Browsing by Author "Keleş G.T."
Now showing 1 - 18 of 18
Results Per Page
Sort Options
Item Upper extremity compartment syndromes following vipera snake bite(2002) Keleş G.T.; Yentür A.; Sakarya M.The aim of this report is present two cases of compartment syndrome following snake envenomations. Both of patients, which are 63-year-old woman and 2-year-old boy, were bitten on their hands by snake. After 48 hours, in the both patients hands oedema and pain progressed. Later echymosis, cyanosis and paresthesia developed and the pulses could not be detected anymore. Both of the cases were diagnosed as compartment syndrome and after fasciotomy they recoveried completely. We postulate that compartment syndrome may occur following snake bites as a delayed local complication, even if signs of systemic poisoning are missing.Item Giant mucinous cystadenocarcinoma: A case report(2003) Kuşcu N.K.; Çaǧlar H.; Íshakoǧlu M.; Kandiloǧlu A.R.; Keleş G.T.We present a mucinous cystadenocarcinoma weighing 10 kg in a postmenopausal woman and the way how we managed the case.Item Assessment of in-hospital cardiopulmonary resuscitation using utstein template in a university hospital(2004) Tok D.; Keleş G.T.; Toprak V.; Topcu I.The aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of in-hospital CPR strategies. © 2004 Tohoku University Medical Press.Item Volatile induction and maintenance of anesthesia using laryngeal mask airway in pediatric patients(2004) Keleş G.T.; Toprak V.; Ok G.; Lüleci N.[No abstract available]Item Subanalgesic Dose of Ketamine Added to Tramadol Does Not Reduce Analgesic Demand; [Tramadole, Subanaljezik Dozda Ketamin İlavesi Analjezik Gereksinimini Azaltmiyor](2004) Yentür E.A.; Topçu I.; Keleş G.T.; Taşyüz T.; Sakarya M.Tramadol is an analgesic with agonistic properties on opioid receptors. In this study we investigated the effect of systemic coadministration of subanalgesic dose of ketamine with tramadol on postoperative tramadol consumption. By this way we intended to find a clue whether tramadol also have opioid induced algesic effect like morphine via NMDA receptors. Thirty patients undergoing abdominal surgery with general anesthesia were enrolled in this prospective, placebo controlled, double blind study. Anesthesia was induced with propofol 2-2.5 mg kg-1 and was maintained with sevoflurane in N2O/O2 mixture. Muscle relaxation was provided by vecuronium. Analgesia was maintained by iv remifentanyl infusion. Infusion of remifentanyl was stopped 15 min before the end of operation, and 10 min later patients were randomly administered either 75 mg kg-1 ketamine (5 mL) and 1 mg kg-1 tramadol (ketamin group) or normal saline (5 ml) and 1 mg kg-1 tramadol bolus (placebo group). Intravenous PCA with tramadol was started on the arrival at postoperative recovery room, and continued for 24 hours in all patients. Pain and sedation scores were evaluated in the recovery room every 15 min until the time of discharge to the ward. Aldrete Post Anesthesia Recovery Scores (≥9) were used as discharge criteria. Total tramadol consumptions at the 6th and 24th hours were recorded. There was no significant difference between the groups with respect to Visual Analog Scale (6.1±1.1 vs 6.6±1.1) and total tramadol consumption (51.5±26.4 vs 53.7±18.3 mg) at the end of recovery period (p>0.05). Also the total tramadol consumptions at 6th and 24th hours (188.9±82.9 vs 215.3±104.7 and 365.0±118.6 vs 403.8±243.8 respectively) were not different between groups (p>0.05). Subanalgesic dose of ketamine did not augment tramadol induced analgesia so these findings may suggest that tramadol does not have NMDA receptor activating property like morphine.Item Relationship between nutrition and ASA-classification in the elderly; [Der zusammenhang von ernährungszustand und ASA-klassifikation bei älteren patienten](2004) Sakarya M.; Karadaǧ F.; Lüleci N.; Keleş G.T.; Topçu I.; Erinçler T.Objective: Old age and bad nourishment are risk factors for the postoperative period. In this study, the "mini nutritional assessment" (MNA) of elderly patients was evaluated before the operation and compared with their ASA-classification. Methods: 215 outpatients (age > 60 years) were included. MNA-score was fixed as follows: MNA 24 - 30 = normal (MNA I); MNA 17 - 23.5 = risk of malnutrition (MNA II; MNA < 17 = undernourished (MNA III). In addition, the ASA-score of all patients was registered. χ2-, Mann-Whitney-U- and correlation analysis were used for statistical analysis. A cut off-value of 24 was fixed for MNA and correlated with the ASA-score. Results: 34,9% of all patients were allocated to MNA II or III, but only 19.9% to ASA III or IV. The sensivity of the ASA-classification for evaluation of the nutritional status was 0.33, selectivity was 0.87, positive predictive value was 0.58 and negative predictive value was 0.70. Conclusion: ASA evaluation is not suitable for assessment of the nutritional status. With regard to typical postoperative complications, the nutritional status of patients should be assessed separately.Item Subanalgesic doses of ketamine and morphine but not morphine alone, prolong the sensory block time of hyperbaric bupivacaine in unilateral spinal anaesthesia(2004) Yentür E.A.; Tok D.; Keleş G.T.; Toprak V.; Aslan F.Aim: In this study, we aimed to compare the sensory and motor effects of a subanalgesic dose of morphine and morphine + ketamine added to 5% hyperbaric bupivacaine (HB) in unilateral spinal anaesthesia. Methods: 45 patients were randomly assigned to one of three groups. The first group received 1.5 ml 0.5% HB + 0.2 ml saline; the second group received 1.5 ml 0.5% HB + 0.1 ml morphine (0.1 mg) + 0.1 ml saline; the third group received 1.5 ml 0.5% HB + 0.1 ml ketamine (0.5 mg) + 0.1 ml morphine (0.1 mg). Maximum block levels, time to reach that level, time to reach T10 level and block levels after 120 min were recorded. Results: Maximum sensory and motor block levels, time to reach these levels and time to reach T10 level were similar in all three groups, but there was less regression of sensory block level in the third group than in the other two groups. Conclusion: Subanalgesic doses of morphine and ketamine added to 0.5% HB extended the sensory block period but not the motor block in unilateral spinal anaesthesia.Item Assessment of neuromuscular and haemodynamic effects of cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia in elderly patients(2004) Keleş G.T.; Yentür A.; Çavuş Z.; Sakarya M.Background and objective: Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia were compared in elderly patients. Methods: The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O2 and remifentanil. Cisatracurium 0.15 mg kg-1 or vecuronium 0.1 mg kg-1 were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored. Results: The average ages of the patients were 72.5 ± 5.1 and 73.6 ± 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 ± 34s vs. 200 ± 50s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 ± 7.5s vs. 33.7 ± 18.6s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables. Conclusions: In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane-remifentanil anaesthesia.Item Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolam(2006) Keleş G.T.; Kurutepe S.; Tok D.; Gazi H.; Dinç G.Background and objectives: The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli ( E. coli ESBL). Methods: All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35°C after which a count of the colonies was compared. Results: Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested. Conclusion: In vitro, midazolam had an antimicrobial effect on E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested. © 2006 Copyright European Society of Anaesthesiology.Item Post-tracheal extubation pulmonary edema in an infant - Case report; [Bebekte ekstübasyon sonrasi gelişen akciǧer ödemi - Olgu sunumu](2007) Topçu I.; Keleş G.T.; Alp Yentür E.; Zeynep Ekici N.; Sakarya M.Upper airway obstruction related to laryngospasm after extubation may lead to negative pressure pulmonary edema. The proposed mechanism is the generation of high negative pressures during respiratory effort associated with glottis closure and laryngospasm leading to pulmonary edema and alveolar hemorrhage. A male premature, twin baby, 2.5 month old, weighing 6 kg was scheduled to perform cystoscopy under general anesthesia for the purpose of diagnosis. After uneventful induction and operation, the infant was extubated. Approximately 5 minutes after extubation, the infant performed significant laryngospasm associated with respiratory distress, tachypnea, cyanosis and significant decrease in peripheral oxygen saturation. Consequently, the patient was reintubated and transferred to the Anesthesiology Intensive Care Unit for mechanical ventilation and further treatment. After 4 hour of mechanical ventilation support, the patient was extubated at the 6th hour. Postoperative 48th hour, he was discharged to the pediatric surgery unite. Negative pressure pulmonary edema is a serious, life-threatening, clinical condition requiring reintubation and mechanical ventilation support associated with prolonged hospital stay even in pediatric cases. Early recognition of patients at risk and preventing laryngospasm are important.Item Methanol poisoning with necrosis corpus callosum(2007) Keleş G.T.; Örgüç S.; Toprak B.; Özaslan S.; Sakarya M.[No abstract available]Item Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery(Associacao Brasileira de Divulgacao Cientifica, 2010) Keleş G.T.; Topçu I.; Ekici Z.; Yentür A.The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-β-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-β-cyclodextrin, group 2 received 40 mg piroxicam-β-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05). During the postoperative period, morphine consumption was 3.03 ± 2.54, 2.7 ± 2.8, and 5.56 ± 3.12 mg for each group, respectively (P < 0.05). As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-β-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-β-cyclodextrin without side effects during the postoperative period.Item Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery(Associacao Brasileira de Divulgacao Cientifica, 2012) Topçu I.; Çivi M.; Öztürk T.; Keleş G.T.; Çoban S.; Yentür E.A.; Okçu G.The effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.Item Effects of high-dose rocuronium on the QTc interval during anaesthesia induction in patients undergoing coronary artery bypass graft surgery; [Koroner arter cerrahisi geçirecek olgularda anestezi İndüksiyonu sırasında yüksek doz roküronyumun QTc İntervali üzerine etkileri](AVES Ibrahim Kara, 2014) Ağdanlı D.; Öztürk T.; Ütük O.; Keleş G.T.Objective: Existing myocardial damage in coronary artery disease patients causes prolonged QT syndrome. The primary objective of this trial is to explore the effects of different doses of muscle relaxant agent rocuronium (0.6 mg.kg−1 and 1.2 mg.kg −1) on QTc following anesthetic induction. Seconder objective is to determine the incidence and kinds of arrythmias.; Methods: In this prospective and randomized trial, patients undergo elective coronary arteria revascularisation surgery were included in one of two groups. Both groups took same anesthetic induction agents; midazolam and fentanyl. Rocuronium was administered in Group 1(n=20) with dose of 0.6 mg. kg−1 and in Group 2 (n=20) with dose of 1.2 mg.kg−1 for muscle relaxation.; Heart rate, avarage arteria pressure and QTc were recorded before induction(T0), after induction(T1), after muscle relaxant(T2), 2 minutes(T3) and 5 minutes after entubation(T4).; Results: QTc was significantly long just in 2 minutes after entubation (in Group 1 and Group 2 respectively, 447.9±28.3, 466.1±37.8ms), than those at the beginning (respectively, 426.9±25.7, 432.0±35.5ms)(p<.0.01). In intergroup comparison, avarage QTc values were similar in all trial periods (p>0.05). The prevalance of arrythmias in between Group 1 (35%, n=7), and Group 2 (15%, n=3) were similar (p=0.06). Arrythmias were recorded 2 minutes after entubation in both groups (n=10, 25%).; Conclusion: In patients undergoing coronary arteria revascularisation surgery, rocuronium doses of 0.6 mg kg −1 and 1.2 mg kg −1 had have prolonged the QTc interval after entubation. Cardiac arrthymias related to long QTc arising after entubation should be taken into consideration. © 2014 by Turkish Anaesthesiology and Intensive Care Society.Item Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: A randomized, double-blind, parallel trial(Associacao Brasileira de Divulgacao Cientifica, 2015) Öztürk T.; Ağdanlı D.; Bayturan Ö.; Çıkrıkcı C.; Keleş G.T.Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation. © 2015, Associacao Brasileira de Divulgacao Cientifica. All rights reserved.Item Comparison of patient satisfaction between general and spinal anaesthesia in emergency caesarean deliveries; [Acil sezaryen operasyonlarında genel ve spinal anestezinin hasta memnuniyeti yönünden karşılaştırılması](AVES Ibrahim Kara, 2017) Açıkel A.; Öztürk T.; Göker A.; Hayran G.G.; Keleş G.T.Objective: Obstetric anaesthesia aims to deliver a healthy baby as well as render a comfortable operation for the mother. This study compared general and spinal anaesthesia in terms of the quality of recovery and patient satisfaction in women undergoing emergency caesarean deliveries. Methods: In total, 100 patients were enrolled in this prospective, single-blind, cross-sectional clinical study. Patients were divided into spinal (n=50) and general (n=50) anaesthesia groups. The recovery score, pain and satisfaction were evaluated by Quality of Recovery Score (QoR-40), Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 24 hours postoperatively. Results: The total QoR-40 scores were significantly higher and the total operation time was longer in the spinal anaesthesia group (median score: 194.5 vs. 179.0, p<0.001 and mean±SD: 69.0±13.3 vs. 62.7±13.4 minutes, p=0.02, respectively). There was no significant difference in VAS and NRS scores between the groups. Conclusion: Both spinal anaesthesia and general anaesthesia have advantages and disadvantages in terms of emergency caesarean deliveries. Spinal anaesthesia speeds up the recovery time and enables the mother to return to normal life earlier, while general anaesthesia has a short initiation time and does not affect patient satisfaction. © 2017 by Turkish Anaesthesiology and Intensive Care Society.Item Efficacy of pleth variability index (PVI) to evaluate intraoperative fluid management during orthopedic spinal surgery: A randomized controlled trial; [Ortopedik spinal cerrahi olgularında İntraoperatif sıvı yönetimini değerlendirmede pleth değişkenlik İndeksinin etkinliği: Randomize kontrollü çalışma](Anestezi Dergisi, 2020) Çevikkalp E.; Topçu I.; Açıkel A.; Sarılar S.; Keleş G.T.; Özyurt B.C.Objective: To prevent complications during major surgery, it is important to monitor blood and fluid treatment. The Pleth Variability İndex (PVI) allows noninvasive assessment of fluid management. It is based on respiratory changes in arterial pulse pressure. In our study, we aimed to compare the management in terms of variations in PVI in response to fluid loading in the monitorization of intraoperative fluid management in major surgery using classical calculation method and CVP Method: The patients were randomized into two equal (n=50) groups. In Group C, the required amount of fluid replacement was carried out with crystalloid solutions using the 4-2-1 rule and by calculating fasting, maintenance, and insensible losses. In the PVI group, 250 mL of crystalloid solution was administered in 5 minutes to patients with a PVI greater than 14%, patients with a PVI less than 14% were administered a fluid infusion with an initial dose of 4 mL kg-1 h-1. Results: In the comparison of intraoperative fluid management the amount of intraoperative fluid replacement was 3522±1098.1 mL in Group C and 1914±542.86 mL in Group PVI (p<0.05). The mean amount of intraoperative red blood cell transfusion was 0.42±0.57 unit in Group C and 0.08±0.27 unit in Group PVI (p<0.05). There were no significant differences between the groups in terms of postoperative red blood cell transfusion (p>0.05) or intraoperative hemoglobin levels (p>0.05). Conclusion: It has been thought that PVI assessment is more valuable than CVP monitoring because it is noninvasive and thus provides better cardiac stabilization with less fluid replacement. It can also provide more accurate results when evaluating intravascular volume status. © Copyright Anesthesiology and Reanimation Specialists’ Society. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).Item Cardiopulmonary resuscitation practices in adult patients with diagnosed or suspected COVID-19 disease; [COVID-19 tanısı veya şüphesi olan erişkin hastalarda kardiyopulmoner resüsitasyon uygulamaları](Anestezi Dergisi, 2021) Akın Ş.; Birbiçer H.; Doruk N.; Keleş G.T.; Özbilgin Ş.Cardiopulmonary resuscitation (CPR) includes all treatment procedures during cardiac arrest. Resuscitation of patients with diagnosed or suspected COVID-19 disease is particularly important in terms of protection and reducing the risk of transmission. In this review, the basic and advanced life support recommendations of Turkish Resuscitation Council for adult patients with a definite or probable diagnosis of COVID-19 are explained within the algorithm framework. © Copyright Anesthesiology and Reanimation Specialists’ Society. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution 4.0 International (CC)