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    Effect of oxygen administration with double nasal cannula on respiratory complications in gastrointestinal endoscopy
    (2025) Demiroz, Duygu; Sanli, Mukadder; Gülhas, Nurçın; Arslan, Ahmet Kadir; Atayan, Yahya; Toplu, Hacı Osman
    In the present study, the purpose was to investigate the effect of oxygen therapy applied with a double nasal cannula on desaturation and respiratory complications in cases planned for gastrointestinal endoscopy. A total of 300 patients with ASA I-II, between the ages of 18-65, who were scheduled to undergo gastrointestinal endoscopy, were included in the study. Following routine monitoring, the patients were randomized into 3 groups using the envelope method. Group TK5 (n=100) was administered 5 liters/minute (L/min) preoxygenation with a nasal oxygen cannula for 5 minutes during the procedure and afterwards, 5 L/min oxygen in the same manner. Group TK15 (n=100) was administered 15 L/min preoxygenation with a nasal oxygen cannula for 5 minutes during the procedure and afterwards, 15 L/min oxygen in the same manner. Group CK30 (n=100): 30 L/min preoxygenation with a double nasal oxygen cannula for 5 minutes, and 30 L/min oxygen in the same manner during and after the procedure. The incidence of desaturation was found to be significantly lower in GTK15 (7%) and GCK30 (2%) compared to GTK5 (31%) (p<0.05). Advanced desaturation was not detected in any patient in GTK15 and GTK30, while it was detected in 18% of the GTK5 group (p<0.05). Severe desaturation was detected in 11% of the GTK5 group, while there was no severe desaturation in the other groups (p<0.05). The duration of desaturation was longer in GTK5 than in the other groups. The time to reach 99% oxygen saturation was significantly shorter in the G15 and G30 groups compared to the G5 group (p < 0.05). This time was significantly shorter in GCK30 than in GTK15 (p<0.05). However, there was a burning sensation in the nose in 30% of the patients in double nasal cannula oxygen applications (p<0.05). It was found that oxygen administration with a double nasal cannula had similar effectiveness to single nasal cannula 15 L/min flows in preventing respiratory complications in sedation applications performed for gastrointestinal system endoscopies, and that respiratory complications were significantly reduced at both flow rates compared to 5 L flow rates. It was also found that a single cannula 15 L/min application was better in terms of patient comfort.
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    Effects of combining nicardipine and remifentanil on surgical visual field and hemodynamic parameters in functional endoscopic sinus surgery
    (2025) Karaaslan, Erol; Gülhas, Nurçın; Ozkan, Ahmet Selim; Tunç, Yeliz; Özdeş, Oya Olcay
    Aim: This study examined the impact of using a Nicardipine/Remifentanil combination inducing controlled hypotension (CH) in Functional Endoscopic Sinus Surgery (FESS). The goal was to minimize bleeding and enhance the visibility of the endoscopic field. The study focused on surgical field visibility, asccess, its hemodynamic consequences, and the impact on postoperative paraöeters such as nausea, vomiting, and pain. Materials and Methods: Our study included 73 patients whose age ranging between 18 and 65 years. The patients were randomly assigned to two groups. Group R (Remifentanil) (n=36) patients, and Group RN (Remifentanil/Nicardipine combination) (n=37) patients. Following intubation, In Group R, patients were administered an intravenous (IV) infusion of Remifentanil at a rate of 0.05–2.0 µg/kg/min, while Group RN received Remifentanil at 0.025–1 µg/kg/min, Nicardipine at 0.5–3.5 µg/kg/min. Target mean arterial pressure (MAP) was set at 50–65 mmHg. After the surgical procedure began, bleeding volume, suction requirements, and surgical field visibility were assessed at 15-minute intervals using the Boezaart scale. Duration of stay in the Post-Anesthesia Care Unit (PACU), incidence of nausea, vomiting, and pain assessment with the Numeric Rating Scale (NRS) were evaluated. Results: PACU length of stay was considerably shorter in Group RN compared to Group R (p=0.003). Pain scoring was greater in Group R (p=0.001). Nausea and vomiting scores were less in group RN (p=0.037). SAP and MAP were considerably lower in group RN (p=0.018 and p=0.023). HR values şin all time intervals were greater in group RN (p= <0.001). Boezaart score was lower in group RN during in all intervals (p= <0.001). Conclusion: The Remifentanil/Nicardipine combination provides better surgical field access and visibility byb inducing controlled hypotension (CH) in FESS. This combination is preferable over Remifentanil alone. It effectively maintains CH and shows greater success in reducing postoperative pain, nausea, and vomiting scores.
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    The effect of different norepinephrine administration methods on hypotension after spinal anesthesia in caesarean sections
    (2024) Gülhas, Nurçın; Ozkan, Ahmet Selim; Düz, Senem Arda; Arslan, Ahmet Kadir; Seyhun, Nurşen
    We aimed to evaluate the effect of different routes of norepinephrine (NE) administration on maternal hypotension in pregnant females undergoing spinal anesthesia for caesarean section. 208 pregnant women were divided randomly into 4 groups (n=52). Bolus 4 μg/ml NE was administered intravenous (iv) immediately after spinal anesthesia in Group PB (Prophylactic Bolus). In Group PI (Prophylactic Infusion), 1 ml of saline solution was applied promptly after spinal anesthesia and then the NE infusion was started at 1 ml/min. In Group TB (Treatment Bolus), 1 ml Physiological Saline (PS) was administered after 1 ml/min infusion of PS immediately after spinal anesthesia and then 1 ml/min NE bolus when blood pressure decreased by 20% after the entry. In Group TBI (Treatment Bolus Infusion), 1 ml PS was administered after 1 ml/min infusion of PS immediately after spinal anesthesia, 1 ml NE and then 1 ml/min NE infusion was initiated when blood pressure decreased by 20% after the entry. At the 4th, 6th, and 8th minutes, the PI Group exhibited higher systolic and mean blood pressures than the other groups (p<.001). Additionally, hypotension was statistically lower in the PI Group than in PB, TB, TBI groups (p<.001), and episodes of hypotension, ephedrine required and extra NE boluses given were statistically lower in the PI Group than in the other groups (p<.001). Umbilical vein (UV) pH values were lower in the TBI Group at compared to the other groups (p<.001). It is suggested that a prophylactic infusion of 4 μg/min of NE in the prevention of hypotension following spinal anesthesia for cesarean section will reduce the possibility of maternal hypotension and better maintain fetal well-being than a prophylactic bolus, a treatment bolus or a posttreatment bolus infusion at the same dose.