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Öğe Anesthetic management in a patient with Friedreich’s Ataxia: A different approach(2017) Akbaş, Sedat; Toy, Erol; Özkan, Ahmet SelimAbstract: Friedreich's Ataxia (FA) is a rare autosomal recessive disease. FA is clinically characterized by progressive ataxia, especially loss of reflex and power in the lower extremities, spasticity and loss of proprioceptive sensory. There is an increased sensitivity to non-depolarizing muscle relaxants in neurodegenerative diseases. Care must be taken of anesthesia management for the use of volatile anesthetics and muscle relaxants, and precautions should be taken for difficult airway management which is due to secondary to kyphoscoliosis and comorbidities. In this case, anesthesia management of emergency operation for septal hematoma by TIVA without using of muscle relaxants and minimalized hemodynamic response depending on the intubation by videolaryngoscope were presentedÖğe Cataract Surgery Anesthesia Management of a Patient with Biotinidase Deficiency(2019) Miniksar, Ökkeş Hakan; Toy, Erol; Özkan, Ahmet SelimAbstract: Biotinidase deficiency is an autosomal recessive rarecongenital disease involving multisystem. Treatmentof the disease with biotin results in rapid biochemicaland clinical improvement. This enzyme deficiencyincludes increased susceptibility to infections,neurological, neuromuscular, respiratory,dermatological and immunological problems.Anesthesia management in these patients; The aim ofthis study is to determine the problems related tocomorbidity and congenital anomalies and to applycomprehensive preoperative strategies to ensure thesafety of the patient peroperatively. In this study, wepresent the successful anesthesia management of a10-month-old boy with BD in cataract surgery.Öğe Dental cerrahide nazotrakeal entübasyon: Direkt laringoskopi ile McGrath videolaringoskopinin karşılaştırılması(İnönü Üniversitesi, 2017) Toy, ErolNazotrakeal entübasyon yapılacak normal hava yoluna sahip hastalarda McGrath videolaringoskopi (VL) ile Macintosh direkt laringoskopiyi (DL) karşılaştırılması amaçlandı. Entübasyon zamanı, hemodinamik yanıtlar üzerindeki etkileri, entübasyon kolaylığı ve Magill forsepsinin kullanımı açısından McGrath VL ve Macintosh DL karşılaştırıldı. Materyal ve Metot: Nazotrakeal entübasyon ile dental cerrahi planlanan ASA I- II, 70 hasta çalışmaya dâhil edildi. McGrath videolaringoskop kullanılarak entübasyon yapılan olgular VL grubu (n=35), Macintosh direkt laringoskop kullanılarak entübasyon yapılan olgular DL grubu (n=35) olarak iki gruba ayrıldı. Operasyon odasına alındıktan sonra hastalara EKG, noninvaziv kan basıncı, SpO2 monitörizasyonu yapıldı. Yüz maskesi ile en az 3 dakika %100 O2 ile preoksijenizasyon uygulandı. Anestezi indüksiyonu 2 mg.kg-1 propofol, 1 μg.kg-1 fentanil ile gerçekleştirildi ve kas gevşemesi için 0.6 mg.kg-1 rokuronyum uygulandı. Rokuronyum enjeksiyonundan 3 dakika sonra hastalar nazotrakeal tüp (Portex® Ivory PVC, North Facing, Nasal, Profile Soft Seal Cuff, Polar Preformed Endotracheal Tube) ile entübe edildi. Anestezi idamesine %50 oksijen-hava karışımı içinde sevofluran ile devam edildi. Olguların anestezi indüksiyonu öncesi (bazal), indüksiyon sonrasında ve entübasyon sonrası 1., 2., 3. ve 5. dakikalarda sistolik arter basıncı (SAB), diastolik arter basıncı (DAB), ortalama arter basıncı (OAB), kalp atım hızı (KAH), periferik oksijen saturasyonu (SpO2) ve end tidal karbondioksit (EtCO2) değerleri kaydedildi. Cormack-Lehane ve Mallampati Skorları, laringeal bası uygulamaları, entübasyon zamanı, Magill forsepsi kullanımı, entübasyon kolaylığı, entübasyona bağlı komplikasyonlar kaydedildi. Bulgular: Grupların demografik özellikleri ve ASA sınıflaması benzerdi. Entübasyon başarısı açısından VL ve DL grupları arasında anlamlı bir fark yoktu. Entübasyon süresi karşılaştırıldığında VL grubunda entübasyon süresi anlamlı olarak daha kısa bulundu. Entübasyon sonrası 1. ve 5. dakika SAB değerleri DL grubunda VL grubuna göre anlamlı olarak daha yüksek bulundu. DAB, OAB ve KAH değerlerinde iki grup arasında anlamlı fark bulunmadı. Entübasyon kolaylığı açısından VL, DL'den anlamlı olarak daha kolay bulundu. Magill forsepsi kullanımı VL grubunda DL grubundan daha düşük çıktı fakat bu fark anlamlı değildi. Komplikasyonlar açısından bir fark bulunamadı. Sonuç: Macintosh DL ile kıyaslandığında, McGrath VL daha hızlı ve daha kolay entübasyon koşulları sağlamaktadır. Entübasyon sonrası hemodinamik yanıt McGrath VL'de daha iyiydi. Nazotrakeal entübasyon için McGrath VL'nin daha tercih edilebilir olduğu düşünüldü.Öğe Nasotracheal intubation for dental surgery: A comparison of direct laryngoscopy with McGrath MAC videolaryngoscopy(2021) Toy, Erol; Özkan, Ahmet Selim; Akbaş, Sedat; Sanli, Mukadder; Durmus, MahmutAim: The purpose of our study was to compare the McGrath MAC videolaryngoscope (VL) with the Macintosh direct laryngoscope (DL) for the efficacy during nasotracheal intubation (NTI) in patients undergoing dental surgery. Material and Methods: In total, 70 American Society of Anesthesiologist physical status (ASA) I-II patients who underwent elective dental surgery requiring NTI were included in this study. The patients were divided to two groups based on intubation using McGrath MAC VL (n=35) and Macintosh DL (n=35). The patients were monitored via electrocardiography (ECG), noninvasive arterial pressure, and peripheral oxygen saturation (SpO2) after they were taken to the operating room. Preoxygenation was performed with face mask for at least 3 minutes with 100 % O2. In addition, 2 mg/kg propofol and 1 µg/kg fentanyl were administered for anesthesia induction, and 0,6 mg/kg rocuronium was administered for muscular relaxation. NTI was performed 3 minutes after rocuronium injection with a nasotracheal tube. Anesthesia was maintained with sevoflurane and 50% air in oxygen. Mean arterial pressure (MAP), heart rate (HR), SpO2 and end tidal-carbon dioxide (EtCO2) were recorded at baseline; after anesthesia induction; and 1st, 2nd, 3th and 5th minutes after intubation. Cormack-Lehane and Mallampati Scores (MPS), laryngeal compression, duration of intubation, using Magill forceps, ease of intubation, and the incidence of complications due to intubation were recorded. Results: The demographic characteristics of the groups were similar. Regarding the success of the intubation, no significant difference was detected between the McGrath MAC VL group and the Macintosh DL group (p >0,05). However, when intubation times were compared, a significant difference was noted between groups (p<0,05). The intubation time was reduced in the McGrath MAC VL group. No statistically significant difference was observed regarding MAP and HR values. Intubation using McGrath MAC VL was significantly easier than direct laryngoscopy (p<0,05). No difference in complications was observed (p>0,05). Conclusion: We compared the McGrath MAC VL with the Macintosh DL for NTI and found that intubation was applied in less time using McGrath MAC VL than Macintosh DL. Intubation was more easy with McGrath MAC VL than Macintosh DL. We believe that McGrath MAC VL can be preferred to DL for NTI.Öğe Nasotracheal intubation with c-mac video-laryngoscope in a patient with Treacher Collins Syndrome(2017) Syndrome, Collins; Özkan, Ahmet Selim; Akbaş, Sedat; Toy, Erol; Yalın, Mehmet Rıdvan; Yılkınc, AyseAbstract: Treacher Collins Syndrome (TCS) is a dominantly inherited autosomal disease which limited to head and neck movement. In management of difficult airways which is seen in patients with TCS, the direct laryngoscope, video-laryngoscope (VL), and fiber-optic laryngoscope (FOB) were successfully utilized. No study that was indicated the successful execution of nasotracheal intubation on a patient with TCS by using C-MAC video-laryngoscope was found in literature review. In this case report, we aimed to share our airway management on a patient with TCS for whom we planned nasotracheal intubation due to a dental surgeryÖğe North Polar Tube Reduces the Risk of Epistaxis during Nasotracheal Intubation: A prospective, Randomized Clinical Trial(Elsevier Science Inc, 2019) Ozkan, Ahmet Selim; Akbas, Sedat; Toy, Erol; Durmus, MahmutObjective: In this study, a north polar tube (Portex (R) North Polar tube [Ivory PVC Portex tube; Smiths Medical International, Hythe, United Kingdom]) (NPT) and spiral tube (ST) were compared for their ability to provide a nasal airway in patients during maxillofacial surgery. Methods: Patients who were aged 18 to 65 years with American Society of Anaesthesiologists score 1 to 2 and Mallampati score 1 to 2 were included in the study. The anesthesia technique was standardized in all patients. Patients were divided into 2 groups randomly: the NPT (n=35) and ST groups (n=35). Anesthesia was administered with 1% to 2% sevoflurane and a mixture of 50% oxygen+ 50% air in both groups. The mean arterial pressure and heart rate values of preinduction; preintubation; and the first, second, third, and fifth minutes of intubation were recorded. Epistaxis, intraoral bleeding, cuff burst, use of Magill pens, duration of intubation, intubation difficulty, laryngeal compression, head position change, and glottic grade were evaluated. Results: There were no significant differences between groups in terms of demographic data (gender, age, height, weight, body mass index, American Society of Anaesthesiologists score, and Mallampati score). Macintosh laryngoscopes were used during intubation in all patients. There was no significant difference between groups in terms of intubation difficulty, duration of intubation, use of Magill pens, and determination of the glottic grade (P > 0.05). Epistaxis was significantly lower in the NPT group than in the ST group (P= 0.012). Intraoral bleeding was significantly higher in the ST group than in the NPT group (P=0.001). During intubation, laryngeal compression (Sellick maneuver) and head position changes were significantly lower in the NPT group than in the ST group (P=0.003 and P < 0.001, respectively). There were no significant differences in mean arterial pressure and heart rate between the 2 groups. Conclusions: We conclude that the NPT was associated with less epistaxis and manipulations such as laryngeal compression and head position changes when compared with the ST during nasotracheal intubation. The velvet-soft polyvinyl chloride material of the NPT appears to be responsible for this advantage. (C) 2018 Published by Elsevier Inc.
