Kemalettin Koltka - Academia.edu (original) (raw)

Papers by Kemalettin Koltka

Regional Anesthesia and Pain Medicine, Sep 1, 2004

We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resect... more We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resection of bladder or prostate. Doses of ropivacaine and bupivacaine were chosen according to a 3:2 ratio found to be equipotent in orthopedic surgery. One hundred patients were randomly assigned to blindly receive either 10 mg of isobaric bupivacaine (0.2%, n ϭ 50) or 15 mg of isobaric ropivacaine (0.3%, n ϭ 50) over 30 s through a 27-gauge Quincke needle at the L2-3 level in the sitting position. Onset and offset times for sensory and motor blockades and mean arterial blood pressure were recorded. Pain at surgical site requiring supplemental analgesics was recorded. Cephalad spread of sensory blocks was higher with bupivacaine (median level, cold T 4 and pinprick T 7) than with ropivacaine (cold T 6 and pinprick

Knee Surgery, Sports Traumatology, Arthroscopy, Apr 6, 2011

Arthroscopic knee surgery is done in outpatient settings; however, postoperative pain is a major ... more Arthroscopic knee surgery is done in outpatient settings; however, postoperative pain is a major barrier for discharge and limits early rehabilitation. The efficacy of intraarticular application of magnesium sulphate, levobupivacaine and lornoxicam, with placebo on postoperative pain after arthroscopic meniscectomy was evaluated. One hundred and twenty ASA status I-II patients undergoing elective arthroscopic meniscectomy were included in this randomized, single blind, prospective study. Group-M (GM) patients had intraarticular 500 mg of magnesium sulphate in 20 ml saline; group-P (GP) patients had intraarticular 20 ml saline; group-LB (GLB) patients had 100 mg levobupivacaine in 20 ml (0.5%); group-L (GL) patients had intraarticular 8 mg of lornoxicam in 20 ml saline before tourniquet deflation. Postoperative analgesia was maintained by iv tramadol PCA 0.3 mg kg(-1) bolus dose and 5 min lockout time during the first 4 h and later with paracetamol 500 mg. The NRS values at rest and at exercise and analgesic consumptions were evaluated at the end of the first, second and 4th hours and at the 12th, 24th and 48th hours by an anaesthesiologist who was blind to the solutions administered. All study groups provided analgesia when compared with GP. The first request of oral analgesic time was shorter in GP. Analgesic consumptions of GP were higher than other groups. Pain scores during 1, 2 and 4 h postoperatively were lower in all study groups than the GP. Administration of all the drugs provided better analgesia than placebo and the most effective one was lornoxicam.

Medicine, Jul 8, 2022

Background: Kidney transplant is always emergent operations and frequently need to be performed a... more Background: Kidney transplant is always emergent operations and frequently need to be performed at nighttime to reduce cold ischemia time (CIT). Previous studies have revealed that fatigue and sleep deprivation can result in adverse consequences of medical procedures. This study aimed to evaluate whether nighttime operation has adverse impact on kidney transplant. Methods: A retrospective analysis of recipients accepted kidney transplant from deceased donors in one center from 2014 to 2016 was performed. Daytime transplant was defined as operation started after 8 AM or ended before 8 PM and nighttime operation was defined as operation ended after 8 PM or started before 8 AM. The incidences of complications such as delayed graft function, acute rejection, surgical complications and nosocomial infections were compared between 2 groups. Student's t-test was used to analyze continuous variables such as serum creatinine (Scr) at 1-year of post-transplant. The Chi-square test was used to analyze categorical variables. Differences in recipients and graft survival were analyzed using Kaplan-Meier methodology and log-rank tests. Results: Among the 443 recipients, 233 (52.6%) were classified into the daytime group and the others 210 (47.4%) were in the nighttime group. The 1-year survival rate of recipients was similar for the recipients in the daytime and nighttime groups (95.3% vs. 95.2%, P = 0.981). Although the 1-year graft survival rate in the nighttime group was slightly superior to that in the daytime group, the difference was not significant (92.4% vs. 88.4%, P = 0.164). Furthermore, Scr and incidence of complications were also not significantly different between the 2 groups. Conclusions: Our results suggested that operation time of kidney transplant with short CIT has no significant impact on the outcome of kidney transplant. Nighttime operation of kidney transplant with short CIT could be postponed to the following day to alleviate the burden on medical staffs and avoid the potential risk.

Turkish journal of trauma & emergency surgery, 2022

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor... more BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Longterm complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Turkish Journal of Trauma and Emergency Surgery

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor... more BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Longterm complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Anaesthesia and Intensive Care, Nov 1, 2009

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacai... more The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 μg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 μg (group R, n=26) or plain bupivacaine 13 mg with fentanyl 20 μg (group B, n=26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher. The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P <0.05). There was no difference in the onset time of motor block. The duration of motor block (Bromage score >0) was shorter in group R (139±39 minutes vs group B 182±46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90±25 minutes vs 130±40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 μg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 μg for spinal anaesthesia in lower abdominal surgery.

Regional Anesthesia and Pain Medicine, 2008

İstanbul Tıp Kitapevleri, 2019

Turkish Journal of Trauma and Emergency Surgery, 2019

BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and pal... more BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan. METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted. RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13±1.1 and 3.32±0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US. CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

Türk Anesteziyoloji ve Reanimasyon Derneği, 2017

Türk Anesteziyoloji ve Reanimasyon Derneği, 2014

Türk Yoğun Bakim Derneği Dergisi, 2011

A significant burn injury is a serious and mortal event. The most important threat to life is hyp... more A significant burn injury is a serious and mortal event. The most important threat to life is hypovolemic shock with complex pathophysiologic mechanisms. Burn depth is classified as first, second, or third degree. Local inflammatory response results a vasodilatation and an increase in vascular permeability. A burn injury is a three dimensional ischemic wound. Zone of coagulation is the zone with maximum damage. Zone of stasis consists of damaged but viable tissues, the tissue is salvageable. In zone of hyperemia tissue perfusion is increased. At the beginning, cardiac output falls and systemic vascular resistance increases; cardiac performance improves as hypovolemia is corrected with fluid resuscitation. While cardiac output increases systemic vascular resistance falls below normal values and a hypermetabolic state develops. Pulmonary vascular resistance increases immediately after thermal injury and this is more prolonged. To avoid secondary pulmonary complications, the smallest r...

Turkish Journal of Trauma and Emergency Surgery, 2020

Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesi... more Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5-2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.

Turkish Journal of Trauma and Emergency Surgery

Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric tra... more Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? dle-income countries (LMICs). [1] Most of these injured pediatric patients are treated in general state hospitals not in special pediatric hospitals. [2] In designated trauma centers, the outcomes of severely injured patients are better compared to non-trauma centers. [3] In most of the LMICs, pediatric trauma centers are few or not present at all.

Ağrı - The Journal of The Turkish Society of Algology, 2020

Laparoskopik kolesistektomilerde paravertebral blok ve intravenöz analjezik yöntemlerin postopera... more Laparoskopik kolesistektomilerde paravertebral blok ve intravenöz analjezik yöntemlerin postoperatif ağrı yönetimi ile opioid tüketimine etkileri Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies

Knee Surgery, Sports Traumatology, Arthroscopy, 2002

Journal of Cardiothoracic and Vascular Anesthesia, 2003

To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) o... more To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement. Design: Prospective clinical investigation. Setting: University hospital. Participants: Thirty-four adult patients. Interventions: After administration of midazolam, 0.025 mg/kg, and fentanyl, 0.5 to 1 g/kg, surgery was performed under topical infiltration with 1% lidocaine. In group I (GI) (n ‫؍‬ 17), patients received thiopental by slow injection and patients in group II (GII) (n ‫؍‬ 17) received propofol before induction of ventricular fibrillation (VF). Measurements and Main Results: Patients received 4.1 ؎ 1.4 mg of midazolam, 114 ؎ 34 g of fentanyl, and 280 ؎ 78 mg of thiopental in GI; and 4.6 ؎ 1.7 mg of midazolam, 119 ؎ 62 g of fentanyl, and 147 ؎ 40 mg of propofol in GII (p > 0.05). Hemodynamics did not show significant differences between the groups at any recording time. Average time needed to regain the pretest sedation level was 16.4 ؎ 8.8 minutes in GI and 10.9 ؎ 5.5 minutes in GII (p ‫؍‬ 0.03). Time required to achieve a score of 10 using a modified Aldrete score was 26.4 ؎ 9.3 minutes in GI and 17.4 ؎ 4.9 in GII (p ‫؍‬ 0.001). Seven patients in GII (41%) and 1 patient in GI (6%) became hypotensive after DFT (p ‫؍‬ 0.04). Conclusions: Deepening the sedation level by slow injection of thiopental or propofol before DFT provided satisfactory conditions during brief episodes of VF. Delay in recovery of arterial pressure after DFT with propofol and delay in arousal and discharge of patients with thiopental are major disadvantages of the regimens.

Regional Anesthesia and Pain Medicine, Sep 1, 2004

We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resect... more We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resection of bladder or prostate. Doses of ropivacaine and bupivacaine were chosen according to a 3:2 ratio found to be equipotent in orthopedic surgery. One hundred patients were randomly assigned to blindly receive either 10 mg of isobaric bupivacaine (0.2%, n ϭ 50) or 15 mg of isobaric ropivacaine (0.3%, n ϭ 50) over 30 s through a 27-gauge Quincke needle at the L2-3 level in the sitting position. Onset and offset times for sensory and motor blockades and mean arterial blood pressure were recorded. Pain at surgical site requiring supplemental analgesics was recorded. Cephalad spread of sensory blocks was higher with bupivacaine (median level, cold T 4 and pinprick T 7) than with ropivacaine (cold T 6 and pinprick

Knee Surgery, Sports Traumatology, Arthroscopy, Apr 6, 2011

Arthroscopic knee surgery is done in outpatient settings; however, postoperative pain is a major ... more Arthroscopic knee surgery is done in outpatient settings; however, postoperative pain is a major barrier for discharge and limits early rehabilitation. The efficacy of intraarticular application of magnesium sulphate, levobupivacaine and lornoxicam, with placebo on postoperative pain after arthroscopic meniscectomy was evaluated. One hundred and twenty ASA status I-II patients undergoing elective arthroscopic meniscectomy were included in this randomized, single blind, prospective study. Group-M (GM) patients had intraarticular 500 mg of magnesium sulphate in 20 ml saline; group-P (GP) patients had intraarticular 20 ml saline; group-LB (GLB) patients had 100 mg levobupivacaine in 20 ml (0.5%); group-L (GL) patients had intraarticular 8 mg of lornoxicam in 20 ml saline before tourniquet deflation. Postoperative analgesia was maintained by iv tramadol PCA 0.3 mg kg(-1) bolus dose and 5 min lockout time during the first 4 h and later with paracetamol 500 mg. The NRS values at rest and at exercise and analgesic consumptions were evaluated at the end of the first, second and 4th hours and at the 12th, 24th and 48th hours by an anaesthesiologist who was blind to the solutions administered. All study groups provided analgesia when compared with GP. The first request of oral analgesic time was shorter in GP. Analgesic consumptions of GP were higher than other groups. Pain scores during 1, 2 and 4 h postoperatively were lower in all study groups than the GP. Administration of all the drugs provided better analgesia than placebo and the most effective one was lornoxicam.

Medicine, Jul 8, 2022

Background: Kidney transplant is always emergent operations and frequently need to be performed a... more Background: Kidney transplant is always emergent operations and frequently need to be performed at nighttime to reduce cold ischemia time (CIT). Previous studies have revealed that fatigue and sleep deprivation can result in adverse consequences of medical procedures. This study aimed to evaluate whether nighttime operation has adverse impact on kidney transplant. Methods: A retrospective analysis of recipients accepted kidney transplant from deceased donors in one center from 2014 to 2016 was performed. Daytime transplant was defined as operation started after 8 AM or ended before 8 PM and nighttime operation was defined as operation ended after 8 PM or started before 8 AM. The incidences of complications such as delayed graft function, acute rejection, surgical complications and nosocomial infections were compared between 2 groups. Student's t-test was used to analyze continuous variables such as serum creatinine (Scr) at 1-year of post-transplant. The Chi-square test was used to analyze categorical variables. Differences in recipients and graft survival were analyzed using Kaplan-Meier methodology and log-rank tests. Results: Among the 443 recipients, 233 (52.6%) were classified into the daytime group and the others 210 (47.4%) were in the nighttime group. The 1-year survival rate of recipients was similar for the recipients in the daytime and nighttime groups (95.3% vs. 95.2%, P = 0.981). Although the 1-year graft survival rate in the nighttime group was slightly superior to that in the daytime group, the difference was not significant (92.4% vs. 88.4%, P = 0.164). Furthermore, Scr and incidence of complications were also not significantly different between the 2 groups. Conclusions: Our results suggested that operation time of kidney transplant with short CIT has no significant impact on the outcome of kidney transplant. Nighttime operation of kidney transplant with short CIT could be postponed to the following day to alleviate the burden on medical staffs and avoid the potential risk.

Turkish journal of trauma & emergency surgery, 2022

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor... more BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Longterm complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Turkish Journal of Trauma and Emergency Surgery

BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor... more BACKGROUND: Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Longterm complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. METHODS: This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. RESULTS: Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). CONCLUSION: In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

Anaesthesia and Intensive Care, Nov 1, 2009

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacai... more The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 μg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 μg (group R, n=26) or plain bupivacaine 13 mg with fentanyl 20 μg (group B, n=26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher. The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P <0.05). There was no difference in the onset time of motor block. The duration of motor block (Bromage score >0) was shorter in group R (139±39 minutes vs group B 182±46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90±25 minutes vs 130±40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 μg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 μg for spinal anaesthesia in lower abdominal surgery.

Regional Anesthesia and Pain Medicine, 2008

İstanbul Tıp Kitapevleri, 2019

Turkish Journal of Trauma and Emergency Surgery, 2019

BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and pal... more BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan. METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted. RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13±1.1 and 3.32±0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US. CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

Türk Anesteziyoloji ve Reanimasyon Derneği, 2017

Türk Anesteziyoloji ve Reanimasyon Derneği, 2014

Türk Yoğun Bakim Derneği Dergisi, 2011

A significant burn injury is a serious and mortal event. The most important threat to life is hyp... more A significant burn injury is a serious and mortal event. The most important threat to life is hypovolemic shock with complex pathophysiologic mechanisms. Burn depth is classified as first, second, or third degree. Local inflammatory response results a vasodilatation and an increase in vascular permeability. A burn injury is a three dimensional ischemic wound. Zone of coagulation is the zone with maximum damage. Zone of stasis consists of damaged but viable tissues, the tissue is salvageable. In zone of hyperemia tissue perfusion is increased. At the beginning, cardiac output falls and systemic vascular resistance increases; cardiac performance improves as hypovolemia is corrected with fluid resuscitation. While cardiac output increases systemic vascular resistance falls below normal values and a hypermetabolic state develops. Pulmonary vascular resistance increases immediately after thermal injury and this is more prolonged. To avoid secondary pulmonary complications, the smallest r...

Turkish Journal of Trauma and Emergency Surgery, 2020

Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesi... more Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5-2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.

Turkish Journal of Trauma and Emergency Surgery

Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric tra... more Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? dle-income countries (LMICs). [1] Most of these injured pediatric patients are treated in general state hospitals not in special pediatric hospitals. [2] In designated trauma centers, the outcomes of severely injured patients are better compared to non-trauma centers. [3] In most of the LMICs, pediatric trauma centers are few or not present at all.

Ağrı - The Journal of The Turkish Society of Algology, 2020

Laparoskopik kolesistektomilerde paravertebral blok ve intravenöz analjezik yöntemlerin postopera... more Laparoskopik kolesistektomilerde paravertebral blok ve intravenöz analjezik yöntemlerin postoperatif ağrı yönetimi ile opioid tüketimine etkileri Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies

Knee Surgery, Sports Traumatology, Arthroscopy, 2002

Journal of Cardiothoracic and Vascular Anesthesia, 2003

To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) o... more To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement. Design: Prospective clinical investigation. Setting: University hospital. Participants: Thirty-four adult patients. Interventions: After administration of midazolam, 0.025 mg/kg, and fentanyl, 0.5 to 1 g/kg, surgery was performed under topical infiltration with 1% lidocaine. In group I (GI) (n ‫؍‬ 17), patients received thiopental by slow injection and patients in group II (GII) (n ‫؍‬ 17) received propofol before induction of ventricular fibrillation (VF). Measurements and Main Results: Patients received 4.1 ؎ 1.4 mg of midazolam, 114 ؎ 34 g of fentanyl, and 280 ؎ 78 mg of thiopental in GI; and 4.6 ؎ 1.7 mg of midazolam, 119 ؎ 62 g of fentanyl, and 147 ؎ 40 mg of propofol in GII (p > 0.05). Hemodynamics did not show significant differences between the groups at any recording time. Average time needed to regain the pretest sedation level was 16.4 ؎ 8.8 minutes in GI and 10.9 ؎ 5.5 minutes in GII (p ‫؍‬ 0.03). Time required to achieve a score of 10 using a modified Aldrete score was 26.4 ؎ 9.3 minutes in GI and 17.4 ؎ 4.9 in GII (p ‫؍‬ 0.001). Seven patients in GII (41%) and 1 patient in GI (6%) became hypotensive after DFT (p ‫؍‬ 0.04). Conclusions: Deepening the sedation level by slow injection of thiopental or propofol before DFT provided satisfactory conditions during brief episodes of VF. Delay in recovery of arterial pressure after DFT with propofol and delay in arousal and discharge of patients with thiopental are major disadvantages of the regimens.