Ayse Karagoz - Academia.edu (original) (raw)
Papers by Ayse Karagoz
European Journal of Anaesthesiology, 2005
Pediatric Anesthesia, 2007
Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart ra... more Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life-threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children. Methods: The study was performed on 20 children admitted for inguinal hernia repair, with normal QTc intervals. Anesthesia was induced with propofol and intubation was achieved with vecuronium. Anesthesia was maintained with 2% sevoflurane (group I, n ¼ 11) or 6% desflurane (group II, n ¼ 9) and 66% nitrous oxide in oxygen. Electrocardiogram recordings were obtained by Holter recorder. QTc intervals were measured at baseline, 5, 10, 15, and 30 min after inhalation. Results: None of the patients had significant arrythmia with desflurane anesthesia. One patient in the sevoflurane group had single, bigemini and multiform ventricular extrasystoles. There was no statistically significant difference in the baseline QTc values of the groups. Desflurane significantly prolonged QTc interval 5 min after induction until 30 min of anesthesia compared with baseline values (P ¼ 0.029), while no significant prolongation was observed with sevoflurane (P ¼ 0.141). Conclusions: Use of 2% sevoflurane during maintenance of anesthesia does not significantly prolong QTc interval while 6% desflurane significantly prolonged QTc interval in children with normal QTc interval undergoing inguinal herniorrhaphy.
Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2004
We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngea... more We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngeal Angiofibroma Resection" by Ezri et al. 1 We wanted to share our similar experience in a patient with hemophilia A and a nasopharyngeal angiofibroma. Nasopharyngeal angiofibroma is a rare benign fibrovascular tumor that can lead to severe, life-threatening epistaxis. We present the anesthetic approach to the nasopharyngeal angiofibroma in a patient with hemophilia A. A 17-year-old male patient who had hemophilia A and a nasopharyngeal mass occluding the cavity had undergone a biopsy in another medical center. After the biopsy, he had life-threatening severe hemorrhage, and tracheotomy had been performed to avoid the risk of aspiration. Histopathologic results revealed a nasopharyngeal angiofibroma. The patient was admitted to our hospital with this diagnosis. To provide for less blood loss throughout the operation, embolization was performed on the tumor mass. Factor VIII was given at 2-hour intervals to keep his serum factor VIII levels at 100% during surgery. He was premedicated with oral diazepam because intramuscular injections may lead to unexpected hematoma. Anesthesia was induced with propofol and vecuronium and maintained by isoflurane and 30% N 2 O in oxygen. He was intubated through the stoma of the tracheotomy with a cuffed endotracheal tube. Electrocardiogram, invasive arterial blood and central venous pressures, pulse oximetry, capnography, and urinary output measurements were recorded. Two 14-G intravenous catheters were placed in the upper extremities. Also, right internal jugular vein was cannulated with a 14-G catheter. Mean arterial pressure was 55 to 75 mmHg throughout the surgery. This was maintained with increasing concentrations of isoflurane and fentanyl, 5 g/kg, when required. During the procedure, which lasted 4 hours, 3,000 mL of crystalloid, 1,000 mL of colloid, 4 units of erythrocytes, and 4 units of plasma were given. Total urinary output and blood loss were 800 mL and 2,000 mL, respectively. The hemoglobin level was maintained around 10 g/dL. Platelets were given in addition to packed cells. Body temperature was preserved by warming the fluids and blood, and warming blankets were used. Intraoperative hypotension and metabolic acidosis were not detected. He was extubated at the end of the surgery and transferred to the intensive care unit. He was discharged from the hospital without any complication. The anesthetic approach during surgery for juvenile nasopharyngeal angiofibroma resection is important in 3 respects: (1) risk of blood aspiration during induction of anesthesia, (2) major surgical bleeding, and (3) airway obstruction after extubation because of edema related to surgery. Since the patient had a tracheotomy, airway management did not lead to any difficulty. Massive blood loss is expected to be a major concern during resection of juvenile nasopharyngeal angiofibroma, especially in a patient with hemophilia A. 2 Similar to Ezri et al, 1 we used isoflurane and fentanyl for deliberate hypotension. Appropriate preoperative precautions and induced hypotension during surgical resection of nasopharyngeal angiofibroma in a patient with hemophilia A provided a safe and successful outcome.
Middle East journal of anaesthesiology, 2012
The incidence of a difficult laryngoscopy/intubation, which could lead to failed intubation is in... more The incidence of a difficult laryngoscopy/intubation, which could lead to failed intubation is in the range of 1.5%-13%. Failed intubation may lead to hypoxia, brain damage or death. Preoperative evaluation of the airway can be accomplished by non-invasive bedside clinical tests during physical examination. We studied interobserver variability for non-invasive prediction of difficult intubation in different anesthesiology residency years. Three hundred eighty four adult patients undergoing elective surgery with general anesthesia and endotracheal intubation were enrolled this study. The investigators were divided in to two groups: three of them were in 4th (Group 1) and the other three were in 1st (Group 2) year of their anesthesiology residency. The variables evaluated were age, weight, height, submental-cervical angle, measurements of mandibular space, deviation of trachea, jaw-hyomental distance, swelling or scar tissue at neck, limited mouth opening, small mouth cavity, macroglo...
Saudi medical journal, 2004
Immunosuppression is directly related to the degree of trauma. The aim of this study is to compar... more Immunosuppression is directly related to the degree of trauma. The aim of this study is to compare the effects of low and high intra-abdominal pressure on immune response in moderate surgical trauma. Twenty-two patients, scheduled for laparoscopic cholecystectomy, were randomly allocated to one of 2 groups according to intra-abdominal pressure: low and high intra-abdominal pressure. This study was conducted in the Hacettepe University Faculty of Medicine, Operation Room, Ankara, Turkey. Serum interleukin (IL)-2 and IL-6 levels were measured. Serum IL-2 showed a significant decrease before the incision in high intra-abdominal pressure group. The increase in serum IL-6 at the end of surgery and postoperatively was lower in low intra-abdominal pressure group. These results, can be interpreted as the immune system, are less depressed when there is lower intra-abdominal pressure. This may have clinical implications in immunocompromised patients.
Tüberküloz ve toraks, 2009
Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complicati... more Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complication that may lead to fatal complications such as pulmonary artery injury. We describe entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature in a patient undergoing right pneumonectomy. This situation resulted with removal of catheter safely without any complication. We concluded that with early recognition of the complication during thoracotomy, is golden standard in preventing pulmonary artery catheter entrapment and surgeons should be aware of the risk of accidentally transfixing pulmonary artery catheter in every type of operation that takes place in thorax.
Allergy and asthma proceedings : the official journal of regional and state allergy societies
Episodes of wheezing are very common in infancy. In pediatrics, indications for flexible bronchos... more Episodes of wheezing are very common in infancy. In pediatrics, indications for flexible bronchoscopy include prolonged wheezing, where airway abnormalities such as malacia disorders, tracheobronchial abnormalities, and vascular ring may be found. The study was performed to determine the diagnostic use of flexible bronchoscopy in wheezy patients who were previously administered bronchodilators and steroids for asthma and whose symptoms recurred or were not improved at all. Infants with wheezing were identified and collected over a 3-year period at the pediatric pulmonology unit. Flexible bronchoscopy was performed for diagnostic purposes in 34 (24 boys and 10 girls) patients with wheezing who were previously treated for asthma. The mean age for the onset of the symptoms was 2.5 months (0-12 months), and the mean age of bronchoscopic assessment was 9 months (45 days-48 months). A definitive diagnosis was made by bronchoscopy in 29 (85%) patients. Functional abnormalities in 15 patien...
Turkish Journal of Anesthesia and Reanimation, 2013
ABSTRACT
Liver Transplantation - Basic Issues, 2012
Transplantation Proceedings, 2007
Background. The main metabolic pathway for defluorination of sevoflurane in the liver produces in... more Background. The main metabolic pathway for defluorination of sevoflurane in the liver produces inorganic fluoride (Fl). The metabolism and effect of sevoflurane on the kidney is not clear during anhepatic phase in liver transplantation. The goal of the present study was to investigate the metabolism and renal effect of sevoflurane by measuring plasma and urine inorganic fluoride, urinary N-acetyl-glucosaminidase (NAG), and plasma creatinine levels in patients undergoing liver transplantations. Methods. After institutional approval and informed consent, we studied nine cases of orthotopic liver transplantation after anesthesia was induced with 5 mg • kg Ϫ1 thiopental, 1 g • kg Ϫ1 fentanyl intravenously, the trachea was intubated after vecuronium bromide 0.1 mg • kg Ϫ1. Anesthesia was maintained with sevoflurane (2%), O 2 , and N 2 O at a total gas flow of 6 L • min Ϫ1 using a semiclosed circle system with a sodalime canister. Blood and urine samples were obtained to measure plasma and urine fluoride concentrations and urinary NAG excretions before induction (P0), hourly during resection (P1, P2, P3), every 15 minutes during anhepatic phase (A1, A2, A3), hourly after reperfusion (neohepatic phase) (N1, N2, N3), and postoperative first hour (Po1). Preoperative (T0) and postoperative day 1 (T1), 3 (T3), 7 (T7) plasma blood urea nitrogen (BUN) and creatinine (Cr) levels were also recorded. Results. Mean duration of surgery was 9:06 Ϯ 0:09 hours. Mean inorganic fluoride concentrations in plasma were in the range of 0.71 Ϯ 0.30 to 28.73 Ϯ 3.31 mole • L Ϫ1. In P3, N1, N2, N3, increases in plasma inorganic fluoride concentrations were significant (P Ͻ .05) and reached a peak value at Po1. The mean urine inorganic fluoride concentrations were 12.49 Ϯ 2.04 to 256.7 Ϯ 49.62 mole • L Ϫ1. In A2, A3, N1, N2, and
Pediatric Anesthesia, 2007
Pediatric Anesthesia, 2004
Anesthetic management of a 3-month-old boy with Beckwith-Wiedemann syndrome for bronchoscopy is r... more Anesthetic management of a 3-month-old boy with Beckwith-Wiedemann syndrome for bronchoscopy is reported. Management may be complicated by a difficult airway, congenital heart disease, and hypoglycemia. We did not have difficulty in airway management either with tracheal intubation or rigid bronchoscopy, but we could not extubate the baby because of tracheomalacia.
Pediatric Anesthesia, 2007
Pediatric Anesthesia, 2006
Pediatric Anesthesia, 2007
is hydrolyzed by plasma esterases after intravenous administration such that 1 g of propacetamol ... more is hydrolyzed by plasma esterases after intravenous administration such that 1 g of propacetamol is hydrolyzed to 0.5 g of paracetamol. There is extensive clinical experience with the use of this prodrug in neonates and children in these countries and its maturational pharmacokinetics in neonates and children have been reported (3,5). An alternative intravenous paracetamol formulation (PerfalganÒ; Bristol-Myers Squibb) has recently become available and is licensed to be used in children from 10 kg upwards in Europe. Two vials (500 mgAE50 ml)1 , 1000 mgAE100 ml)1), both with the same concentration (10 mgAEml)1) are available. Tolerance and analgesic efficacy of this new intravenous paracetamol solution in children after inguinal hernia repair was recently reported in this journal (6). Autret et al. (7) evaluated single dose IV administration of 15 mgAEkg)1 of propacetamol in neonates and infants, equal to 7.5 mgAEkg)1 paracetamol. Based on these observations, the present French guidelines suggest to administer maximal 30 mg (4 • 7.5 mgAEkg)1 paracetamol) in neonates although the practice is to use a loading dose of 15 mgAEkg)1 IV paracetamol. We documented the pharmacokinetics of 20 and 40 mgAE kg)1 of propacetamol (equal to 10 and 20 mgAEkg)1 of IV paracetamol) in preterm and term neonates (8). A multiple dose study regimen was extrapolated from this single dose study and evaluated a loading dose of 30 mgAEkg)1 (equal to 15 mgAEkg)1 of IV paracetamol) in all neonates followed by a maintenance dose of 20 mgAEkg)1 of propacetamol (i.e. 10 mgAEkg)1 of IV paracetamol) using a dosing interval based on the postconception age (PCA > 36 weeks: 6 h, PCA 32-36 weeks: 8 h, PCA < 32 weeks: 12 h) (3). There are advantages of the more recently marketed formulation (Perfalgan) compared with the propacetamol (Prodafalgan) as the vials are 'ready-for-use' and the administration is better tolerated, also in children (6). However, dose miscalculations during clinical care may counterbalance these advantages. In Table 1, we provide the reader with the dose suggestions currently use in the neonatal intensive care unit (University Hospital Gasthuisberg, Leuven, Belgium) of both intravenous propacetamol and intravenous paracetamol in neonates. These dose suggestions are based on the pharmacokinetic studies performed in neonates, but pharmacodynamics in this specific population have yet to be studied.
Pacing and Clinical Electrophysiology, 2013
Catheter cryoablation of supraventricular tachycardias involving the perinodal regions is conside... more Catheter cryoablation of supraventricular tachycardias involving the perinodal regions is considered to be a safer alternative compared to radiofrequency ablation. Limited information is available for efficacy, midterm outcomes, and complications regarding the ablation of parahissian accessory pathways (APs) in pediatric patients. A retrospective review of all pediatric patients who underwent cryoablation for treatment of a parahissian AP was performed. Twenty-five patients (median age 13 years and weight 45.6 kg) underwent cryoablation of a parahissian AP. Median number of cryolesions applied was four (range: 3-6). Initial procedural success was achieved in 23 patients (23/25, 92%). Transient third-degree atrioventricular (AV) block was noted in two patients. There was no permanent AV block. Transient right bundle branch block (RBBB) was observed in one patient and permanent RBBB occurred in two patients. Of the patients successfully ablated with cryo, there was only one recurrence (1/23, 4.3%) over a follow-up of 17.5 months (range 6-34 months). Cryoablation of parahissian APs is both safe and effective with a low risk of recurrence in pediatric patients.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngea... more We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngeal Angiofibroma Resection" by Ezri et al. 1 We wanted to share our similar experience in a patient with hemophilia A and a nasopharyngeal angiofibroma. Nasopharyngeal angiofibroma is a rare benign fibrovascular tumor that can lead to severe, life-threatening epistaxis. We present the anesthetic approach to the nasopharyngeal angiofibroma in a patient with hemophilia A. A 17-year-old male patient who had hemophilia A and a nasopharyngeal mass occluding the cavity had undergone a biopsy in another medical center. After the biopsy, he had life-threatening severe hemorrhage, and tracheotomy had been performed to avoid the risk of aspiration. Histopathologic results revealed a nasopharyngeal angiofibroma. The patient was admitted to our hospital with this diagnosis. To provide for less blood loss throughout the operation, embolization was performed on the tumor mass. Factor VIII was given at 2-hour intervals to keep his serum factor VIII levels at 100% during surgery. He was premedicated with oral diazepam because intramuscular injections may lead to unexpected hematoma. Anesthesia was induced with propofol and vecuronium and maintained by isoflurane and 30% N 2 O in oxygen. He was intubated through the stoma of the tracheotomy with a cuffed endotracheal tube. Electrocardiogram, invasive arterial blood and central venous pressures, pulse oximetry, capnography, and urinary output measurements were recorded. Two 14-G intravenous catheters were placed in the upper extremities. Also, right internal jugular vein was cannulated with a 14-G catheter. Mean arterial pressure was 55 to 75 mmHg throughout the surgery. This was maintained with increasing concentrations of isoflurane and fentanyl, 5 g/kg, when required. During the procedure, which lasted 4 hours, 3,000 mL of crystalloid, 1,000 mL of colloid, 4 units of erythrocytes, and 4 units of plasma were given. Total urinary output and blood loss were 800 mL and 2,000 mL, respectively. The hemoglobin level was maintained around 10 g/dL. Platelets were given in addition to packed cells. Body temperature was preserved by warming the fluids and blood, and warming blankets were used. Intraoperative hypotension and metabolic acidosis were not detected. He was extubated at the end of the surgery and transferred to the intensive care unit. He was discharged from the hospital without any complication. The anesthetic approach during surgery for juvenile nasopharyngeal angiofibroma resection is important in 3 respects: (1) risk of blood aspiration during induction of anesthesia, (2) major surgical bleeding, and (3) airway obstruction after extubation because of edema related to surgery. Since the patient had a tracheotomy, airway management did not lead to any difficulty. Massive blood loss is expected to be a major concern during resection of juvenile nasopharyngeal angiofibroma, especially in a patient with hemophilia A. 2 Similar to Ezri et al, 1 we used isoflurane and fentanyl for deliberate hypotension. Appropriate preoperative precautions and induced hypotension during surgical resection of nasopharyngeal angiofibroma in a patient with hemophilia A provided a safe and successful outcome.
International Urology and Nephrology, 2014
To investigate the effects of oral carbohydrate solution consumed until 2 h before the surgery in... more To investigate the effects of oral carbohydrate solution consumed until 2 h before the surgery in the patients that would undergo open radical retropubic prostatectomy on postoperative metabolic stress, patient anxiety, and comfort. A total of 50 adult patients, who were in ASA I-II group and would undergo open radical retropubic prostatectomy, were included in the study. While Group 1 = CH (n = 25) received oral glucose solution, Group 2 = FAM (n = 25) was famished starting from 24:00 h. Blood glucose, insulin, and procalcitonin levels of the patients were recorded, and the patients completed state-trait anxiety inventory (STAI) test, which reflects the anxiety level of the patients, both before surgery and on the postoperative 24th hour. In order to evaluate patient comfort, senses of hunger, thirst, nausea, and cold were assessed in the morning prior to the surgery. No difference was observed between the two groups in terms of demographic data and insulin resistance levels (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Comparing with the preoperative levels, insulin resistance showed statistically significant elevation in both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Procalcitonin levels were similarly increased in both groups in the postoperative period (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Preoperative and postoperative STAI state scores were similar in both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). With regard to preoperative patient comfort, sense of hunger was present in lesser number of subjects and at lower level in Group 1 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Preoperative consumption of high carbohydrate drink (Pre-op) decreases insulin resistance and enhances patient comfort leading to lesser sense of hunger and thirst in the preoperative period in open radical retropubic prostatectomies.
European Journal of Pain, 2006
ABSTRACT Objective: The aim of the study was to compare the effects of prilocaine, bupivacaine an... more ABSTRACT Objective: The aim of the study was to compare the effects of prilocaine, bupivacaine and ropivacaine for postoperative pain management in children. Method: Sixty ASA I-II children between 1 and 7 years of age and scheduled for urologic surgery with general anaesthesia were recruited. The patients were randomly allocated into three groups. Group I received caudal prilocaine 1% 0.5 mL kg -1 after the operation, Group II received 0.25% 1 mL kg -1 bupivacaine and Group III received 0.25% 1 mL kg -1 after induction of anesthesia. During anaesthesia, hemodynamic parameters and fentanyl requirements were recorded. Haemodynamic parameters, sedation and pain scores were recorded at 15 and 30 minutes, 1, 2, 4 and 6 hours following recovery from anaesthesia. Pain was evaluated by CHEOPS and sedation with a five point sedation test. Results: Demographic data were similar in all groups. No statistically significant differences between the groups were observed in intraoperative haemodynamic parameters. The first analgesic requirement time was 247.5±159.0 minutes in Group I, 315.0±117.8 minutes in Group II and 340.2±93.9 minutes in Group III. The intraoperative fentanyl requirement was higher in Group I than in the other two groups (p<0.05). Sedation scores and CHEOPS were similiar in all groups. No motor block was seen in either group on awakening. There were no differences in the insidence of emesis, vomiting and urinary retention among the groups. Conclusion: All three anesthetic agents may be used effectively in caudal anesthesia in children but time to first analgesic requirement was found to be shorter for prilocaine.
European Journal of Pain, 2006
... How to Cite. Karakas, O., Canbay, O., Celebi, N., Sahin, A., Karagoz, A., Iskit, A. and Aypar... more ... How to Cite. Karakas, O., Canbay, O., Celebi, N., Sahin, A., Karagoz, A., Iskit, A. and Aypar, U. (2006), 317 THE EFFECTS OF LORNOXICAM AND KETAMINE ON INFLAMMATION AND MECHANICAL HYPERALGESIA MODELS IN RATS. European Journal of Pain, 10: S85. ...
European Journal of Anaesthesiology, 2005
Pediatric Anesthesia, 2007
Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart ra... more Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life-threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children. Methods: The study was performed on 20 children admitted for inguinal hernia repair, with normal QTc intervals. Anesthesia was induced with propofol and intubation was achieved with vecuronium. Anesthesia was maintained with 2% sevoflurane (group I, n ¼ 11) or 6% desflurane (group II, n ¼ 9) and 66% nitrous oxide in oxygen. Electrocardiogram recordings were obtained by Holter recorder. QTc intervals were measured at baseline, 5, 10, 15, and 30 min after inhalation. Results: None of the patients had significant arrythmia with desflurane anesthesia. One patient in the sevoflurane group had single, bigemini and multiform ventricular extrasystoles. There was no statistically significant difference in the baseline QTc values of the groups. Desflurane significantly prolonged QTc interval 5 min after induction until 30 min of anesthesia compared with baseline values (P ¼ 0.029), while no significant prolongation was observed with sevoflurane (P ¼ 0.141). Conclusions: Use of 2% sevoflurane during maintenance of anesthesia does not significantly prolong QTc interval while 6% desflurane significantly prolonged QTc interval in children with normal QTc interval undergoing inguinal herniorrhaphy.
Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2004
We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngea... more We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngeal Angiofibroma Resection" by Ezri et al. 1 We wanted to share our similar experience in a patient with hemophilia A and a nasopharyngeal angiofibroma. Nasopharyngeal angiofibroma is a rare benign fibrovascular tumor that can lead to severe, life-threatening epistaxis. We present the anesthetic approach to the nasopharyngeal angiofibroma in a patient with hemophilia A. A 17-year-old male patient who had hemophilia A and a nasopharyngeal mass occluding the cavity had undergone a biopsy in another medical center. After the biopsy, he had life-threatening severe hemorrhage, and tracheotomy had been performed to avoid the risk of aspiration. Histopathologic results revealed a nasopharyngeal angiofibroma. The patient was admitted to our hospital with this diagnosis. To provide for less blood loss throughout the operation, embolization was performed on the tumor mass. Factor VIII was given at 2-hour intervals to keep his serum factor VIII levels at 100% during surgery. He was premedicated with oral diazepam because intramuscular injections may lead to unexpected hematoma. Anesthesia was induced with propofol and vecuronium and maintained by isoflurane and 30% N 2 O in oxygen. He was intubated through the stoma of the tracheotomy with a cuffed endotracheal tube. Electrocardiogram, invasive arterial blood and central venous pressures, pulse oximetry, capnography, and urinary output measurements were recorded. Two 14-G intravenous catheters were placed in the upper extremities. Also, right internal jugular vein was cannulated with a 14-G catheter. Mean arterial pressure was 55 to 75 mmHg throughout the surgery. This was maintained with increasing concentrations of isoflurane and fentanyl, 5 g/kg, when required. During the procedure, which lasted 4 hours, 3,000 mL of crystalloid, 1,000 mL of colloid, 4 units of erythrocytes, and 4 units of plasma were given. Total urinary output and blood loss were 800 mL and 2,000 mL, respectively. The hemoglobin level was maintained around 10 g/dL. Platelets were given in addition to packed cells. Body temperature was preserved by warming the fluids and blood, and warming blankets were used. Intraoperative hypotension and metabolic acidosis were not detected. He was extubated at the end of the surgery and transferred to the intensive care unit. He was discharged from the hospital without any complication. The anesthetic approach during surgery for juvenile nasopharyngeal angiofibroma resection is important in 3 respects: (1) risk of blood aspiration during induction of anesthesia, (2) major surgical bleeding, and (3) airway obstruction after extubation because of edema related to surgery. Since the patient had a tracheotomy, airway management did not lead to any difficulty. Massive blood loss is expected to be a major concern during resection of juvenile nasopharyngeal angiofibroma, especially in a patient with hemophilia A. 2 Similar to Ezri et al, 1 we used isoflurane and fentanyl for deliberate hypotension. Appropriate preoperative precautions and induced hypotension during surgical resection of nasopharyngeal angiofibroma in a patient with hemophilia A provided a safe and successful outcome.
Middle East journal of anaesthesiology, 2012
The incidence of a difficult laryngoscopy/intubation, which could lead to failed intubation is in... more The incidence of a difficult laryngoscopy/intubation, which could lead to failed intubation is in the range of 1.5%-13%. Failed intubation may lead to hypoxia, brain damage or death. Preoperative evaluation of the airway can be accomplished by non-invasive bedside clinical tests during physical examination. We studied interobserver variability for non-invasive prediction of difficult intubation in different anesthesiology residency years. Three hundred eighty four adult patients undergoing elective surgery with general anesthesia and endotracheal intubation were enrolled this study. The investigators were divided in to two groups: three of them were in 4th (Group 1) and the other three were in 1st (Group 2) year of their anesthesiology residency. The variables evaluated were age, weight, height, submental-cervical angle, measurements of mandibular space, deviation of trachea, jaw-hyomental distance, swelling or scar tissue at neck, limited mouth opening, small mouth cavity, macroglo...
Saudi medical journal, 2004
Immunosuppression is directly related to the degree of trauma. The aim of this study is to compar... more Immunosuppression is directly related to the degree of trauma. The aim of this study is to compare the effects of low and high intra-abdominal pressure on immune response in moderate surgical trauma. Twenty-two patients, scheduled for laparoscopic cholecystectomy, were randomly allocated to one of 2 groups according to intra-abdominal pressure: low and high intra-abdominal pressure. This study was conducted in the Hacettepe University Faculty of Medicine, Operation Room, Ankara, Turkey. Serum interleukin (IL)-2 and IL-6 levels were measured. Serum IL-2 showed a significant decrease before the incision in high intra-abdominal pressure group. The increase in serum IL-6 at the end of surgery and postoperatively was lower in low intra-abdominal pressure group. These results, can be interpreted as the immune system, are less depressed when there is lower intra-abdominal pressure. This may have clinical implications in immunocompromised patients.
Tüberküloz ve toraks, 2009
Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complicati... more Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complication that may lead to fatal complications such as pulmonary artery injury. We describe entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature in a patient undergoing right pneumonectomy. This situation resulted with removal of catheter safely without any complication. We concluded that with early recognition of the complication during thoracotomy, is golden standard in preventing pulmonary artery catheter entrapment and surgeons should be aware of the risk of accidentally transfixing pulmonary artery catheter in every type of operation that takes place in thorax.
Allergy and asthma proceedings : the official journal of regional and state allergy societies
Episodes of wheezing are very common in infancy. In pediatrics, indications for flexible bronchos... more Episodes of wheezing are very common in infancy. In pediatrics, indications for flexible bronchoscopy include prolonged wheezing, where airway abnormalities such as malacia disorders, tracheobronchial abnormalities, and vascular ring may be found. The study was performed to determine the diagnostic use of flexible bronchoscopy in wheezy patients who were previously administered bronchodilators and steroids for asthma and whose symptoms recurred or were not improved at all. Infants with wheezing were identified and collected over a 3-year period at the pediatric pulmonology unit. Flexible bronchoscopy was performed for diagnostic purposes in 34 (24 boys and 10 girls) patients with wheezing who were previously treated for asthma. The mean age for the onset of the symptoms was 2.5 months (0-12 months), and the mean age of bronchoscopic assessment was 9 months (45 days-48 months). A definitive diagnosis was made by bronchoscopy in 29 (85%) patients. Functional abnormalities in 15 patien...
Turkish Journal of Anesthesia and Reanimation, 2013
ABSTRACT
Liver Transplantation - Basic Issues, 2012
Transplantation Proceedings, 2007
Background. The main metabolic pathway for defluorination of sevoflurane in the liver produces in... more Background. The main metabolic pathway for defluorination of sevoflurane in the liver produces inorganic fluoride (Fl). The metabolism and effect of sevoflurane on the kidney is not clear during anhepatic phase in liver transplantation. The goal of the present study was to investigate the metabolism and renal effect of sevoflurane by measuring plasma and urine inorganic fluoride, urinary N-acetyl-glucosaminidase (NAG), and plasma creatinine levels in patients undergoing liver transplantations. Methods. After institutional approval and informed consent, we studied nine cases of orthotopic liver transplantation after anesthesia was induced with 5 mg • kg Ϫ1 thiopental, 1 g • kg Ϫ1 fentanyl intravenously, the trachea was intubated after vecuronium bromide 0.1 mg • kg Ϫ1. Anesthesia was maintained with sevoflurane (2%), O 2 , and N 2 O at a total gas flow of 6 L • min Ϫ1 using a semiclosed circle system with a sodalime canister. Blood and urine samples were obtained to measure plasma and urine fluoride concentrations and urinary NAG excretions before induction (P0), hourly during resection (P1, P2, P3), every 15 minutes during anhepatic phase (A1, A2, A3), hourly after reperfusion (neohepatic phase) (N1, N2, N3), and postoperative first hour (Po1). Preoperative (T0) and postoperative day 1 (T1), 3 (T3), 7 (T7) plasma blood urea nitrogen (BUN) and creatinine (Cr) levels were also recorded. Results. Mean duration of surgery was 9:06 Ϯ 0:09 hours. Mean inorganic fluoride concentrations in plasma were in the range of 0.71 Ϯ 0.30 to 28.73 Ϯ 3.31 mole • L Ϫ1. In P3, N1, N2, N3, increases in plasma inorganic fluoride concentrations were significant (P Ͻ .05) and reached a peak value at Po1. The mean urine inorganic fluoride concentrations were 12.49 Ϯ 2.04 to 256.7 Ϯ 49.62 mole • L Ϫ1. In A2, A3, N1, N2, and
Pediatric Anesthesia, 2007
Pediatric Anesthesia, 2004
Anesthetic management of a 3-month-old boy with Beckwith-Wiedemann syndrome for bronchoscopy is r... more Anesthetic management of a 3-month-old boy with Beckwith-Wiedemann syndrome for bronchoscopy is reported. Management may be complicated by a difficult airway, congenital heart disease, and hypoglycemia. We did not have difficulty in airway management either with tracheal intubation or rigid bronchoscopy, but we could not extubate the baby because of tracheomalacia.
Pediatric Anesthesia, 2007
Pediatric Anesthesia, 2006
Pediatric Anesthesia, 2007
is hydrolyzed by plasma esterases after intravenous administration such that 1 g of propacetamol ... more is hydrolyzed by plasma esterases after intravenous administration such that 1 g of propacetamol is hydrolyzed to 0.5 g of paracetamol. There is extensive clinical experience with the use of this prodrug in neonates and children in these countries and its maturational pharmacokinetics in neonates and children have been reported (3,5). An alternative intravenous paracetamol formulation (PerfalganÒ; Bristol-Myers Squibb) has recently become available and is licensed to be used in children from 10 kg upwards in Europe. Two vials (500 mgAE50 ml)1 , 1000 mgAE100 ml)1), both with the same concentration (10 mgAEml)1) are available. Tolerance and analgesic efficacy of this new intravenous paracetamol solution in children after inguinal hernia repair was recently reported in this journal (6). Autret et al. (7) evaluated single dose IV administration of 15 mgAEkg)1 of propacetamol in neonates and infants, equal to 7.5 mgAEkg)1 paracetamol. Based on these observations, the present French guidelines suggest to administer maximal 30 mg (4 • 7.5 mgAEkg)1 paracetamol) in neonates although the practice is to use a loading dose of 15 mgAEkg)1 IV paracetamol. We documented the pharmacokinetics of 20 and 40 mgAE kg)1 of propacetamol (equal to 10 and 20 mgAEkg)1 of IV paracetamol) in preterm and term neonates (8). A multiple dose study regimen was extrapolated from this single dose study and evaluated a loading dose of 30 mgAEkg)1 (equal to 15 mgAEkg)1 of IV paracetamol) in all neonates followed by a maintenance dose of 20 mgAEkg)1 of propacetamol (i.e. 10 mgAEkg)1 of IV paracetamol) using a dosing interval based on the postconception age (PCA > 36 weeks: 6 h, PCA 32-36 weeks: 8 h, PCA < 32 weeks: 12 h) (3). There are advantages of the more recently marketed formulation (Perfalgan) compared with the propacetamol (Prodafalgan) as the vials are 'ready-for-use' and the administration is better tolerated, also in children (6). However, dose miscalculations during clinical care may counterbalance these advantages. In Table 1, we provide the reader with the dose suggestions currently use in the neonatal intensive care unit (University Hospital Gasthuisberg, Leuven, Belgium) of both intravenous propacetamol and intravenous paracetamol in neonates. These dose suggestions are based on the pharmacokinetic studies performed in neonates, but pharmacodynamics in this specific population have yet to be studied.
Pacing and Clinical Electrophysiology, 2013
Catheter cryoablation of supraventricular tachycardias involving the perinodal regions is conside... more Catheter cryoablation of supraventricular tachycardias involving the perinodal regions is considered to be a safer alternative compared to radiofrequency ablation. Limited information is available for efficacy, midterm outcomes, and complications regarding the ablation of parahissian accessory pathways (APs) in pediatric patients. A retrospective review of all pediatric patients who underwent cryoablation for treatment of a parahissian AP was performed. Twenty-five patients (median age 13 years and weight 45.6 kg) underwent cryoablation of a parahissian AP. Median number of cryolesions applied was four (range: 3-6). Initial procedural success was achieved in 23 patients (23/25, 92%). Transient third-degree atrioventricular (AV) block was noted in two patients. There was no permanent AV block. Transient right bundle branch block (RBBB) was observed in one patient and permanent RBBB occurred in two patients. Of the patients successfully ablated with cryo, there was only one recurrence (1/23, 4.3%) over a follow-up of 17.5 months (range 6-34 months). Cryoablation of parahissian APs is both safe and effective with a low risk of recurrence in pediatric patients.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngea... more We read with great interest the article entitled "Anesthetic Management of Juvenile Nasopharyngeal Angiofibroma Resection" by Ezri et al. 1 We wanted to share our similar experience in a patient with hemophilia A and a nasopharyngeal angiofibroma. Nasopharyngeal angiofibroma is a rare benign fibrovascular tumor that can lead to severe, life-threatening epistaxis. We present the anesthetic approach to the nasopharyngeal angiofibroma in a patient with hemophilia A. A 17-year-old male patient who had hemophilia A and a nasopharyngeal mass occluding the cavity had undergone a biopsy in another medical center. After the biopsy, he had life-threatening severe hemorrhage, and tracheotomy had been performed to avoid the risk of aspiration. Histopathologic results revealed a nasopharyngeal angiofibroma. The patient was admitted to our hospital with this diagnosis. To provide for less blood loss throughout the operation, embolization was performed on the tumor mass. Factor VIII was given at 2-hour intervals to keep his serum factor VIII levels at 100% during surgery. He was premedicated with oral diazepam because intramuscular injections may lead to unexpected hematoma. Anesthesia was induced with propofol and vecuronium and maintained by isoflurane and 30% N 2 O in oxygen. He was intubated through the stoma of the tracheotomy with a cuffed endotracheal tube. Electrocardiogram, invasive arterial blood and central venous pressures, pulse oximetry, capnography, and urinary output measurements were recorded. Two 14-G intravenous catheters were placed in the upper extremities. Also, right internal jugular vein was cannulated with a 14-G catheter. Mean arterial pressure was 55 to 75 mmHg throughout the surgery. This was maintained with increasing concentrations of isoflurane and fentanyl, 5 g/kg, when required. During the procedure, which lasted 4 hours, 3,000 mL of crystalloid, 1,000 mL of colloid, 4 units of erythrocytes, and 4 units of plasma were given. Total urinary output and blood loss were 800 mL and 2,000 mL, respectively. The hemoglobin level was maintained around 10 g/dL. Platelets were given in addition to packed cells. Body temperature was preserved by warming the fluids and blood, and warming blankets were used. Intraoperative hypotension and metabolic acidosis were not detected. He was extubated at the end of the surgery and transferred to the intensive care unit. He was discharged from the hospital without any complication. The anesthetic approach during surgery for juvenile nasopharyngeal angiofibroma resection is important in 3 respects: (1) risk of blood aspiration during induction of anesthesia, (2) major surgical bleeding, and (3) airway obstruction after extubation because of edema related to surgery. Since the patient had a tracheotomy, airway management did not lead to any difficulty. Massive blood loss is expected to be a major concern during resection of juvenile nasopharyngeal angiofibroma, especially in a patient with hemophilia A. 2 Similar to Ezri et al, 1 we used isoflurane and fentanyl for deliberate hypotension. Appropriate preoperative precautions and induced hypotension during surgical resection of nasopharyngeal angiofibroma in a patient with hemophilia A provided a safe and successful outcome.
International Urology and Nephrology, 2014
To investigate the effects of oral carbohydrate solution consumed until 2 h before the surgery in... more To investigate the effects of oral carbohydrate solution consumed until 2 h before the surgery in the patients that would undergo open radical retropubic prostatectomy on postoperative metabolic stress, patient anxiety, and comfort. A total of 50 adult patients, who were in ASA I-II group and would undergo open radical retropubic prostatectomy, were included in the study. While Group 1 = CH (n = 25) received oral glucose solution, Group 2 = FAM (n = 25) was famished starting from 24:00 h. Blood glucose, insulin, and procalcitonin levels of the patients were recorded, and the patients completed state-trait anxiety inventory (STAI) test, which reflects the anxiety level of the patients, both before surgery and on the postoperative 24th hour. In order to evaluate patient comfort, senses of hunger, thirst, nausea, and cold were assessed in the morning prior to the surgery. No difference was observed between the two groups in terms of demographic data and insulin resistance levels (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Comparing with the preoperative levels, insulin resistance showed statistically significant elevation in both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Procalcitonin levels were similarly increased in both groups in the postoperative period (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Preoperative and postoperative STAI state scores were similar in both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). With regard to preoperative patient comfort, sense of hunger was present in lesser number of subjects and at lower level in Group 1 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Preoperative consumption of high carbohydrate drink (Pre-op) decreases insulin resistance and enhances patient comfort leading to lesser sense of hunger and thirst in the preoperative period in open radical retropubic prostatectomies.
European Journal of Pain, 2006
ABSTRACT Objective: The aim of the study was to compare the effects of prilocaine, bupivacaine an... more ABSTRACT Objective: The aim of the study was to compare the effects of prilocaine, bupivacaine and ropivacaine for postoperative pain management in children. Method: Sixty ASA I-II children between 1 and 7 years of age and scheduled for urologic surgery with general anaesthesia were recruited. The patients were randomly allocated into three groups. Group I received caudal prilocaine 1% 0.5 mL kg -1 after the operation, Group II received 0.25% 1 mL kg -1 bupivacaine and Group III received 0.25% 1 mL kg -1 after induction of anesthesia. During anaesthesia, hemodynamic parameters and fentanyl requirements were recorded. Haemodynamic parameters, sedation and pain scores were recorded at 15 and 30 minutes, 1, 2, 4 and 6 hours following recovery from anaesthesia. Pain was evaluated by CHEOPS and sedation with a five point sedation test. Results: Demographic data were similar in all groups. No statistically significant differences between the groups were observed in intraoperative haemodynamic parameters. The first analgesic requirement time was 247.5±159.0 minutes in Group I, 315.0±117.8 minutes in Group II and 340.2±93.9 minutes in Group III. The intraoperative fentanyl requirement was higher in Group I than in the other two groups (p<0.05). Sedation scores and CHEOPS were similiar in all groups. No motor block was seen in either group on awakening. There were no differences in the insidence of emesis, vomiting and urinary retention among the groups. Conclusion: All three anesthetic agents may be used effectively in caudal anesthesia in children but time to first analgesic requirement was found to be shorter for prilocaine.
European Journal of Pain, 2006
... How to Cite. Karakas, O., Canbay, O., Celebi, N., Sahin, A., Karagoz, A., Iskit, A. and Aypar... more ... How to Cite. Karakas, O., Canbay, O., Celebi, N., Sahin, A., Karagoz, A., Iskit, A. and Aypar, U. (2006), 317 THE EFFECTS OF LORNOXICAM AND KETAMINE ON INFLAMMATION AND MECHANICAL HYPERALGESIA MODELS IN RATS. European Journal of Pain, 10: S85. ...