Browsing by Author "Keles G.T."

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    Subcutaneous emphysema following severe vomiting after emerging from general anesthesia
    (2004) Toprak V.; Keles G.T.; Kaygisiz Z.; Tok D.
    Postoperative nausea and vomiting-related subcutaneous emphysema is an unexpected complication, especially after uneventful surgery and anesthesia. Here we report and discuss two cases of subcutaneous emphysema following severe retching and vomiting which resolved spontaneously after several days.
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    The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section
    (Associacao Brasileira de Divulgacao Cientifica, 2009) Yentur E.A.; Topcu I.; Ekici Z.; Ozturk T.; Keles G.T.; Civi M.
    Both epidural and general anesthesia can impair thermoregulatory mechanisms during surgery. However, there is lack of information about the effects of different methods of anesthesia on newborn temperature. The purpose of this study was to determine whether there are differences in newborn rectal temperature related to type of anesthesia. Sixty-three pregnant women were randomly assigned to receive general or epidural anesthesia. Maternal core temperature was measured three times with a rectal probe just before anesthesia, at the beginning of surgery and at delivery. In addition, umbilical vein blood was sampled for pH. The rectal temperatures of the babies were recorded immediately after delivery, and Apgar scores were determined 1, 5, and 10 min after birth. The duration of anesthesia and the volume of intravenous fluid given during the procedure (833 ± 144 vs 420 ± 215 mL) were significantly higher in the epidural group than in the general anesthesia group (P < 0.0001). Maternal rectal temperatures were not different in both groups at all measurements. In contrast, newborn rectal temperatures were lower in the epidural anesthesia group than in the general anesthesia group (37.4 ± 0.3 vs 37.6 ± 0.3° C; P < 0.05) immediately after birth. Furthermore, the umbilical vein pH value (7.31 ± 0.05 vs 7.33 ± 0.01; P < 0.05) and Apgar scores at the 1st-min measurement (8.0 ± 0.9 vs 8.5 ± 0.7; P < 0.05) were lower in the epidural anesthesia group than in the general anesthesia group. Since epidural anesthesia requires more iv fluid infusion and a longer time for cesarean section, it involves a risk of a mild temperature reduction for the baby which, however, did not reach the limits of hypothermia.
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    The effect of remifentanil on the emergence characteristics of children undergoing FBO for bronchoalveolar lavage with sevoflurane anaesthesia
    (2009) Ozturk T.; Erbuyun K.; Keles G.T.; Ozer M.; Yuksel H.; Tok D.
    Background and objective The aim of this study was to compare the effects of sevoflurane vs. sevoflurane and remifentanil on cough and agitation during emergence and recovery after fiberoptic bronchoscopy. Methods Children between 2 and 6 years of age undergoing fiberoptic bronchoscopy were enrolled. All patients were premedicated with oral midazolam. Patients were randomly assigned to either group S (sevoflurane alone, n = 25) or group SR (sevoflurane with remifetanil, n = 25). Anaesthesia was induced and maintained with sevoflurane in all patients. Group SR received remifentanil at a bolus dose of 1 μg/kg over 2 min followed by a maintenance infusion of 0.15 μg/kg/min. In addition to routine anaesthesia documentation, agitation scores and cough scores were recorded every 5 min during emergence and recovery. Results Duration of the procedure, anaesthesia and emergence phases was similar in both groups (P>0.05). Time until recovery was significantly shorter in group SR than in group S (7.0 ± 5.5 min and 13.0 ± 3.5 min, respectively; P = 0.001). Cough scores were not significantly different between the two groups during emergence and recovery (Kruskal-Wallis ANOVA test, P0.05). However, the mean agitation score at 5 min in group SR was significantly higher than that in group S (Kruskal-Wallis ANOVA test, P<0.01). One case of hypoxaemia from thoracic rigidity occurred in a patient in group SR. Conclusion The addition of remifentanil significantly shortened recovery time in children undergoing fiberoptic bronchoscopy under sevoflurane anaesthesia. In the recovery period, remifentanil did not decrease cough, and increased agitation. © 2009 European Society of Anaesthesiology.
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    Balanced anesthesia with dexmedetomidine added desflurane or sevoflurane in spinal surgery
    (2012) Keles G.T.; Ozer M.; Dede G.; Temiz C.; Horasan G.D.; Civi M.
    Objectives: Sevoflurane and desflurane inhalational anesthetics are used for fast-track neuroanesthesia. Dexmedetomidine is used to provide analgesia, sedation and hemodynamic stability. Other anesthetic and analgesic requirements decrease when dexmedetomidine is administered, thus it is an interesting option for intraoperative agent for general anesthesia. We aim to compare desflurane and sevoflurane with dexmedetomidine in the operating room (OR) and Post-Anesthesia Care Unit (PACU) by using Fast-Tract -Criteria (FTC) and Aldrete Criteria (AC) for spinal surgery patients. Methods: A double-blind study was conducted. One hundred ASA I-II patients aged 18-65 were randomly divided into two groups. Following the standard anesthesia induction, Group (D+D) (n=50) received 2-4 % desflurane + 0.2 μg/kg/h dexmedetomidine and Group (S+D) (n=50) received 1-3 % sevoflurane + 0.2 μg/kg/h dexmedetomidine in 60 % N2O for anesthesia management. Extubation times, and FTC and AC were evaluated in the OR at the 5th and 10th minutes and in PACU at the 5th, 15th and 25th minutes. P< 0.05 was considered significant. Results: Demographic features of the patients in the two groups were similar. Extubation time in Group (D+D) was shorter than that in Group (S+D) (5.9 ± 2.4 and 8.3 ± 3.9 min respectively, p=0.001). In OR at the 10th min, and in PACU at the 5th min; Group (D+D) had a higher AC score than did Group (S+D) (p=0.001), and also at the 15th min., Group (D+D) had a higher FTC (P=0.01) and AC (p=0.007) scores than did Group (S+D). In all the patients, targeted discharge points were achieved at the 25th minute in PACU Conclusions: Balanced anesthesia with desflurane / dexmedetomidine combination is superior to sevoflurane / dexmedetomidine in extubation time and time to reach an AC ≥ 9 and FTC ≥ 13 in spinal surgery. © 2012 Keles GT, et al.
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    Evaluation of in-hospital cardiac arrest patients; [Hastane Içi Kardiyak Arrest Olgularinin Deǧerlendirilmesi]
    (Anestezi Dergisi, 2019) Keles G.T.; Çevikkalp E.; Açikel A.; Topçu I.
    Objective: Cardiac arrest is a suddenly developed unexpected clinical condition characterized with cessation of cardiac functions or inability to palpate pulsations in major arteries; loss of respiratory functions and consciousness. The aim of this study was to evaluate prospectively inhospital cardiac arrest cases. Method: We aimed to evaluate the patients diagnosed with cardiac arrest developed in the hospital using cardiopulmonary resuscitation procedure (CPR). Demographic variables as age, gender, body mass index (BMI), disease groups, reversible causes of cardiac arrest, dosages of drugs used, time to return to spontaneous circulation, heart rhythm during cardiac arrest, and blood pressure values were recorded. All data were evaluated in SPSS 15.0 statistical program using appropriate tests and p<0.05 is accepted as the level of statistical significance. Results: We included 189 patients in the study with a mean age of 58.49±16.78 years. Seventyone patients were women (37.5%), 118 patients were men (62.5%). Mean BMIs of female (n=71), and male patients (n=118) were 27.04±5.78 kgm-2 and 23.60±4.37 kgm-2, respectively (p<0.05). Respective percentages of patients had experienced HT (n=66: 34.9%), DM (n=54: 28.5%), CAD (n=46: 24.3%), COPD (n=24: 12.6%), CRF (12.1%), SVD (n=27: 14.2%), CHF (n=27: 14.2%) and MI (n=13: %6.8). DM was seen in significantly higher number of women (p<0.05). NEA (18.5%), and asystole (77.2%) were arrest rhythms. The most frequently seen reversible causes that induced arrest were hypoxia (n=20: 10.6%) and hypo-hyperkalemi (n=16: 8.5%). Mean duration of CPR was 38.47±14.71 min. (n=189). In the 46 of the patients (24.3%), spontaneous circulations returned, and 143 of them (75.5%) exited. Mean duration of resuscitation applied for patients (n=46) whose spontaneous respiration was recovered was 14.80±9.07 min. SBP, and DBP were recorded as 74.35±32.63 mmHg, and 45.00±18.34 mmHg, respectively. Conclusion: In cardiac arrests of in-patiens most frequently non-shockable rhythms such as pulseless electrical activity and asystole are seen. The short duration of cardiac arrest is in favor for survival. Reversible causes of cardiac arrest should be pre-determined and in the evaluation of critical evaluation of patients emergency intervention team should be notified.before development of cardiac arrest. © Copyright Association of Anesthesiologists and Reanimation Specialists.