliary clearance, maintains body temperature, and reduces water loss. LFA has been recommended for anesthesiologists in recent years to avoid high fresh gas flow (FGF). However, LFA use is limited due to associated risks. The main purpose of this study was to investigate whether LFA according to body weight, which is the main determinant of oxygen requirement, is feasible and safe in the normoxia range. The second aim was to show that this method can provide economic benefit. Methods Eighty donor hepatectomy cases were included to study in two groups as prospective, observational. A surgery room and a team were allocated only for this study. Considering the oxygen requirement (approximately 3-3.5 mL/kg/min), for the first 40 cases, 10 mL/kg (group 10) FGF was applied; for the second 40 cases, 20 mL/kg (group 20) was applied. Desflurane (Suprane (c)) was used as an inhalation agent, and analgesia was achieved with remifentanil infusion. Patients' demographic, respiratory, hemodynamic, and tissue perfusion parameters (SpO(2) and NIRS), and comsumption data (anesthetic agent and CO2 absorbent) were collected and compared. Results No significant differences were detected between the groups in terms of demographic data, duration of surgery, and hemodynamic, respiratory, and tissue perfusion parameters. These parameters were within normal limits in all patients at all times. The maximum O-2 concentration in the FGF that maintained FiO(2):0.4 and provided adequate oxygenation during the LFA was 61% (min 56%; max 67%) in group 10, and 47% (min 43%; max 51%) in group 20. The hourly anesthetic agent consumption was significantly different in group 10 than in group 20 (12.4 +/- 4 mL vs. 21.5 +/- 8 mL/h, respectively (p < 0.001). Conclusions We performed 10 mL/kg FGF speed without deviating from the safety limits to be FiO(2):0.4 in donor hepatectomies, reducing the total costs 38% compared with 20 mL/kg FGF.Öğe Feasibility, safety, and economic consequences of using minimal flow anaesthesia by Maquet FLOW-i equipped with automated gas control(Nature Portfolio, 2021) Colak, Yusuf Z.; Toprak, Huseyin, ILow fresh gas flow rates are recommended because of their benefits, however, its use is limited due to associated risks. The main purpose of this study was to investigate whether 300 mL of fresh gas flow that practised with automated gas control mode is applicable and safe. The second aim is to show that automated mode can provide economic benefits. Sixty hepatectomy cases who suitable criterias were included to cohort study in three groups as prospective, sequential, observational. An operating room were allocated only for this study. 300 mL fresh gas flow with automated mode (groupA3), 600 mL fresh gas flow with automated mode (groupA6) and, 600 mL fresh gas flow with manually (groupM6) was applied. Patients' respiratory, hemodynamic parameters (safety), number of setting changes, O-2 concentration in the flowmeter that maintained FiO(2):0.4 during the low flow anaesthesia (feasibility) and comsumption data of anaesthetic agent and CO2 absorber (economical) were collected and compared. p < 0.05 was accepted as statistical significance level. No significant differences were detected between the groups in terms of demographic data and duration of operation. Safety datas (hemodynamic, respiratory, and tissue perfusion parameters) were within normal limits in all patients. O-2 concentration in the flowmeter that maintained FiO(2):0.4 was statistically higher in groupA3 (92%) than other groups (p < 0.001) but it was still within applicable limits (below the 100%). Number of setting changes was statistically higher in groupM6 than other groups (p < 0.001). The anaesthetic agent consumption was statistically less in groupA3 (p = 0.018). We performed fresh gas flow of 300 mL by automated mode without deviating from the safety limits and reduced the consumption of anaesthetic agent. We were able to maintain FiO(2):0.4 in hepatectomies without much setting changes, and we think that the automated mode is better in terms of ease of practise.Öğe Noninvasive Indocyanine Green as an Early Prediction Test for Liver Transplantation in Three Patients With ALF(Lippincott Williams & Wilkins, 2015) Colak, Yusuf Z.; Ince, Volkan; Ucar, Hacer; Aydin, Cemalettin; Toprak, Huseyin I.; Yilmaz, Sezai[Abstract Not Available]Öğe Trending and Accuracy of Noninvasive Hemoglobin Monitoring During Liver Transplantation(Lippincott Williams & Wilkins, 2016) Toprak, Huseyin I.; Ucar, Muharrem; Colak, Yusuf Z.; Ucar, Hacer[Abstract Not Available]
