Browsing by Author "Ozturk, T"

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    Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial
    Ozturk, T; Acikel, A; Yilmaz, O; Topçu, I; Çevikkalp, E; Yuksel, H
    Study Objective: To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. Design: Randomized, double-blind, placebo-controlled trial. Setting: Operating room, postoperative recovery area. Patients: Sixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL. Interventions: After discontinuation of anesthetics at the end of FOBL, patients were randomly divided into 3 groups: in group K, children were administered 0.5 mg/kg of ketamine; in group P, 0.5 mg/kg of propofol; and in group C, 0.1 mL/kg of normal saline. Measurements: Anesthesia time, procedure time, emergence time, and recovery time were recorded. Coughing and delirium scores were recorded as the patient fully emerged from anesthesia (time 0) and 5, 10, 15, and 20 minutes later. Main Results: The percentage of children with moderate or severe cough during emergence was similar in all groups. Mean delirium scores at emergence (TO) were significantly lower in group K than those in group P and in group C (P = .0001 and P = .02). Mean delirium score at 5 minutes in group K (6 [5-10]) was significantly lower than that of group C (P = .02) and similar to that of group P. The recovery time of group K was significantly longer than that of group C and group P (P = .01 and P = .03, respectively). Conclusions: Ketamine or propofol given at the end of sevoflurane-remifentanil general anesthesia in children undergoing FOBL did not decrease cough more than normal saline during the emergence period. Ketamine and propofol, compared to normal saline, had a beneficial effect on decreasing the incidence of emergence delirium. Ketamine lengthened recovery time. (C) 2016 Elsevier Inc. All rights reserved.
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    The effects of perioperative goal-directed therapy on acute kidney injury after cardiac surgery in the early period
    Özdemir, I; Ozturk, T; Amanvermez, D; Yildirim, F; Sengel, A; Özdemir, IH
    Background: This study aims to investigate the effects of goal directed fluid therapy on the development of acute kidney injury in the perioperative period in patients undergoing cardiopulmonary bypass.Methods: Between November 2019 and May 2021, a total of 60 patients (46 males, 14 females; mean age: 62.5 +/- 9.6 years; range, 44 to 76 years) who were scheduled for elective coronary artery bypass grafting or valve surgery under cardiopulmonary bypass were included in the study. The patients were divided into two groups as the study group (Group S, n=30) and control group (Group C, n=30). The patients in Group C were treated with standard therapy, while the patients in Group S were treated with goal-directed fluid therapy. The Kidney Disease: Improving Global Outcomes (KDIGO) classification and renal biomarkers were used for the evaluation of acute kidney injury.Results: Acute kidney injury rates were similar in both groups (30%). Postoperative fluid requirement, intra-, and postoperative erythrocyte suspension requirements were significantly lower in Group S than Group C (p=0.002, p=0.02, and p=0.002, respectively). Cystatin-C was lower in Group S (p<0.002). The kidney injury molecule-1, glomerular filtration rate, and creatinine levels were similar in both groups. The length of hospital stay was longer in Group C than Group S (p<0.001).Conclusion: Although goal-directed fluid therapy does not change the incidence of acute kidney injury in patients undergoing cardiac surgery, it can significantly decrease Cystatin-C levels. Goal-directed fluid therapy can also decrease fluid and erythrocyte requirements with shorter length of hospital stay.
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    Efficacy and cost-effectiveness of cell saver usage in the repair of thoracic aortic aneurysms and dissections
    Senarslan, DA; Yildirim, F; Kurdal, AT; Damar, A; Ozturk, T; Tetik, O
    Introduction: A substantial amount of blood loss occurs during the open repair of aortic aneurysms or dissections. The aim of the present study is to determine the efficacy and cost-effectiveness of cell saver devices in blood conservation during the open repair of thoracic aortic pathologies. Methods: The present study prospectively collected the data pertaining to 25 patients who underwent surgical management of thoracic aortic aneurysms or dissections using a cell saver (Group 1, n = 25). The volume and cost of transfusion and postoperative outcomes were compared with the second group of patients who underwent surgery without the use of cell savers in the previous year (Group 2, n = 25); the data pertaining to the same were retrospectively collected from the hospital records. The patient characteristics and categorical variables were compared using the x(2) test and Fisher's exact test. Transfusion volume and costs were compared using the independent samples t-test and Mann-Whitney U test. Results: The patients in both the groups displayed similar characteristics and risk factors. The total volume of allogenic red blood cell (p < 0.001) and total blood product (p = 0.01) transfusions were significantly lower in Group 1. The cost of red blood cell (p < 0.001) and total transfusions (p = 0.03) were lower in Group 1. The two groups displayed similar in-hospital morbidity and mortality rates. Conclusions: There was a significant association between the use of cell savers and the decreased need for red blood cell and total blood product transfusions. Considering the cost of the cell saver set, transfusion costs in the two groups were comparable.
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    The effect of regional and general anaesthesia on cerebral oxygenation in shoulder arthroscopy
    Acikel, A; Topcu, I; Ozturk, T; Keles, GT; Ozalp, T
    Aim: Shoulder arthroscopy in the beach-chair position can negatively affect cerebral perfusion and oxygenation, and thus, neurocognitive function. In this study, we aimed to compare the effects of general and regional anaesthesia (GA and RA, respectively) on cerebral oxygenation in patients undergoing shoulder arthroscopy in the beach-chair position. Material and Methods: This prospective, randomized study included 60 patients who underwent shoulder arthroscopy in the beach-chair position. Patients were divided into two groups: (1) GA (n = 30), and (2) RA using an interscalene brachial plexus block (ISB; n = 30). All patients were laid supine prior to GA or ISB (T0), and after induction of GA or ISB (T1). Next, patients were placed in the beach-chair position. The right and left cerebral oxygen saturation (NIRS-R, NIRS-L, respectively), peripheral oxygen saturation (SpO2), heart rate (HR), and mean arterial pressure (MAP) values were recorded at T0 and T1, as well as 5 (T2), 10 (T3), 20 (T4), and 30 minutes (T5) after patients were placed in the beach-chair position. Results: Patient's clinical characteristics, initial laboratory findings, and perioperative data were similar in both groups. Compared to T0, MAP was significantly lower at T1, T2, T3, and T4 in the GA group. Tukey's HSD test indicated p<0.05, p<0.0001, p<0.0001, and p<0.001, respectively. Although NIRS-R and NIRS-L values fluctuated substantially, there were no differences between groups at any of the pre-defined time points. Discussion: ISB in the beach-chair position may better preserve cerebral oxygenation compared to GA.
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    Does remote ischemic preconditioning affect the systemic inflammatory response by modulating presepsin levels?
    Bayram, B; Senarslan, DA; Sengel, A; Ozturk, T; Onur, E; Iskesen, I
    Objective: We investigated the effect of Remote Ischemic Preconditioning (RIPC) on the inflammatory response during CPB by means of serum presepsin levels at preoperative and postoperative 1st and 24th h. Methods: In this prospective, randomized, cross-sectional study we included 81 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). Patients were randomized and RIPC was applied to 40 patients in the study group before anesthesia. The remaining 41 patients were determined as the control group. The relationships between RIPC and factors such as presepsin, C-reactive protein (CRP), and leukocyte levels were investigated. Results: There was no significant difference between the groups in postoperative leukocyte and CRP values (p = 0.52, p = 0.13, respectively). When the preoperative and postoperative first hour presepsin values of the patients were compared, no significant difference was found in the control group (p = 0.17), but a significant difference was found in the study group (p < 0.05). When the presepsin values were compared between the groups, a significant difference was found only in the postoperative first hour value (p < 0.05). Conclusions: It was observed that RIPC application caused to increase the presepsin levels in the postoperative first hour significantly in the study group (p < 0.05).
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    Is Attenuation of Oxidative Stress Helpful to Understand the Mechanism of Remote Ischemic Preconditioning in Cardiac Surgery?
    Yildirim, F; Iskesen, I; Kurdal, AT; Ozturk, T; Taneli, F; Gozukara, C; Ozbakkaloglu, A
    Objectives: The aim of this study was to determine the effect of remote ischemic preconditioning (RIPC) on markers of cardiac ischemia and response to oxidative stress in patients undergoing coronary artery bypass grafting (CABG) surgery. Design: A prospective, randomized, and blinded study. Setting: A single-center university hospital. Participants: This study included patients who underwent isolated CABG surgery with cardiopulmonary bypass who were selected carefully to prevent confounding with factors known to affect markers of ischemia-reperfusion and response to oxidative stress. Interventions: The authors randomly assigned patients to RIPC to the left lower extremity using a blood pressure cuff (study group) or a cuff that was applied but not inflated or deflated (control group). Measurements and Main Results: At 6 hours after CABG surgery, high-sensitivity cardiac troponin T levels were significantly lower in the study group than in the control group. Levels of superoxide dismutase, an antioxidant enzyme, were significantly greater 15 minutes after release of the cross-clamp in the study group, whereas malondialdehyde levels were lower (not significantly) at 1 and 15 minutes after release of the cross-clamp. Hemodynamic parameters were not significantly different at any time point during the study. Conclusions: The authors' method of RIPC before CABG surgery resulted in less myocardial ischemia, as indicated by lower troponin levels. Changes in levels of endogenous antioxidant enzymes supported the hypothesis that this protection from ischemia-reperfusion injury was related to scavenging of free oxygen radicals. Future studies might include a more heterogeneous population and medications that lower the body's response to oxidative stress. (C) 2016 Elsevier Inc. All rights reserved.
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    The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section
    Yentur, EA; Topcu, I; Ekici, Z; Ozturk, T; Keles, GT; 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 degrees 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
    Ozturk, T; Erbuyun, K; Keles, GT; 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 mu g/kg over 2 min followed by a maintenance infusion of 0.15 mu g/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, P>0.05). 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. Eur J Anaesthesiol 26:338-342 (c) 2009 European Society of Anaesthesiology.
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    Management of a patient with giant aneurysms in the popliteal and coronary arteries
    Yildirim, F; Senarslan, DA; Ozturk, T; Tetik, O
    Coexistence of multiple peripheric arterial and coronary artery aneurysms of different sizes is extremely rare in young adults. We present a case of rare giant coronary aneurysm and concurrent giant left popliteal aneurysm treated with classical open repair.
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    Bentall Operation in a Patient With Severe Hemophilia A and Marfan Syndrome by Use of a Biologic Composite Graft
    Yildirim, F; Ozbakkaloglu, A; Ozturk, T; Tetik, O
    We describe a patient with severe hemophilia A and Marfan syndrome who underwent an elective Bentall operation. Because of the severe hemophilia, anticoagulation could not be given postoperatively; thus, a biologic Valsalva conduit graft was used. During the procedure, factor VIII was given as a bolus dose just before incision, then by continous infusion intra-operatively to maintain the factor VIII activity level between 200% and 300%. Minimal postoperative bleeding occurred. The infusion was continued postoperatively at a lower dose until all chest tubes, pacing wires, and invasive catheters were removed. The patient was discharged on postoperative day 7 without adverse events. (C) 2016 by The Society of Thoracic Surgeons
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    Levosimendan Attenuates Reperfusion Injury in an Isolated Perfused Rat Heart Model
    Ozturk, T; Gok, S; Nese, N
    Objectives: The aim of this study was to investigate the effect of levosimendan on apoptosis and infarct size when administered before ischemia in an isolated rat heart model. Design: An in vitro experimental study. Setting: Animal laboratory. Participants: Isolated perfused rat heart preparation (n = 22). Interventions: Perfusion with Krebs-Henseleit solution was performed for 30 minutes and then 0.1 mu mol/L of levosimendan was added to the perfusion fluid for 10 minutes before global ischemia; the control hearts received no levosimendan. Hearts underwent global ischemia for 30 minutes and then were reperfused for 30 minutes before specimens were obtained for testing. Measurements and Main Results: Infarct sizes were measured at the end of the reperfusion period and expressed as a percentage of the area at risk. Myocardial apoptosis was detected by using the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labelling (TUNEL) method. Bcl-2 expression was determined to detect antiapoptotic activity. Infarct size was significantly less in the levosimendan group (26% +/- 3% v 40% +/- 4%, respectively; p = 0.009). Levosimendan significantly reduced the proportion of TUNEL-positive cardiomyocytes (3 1 v 20 4, respectively; p < 0.001) and increased Bcl-2 expression compared with control hearts (44% +/- 3% v 31% +/- 3%, respectively; p = 0.01). Recovery of left ventricular developed pressure 30 minutes after reperfusion in ischemic hearts pretreated with levosimendan was significantly better than that of placebotreated hearts (53% +/- 3% v 38% +/- 3% of baseline, respectively; p = 0.004). Conclusions: Levosimendan has a cardioprotective effect when administered before ischemia in ischemia-reperfusion injury. This effect may be useful in elective cardiac surgery for protecting myocytes from ischemia-reperfusion induced apoptosis. (C) 2010 Elsevier Inc. All rights reserved.
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    Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy
    Ozturk, T; Kaya, H; Aran, G; Aksun, M; Savaci, S
    Background. In an attempt to decrease haemodynamic instability and early postoperative complications such as nausea, vomiting, and pain, esmolol was added to the routine alfentanil infusion of patients with treated hypertension undergoing laparoscopic cholecystectomy. Methods. Forty consecutive ASA class II patients with controlled hypertension about to undergo laparoscopic cholecystectomy were randomized into two groups: an esmolol group (Group E, n=20) was given a 1 mg kg(-1) bolus of esmolol and a placebo group (Group P, n=20) was given an identical volume of Ringer's lactate. The rate of esmolol infusion was adjusted to keep the heart rate between 65 and 75 beats min(-1) and was 5-10 mu g kg(-1) min(-1) throughout the procedure. After operation, patients reported their nausea using a four-point scale. Results. Esmolol had an opioid-sparing effect intraoperatively (P=0.001). Postoperative requirements for antiemetics were significantly less in the esmolol group, with no antiemetics given to eight patients. In the placebo group, however, all patients required at least one dose of antiemetic (P=0.007). The frequency of PONV did not correlate to the amounts of alfentanil, propofol, postoperative antiemetics consumed, or to female gender, non-smoking status, and history of PONV or motion sickness. Postoperative analgesic consumption in Group E was significantly lower than in Group P (P=0.012). Conclusions. Esmolol had an opioid-sparing effect in the intraoperative and immediate postoperative period in hypertensive patients undergoing laparoscopy. When combined with alfentanil, it was more effective than placebo in decreasing early PONV.