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Öğe Anaesthetic Management in Obstructive Sleep Apnea Syndrome for Adenotonsillectomy(Aves, 2014) Sanli, Mukadder; Toplu, Yuksel; Ozgul, Ulku; Kayhan, Gulay Erdogan; Gulhas, NurcinThe anaesthetic management of adenotonsillectomy in children with obstructive sleep apnea syndrome was characteristic due to respiratory and cardiac side effects. A detailed physical examination in the preoperative period should be performed, including children's respiratory and cardiac systems. If they have an active infection, surgery should be postponed until the end of medical treatment. Preparation for difficult airway management should be done in the preoperative period. In this case, we presented a report of two children who had obstructive sleep apnea syndrome, with airway management performed at the right lateral position to prevent the pharyngeal collapse and rapid sequence intubation performed using a short-acting muscle relaxant.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 Comparison of the effects of dexmedetomidineremifentanil and propofol-remifentanil combinations on postoperative cognitive functions in patients undergoing hysteroscopy: A randomized prospective study(2019) Atasoy, Idris; Soyalp, Celaleddin; Gulhas, NurcinAim: In the present study, we aimed to compare Dexmedetomidine-Remifentanil and Propofol-Remifentanil combinations in terms of postoperative cognitive functions in hysteroscopy attempts. Material and Methods: A total of 70 ASA I-II patients who were aged between 18 and 65 years were included in the study following the ethics committee approval. The patients were randomized into two groups (n=35), and standard routine monitoring were applied to them. The sedation depth was evaluated with Ramsey Sedation Score (RSS) before and after the sedation; and cognitive functions of the groups were evaluated with the Minimal Mental State Test (MMST). Propofol 1 mg/kg bolus 25-100 µg/kg/min infusion was administered to Group PR, and Dexmedetomidine 1 µg/kg bolus 0.4-0.7 µg/ kg/h infusion dose was administered to Group DR. Remifentanil 0.25 µg/kg bolus 0.04 µg /kg/min infusion was administered to the groups, and the groups were followed to ensure RSS≥4. Result: In cognitive functions, it was observed that there was significant regression in Group PR in postoperative period compared to the preoperative period (p<0.05). The hemodynamic parameters were lower in Group DR than in Group PR at 5th, 10th and 15th minutes following the hysteroscopy (p<0.05). The Modified Aldrete Score in Group DR were high, and pain scores were lower (p<0.05). Satisfaction with the surgeon, patient and anesthetist scores were higher in Group DR. No respiratory depression was observed (p<0.05). Conclusion: We believe that administering Dexmedetomidine-Remifentanil combination in sedation in hysteroscopy ensures better postoperative cognitive function, recovery conditions, analgesia, and patient and surgeon satisfaction compared to the PropofolRemifentanil combination.Öğe Current status of nitrous oxide use in operating rooms of Turkey(Kuwait Medical Assoc, 2023) Demirkiran, Hilmi; Tekeli, Arzu Esen; Yardimci, Cevdet; Korkutata, Zeki; Keskin, Siddik; Gulhas, NurcinObjective: Investigating the justifications of nitrous oxide (N2O) use in Turkey's hospitals and usage trends during the last five years. Design: A cross-sectional study Setting: A total of 170 university hospitals, training and research hospitals, state hospitals and private hospitals in Turkey. Subjects: Clinical chiefs of 170 anesthesia departments Interventions: A survey was conducted. The Kruskal-Wallis, Mann-Whitney U, Kolmogorov-Smirnov, Chi-square and Fisher tests were performed. This trial was registered at Clinical Trials.gov (NCT04124562). Main outcome measure(s): Hospital type, frequency of N2O use, how many times general anesthesia was used in a month, number of cases N2O was used on the day of the study, the status of N2O use by anesthetists in the last five years, and the reasons for its use were questioned. Results: N2O use combined with inhaled anesthetics was reported by 119 (72.1%) clinical chiefs of anesthesia departments. The mean number of general anesthesia cases in one month in 165 (84.1%) clinics included in this study was reported to be 95,044. The number of cases using N2O combined with inhalational anesthetics was 1401 (39.6%) in one day. Regarding N2O usage in the last five years, 68 (41.2%) anesthetists responded that their usage rate had decreased, 48 (29.1%) stated that they had stopped using, and 47 (28.5%) anesthetists responded that their usage rate was unchanged. Stopping or reducing N2O use due to environmental or global climate and pollution concerns were observed more frequently in the operating rooms of the university hospitals (P<0.05). Conclusion: Despite a reduced usage rate of N2O in Turkey, it is still higher than that of European countries.Öğe Does Rocuroinum Dose Adjusted Due to Lean Body Weight Provide Adequate Intubation Conditions?: A Prospective Observational Study(Wiley-Hindawi, 2022) Demiroz, Duygu; Colak, Yusuf Ziya; Iclek, Sumeyye Koc; Erdogan, Mehmet Ali; Yagci, Neslihan Altunkaya; Durmus, Mahmut; Gulhas, NurcinIntroduction and Aim. There is no consensus on the weight parameters to use when titrating the dosage of the neuromuscular blocking agents during intubation. In our study, we administered rocuronium, based on either the lean body weight (LBW) or the total body weight in patients with body mass index (BMI) of 18.5 to 34.9 and compared the duration of action of the drug and its effects on tracheal intubation conditions and hemodynamic parameters. Methods. This is a prospective, observational study. Patients between the ages of 18 and 65 with BMI of 18.5-34.9, who are expected to be under general anesthesia for less than 6 hours, were divided into 3 groups according to their BMI (Group 1 BMI = 18.5-24.9, Group 2 BMI = 25-29.9, Group 3 BMI = 30-34.9). These groups were randomly divided into 2 subgroups: Groups LBW; 1 LBW, 2 LBW, and 3 LBW were given rocuronium intubation dosages based on their LBW while control groups; 1K, 2K, and 3K were given 0.6 mg/kg rocuronium according to their total body weight. The data on the duration of action of rocuronium and its effects on the endotracheal intubation conditions were evaluated. Results. In Group 1, T1 time was found to be significantly longer (p=0.001). Intubation score and the use of additional rocuronium dose were found to be significantly higher in Group 1 LBW than in Group 1K (p=0.001). In Group 1, an additional rocuronium dose was needed to achieve optimal intubation conditions for subgroup 1 LBW. Rocuronium duration of action was found to be significantly longer in control groups 2 and 3, that received TBW-based dosage. Conclusion. In adult patients with a BMI of 18.5 and 24.9 BMI, we report optimal intubation conditions with the LBW-adjusted rocuronium dosage.Öğe The effect of low-dose ketamine on ephedrine requirement following spinal anesthesia in cesarean sections: a randomised controlled trial(Drunpp-Sarajevo, 2012) Gulhas, Nurcin; Ozgul, Ulku; Erdil, Feray; Sanli, Mukadder; Nakir, Hamza; Yologlu, Saim; Durmus, MahmutBackground: We aimed to assess the effectiveness of subanesthetic doses of ketamine on ephedrine requirement in patients scheduled for Cesarean section under spinal anesthesia. Methods: ASA I-II, 105, patients were enrolled in the study. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine and 15 mu g fentanyl. Following spinal anesthesia, patients were randomly allocated to three groups. Group Placebo: 2 mL of intravenous physiological saline, Group Ketamine 0.25: 0.25 mg.kg(-1) of intravenous ketamine, and Group Ketamine 0.5: 0.5 mg.kg(-1) of intravenous ketamine was received. Results: The systolic and mean blood pressures were similar in the groups. There were no significant differences between the groups, number of hypotensive attacks, as well as the amount of ephedrine used. The sedation scores in Group Ketamine 0.25 and Group Ketamine 0.5 were significantly higher than Group Placebo (p=0.001) Conclusions: Subanesthetic dose of ketamine is not effective on decreasing ephedrine requirement in Cesarean section under spinal anesthesia.Öğe The effect of magnesium on emergence agitation in children undergoing adenotonsillectomy under sevoflurane general anesthesia: a prospective randomised clinical trial(Drunpp-Sarajevo, 2012) Yucel, Aytac; Begec, Zekine; Ozgul, Ulku; Aydogan, M. Said; Gulhas, Nurcin; Ersoy, M. OzcanBackground: The aim of this study was to assess the effect of magnesium on the incidence of emergence agitation in preschool-aged children undergoing adenotonsillectomy with sevoflurane anaesthesia. Patients & Methods: 42 children, aged between 3 to 7 years, were randomised into either group M (magnesium, n=26) or group C (saline for controls, n=26). Anesthesia was induced by mask with 8 % sevoflurane in nitrous oxide and oxygen. Magnesium 15 mg.kg(-1) or saline was administered in about 20 minutes after the endotracheal intubation intraoperatively. All patients were ventilated with 60% nitrous oxide and sevoflurane was given at 1-1.5 MAC in oxygen. Mean blood pressure, heart rate, pulse oximetry, eye-opening time, extubation time were recorded in the operating room. In recovery, patients were evaluated using modified Aldrete score, the Pediatric Anesthesia Emergence Delirium (PAED) scale and the Oucher visual analog Pain Scale. Postoperative nause, vomiting, and airway complication and first analgesic application were recorded. Results: Time to eye opening, tracheal extubation, and first analgesic administration were not different between the groups. There were no statistically significant differences in mean arterial pressure and heart rate, pain score and PAED peak scale between the groups (p > 0.05). The modified Aldrete score was significantly lower in the magnesium group (p=0.004). There was no statistically significant difference between the groups regarding side effects. Conclusions: We conclude that the administration of magnesium 15 mg.kg(-1) did not have any significant effect in reducing the incidence of emergence agitation in children undergoing adenotonsillectomy under sevoflurane anaesthesia.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.Öğe Effects of ketofol and propofol on intubation conditions and hemodynamics without the use of neuromuscular blockers in patients undergoing tympanomastoidectomy(2019) Demiroz Aslan, Duygu; Ucar, Muharrem; Erdogan, Mehmet Ali; Sanli, Mukadder; Gulhas, Nurcin; Çolak, Cemil; Durmus, MahmutAbstract: The effect of ketofol, a mixture of ketamine and propofol in various ratios, on hemodynamic, for intubation without the use of neuromuscular blockers, has not been elucidated in patients undergoing tympanomastoidectomy. We evaluated the effects of ketofol and propofol on intubation conditions and hemodynamic without the use of a neuromuscular blocker. The prospective randomized, double-blinded study was scheduled for tympanoplasty or mastoidectomy. The patients were divided randomly into a propofol group (Group P) and a ketofol group (Group KP). Intubation conditions, changes in hemodynamics, HR, MAP, systolic arterial pressure (SAP), and SpO2 values were recorded before induction, after induction, after intubation, and at 3-min intervals during the first 30 min, 5-min intervals for the next 30 min, and 10-min intervals after that. In the intragroup evaluation, SAP, DAP, MAP and HR values were lower in both groups compared to the baseline values. Hemodynamic values were significantly lower in Group P than in Group KP after intubation compared to baseline. DAP at 12 and 18 min, DAP and MAP at 24 min, SAP, DAP and MAP at 27 min, and SAP and MAP at 30 min after the start of the operation were significantly lower in Group P than in Group KP. The need for ephedrine and the number of patients who required ephedrine were significantly lower in Group KP than in Group P. Ketofol provided appropriate intubation conditions similar to propofol, without the use of a neuromuscular blocker, and contributed to better hemodynamic conditions in patients undergoing tympanomastoidectomy.Öğe Effects of tracheal intubation without muscle relaxants on postoperative recovery conditions in patients with obstructive sleep apnea: A double-blind randomized controlled study(2019) Soyalp, Celaleddin; Tuncdemir, Yunus Emre; Yuzkat, Nureddin; Gulhas, NurcinAim: We aimed to compare intubation with and without neuromuscular blocking agents with regard to intubation success, hemodynamic parameters, and postoperative recovery in Obstructive sleep apnea patients.Materials and Methods: The study included 60 patients with a STOP-Bang (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) score of ≥3. The patients were randomly divided into two groups: (I) rocuronium group (Group E) and (II) remifentanil group (Group R). Group R received 4 mcg/kg remifentanil and Group E received 0.6 mg/kg rocuronium and then the patients’ intubation difficulty scale scores and their responses to train-of-four (TOF) nerve stimulation, and postoperative recovery were evaluated in both groups.Results: The median time to recovery of the TOF ratio to 0 following anesthetic induction was significantly higher in Group R compared to Group E (p0.001). The overall incidences of postoperative sore throat and hoarseness were remarkably high (p0.002 and p0.001, respectively). The numbers of patients with relaxed vocal cords and complete jaw relaxation were significantly higher in Group E compared to Group R (p0.001). Conclusion: The results indicated that rocuronium provides better intubation conditions and leads to less peri- and post-operative complications compared to remifentanil.Keywords: Obstructive sleep apnea syndrome; intubation without muscle relaxants; postoperative recovery; stop bang tracheal intubation.Öğe Obstetric admissions to the intensive care unit in a tertiary referral hospital(W B Saunders Co-Elsevier Inc, 2010) Togal, Turkan; Yucel, Neslihan; Gedik, Ender; Gulhas, Nurcin; Toprak, H. Ilksen; Ersoy, M. OzcanPurpose The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome Materials and Methods All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared Results Seventy-three obstetric patients were admitted to the ICU There were 9 maternal deaths and 24 fetal deaths For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients the SAPS II score was 64 and estimated maternal mortality rate was 73% The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates Conclusions Pregnancy induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS 11 (C) 2010 Elsevier Inc All rights reservedÖğe The Relationship between Preoperative Smoking Cessation, Anxiety, and Postoperative Anxiety and Pain: A Prospective Clinical Trial at a University Hospital in the East of Turkey on 120 Participants(Pakistan Medical Assoc, 2022) Tekeli, Arzu Esen; Demirkiran, Hilmi; Kacar, Cemal; Duzenli, Ufuk; Gulhas, NurcinObjective: To reveal the relationship between smoking cessation before surgery, pre- and post-operative anxiety, and pain among chronic smokers. Method: The cross sectional prospective clinical study was conducted in 2018 on the east of Turkey, in Van Yiiziincii Yil University Dursun Oda ba Medical Center in city of Van. After approval from the ethics committee participants of either gender aged 20-60 years scheduled to undergo rhinoplasty surgery and graded as American Society of Anaesthesiologists I-II were included.The participants were categorised into smokers group S and non-smokers group NS. Spielberger State-Trait Anxiety Inventory values for preoperative period, postoperative 0, which is the moment when the modified Aldrete score is >9, as well as for 2, 4 and 6 hours, and visual analogue scale values for the postoperative 0, 2, 4 and 6 hours were recorded. Data was analysed using SPSS 26. Results: Of the 120 patients, there were 60(50%) in group S; 28(46.7%) females, 32(52.3%) males, overall mean age 33.0 +/- 9.7 years. In group NS, there were 34(56.7%) females and 26(43.3%) males with an overall mean age of 34.7 +/- 10.1 years (p>0.05). Group S had Spielberger State Trait Anxiety Inventory preoperative and postoperative values significantly higher than group NS (p<0.05). While the values for postoperative 4 and 6 hours increased in group S, corresponding values decreased in group NS (p<0.05). Conclusion: High anxiety scores in preoperative period appeared to be associated with stress from surgery and anaesthesia and could have been caused by smoking dependency during the preoperative and postoperative periods.Öğe Thromboelastographic comparison of the effects of different fluid preloading regimens delivered before spinal anesthesia(Drunpp-Sarajevo, 2012) Ozen, Irsat; Togal, Turkan; Aydogan, Mustafa Said; Erdogan, Mehmet Ali; Nakir, Hamza; Gulhas, Nurcin; Toprak, Huseyin IlksenIntroduction: Various fluids used for preloading purposes prior to spinal anesthesia. Coagulation disorders can occur due to use of those fluids at large volumes [1]. We aimed to compare the impact of different preloading fluids over coagulation parameters. Method: Sixty-eight patients of ASA I-II physical status who were aged between 18 and 75 years, and scheduled for orthopedic surgery under spinal anesthesia, were included in the study. Prior to the spinal anesthesia, preloading was carried out by RL in Group R (n=16), HES (130/0.4) in Group H (n=16), polygeline in Group P (n=16), and succinylated gelatin 7 ml/kg in Group S (n=16). RL was used as the maintenance fluid in all the groups. Thromboelastography, CBC, PTT, aPTT, fibrinogen values were assessed at baseline and 2 hours. Results: Groups P and S displayed significantly prolonged PTT values. While Groups R and P showed significantly prolonged PTT-INR values, groups R and H exhibited significantly prolonged aPTT values. Groups R, P, and S demonstrated significant decreases in TEG parameters including R, K, CI, and TMA. The increase in a angle was significant in groups R and S. Conclusion: Fluid preloading with HES was not found to affect the coagulation parameters, however, polygeline and succinylated gelatin were observed to cause moderate hypercoagulation. Therefore, we believe that HES may be preferred over succinylated gelatin and polygeline in cases with hypercoagulability.
