Browsing by Author "Kefi A."

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    Seizures, metabolic acidosis and coma resulting from acute isoniazid intoxication
    (Australian Society of Anaesthetists, 2005) Topcu I.; Yentur E.A.; Kefi A.; Ekici N.Z.; Sakarya M.
    Isoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unitfor ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.
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    What factors are related to patients' anaesthesia related anxiety during the post operative period?; [Postoperatif dönemde hastalarin anestezi konusundaki endişeleri nelerdir?]
    (2005) Tezcan-Keleş G.; Toprak V.; Kefi A.; Tok D.
    Aim: We aimed to determine factors causing anxiety immediately and 24 hours after surgery in patients undergoing general anaesthesia. Material and Methods: Following the Institutional Ethics Committee approval and informed consent, 173 eases were studied. A standard evaluation form rated patient anxiety about postoperative pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, thirst, gagging on the tracheal tube and awareness during anaesthesia. Anxiety was rated using a 1 to 10 point verbal "numeric anxiety scale". (NAS) where a score of "1" represented "least upsetting condition" and "10" represented the "most upsetting condition". Results: Pain caused the most anxiety (immediately postoperative NAS=4.6±3.6 increasing to 5.8±3.7 on postoperative day one. Awareness during anaesthesia (3.2+4.0), sore throat (2.8±3.4), disorientation (2.5±3.5) and drowsiness (2.1±2.9) were other major eauses of anxiety. While the increase in anxiety related to pain increased significantly on postoperative day one, there was a decreased in changes in the other factors over this time. Conclusion: Postoperative pain is the most common anaesthesia-related factor causing anxiety in patients undergoing general anaesthesia. This finding underscores the importance of detailed preoperative communication with patients regarding their perioperative pain management.
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    Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesia; [Wirksamkeit von clonidin und fentanyl als zusatz bei der postoperativen patientenkontrollierten epiduralanalgesie mit bupivacain]
    (2005) Topcu I.; Luleci N.; Tekin S.; Kefi A.; Erincler T.
    Background and Objectives: The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy. Methods: 75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125% bupivacaine, Group F 0.125% bupivacaine plus 1 μg × ml-1 fentanyl, Group C 0.125% bupivacaine plus 0.75 μg × ml-1 clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05). Conclusions: Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction. © Georg Thieme Verlag KG Stuttgart.
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    Clinical and radiologic evaluations for predicting difficult tracheal intubation; [Valutazioni cliniche e radiologiche per prevedere l'intubazione tracheale difficile]
    (2006) Topcu I.; Ovali G.Y.; Yentur E.A.; Kefi A.; Tuncyurek O.; Pabuscu Y.
    Objective: The aim of this study is to predict difficult endotracheal intubations preoperatively with clinical and radiographical parameters (lateral x-ray) and to assess their reliability. Design: 208 adult patients (68 male, 140 female) submitted for elective surgery under general anaesthesia were included into this study. Age, height, weight, inter-incisor gap, neck circumference, sternomental and thyromental distance, modified Mallampati classification and protruding upper teeth were measured during preoperative evaluation. Lateral cervical spine radiographs were evaluated to predict the skeletal structure associated with difficult intubation. Laryngeal view was graded according to Cormack-Lehane laryngoscopic classification. The number and duration of attempts at each tracheal intubation were recorded. Results: We obtained the percentage of difficult intubations to be 5.7%. There was no significant association between difficult intubation and age, weight, thyromental and sternomental distances, mandibular protrusion, Wilson risk scores, inter-incisor gap and neck circumference (p > 0.05). Difficult intubations were associated with male sex, Cormack-Lehane grade 3 or 4 and two and more increased Mallampati grade (p < 0.05). After taking the measurements on the radiographs, we observed a significant association between temporomandibular joint (TMJ) to tip of upper incisors (V1), length of the perpendicular from the hard palate to the tip of the upper incisors (V2), TMJ to tip of lower incisors (V5), the distance from the upper incisors to the corniculate cartilages (V17), the anteroposterior thickness of the tongue (V19) for difficult intubation with stepwise multivariate logistic regression model (p < 0.05). According to Cormack-Lehane classification we calculated the highest sensitivity as (83.3%), specificity as (95.9%), positive predictive value as (55.6%) and negative predictive value as (98.9%). Conclusion: We conclude that these clinical and radiographic measurements are of little value in predicting difficult intubation in adults when used alone. For elective cases, we advocate taking additional radiological examinations, if clinical findings predict or indicate the probability of a difficult airway.
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    A comparison of bupivacaine, bupivacaine-fentanyl and bupivacaine-ketamine in patient-controlled epidural analgesia; [Hasta Kontrollü Analjezi̇de Epi̇dural Bupi̇vakȧin Bupi̇vakai̇n-Fentani̇l ve Bupi̇vakai̇n-Ketaṁiṅin Etki̇leri̇ni̇n Karşilaştirilmasi]
    (2006) Tekin S.G.; Topçu I.; Kefi A.; Enrinçler T.
    Background: In this study, the analgesic and side effects of bupivacaine with combinations of ketamine and fentanyl using patient-controlled-epidural analgesia (PLEA) methods in the postoperative period of total abdominal hysterectomy (TAH) operations were compared. Method: Sixty ASA I-II patients aged between 18-65 years were included, Following epidural catheterization the patients were operated under general anesthesia, After surgery, patients were randomly allocated to 3 groups in a double-blinded fashion to receive PCEA as Group B: 0.125% bupivacaine, Group BF: 0.125% bupivacaine plus 0.1 mg fentanyl and Group BK.: 0.125% bupivacaine plus 40 mg ketamine solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in a 4 hour limit) in 100 mL salin. Hemodynamic parameters, VAS scores, total analgesic consumption, additional analgesic requirements, sedation scores, satisfaction scores and probable side-effects were evaluated for 24 h. Results: Total analgesic consumption was lower in the fentanyl group (p<0.05), Therefore VAS scores in the fentanyl group were lower than the other groups at the 1 hour and the 24 hour assessments (p<0.05), Postoperative analgesic consumption was lower in the ketamine group compared to the control group, There was no difference in side effects and additional analgesic requirement between the groups. Conclusion: Fentanyl and ketamine may be used safely by PCEA for postoperative analgesia, These adjuncts increase analgesic quality and patient satisfaction without increased side effects.