demet altun - Academia.edu (original) (raw)
Papers by demet altun
Turkish Journal of Intensive Care
Objective: Hip fractures are an important health problem in geriatric patients. Preoperative esti... more Objective: Hip fractures are an important health problem in geriatric patients. Preoperative estimation of mortality risk can be done by assessing malnutrition, establishing a perioperative treatment plan, determining the prognosis, and reducing morbidity and mortality. The prognostic nutritional index (PNI) is a simple, cost-effective, and easily applicable indicator of nutritional status in patients. This study aimed to determine the relationship between preoperative PNI and postoperative mortality in patients with hip fracture. Materials and Methods: This prospective observational study included 183 patients aged 65-95 years who had I-IV American Society of Anesthesiologists physical status and were operated within the first 48 h after hip fracture. Patients were divided into two groups according to the 37.25 cutoff value of PNI. In total, 172 patients completed the study, of which 53 were in the low PNI group and 119 in the high PNI group. Results: The length of hospital stay, postoperative delirium, and 3-month mortality were significantly higher in the low PNI group than in the high PNI group (p=0.035, p=0.001, p=0.0001, respectively). Conclusion: Using PNI for diagnosing malnutrition in patients with hip fractures can help create an optimized treatment plan and reduce mortality. PNI is an easily calculated, objective, and inexpensive biomarker that can be used in routine screening.
The Turkish Journal of Ear Nose and Throat, 2017
Tracheal stenosis is an important clinical problem. Several treatment modalities are being used s... more Tracheal stenosis is an important clinical problem. Several treatment modalities are being used such as tracheal dilatation, laser surgery, surgical resection, and reconstruction. Surgery of the trachea is a special endeavor where the airway is shared by the surgeon and the anesthesiologist. In this article, we discussed the various methods of anesthesia and airway management in three cases who developed tracheal stenosis secondary to prolonged intubation in intensive care and were performed tracheal dilation, laser surgery, resection, and end-to-end anastomosis.
Objective: This study aims to compare stimulator-guided peripheral nerve block with and without u... more Objective: This study aims to compare stimulator-guided peripheral nerve block with and without ultrasonography techniques to investigate the block procedure time, sensory and motor block onset time, pain related to the block procedure-related pain, and anesthesia-related complications. Methods: Patients were randomized into two groups: The nerve stimulator (NS)-guided technique group (n=30) and the NS with ultrasound (NU)-guided technique group (n=30). One-quarter of the solution prepared with prilocaine 2% and lidocaine 2% with the height/5 formula was injected around each nerve after receiving a motor response between 0.3-0.5 mA. The block procedure time, sensory and motor block onset time, the number of skin punctures, procedure-related preoperative complications, procedure-related postoperative complications, and visual analog scale (VAS) (0-10) scores were recorded. The heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and peripheral ...
Journal of Anesthesiology and Reanimation Specialists’ Society, 2021
INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measu... more INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p<0.001, r= 0.619, r2=0.383, 95% CI=0.419-0.838). Similarly the correlation of subglottic tracheal diameter and best-fit ETT was significant (p<0.001, r=0.7...
Pediatric Anesthesia, 2019
Airway ultrasound can provide useful information for airway management 1 including prediction of ... more Airway ultrasound can provide useful information for airway management 1 including prediction of proper endotracheal tube size in pediatric patients as reported by several authors. 2-7 Ultrasound owes its recent popularity in airway to its dynamic, real-time, and minimally invasive assessment at bedside with user friendly features. 1 However, this technique also requires knowledge on its equipment, application, image optimization, identification of sonoanatomy, and interpretation of images. 8 There are studies of airway ultrasound learning primarily focused on localization of cricothyroid membrane. 9,10 Yet, literature on pediatric airway ultrasound learning or getting proficiency is lacking. 8 Lakhal et al 11 performed a feasibility study where 15 training examinations performed by the same echographer provided reproducible and reliable measurement of transverse cricoid lumen diameter
![Research paper thumbnail of Erratum to “High frequency jet ventilation during endolaryngeal surgery: Risk factors for complications” [Auris Nasus Larynx 45 (2018) 1047–1052]](https://attachments.academia-assets.com/104002359/thumbnails/1.jpg)
](Auris Nasus Larynx, 2019
Objective: Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-... more Objective: Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods: 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO 2 and end-tidal CO 2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results: 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31-1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52-328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0-1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97-46.49). Conclusion: Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2019
The aims of this randomized prospective mannequin study were to determine the amount of attempts ... more The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves. Methods: Difficult airway simulation was achieved with tongue edema in mannequin. After approval of volunteers, we asked 15 anesthesiology residents without any experience with fiberscopes to intubate with each device in a random order. Intubation success (endotracheal intubation within 120 seconds), the degree of difficulty of intubation, and reality of simulation using a 10-point scale were recorded. Learning curves were generated with cumulative sum method. Results: With Bonfils, 13 volunteers were able to pass lower decision boundary with a median number of 26 [95% confidence interval (CI) = 21.4-25.9] attempts, whereas in SensaScope, the same outcome was observed in 10 residents with a median number of attempts of 26 (95% CI = 23.5-32.5). Total success rate was found significantly higher with Bonfils compared with SensaScope (550/600 vs 512/600, respectively, P < 0.001). Intubation with Bonfils was considered as less difficult compared with SensaScope [median = 4 (95% CI = 3.32-4.42) and 6 (95% CI = 4.96-6.64), P = 0.01, respectively]. The reality of the simulation was rated as a median of 5 (95% CI = 4.37-5.8). Conclusions: Although a similar number of attempts were required to reach predetermined competency for both fiberscopes, only 10 of residents were able to obtain the targeted success using SensaScope as compared with 13 with Bonfils. Inexperienced residents found intubation via Bonfils less difficult than SensaScope. High individual variability in obtaining competency observed in this study with cumulative sum analysis underlines the importance of defining success a priori to simulation, the need for follow-up of individual progress, and the need to offer adequate trials to achieve competency. Therefore, learning opportunities should be adapted accordingly.
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.
Turkish journal of anaesthesiology and reanimation, 2016
The aim of this feasibility study was to investigate the first attempt success of ultrasonography... more The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway ...
Turkish Journal of Anesthesia and Reanimation, 2016
Determining the blood flow through intra and extra-cranial arteries during neck extension may be ... more Determining the blood flow through intra and extra-cranial arteries during neck extension may be helpful but is a controversial issue. We aimed to elucidate the changes in cerebral blood flow related to head positioning during thyroid surgery by carotid Doppler examination and regional oxygen saturation variations. Methods: Thirty patients were recruited to the study. Patients were positioned with a final position of thyroidectomy consisting a 30° semi Fowler with the extension of neck and head. Values of peak systolic velocity, average velocity, arterial diameter and blood flow volume of the common carotid artery were calculated. Bilateral regional cerebral oxygen saturation were monitored continuously. Results: At the end of the operation, peak systolic velocity, average velocity and blood flowvolume of the common carotid artery decreased significantly compared to the baseline measurement (p<0.001). Both left and right cerebral oximetry measurements showed a significant increase after induction and the increased oxymetric values persisted at the end of the operation (p<0.001). Age, body mass index, surgical duration and anaesthesia duration were found not to be correlated with the changes occurred in the values of peak systolic velocity, average velocity, arterial diameter, blood flow volume of the common carotid artery, left and right regional cerebral oxygen saturation after induction and at the end of surgery. Conclusion: The head and neck extension given for thyroidectomy negatively affect carotid blood flow and cerebral oxygenation gradually and become pronounced especially at the end of surgery. In conclusion, it is important to maintain the cerebral perfusion pressure and cerebral blood flow.
Turkish Journal of Anesthesia and Reanimation, 2016
Critical incident reporting systems (CIRS) and morbidity-mortality meetings (MMMs) offer the adva... more Critical incident reporting systems (CIRS) and morbidity-mortality meetings (MMMs) offer the advantages of identifying potential risks in patients. They are key tools in improving patient safety in healthcare systems by modifying the attitudes of clinicians, nurses and staff (human error) and also the system (human and/or technical error) according to the analysis and the results of incidents. Methods: One anaesthetist assigned to an administrative and/or teaching position from all university hospitals (UHs) and training and research hospitals (TRHs) of Turkey (n=114) was contacted. In this survey study, we analysed the facilities of anaesthetists in Turkish UHs and TRHs with respect to CIRS and MMMs and also the anaesthetists' knowledge, experience and attitudes regarding CIs. Results: Anaesthetists from 81 of 114 teaching hospitals replied to our survey. Although 96.3% of anaesthetists indicated CI reporting as a necessity, only 37% of departments/hospitals were reported to have CIRS. True definition of CI as "an unexpected /accidental event" was achieved by 23.3% of anaesthetists with CIRS. MMMs were reported in 60.5% of hospitals. Nevertheless, 96% of anaesthetists believe that CIRS and MMMs decrease the incidence of CI occurring. CI occurrence was attributed to human error as 4 [1-5]/10 and 3 [1-5]/10 in UHs and TRHs, respectively (p=0.005). In both hospital types, technical errors were evaluated as 3 [1-5]/10 (p=0.498). Conclusion: This first study regarding CIRS in the Turkish anaesthesia departments/hospitals highlights the lack of CI knowledge and CIRS awareness and use in anaesthesia departments/teaching hospitals in Turkey despite a safety reporting system set up by the Turkish Ministry of Health.
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society, 2013
Transport süreci kritik hastalar için çeşitli sorun ve komplikasyonlara açıktır. Farklı hasta gru... more Transport süreci kritik hastalar için çeşitli sorun ve komplikasyonlara açıktır. Farklı hasta gruplarında bu süreçteki komplikasyonların sıklığı, niteliği ve bunlarla ilişkili unsurlar araştırılmaktadır. Çalışmamızda hastane içi nakilde açık kalp cerrahisi gibi özellikli bir hasta grubunda yaşanan sorunları araştırmayı hedefledik. Gereç ve Yöntem: Ocak-Eylül 2013 tarihleri arasında elektif kalp cerrahisi geçiren tüm olgular çalışmaya dâhil edildi. Transport başlangıcı hastanın ameliyat bitiminde sabit monitör ve ventilatörden, taşınabilir monitör ve ventilatöre geçilmesi olarak belirlendi. Nakil sonu ise hastanın yoğun bakımda sabit monitör ve ventilatöre bağlanması olarak kabul edildi. Sürecin başlangıç ve sonucundaki kan basıncı, kalp hızı (KH) ve oksijen satürasyonu ile yoğun bakıma giriş kan gazı verileri kaydedildi. Transportun başından sonuna kadar geçen sürede karşılaşılan tüm komplikasyonlar kayıt altına alındı.
Journal of the Turkish Anaesthesiology and Intensive Care Society, 2012
Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok ... more Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok uygulama süresinin eğitim hastanesinde ameliyat odası kullanım süresini uzattığına dair yaygın kanının sorgulanması hedeflenmiştir. Gereç ve Yöntem: Elektif sezaryen operasyonu planlanan ASA I-II 120 gebe, spinal ve genel anestezi olarak 2 grupta çalışmaya alınmıştır. Her iki anestezi tekniği de eğitmen gözetiminde benzer deneyimdeki tıpta uzmanlık öğrencileri tarafından uygulanmıştır. Hastaların demografik verileri, gebelik özellikleri, t hazır (ameliyat odasına giriş-ameliyat için hazır olma süresi), t insizyon (giriş-cerrahi insizyon), t histerotomi (cerrahi insizyon-histerotomi), t histerotomi-doğum (histerotomi-göbek kordonuna klemp konulması), t derlenme (cerrahi bitiş-uyanma odasına giriş süresi), t operasyon (cerrahi başlangıç-bitiş), t ameliyat odası (ameliyat odası giriş-çıkış) süreleri, operasyon sırasında kullanılan sıvı ve efedrin miktarı kaydedilmiş. Ayrıca yenidoğanların demografik verileri, Apgar skorları ve umbilikal ven kan gazı verileri değerlendirilmiştir. Bulgular: Gebelerin demografik verileri ve gebelik özellikleri benzer bulunmuştur. Spinal anestezi grubunda t hazır , t insizyon , t histerotomi ve t histerotomi-doğum süresi, genel anestezi grubunda ise t derlenme süresi anlamlı derecede uzun olarak saptanmıştır. Ameliyat odası kullanım süreleri spinal ve genel anestezi grubunda benzer bulunmuştur (72.9±16.7 ve 70.2±12.9 dk.). Spinal anestezi alan gebelerde sıvı tüketimi ve efedrin gereksinimi daha fazla olmuştur. Yenidoğanların demografik verileri, PCO 2 değerleri arasında fark saptanmamıştır. Genel anestezi grubunda spinale oranla yenidoğanların PO 2 değerleri daha yüksek (36.7±14.2 ve 28.1±7.8 mmHg; p<0.001), pH değerleri ise daha düşük (7.32±0.04 ve 7.34±0.06; p=0.049) olmuştur, ancak bu değişiklikler Apgar skorlarına yansımamıştır. Sonuç: Cerrahi kanının aksine, eğitim hastanesinde spinal anestezi uygulaması ameliyat odası kullanım süresini arttırmamaktadır.
Turkish Journal of Anesthesia and Reanimation, 2014
Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or ... more Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or granulomatous lesions at the cuff level or tip of the tube may be observed on the tracheal wall. This injury mainly occurs due to excessive pressure of the cuff on the tracheal wall and may be prevented by a high-volume, low-pressure cuff and a carefully monitored tracheostomy tube. Although there is an overall improvement in the design of high-volume cuffs, hyperinflation of these cuffs may still contribute to tracheal injuries. If the size of the granuloma is limited, the lesion is treated by excision (microlaryngeal surgery) under general anaesthesia. Using jet ventilation during the operation minimizes the trauma caused by intubation and reduces the risk of oedema and the risk of barotrauma, as it provides ventilation over a possible stenosis. In addition to providing better visualization of the surgical field and superior surgeon comfort, jet ventilation also increases the success of the operation. In this case report, we aimed to present a successful anaesthesia technique performed by jet ventilation in a patient with a postintubation granuloma, which was excised by microlaryngeal surgery without the need for reintubation.
Journal of Anesthesia, 2013
PurposeIn patients who are hospitalized for surgery, anxiety disorders are frequently observed. A... more PurposeIn patients who are hospitalized for surgery, anxiety disorders are frequently observed. Anxiety affects the patient’s perception of postoperative pain and has a negative impact on recovery from anesthesia. This study attempted to compare the effect of preoperative anxiety on postoperative pain control and recovery from anesthesia in patients undergoing laparoscopic cholecystectomy.MethodsA total of 80 patients were enrolled who were undergoing laparoscopic cholecystectomy. Demographic characteristics of the patients were recorded. Beck’s anxiety ınventory (BAI) was administered to the patients: patients with anxiety were included in the high-anxious patient group (group H) and patients without anxiety were enrolled in the low-anxious group (group L). Duration of surgery, duration of anesthesia, extubation time, and adverse effects were recorded. During the postoperative period, patient-controlled analgesia with tramadol was used for pain control. Visual analog scale (VAS) scores and tramadol consumption of all patients were recorded.ResultsAmong all patients, 31 (38.75 %) patients had preoperative anxiety, and significant correlation was found between the days of hospitalization and preoperative score of BAI. In group L, extubation time, the time for the modified Aldrete score to reach 9, was seen as significantly shorter and fewer postoperative side effects were determined. Also in group L, postoperative VAS score and tramadol consumption were significantly lower, and less tenoxicam was needed.ConclusionA high preoperative anxiety level negatively affects recovery from anesthesia and control of postoperative pain. In this patient group, the increased need for postoperative analgesia must be adequately met.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2016
Introduction: The performance of laryngoscopes that have been developed for difficult airways can... more Introduction: The performance of laryngoscopes that have been developed for difficult airways can vary widely. The aim of the study was to compare Macintosh, McCoy, McGrath MAC, and C-MAC laryngoscopes in cervical immobilization and tongue edema scenarios in a mannequin, primarily to evaluate the time to intubation. Methods: In this randomized crossover study, 41 anesthesiology residents used 4 laryngoscopes in a mannequin (SimMan 3G) in 2 different scenarios. Intubation time (insertion of the blade between the teeth, to placement of the endotracheal tube into the trachea) longer than 120 seconds or inability to successfully place the endotracheal tube into the trachea after 5 or more attempts was defined as intubation failure. Besides intubation time, laryngoscopic view, number of intubation attempts, presence of esophageal intubation, need for stylet, difficulty of intubation, and success rate were recorded as secondary outcomes. Results: Intubation time was observed from longest to shortest as McGrath 9 McCoy 9 C-MAC 9 Macintosh in both scenarios. Laryngeal view was better with C-MAC laryngoscope. McGrath laryngoscope performed poorly specifically in tongue edema scenarios, which resulted in higher number of intubation attempts, esophageal intubation, need for intubation stylets, and overall intubation failure. Conclusions: The short intubation time observed with the Macintosh underlines the necessity of familiarity in success. Tongue edema is a more challenging scenario for simulated difficult airway and the McGrath may not be a good choice for such a scenario.
Auris, nasus, larynx, Jan 17, 2018
Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-f... more Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO2 and end-tidal CO2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31–1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52–328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0–1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97–46.49). Conclusion Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.
Turkish Journal of Intensive Care
Objective: Hip fractures are an important health problem in geriatric patients. Preoperative esti... more Objective: Hip fractures are an important health problem in geriatric patients. Preoperative estimation of mortality risk can be done by assessing malnutrition, establishing a perioperative treatment plan, determining the prognosis, and reducing morbidity and mortality. The prognostic nutritional index (PNI) is a simple, cost-effective, and easily applicable indicator of nutritional status in patients. This study aimed to determine the relationship between preoperative PNI and postoperative mortality in patients with hip fracture. Materials and Methods: This prospective observational study included 183 patients aged 65-95 years who had I-IV American Society of Anesthesiologists physical status and were operated within the first 48 h after hip fracture. Patients were divided into two groups according to the 37.25 cutoff value of PNI. In total, 172 patients completed the study, of which 53 were in the low PNI group and 119 in the high PNI group. Results: The length of hospital stay, postoperative delirium, and 3-month mortality were significantly higher in the low PNI group than in the high PNI group (p=0.035, p=0.001, p=0.0001, respectively). Conclusion: Using PNI for diagnosing malnutrition in patients with hip fractures can help create an optimized treatment plan and reduce mortality. PNI is an easily calculated, objective, and inexpensive biomarker that can be used in routine screening.
The Turkish Journal of Ear Nose and Throat, 2017
Tracheal stenosis is an important clinical problem. Several treatment modalities are being used s... more Tracheal stenosis is an important clinical problem. Several treatment modalities are being used such as tracheal dilatation, laser surgery, surgical resection, and reconstruction. Surgery of the trachea is a special endeavor where the airway is shared by the surgeon and the anesthesiologist. In this article, we discussed the various methods of anesthesia and airway management in three cases who developed tracheal stenosis secondary to prolonged intubation in intensive care and were performed tracheal dilation, laser surgery, resection, and end-to-end anastomosis.
Objective: This study aims to compare stimulator-guided peripheral nerve block with and without u... more Objective: This study aims to compare stimulator-guided peripheral nerve block with and without ultrasonography techniques to investigate the block procedure time, sensory and motor block onset time, pain related to the block procedure-related pain, and anesthesia-related complications. Methods: Patients were randomized into two groups: The nerve stimulator (NS)-guided technique group (n=30) and the NS with ultrasound (NU)-guided technique group (n=30). One-quarter of the solution prepared with prilocaine 2% and lidocaine 2% with the height/5 formula was injected around each nerve after receiving a motor response between 0.3-0.5 mA. The block procedure time, sensory and motor block onset time, the number of skin punctures, procedure-related preoperative complications, procedure-related postoperative complications, and visual analog scale (VAS) (0-10) scores were recorded. The heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and peripheral ...
Journal of Anesthesiology and Reanimation Specialists’ Society, 2021
INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measu... more INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p<0.001, r= 0.619, r2=0.383, 95% CI=0.419-0.838). Similarly the correlation of subglottic tracheal diameter and best-fit ETT was significant (p<0.001, r=0.7...
Pediatric Anesthesia, 2019
Airway ultrasound can provide useful information for airway management 1 including prediction of ... more Airway ultrasound can provide useful information for airway management 1 including prediction of proper endotracheal tube size in pediatric patients as reported by several authors. 2-7 Ultrasound owes its recent popularity in airway to its dynamic, real-time, and minimally invasive assessment at bedside with user friendly features. 1 However, this technique also requires knowledge on its equipment, application, image optimization, identification of sonoanatomy, and interpretation of images. 8 There are studies of airway ultrasound learning primarily focused on localization of cricothyroid membrane. 9,10 Yet, literature on pediatric airway ultrasound learning or getting proficiency is lacking. 8 Lakhal et al 11 performed a feasibility study where 15 training examinations performed by the same echographer provided reproducible and reliable measurement of transverse cricoid lumen diameter
Auris Nasus Larynx, 2019
Objective: Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-... more Objective: Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods: 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO 2 and end-tidal CO 2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results: 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31-1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52-328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0-1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97-46.49). Conclusion: Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2019
The aims of this randomized prospective mannequin study were to determine the amount of attempts ... more The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves. Methods: Difficult airway simulation was achieved with tongue edema in mannequin. After approval of volunteers, we asked 15 anesthesiology residents without any experience with fiberscopes to intubate with each device in a random order. Intubation success (endotracheal intubation within 120 seconds), the degree of difficulty of intubation, and reality of simulation using a 10-point scale were recorded. Learning curves were generated with cumulative sum method. Results: With Bonfils, 13 volunteers were able to pass lower decision boundary with a median number of 26 [95% confidence interval (CI) = 21.4-25.9] attempts, whereas in SensaScope, the same outcome was observed in 10 residents with a median number of attempts of 26 (95% CI = 23.5-32.5). Total success rate was found significantly higher with Bonfils compared with SensaScope (550/600 vs 512/600, respectively, P < 0.001). Intubation with Bonfils was considered as less difficult compared with SensaScope [median = 4 (95% CI = 3.32-4.42) and 6 (95% CI = 4.96-6.64), P = 0.01, respectively]. The reality of the simulation was rated as a median of 5 (95% CI = 4.37-5.8). Conclusions: Although a similar number of attempts were required to reach predetermined competency for both fiberscopes, only 10 of residents were able to obtain the targeted success using SensaScope as compared with 13 with Bonfils. Inexperienced residents found intubation via Bonfils less difficult than SensaScope. High individual variability in obtaining competency observed in this study with cumulative sum analysis underlines the importance of defining success a priori to simulation, the need for follow-up of individual progress, and the need to offer adequate trials to achieve competency. Therefore, learning opportunities should be adapted accordingly.
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.
Turkish journal of anaesthesiology and reanimation, 2016
The aim of this feasibility study was to investigate the first attempt success of ultrasonography... more The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway ...
Turkish Journal of Anesthesia and Reanimation, 2016
Determining the blood flow through intra and extra-cranial arteries during neck extension may be ... more Determining the blood flow through intra and extra-cranial arteries during neck extension may be helpful but is a controversial issue. We aimed to elucidate the changes in cerebral blood flow related to head positioning during thyroid surgery by carotid Doppler examination and regional oxygen saturation variations. Methods: Thirty patients were recruited to the study. Patients were positioned with a final position of thyroidectomy consisting a 30° semi Fowler with the extension of neck and head. Values of peak systolic velocity, average velocity, arterial diameter and blood flow volume of the common carotid artery were calculated. Bilateral regional cerebral oxygen saturation were monitored continuously. Results: At the end of the operation, peak systolic velocity, average velocity and blood flowvolume of the common carotid artery decreased significantly compared to the baseline measurement (p<0.001). Both left and right cerebral oximetry measurements showed a significant increase after induction and the increased oxymetric values persisted at the end of the operation (p<0.001). Age, body mass index, surgical duration and anaesthesia duration were found not to be correlated with the changes occurred in the values of peak systolic velocity, average velocity, arterial diameter, blood flow volume of the common carotid artery, left and right regional cerebral oxygen saturation after induction and at the end of surgery. Conclusion: The head and neck extension given for thyroidectomy negatively affect carotid blood flow and cerebral oxygenation gradually and become pronounced especially at the end of surgery. In conclusion, it is important to maintain the cerebral perfusion pressure and cerebral blood flow.
Turkish Journal of Anesthesia and Reanimation, 2016
Critical incident reporting systems (CIRS) and morbidity-mortality meetings (MMMs) offer the adva... more Critical incident reporting systems (CIRS) and morbidity-mortality meetings (MMMs) offer the advantages of identifying potential risks in patients. They are key tools in improving patient safety in healthcare systems by modifying the attitudes of clinicians, nurses and staff (human error) and also the system (human and/or technical error) according to the analysis and the results of incidents. Methods: One anaesthetist assigned to an administrative and/or teaching position from all university hospitals (UHs) and training and research hospitals (TRHs) of Turkey (n=114) was contacted. In this survey study, we analysed the facilities of anaesthetists in Turkish UHs and TRHs with respect to CIRS and MMMs and also the anaesthetists' knowledge, experience and attitudes regarding CIs. Results: Anaesthetists from 81 of 114 teaching hospitals replied to our survey. Although 96.3% of anaesthetists indicated CI reporting as a necessity, only 37% of departments/hospitals were reported to have CIRS. True definition of CI as "an unexpected /accidental event" was achieved by 23.3% of anaesthetists with CIRS. MMMs were reported in 60.5% of hospitals. Nevertheless, 96% of anaesthetists believe that CIRS and MMMs decrease the incidence of CI occurring. CI occurrence was attributed to human error as 4 [1-5]/10 and 3 [1-5]/10 in UHs and TRHs, respectively (p=0.005). In both hospital types, technical errors were evaluated as 3 [1-5]/10 (p=0.498). Conclusion: This first study regarding CIRS in the Turkish anaesthesia departments/hospitals highlights the lack of CI knowledge and CIRS awareness and use in anaesthesia departments/teaching hospitals in Turkey despite a safety reporting system set up by the Turkish Ministry of Health.
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society, 2013
Transport süreci kritik hastalar için çeşitli sorun ve komplikasyonlara açıktır. Farklı hasta gru... more Transport süreci kritik hastalar için çeşitli sorun ve komplikasyonlara açıktır. Farklı hasta gruplarında bu süreçteki komplikasyonların sıklığı, niteliği ve bunlarla ilişkili unsurlar araştırılmaktadır. Çalışmamızda hastane içi nakilde açık kalp cerrahisi gibi özellikli bir hasta grubunda yaşanan sorunları araştırmayı hedefledik. Gereç ve Yöntem: Ocak-Eylül 2013 tarihleri arasında elektif kalp cerrahisi geçiren tüm olgular çalışmaya dâhil edildi. Transport başlangıcı hastanın ameliyat bitiminde sabit monitör ve ventilatörden, taşınabilir monitör ve ventilatöre geçilmesi olarak belirlendi. Nakil sonu ise hastanın yoğun bakımda sabit monitör ve ventilatöre bağlanması olarak kabul edildi. Sürecin başlangıç ve sonucundaki kan basıncı, kalp hızı (KH) ve oksijen satürasyonu ile yoğun bakıma giriş kan gazı verileri kaydedildi. Transportun başından sonuna kadar geçen sürede karşılaşılan tüm komplikasyonlar kayıt altına alındı.
Journal of the Turkish Anaesthesiology and Intensive Care Society, 2012
Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok ... more Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok uygulama süresinin eğitim hastanesinde ameliyat odası kullanım süresini uzattığına dair yaygın kanının sorgulanması hedeflenmiştir. Gereç ve Yöntem: Elektif sezaryen operasyonu planlanan ASA I-II 120 gebe, spinal ve genel anestezi olarak 2 grupta çalışmaya alınmıştır. Her iki anestezi tekniği de eğitmen gözetiminde benzer deneyimdeki tıpta uzmanlık öğrencileri tarafından uygulanmıştır. Hastaların demografik verileri, gebelik özellikleri, t hazır (ameliyat odasına giriş-ameliyat için hazır olma süresi), t insizyon (giriş-cerrahi insizyon), t histerotomi (cerrahi insizyon-histerotomi), t histerotomi-doğum (histerotomi-göbek kordonuna klemp konulması), t derlenme (cerrahi bitiş-uyanma odasına giriş süresi), t operasyon (cerrahi başlangıç-bitiş), t ameliyat odası (ameliyat odası giriş-çıkış) süreleri, operasyon sırasında kullanılan sıvı ve efedrin miktarı kaydedilmiş. Ayrıca yenidoğanların demografik verileri, Apgar skorları ve umbilikal ven kan gazı verileri değerlendirilmiştir. Bulgular: Gebelerin demografik verileri ve gebelik özellikleri benzer bulunmuştur. Spinal anestezi grubunda t hazır , t insizyon , t histerotomi ve t histerotomi-doğum süresi, genel anestezi grubunda ise t derlenme süresi anlamlı derecede uzun olarak saptanmıştır. Ameliyat odası kullanım süreleri spinal ve genel anestezi grubunda benzer bulunmuştur (72.9±16.7 ve 70.2±12.9 dk.). Spinal anestezi alan gebelerde sıvı tüketimi ve efedrin gereksinimi daha fazla olmuştur. Yenidoğanların demografik verileri, PCO 2 değerleri arasında fark saptanmamıştır. Genel anestezi grubunda spinale oranla yenidoğanların PO 2 değerleri daha yüksek (36.7±14.2 ve 28.1±7.8 mmHg; p<0.001), pH değerleri ise daha düşük (7.32±0.04 ve 7.34±0.06; p=0.049) olmuştur, ancak bu değişiklikler Apgar skorlarına yansımamıştır. Sonuç: Cerrahi kanının aksine, eğitim hastanesinde spinal anestezi uygulaması ameliyat odası kullanım süresini arttırmamaktadır.
Turkish Journal of Anesthesia and Reanimation, 2014
Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or ... more Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or granulomatous lesions at the cuff level or tip of the tube may be observed on the tracheal wall. This injury mainly occurs due to excessive pressure of the cuff on the tracheal wall and may be prevented by a high-volume, low-pressure cuff and a carefully monitored tracheostomy tube. Although there is an overall improvement in the design of high-volume cuffs, hyperinflation of these cuffs may still contribute to tracheal injuries. If the size of the granuloma is limited, the lesion is treated by excision (microlaryngeal surgery) under general anaesthesia. Using jet ventilation during the operation minimizes the trauma caused by intubation and reduces the risk of oedema and the risk of barotrauma, as it provides ventilation over a possible stenosis. In addition to providing better visualization of the surgical field and superior surgeon comfort, jet ventilation also increases the success of the operation. In this case report, we aimed to present a successful anaesthesia technique performed by jet ventilation in a patient with a postintubation granuloma, which was excised by microlaryngeal surgery without the need for reintubation.
Journal of Anesthesia, 2013
PurposeIn patients who are hospitalized for surgery, anxiety disorders are frequently observed. A... more PurposeIn patients who are hospitalized for surgery, anxiety disorders are frequently observed. Anxiety affects the patient’s perception of postoperative pain and has a negative impact on recovery from anesthesia. This study attempted to compare the effect of preoperative anxiety on postoperative pain control and recovery from anesthesia in patients undergoing laparoscopic cholecystectomy.MethodsA total of 80 patients were enrolled who were undergoing laparoscopic cholecystectomy. Demographic characteristics of the patients were recorded. Beck’s anxiety ınventory (BAI) was administered to the patients: patients with anxiety were included in the high-anxious patient group (group H) and patients without anxiety were enrolled in the low-anxious group (group L). Duration of surgery, duration of anesthesia, extubation time, and adverse effects were recorded. During the postoperative period, patient-controlled analgesia with tramadol was used for pain control. Visual analog scale (VAS) scores and tramadol consumption of all patients were recorded.ResultsAmong all patients, 31 (38.75 %) patients had preoperative anxiety, and significant correlation was found between the days of hospitalization and preoperative score of BAI. In group L, extubation time, the time for the modified Aldrete score to reach 9, was seen as significantly shorter and fewer postoperative side effects were determined. Also in group L, postoperative VAS score and tramadol consumption were significantly lower, and less tenoxicam was needed.ConclusionA high preoperative anxiety level negatively affects recovery from anesthesia and control of postoperative pain. In this patient group, the increased need for postoperative analgesia must be adequately met.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2016
Introduction: The performance of laryngoscopes that have been developed for difficult airways can... more Introduction: The performance of laryngoscopes that have been developed for difficult airways can vary widely. The aim of the study was to compare Macintosh, McCoy, McGrath MAC, and C-MAC laryngoscopes in cervical immobilization and tongue edema scenarios in a mannequin, primarily to evaluate the time to intubation. Methods: In this randomized crossover study, 41 anesthesiology residents used 4 laryngoscopes in a mannequin (SimMan 3G) in 2 different scenarios. Intubation time (insertion of the blade between the teeth, to placement of the endotracheal tube into the trachea) longer than 120 seconds or inability to successfully place the endotracheal tube into the trachea after 5 or more attempts was defined as intubation failure. Besides intubation time, laryngoscopic view, number of intubation attempts, presence of esophageal intubation, need for stylet, difficulty of intubation, and success rate were recorded as secondary outcomes. Results: Intubation time was observed from longest to shortest as McGrath 9 McCoy 9 C-MAC 9 Macintosh in both scenarios. Laryngeal view was better with C-MAC laryngoscope. McGrath laryngoscope performed poorly specifically in tongue edema scenarios, which resulted in higher number of intubation attempts, esophageal intubation, need for intubation stylets, and overall intubation failure. Conclusions: The short intubation time observed with the Macintosh underlines the necessity of familiarity in success. Tongue edema is a more challenging scenario for simulated difficult airway and the McGrath may not be a good choice for such a scenario.
Auris, nasus, larynx, Jan 17, 2018
Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-f... more Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO2 and end-tidal CO2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31–1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52–328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0–1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97–46.49). Conclusion Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.