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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 Anaesthesia Management of a Case with Hereditary Angioedema for Whom Tracheal Dilatation was Planned(Galenos Publ House, 2025) Ucar, Muharrem; Sanli, Mukadder; Akturk, Sezai; Gulcek, Ilham; Erdil, Feray AkgulHereditary angioedema (HAE) causes recurrent angioedema attacks in the oropharynx, larynx, face, and other regions due to bradykinin overproduction as a result of C1 esterase inhibitor deficiency. Surgical interventions requiring general anaesthesia might trigger HAE attacks. Laryngeal angioedema is the most important cause of perioperative mortality. Tracheal dilatation was performed by rigid bronchoscopy in our patient with type 1 HAE, because of tracheal stenosis due to prolonged intubation, which occurred after the attack. The patient was administered 2x500 IU C1 esterase inhibitor approximately 24 hours before rigid bronchoscopy. No complication developed after the first procedure. Two months later, tracheal dilatation was repeated and 2x500 IU C1 esterase inhibitor was administered. While the patient was followed up in the intensive care unit, significant oedema developed in the facial area, especially the tongue and lips, approximately 10 hours after the procedure. Our patient also had stridor due to airway obstruction. The patient was treated with 1000 IU C1 esterase inhibitor and 3 units of fresh frozen plasma (FFP). After FFP, edema started to regress. The patient was discharged after symptoms improved. The patient should be monitored in the intensive care unit for a minimum of 48 hours to monitor for postoperative laryngeal oedema.Öğe Anaesthetic Management in Electroconvulsive Therapy During Early Pregnancy(Aves, 2014) Ozgul, Ulku; Erdogan, Mehmet Ali; Sanli, Mukadder; Erdil, Feray; Begec, Zekine; Durmus, MahmutThe management of major psychiatric conditions during pregnancy is exceptionally difficult. Pharmacoresistant, life-threatening and severe symptoms such as catatonia and suicidal behavior affect the health and safety of both mother and child. In such cases, electroconvulsive therapy (ECT) may be considered as an alternative to pharmacologic treatment. In this report, we aimed to present anaesthetic management of a patient, who was 13 weeks pregnant and needed ECT due to major depression.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 Anesthesia Management in a Child with Osteogenesis Imperfecta and Epidural Hemorrhage(Elsevier Science Inc, 2013) Erdogan, Mehmet Ali; Sanli, Mukadder; Ersoy, Mehmet OzcanOsteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.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 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 Changes in Melatonin, Cortisol, and Body Temperature, and the Relationship Between Endogenous Melatonin Levels and Analgesia Consumption in Patients Undergoing Bariatric Surgery(Springer, 2018) Altunkaya, Neslihan; Erdogan, Mehmet Ali; Ozgul, Ulku; Sanli, Mukadder; Ucar, Muharrem; Ozhan, Onural; Sumer, FatihBackground Melatonin has analgesic, anti-inflammatory, sedative, and anxiolytic properties. However, the relationship between endogenous melatonin levels and postoperative analgesic requirements has not been well elucidated in patients undergoing bariatric surgery. We studied endogenous melatonin levels, cortisol levels, body temperatures, and the relationship between the level of endogenous melatonin and postoperative morphine consumption. Methods The trial was conducted among 30 patients who were scheduled for laparoscopic bariatric surgery. Their ages were between 18 and 65 years and their BMIs were above 40 kg/m(2). Secretion of melatonin, cortisol, and body temperature was monitored before the anesthetic induction, at 2 h intraoperatively, and at 2, 6, 10, (2:00 A.M.) and 24 h postoperatively. For each patient, morphine consumption was assessed at postoperative visits. The primary outcomes were to measure endogenous melatonin levels and to examine the relationship between these levels and morphine consumption. The secondary outcome was to observe the changes in cortisol and body temperature. Results There was a significant decrease in melatonin levels when preoperative melatonin levels were compared with intraoperative and all postoperative follow-up periods (p < 0.05). When the correlation between plasma melatonin levels and the postoperative morphine consumption of the patients was inspected, there was a significant correlation in all of the follow-up periods (p < 0.05). When preoperative cortisol levels were compared with intraoperative and postoperative cortisol levels, there was a significant difference in the follow-up periods, except two periods (p < 0.05). Body temperatures were similar in all measurement periods. Conclusions Endogenous melatonin secretion was significantly decreased in the intraoperative and postoperative periods. Furthermore, there was a significant inverse correlation between changes in endogenous melatonin levels and morphine consumption.Öğe Changes in melatonin, cortisol, and body temperature, and the relationship between endogenousmelatonin levels and analgesia consumption in patients undergoing bariatric surgery(Sprınger, 233 sprıng st, new york, ny 10013 usa, 2018) Altunkaya, Neslihan; Erdogan, Mehmet Ali; Ozgul, Ulku; Sanli, Mukadder; Ucar, Muharrem; Ozhan, Onural; Sumer, Fatih; Erdogan, Selim; Colak, Cemil; Durmus, MahmutBackground Melatonin has analgesic, anti-inflammatory, sedative, and anxiolytic properties. However, the relationship between endogenous melatonin levels and postoperative analgesic requirements has not been well elucidated in patients undergoing bariatric surgery. We studied endogenous melatonin levels, cortisol levels, body temperatures, and the relationship between the level of endogenous melatonin and postoperative morphine consumption. Methods The trial was conducted among 30 patients who were scheduled for laparoscopic bariatric surgery. Their ages were between 18 and 65 years and their BMIs were above 40 kg/m(2). Secretion of melatonin, cortisol, and body temperature was monitored before the anesthetic induction, at 2 h intraoperatively, and at 2, 6, 10, (2:00 A.M.) and 24 h postoperatively. For each patient, morphine consumption was assessed at postoperative visits. The primary outcomes were to measure endogenous melatonin levels and to examine the relationship between these levels and morphine consumption. The secondary outcome was to observe the changes in cortisol and body temperature. Results There was a significant decrease in melatonin levels when preoperative melatonin levels were compared with intraoperative and all postoperative follow-up periods (p < 0.05). When the correlation between plasma melatonin levels and the postoperative morphine consumption of the patients was inspected, there was a significant correlation in all of the follow-up periods (p < 0.05). When preoperative cortisol levels were compared with intraoperative and postoperative cortisol levels, there was a significant difference in the follow-up periods, except two periods (p < 0.05). Body temperatures were similar in all measurement periods. Conclusions Endogenous melatonin secretion was significantly decreased in the intraoperative and postoperative periods. Furthermore, there was a significant inverse correlation between changes in endogenous melatonin levels and morphine consumption.Öğe Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial(Elsevier Science Inc, 2018) Kayhan, Gulay Erdogan; Sanli, Mukadder; Ozgul, Ulku; Kirteke, Ramazan; Yologlu, SaimStudy objective: Multimodal analgesic strategies are recommended to decrease opioid requirements and opioid-induced respiratory complications in patients undergoing laparoscopic bariatric surgery. Recent studies have demonstrated that intravenous ibuprofen decreases opioid consumption compared with placebo. The primary aim of this study was to compare the effect of intravenous ibuprofen and intravenous acetaminophen on opioid consumption. We also aimed to compare postoperative pain levels and side effects of the drugs. Design: Randomized, double-blinded study. Setting: University hospital. Patients: Eighty patients, aged 18-65 years, (ASA physical status undergoing laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass surgery were included in this study. Interventions: Patients were randomized to receive 800 mg ibuprofen or 1 g acetaminophen intravenously every 6 h for the first 24 h following surgery; in addition, patient-controlled analgesia with morphine was administered. Measurements: Postoperative morphine consumption in the first 24 h, visual analog scale (VAS) pain scores at rest and with movement, and opioid related side effects were assessed. In addition, time to passage of flatus, surgical complications, lengths of intensive care unit and hospital stay, and laboratory parameters were recorded. Main results: The mean morphine consumption was 23.94 +/- 13.89 mg in iv ibuprofen group and 30.23 +/- 13.76 mg in the acetaminophen group [mean difference: -6.28 (95% CI, -12.70, 0.12); P = 0.055]. The use of intravenous ibuprofen was associated with reduction in pain at rest (AUC, 1- to 24-h, P < 0.001 and 12- to 24-h, P = 0.021) and pain with movement (AUC, 1-24, 6-24, and 12-24 h, P < 0.001). Intravenous ibuprofen was well tolerated with no serious side effects except dizziness. Conclusions: Intravenous ibuprofen did not significantly reduce opioid consumption compared to intravenous acetaminophen; however, it reduced the severity of pain. Intravenous ibuprofen may be a good alternative to intravenous acetaminophen as part of a multimodal postoperative analgesia in patients undergoing bariatric surgery.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 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 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 OsmanIn 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.Öğe Effect of video laryngoscope on Tp-e interval, QTc and Tp-e/QTc ratio compared with direct laryngoscope in patients with double-lumen tube undergoing thoracic surgery(2024) Kadıoğlu, Mustafa; Ucar, Muharrem; Erdogan, Mehmet Ali; Sanli, Mukadder; Colak, Yusuf Ziya; Erdil, Feray Akgül; Altunkaya, NeslihanAim: QT interval is generally related to the increased risk of polymorphic ventricular tachycardias and ventricular arrythmias. Intubation and laryngoscopy might change in cardiac repolarization and an increase in QT interval length. Video laryngoscopes provide better laryngeal view, higher intubation success, and better correct positioning on double-lumen tube (DLT) intubation. We aimed to compare McGRATH MAC 5 video laryngoscope to direct Macintosh laryngoscope and their effects on Tp-e interval, QTc and Tp-e/QTc ration in those patients requiring intubation having DLT. Materials and Methods: The randomly controlled prospective work is carried out on 94 patients, scheduled for thoracic surgery, aged between 18-65. After anaesthetic induction and before tracheal intubation, all patients airway were evaluated Cormack and Lehane in using a Macintosh laryngoscope and patients having Cormack and Lehane grade-1 or -2a views included in study. The patients who are intubated with video laryngoscope (McGRATH MAC) are allocated into Group V and intubated with direct Macintosh Laryngoscope was allocated into Group L. The primary aim was compared between the two devices on Tp-e interval, QTc and Tp-e/QTc ratio with ECG recordings. The secondary goal was assessment of hemodynamic status and intubation conditions. Results: In Group V, QTc interval, Tp-e intreval and Tp-e/QTc ratio was lower in a significant way than Group L. There has not been a significant difference in terms of hemodynamic assessment among those two groups at all measurement periods. CormackLehane scores, intubation times, DLT types and sizes were similar between two groups. Conclusion: McGRATH MAC video laryngoscope decreased Tp-e interval, QTc and Tp-e/QTc ratio compared to direct Maintosh laryngoscope. Hemodynamic response and intubation parameters are seen as similar to each other in both of the present groups.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 The Effects of Remifentanil on Hemodynamic Response Attenuation After Electroconvulsive Therapy Under Sevoflurane Anesthesia(Lippincott Williams & Wilkins, 2017) Erdil, Feray; Ozgul, Ulku; Sanli, Mukadder; Kayhan, Gulay; Colak, Cemil; Durmus, MahmutPurpose We evaluated the effects of a single loading dose of remifentanil (1 g/kg) administered as an adjunct to sevoflurane, on the duration of seizure activity, recovery times, and hemodynamic profiles, during electroconvulsive therapy. Methods The patients were randomly allocated to receive sevoflurane-saline (Group SS) or sevoflurane-remifentanil (Group SR). Sevoflurane (8%) was initiated for anesthesia induction in both groups until loss of consciousness was achieved. Remifentanil was then administered to Group SR via a 1-g/kg intravenous bolus. Patients in Group SS received saline in the same manner. Mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (T1), at the loss of consciousness (T2), and at 0, 1, 3, and 10 minutes after the electrical stimuli were completed (T3, T4, T5, and T6, respectively). Results Compared with the baseline values, HR increased significantly in Group SS at times T2 and T4 to T6 and decreased significantly in Group SR at time T2. When the groups were compared, we found that HR decreased significantly in Group SR at T2 and T4 to T6. Compared with baseline, MAP increased in Group SS between T3 and T6, and MAP decreased in Group SR at T2 and increased at T3 to T4. Mean arterial pressure decreased to a greater extent in Group SR than in Group SS during the T2 to T6 period. There were no group differences in seizure duration or recovery time. Conclusions The addition of 1-g/kg remifentanil to anesthetic induction with sevoflurane attenuated the acute hemodynamic response to electroconvulsive therapy under sevoflurane anesthesia without adversely affecting the duration of seizure activity or the recovery profile.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 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 Anesthesia Management During Peroral Endoscopic Myotomy in Patients with Achalasia: A Retrospective Study(Mdpi, 2025) Sanli, Mukadder; Akbulut, Sami; Ucar, Muharrem; Bilgic, YilmazBackground: Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent peristalsis, which increases the risk of aspiration during anesthesia. Peroral endoscopic myotomy (POEM) is a minimally invasive therapeutic approach requiring tailored anesthetic management. This study aimed to evaluate perioperative anesthesia management during POEM, focusing on ventilation parameters, intraoperative hemodynamics, laboratory changes, and the incidence and severity of postoperative complications. Methods: A retrospective analysis was conducted on 51 patients who underwent POEM between June 2016 and April 2025. Demographic features, anesthesia techniques, intraoperative physiologic parameters, hematologic profiles, and postoperative complications were evaluated. Standard preoperative fasting protocols were implemented. Rapid sequence induction (RSI) with propofol and rocuronium was followed by endotracheal intubation. Desflurane was used for maintenance anesthesia, with ventilation settings adjusted to limit end-tidal carbon dioxide (ETCO2) elevation. Results: The median age of patients was 48 years, with a slight female (52.9%) predominance. Most patients were American Society of Anesthesiologists (ASA) II (64.7%) or ASA III (35.3%) scores and had comorbid hypertension (31.4%) or diabetes (11.8%). The median anesthesia duration was 180 min, and the peak inspiratory pressure remained stable at 25 mmHg. Oxygen saturation (SpO(2)) improved during the procedure, while ETCO2 increased from baseline to 49 mmHg by the end. Blood pressure declined transiently but recovered intraoperatively. Hematologic analysis showed significant increases in white blood cell (WBC) and neutrophils and mild decreases in hemoglobin, hematocrit, and platelets. Early postoperative complications included subcutaneous emphysema (19.6%), minor bleeding (9.8%), and pneumoperitoneum (7.84%). Two patients required tube thoracostomy due to pneumothorax, but no patient developed a complication requiring surgical exploration. During a median follow-up of 546 days, no mortality was reported. Long-term complications were infrequent, with gastroesophageal reflux disease (GERD) (3.92%) and esophagitis (1.96%) being the most notable. Conclusions: POEM can be performed safely with appropriate anesthetic management. Despite significant physiologic changes during carbon dioxide (CO2) insufflation, no life-threatening complications occurred, and the majority of adverse events were minor and self-limiting. Close intraoperative monitoring and interdisciplinary coordination contribute to favorable perioperative outcomes.Öğe İnfantlarda no: 1 I-gel ve Air-Q supraglottik havayolu araçlarının etkinliğinin karşılaştırılması: Randomize kontrollü bir çalışma(2026) Ucar, Muharrem; Sanli, Mukadder; Begec, ZekineAmaç: Supraglottik hava yolu araçları (SGA’lar), anestezi ve acil hava yolu yönetiminde temel araç- lar haline gelmiştir. İkincil nesil bir araç olan I-Gel, perilarenjyal anatomiyi yansıtacak şekilde tasar- lanmış şişirilemeyen termoplastik elastomer manşet ve aspirasyon riskini azaltmak için mide kanalı özelliklerine sahiptir. Buna karşılık, Air-Q SGA, entübasyonu kolaylaştırmak için tasarlanmış kavisli, sert bir tüp ve epiglotik izolasyonu optimize eden bir tasarım ile karakterize edilir. Bu çalışma, infant popülasyonunda No: 1 I-Gel ve Air-Q araçlarının klinik performansını karşılaştırmayı amaçlamıştır. Yöntemler: Bu prospektif, randomize kontrollü çalışmaya, elektif alt karın cerrahisi geçiren 61 Ameri- kan Anesteziyologlar Derneği fiziksel durum sınıflaması I-II infant (<5 kg) dâhil edildi. Hastalar, I-Gel veya Air-Q aracını alacak şekilde randomize edildi. Birincil sonuç, hava yolu kaçak basıncıydı. İkincil ölçütler arasında kaçak hacmi, yerleştirme süresi, deneme sayısı, yerleştirme koşulları ve ventilasyon kalitesi yer aldı. Bulgular: I-Gel grubu, Air-Q grubuna kıyasla anlamlı olarak daha kısa ortalama yerleştirme süresi göstermiştir (p < 0,001) ( Sırasıyla17,00 ± 4,27 s,23,10 ± 5,52 s) . Ventilasyon kalitesi puanları I-Gel grubunda anlamlı olarak daha üstündü (p = 0,039). Ayrıca, I-Gel ile kaçak hacmi Air-Q’ya kıyasla önemli ölçüde daha düşüktü (p = 0,040). Sonuç: 5 kg’dan daha hafif infantlarda, 1 numaralı I-Gel, yerleştirme hızı, sızdırmazlık bütünlüğü (daha düşük kaçak hacmi) ve ventilasyon kalitesi açısından Air-Q’ya göre üstünlük gösterdi.
