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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 Anesthetic management of Guillain Barre Syndrome in a pregnant woman(2017) Gulhas, Nurcin; Erdogan Kayhan, Gulay; Karademir, Ali; Sanli, Mukadder; Durmus, MahmutGuillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy with symmetrical weakness characterized by loss of sensation and reflexes. During pregnancy the morbidity and mortality of GBS is high. GBS patients are prone to acute respiratory failure due to weaknes of respiratory muscles, hypotension associated with autonomic dysfunction, hemodynamic instability such as the development of hypertension and arrhythmia. Patients may need intensive care. The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient. Therefore, we aimed to present the anesthetic management of cesarean planned in a GBS case.Öğe The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties(Tubıtak scıentıfıc & technıcal research councıl turkey, ataturk bulvarı no 221, kavaklıdere, ankara, 00000, turkey, 2016) Sanli, Mukadder; Gulhas, Nurin; Bilen, Bilge Turk; Erdogan Kayhan, Gulay; Ucar, Muharrem; Aytekin, Ahmet Hamdi; Yologlu, SaimBackground/aim: The objective of this study was to examine the effect of addition of subanesthetic doses of ketamine to an epinephrine-lidocaine solution on postoperative pain, analgesic use, and patient comfort during rhinoplasties. Materials and methods: Ninety patients were randomly divided into three groups: Group L, lidocaine with epinephrine; Group K, lidocaine with epinephrine plus ketamine; and Group S (control group), physiological saline solution with epinephrine. The local anesthetic solution was injected as preincisionally with intranasal submucosal infiltration following induction of general anesthesia. We evaluated visual pain score, analgesic demand, Wilson sedation score, and antiemetic demand at 5, 15, and 30 min and 1, 2, 4, 6, 8, 16, and 24 h after the operation. The patient satisfaction score was checked 24 h after the operation. Results: Visual pain score was significantly reduced in Group K in comparison with the other groups and this group did not need any rescue analgesics (P < 0.05). The postoperative patient satisfaction scores were highest in Group K compared with the other groups (P < 0.05). Conclusion: Addition of ketamine solution to lidocaine for infiltration block during rhinoplasty was successful in decreasing pain during postoperative periods and reducing analgesic consumption during the first 24 h after the operation.Öğe Effects of different epidural initiation volumes on postoperative analgesia in cesarean section(Tubitak Scientific & Technological Research Council Turkey, 2020) Kacmaz, Osman; Gulhas, Nurcin; Erdogan Kayhan, Gulay; Durmus, MahmutBackground/aim: The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections. Materials and methods: Eighty-one pregnant women, aged 18-45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 mu g/ml, of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively. Results: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions: The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.
