MCBÜ Açıkerişim Sistemi :: Browsing by Author "Topçu I."

Browsing by Author "Topçu I."

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The effect of adding clonidine to prilocaine in brachial plexus blockade; [Prilokaine klonidin eklenmesinin brakiyal pleksus bloǧuna katkisi]
(2001) Tekin I.; Topçu I.
The aim of this study was to determine the analgesic and systemyc effects of a low dose clonidine added to prilocaine in brachial plexus blockade. We studied 40 ASA I-II class patients in two equal groups who were scheduled for elective upper arm surgery. Brachial plexus block was performed with 30 mL of 1.5 % prilocaine in Group 1 and 75 μg clonidine was added to same solution in Group II. We monitored heart rate (HR), systolic and diastolic arterial blood pressure (SBP, DBP) and peripheral O2 saturation (SpO2) throughout the study. We recorded HR, SBP, DBP and sedation scores at 0, 10, 20, 30, 60, 120. minutes. Onset of action and duration of sensory and motor blockade, adverse effects and complications were recorded. Onset of motor and sensory block in radial, median and ulnar nerve were not different between the groups. Duration of motor and sensory block in radial and median nerve were more extended in Group II but there were no difference in ulnar nerve. This study suggests that, adding 1 μg/kg clonidine to prilocaine in brachial plexus blockade increases the duration of the block.
The Effect of Hyperventilation on the Increase of Cerebral Blood Flow Velocity Secondary to Deflation of the Tourniquet in Lower Extremity Surgery; [Alt Ekstremite Cerrahisinde Turnike Açilmasina Sekonder Beyin Kan Akim Hizi Artişina Hiperventilasyonun Etkisi]
(2003) Sakarya M.; Topçu I.; Özkol M.; Yentür A.; Yercan H.; Okçu G.
We aimed to investigate the effects of hyperventilation on cerebral blood flow (CBF) in order to maintain normocapnia following the deflation of the tourniquet in patients undergoing elective lower extremity operation during intravenous general anesthesia (TIVA). In all cases(n=15), anaesthesia was induced by 2 mg kg-1 propofol, 1 μg kg-1 remifentanyl and 1 mg kg-1 vecuronium, and was maintained with the mixture of 50 % air-O2, 6-8 mg kg-1 dk-1 propofol and 0.5 μg kg-1 dk-1 remifentanyl infusions. Patients were randomized into two groups. Group I (n=7) was ventilated by f=10/min and V T=8 mL kg-1. Patients in group II (n=8) were ventilated similarly as group I until the deflation of tourniquet, and following deflation by increasing respiratory frequency adjusted to maintain end-tidal CO 2 (PETCO2) between 30-35 mmHg. Middle cerebral artery (MCA) flow velocity was measured by transcranial Doppler ultrasonography as mean (m-MCA) and peak (p-MCA) values. Data were recorded 5 minutes before tourniquet deflation (control), and every minute in the first 10 minutes following deflation While there has been no difference for p-MCA, m-MCA and PaCO2 in group II, significant increases (p<0.05) in mean MCA flow velocity were obtained in 2nd, 3rd and 4th minutes in group I. Maximum increase was obtained in 3rd minute and determined as 52±7 cm/sec. The increases of PaCO2 were obtained in 2 to 6 minutes (p<0.05) and maximum level was 41±1 mmHg (25 %±3 %) in 3rd minute. We concluded that, the increase of MCA flow velocity and CBF related to the increase of PaCO2 after deflation of the pneumatic tourniquet may be prevented by maintaining normocapnia provided by increasing minute ventilation.
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.
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.
The comparison of efficiency of bupivacaine-fentanyl with ropivacaine-fentanyl in patient controlled epidural analgesia for labour; [Hasta kontrollü epidural doǧum analjezisi için bupivakain fentanil ile ropivakain fentanilin etkinliǧinin karşilaştirilmasi]
(2004) Topçu I.; Yentür E.A.; Tekin S.; Çavuş Z.; Ekici N.Z.; Sakarya M.
In this prospective, randomized, double-blinded study we aimed to evaluate the efficiency of 1μg mL-1 fentanyl with 0.125% bupivacaine and 1μg mL-1 fentanyl with 0.125% ropivacaine by patient controlled epidural analgesia (PCEA) for labour. The study was performed in 2 groups; each consisted of 20 pregnants which had healthy, single fetus in 36-41 gestational weeks with normal fetal pulse pattern in vertex position, 3-6 cm of cervical dilatation and at active phase of labour. Solution of 1μg mL-1 fentanyl with 0.125% ropivacaine was applied to Group I and 1μg mL-1 fentanyl with 0.125% bupivacaine to Group II. PCEA was programmed as 5 ml bolus dose, 10 minutes lock-out (without basal infusion, and 1-4 h limit) and 10 mL loading dose. Patients' pain was evaluated by VAS (visual analog scale) (0-100mm), sensory block by PinPrick test (0-3) and motor block by modified Bromage scale. Maternal mean arterial pressure (MAP), heart rate (HR) and fetal HR were recorded during the labour. Umblical artery blood pH, APGAR of fetus and patient satisfaction after delivery (1-5) were assessed. Mode of delivery (normal, operative and cesarean), side-effects, duration of labour and analgesics consumption for the first and second stages of labour were recorded by calculating the values via PCEA. No differences were obtained in the evaluation of MAP, HR, fetal HR, VAS, sensory block, amount of analgesics solution, mode of delivery, duration of labour, side effects and patient satisfaction between the groups. However, lesser motor block was observed in ropivacaine/fentanyl group rather than bupivacaine/fentanyl group (p<0.05). Consequently, both 1μg mL-1 fentanyl with 0.125% ropivacaine and 1μg mL-1 fentanyl with 0.125% bupivacaine by patient controlled epidural analgesia (PCEA) for labour, provided sufficient and trustworthy analgesia. Similar effects were obtained on hemodynamics but because of lesser motor block effect, we propose that ropivacaine more superior for labour analgesia.
Effects of sevofluran on cell division and levels of sister chromatid exchange; [Die wirkung von sevofluran auf zellteilung, mitose-index (MI) und austausch der schwesterchromatide (sister chromatide exchange SCE)]
(2005) Lüleci N.; Sakarya M.; Topçu I.; Lüleci E.; Erinçler T.; Solak M.
Objective: Purpose of the study was to investigate the mitotic index (MI) and sister chromatid exchange (SCE) levels to identify the mutagenic and carcinogenic effects of sevoflurane (sevoflurane). Methods: 42 non-smoking male and female turkish patients of ASA-risk I and II were included. The patients received an anaesthesia induction with 8% sevoflurane in 100% oxygen ("tidal volume methode") and 0,1 mg/kg BW vecuronium for neuromuscular block and endotracheal intubation. Anaesthesia was maintained with 2.0-2.5 sevoflurane in 60% N2O and 40% O2. Four 5 ml venous blood samples werde taken: before induction (control), 60 minutes, 24 hours and 5 days after sevoflurane anesthesia. Samples were prepared according to the periferic blood culture assay, modified by Morhead and co-workers, and levels of MI and SCE were examined. Results: 60 minutes after sevoflurane-anaesthesia a significant decrease of MI was found compared to controls (p < 0.01). This depression was lower after 24 hours (p < 0.05) and reversible after 5 days. SCE increased significantly during 60 minutes of anaesthesia (p < 0.001), was also lower after 24 hours (5.6 ± 2.4 vs. 4.4 ± 1.7) and returned to normal levels after 5 days (p > 0.05). Conclusion: The application of sevoflurane for anaesthesia may influence the cell division in humans and may have a mutagenic effect on DNA at the cell level, which is reversible.
Retrospective clinical evaluation of intoxication cases requiring critical care treatment; [Yoǧun Bakim Tedavisi Gerektiren Zehirlenme Olgularinin Retrospektif Olarak Deǧerlendirilmesi]
(2005) Topçu I.; Sakarya M.; Çetinkaya B.; Taşyüz T.; Ekici N.Z.
The purpose of this study was to analyze the intoxication cases requiring critical care treatment and to evaluate the prognosis using an objective clinical scoring system: APACHE II "Acute Physiology and Chronic Health Evaluation Scoring System". Between 1999 and 2003, 165 ICU patients, were evaluated retrospectively according to demographic data, route of intoxication, intoxicating material and the reason for intoxication, in order to estimate the prognosis and clinical course. The mean age of patients was 28.8. Of the poisoning cases, 39.4% were male and 60.6% were female patients. According to the distribution of occupations, the incidence was obtained as 29.1% housewife and student, 12.1% unemployed, 8.5% self-employed, 6.1% soldiers, 3.6% farmer and 13.9% the others. Intoxications were 88.5% oral and 10.3% by inhalation. 69.1% of the causes for intoxication were suicidal intent, 27.9% accidental and 3% overdose. 97.6% of the cases recovered and were discharged, while 2.4% died. There is a correlation between the length of stay in the ICU and mortality with the APACHE II score (p<0.05). As a result, APACHE II scores may be used to evaluate the severity of the case in order to estimate the prognosis in acute intoxication cases requiring critical care treatment.
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.
Comparison of preoperative tests for predicting difficult endotracheal intubation; [Zor endotrakeal entübasyonun tahmininde preoperatif testlerin etkinliǧinin karşilaştirilmasi]
(2006) Sabanci Ü.; Topçu I.; Tekin S.; Ekici N.Z.; Lüleci N.
Aim: Many different teats were proposed preoperatively to predict difficult endotracheal intubations. In this prospective study, we aimed to assess the effectiveness of the tests for predicting difficult intubation. Materials and Methods: 603 adult patients (238 male, 365 female) submitted for elective surgery under general anesthesia were included in this study. Age, height, weight, interincisor gap, neck circumference, sternomental and thyromental distance were recorded during prcoperative evaluation. Wilson risk score, modified Mallampati classification, head-neck movement, mandibular protrusion, history of difficult laryngoscopy or intubation and anatomic anomalies were also noted. Cormack and Lehane classification was used for visualization of the larynx. The number and duration of attempts at each tracheal intubation were recorded. Results: Tracheal intubations were difficult to perform in 25 (4.1%) patients. There was not any significant correlation between the difficult intubation and weight, thyromental and sternomental distances, mandibular protrusion and limited neck extension of the patients (p>0.05). Difficult intubations had significant association with increased age, male sex, two and more Wilson's risk score, mean interincisor gap and neck circumference, increased Mallampati score, Cormack-Lehane Grade 3 or 4 and decreased mouth opening (p<0.05). <2 cm interincisor gap had high (99 %) specificity. Also sensitivity of Cormack-Lehane Grade 3 or 4 was found higher (71%) than other parameters. Concluions: Cormack and Lehane classification is the most valuable test for predicting difficult intubation. Therefore laringoscopic view must be evaluated well and suitable position for the patient must be obtained. The highest specificity (99.8%) and positive predictive value (50%) belongs to <2 cm interincisor gap in our patients as a preoperative test. Not all but some of the preoperative tents have significant predictive value for difficult intubation.
Comparison of effects of dexmedetomidine and magnesium in traumatic brain injury; [Travmatik beyin hasarinda serebral korumada deksmedetomidin ve magnezyumun etkilerinin karşilaştirilmasi]
(2006) Çavuş Z.; Topçu I.; Vatansever S.; Var A.; Sakarya M.
Aim: Prevention of secondary serebral injury plays a major role in intensive care of head injury patients. In this study, the effects of dexmedetomidine and magnesium to prevent brain injury in head trauma are compared. Materials and Methods: Diffuse head injury was induced in 30 adult Wistar albino male rats by Marmarou method after anesthetized by intraperitoneal injection of 30 mg kg-1 sodium thiopental. Rats were divided randomly into 3 groups, each consisting of 10 rats: 2 mL saline to Group 1, 2 mL 100 μg kg-1 dexmedetomidine to Group II and 2 mL 750 μmol kg-1 magnesium sulphate to Group III were administered by intraperitoneal route. Rats were sacrificed by cervical dislocation 120 minutes after the drug administration and brain tissues were obtained without damaging the brains. Brain tissue samples were divided into two by interhemispheric incision for biochemical and histological analysis. Brain tissues were fixed in 10% formalin solution and embedded in paraffin and examined by hematoxylin-eosin staining for morphological alterations. Sections were stained via TUNEL method in order to detect apoptosis. The tissue concentration of malonyldialdehyde (MDA), Superoxide dismutase (SOD) and glutathione peroxidasc (GSH-Px) in brain tissue was also measured. Results: Hematoxylin-eosin-stained brain sections arc compared; dexmedetomidine is more effective than magnesium in reducing brain cell injury caused by head trauma. Evaluation of apoptosis by the TUNEL method revealed that magnesium is more effective than dexmedetomidine in preventing cell death. Malonyldialdehyde (MDA) levels of Group I was found significantly lower than Group II and III (p<0.05). Also the decrease in the level of superoxide dismutase (SOD) in Group I was found significantly higher than Group II and III. There was no difference in glutathione peroxidasc (GSH-Px) levels between the groups. Conclusion: Dexmedetomidine reduces secondary cerebral injury significantly: however, magnesium prevents apoptosis more effective than dexmedetomidine in experimental models of diffuse traumatic brain injury. The effects of magnesium and dexmedetomidine in brain cell protection may occur through different mechanisms but not by enzymes because the biochemical results arc in contradiction with the histopathological analysis.
The effects of esmolol on anesthetic and analgesic requirement; [Esmololün anestezik ve analjezik gereksinimi üzerine etkisi]
(2007) Topçu I.; Öztürk T.; Taşyüz T.; Işik R.; Çetin I.; Sakarya M.
Aim: There are many adjuvant agents which decrease the need of anesthetic and analgesic drugs during general anesthesia management. The comparison of the effects of esmolol, a β1 receptor antagonist with a ultra-short-acting, is aimed upon the consumption of analgesic, anesthetic and neuromuscular blocker drugs in this randomized, double-blinded study. Materials and Methods: 18-70 year old, ASA I-II, 60 patients scheduled for elective abdominal operations under general anesthesia were equally divided into 2 groups. In Group E; 1 mg kg-1 esmolol infusion was started slowly prior to induction and 250 μg kg-1 min-1 esmolol infusion lasted during the operation, in Group C (control group) isotonic solution was administered in the same volume. Propofol (due to BIS values) and remifentanil (due to heart beat rate and blood pressure) were administered by TIVA in anesthesia maintenance to the patients. Rocuronium was used as a neuromuscular blocker drug. All hemodynamics values of the cases, the amounts of the anesthetic consumption, analgesic and neuromuscular blocker drugs before and after induction were recorded. Results: There was no difference for age, gender, type and period of operation and induction doses between the groups (p>0.05). The need of analgesic and anesthetic drug was decreased but the consumption of neuromuseular blocker drug not affected in Group E than Group K (p<0.05). Mean arterial blood pressure and heart beat rate variables were more stabile in the perioperative period in Group E. The hemodynamic response to intubation and extubation were reduced by esmolol infusion. Conclusion: The results suggest that the perioperative esmolol administration may reduce intraoperative requirement of the anesthetics and the analgesic to prevent acute autonomic responses during anesthesia and surgery.
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.
Effects of esmolol on hemodynamic responses to laryngoscopy and tracheal intubation in diabetic versus non-diabetic patients
(2007) Taşyüz T.; Topçu I.; Özaslan S.; Sakarya M.
Aim: We aimed to investigate the efficiency of esmolol, a short-acting β-blocker, in preventing the hemodynamic response to laryngoscopy and endotracheal intubation in diabetic patients. Materials and Methods: Eighty diabetic or non-diabetic patients with ASA physical status I-II scheduled for noncardiac surgery were included in this study. They were divided randomly into 4 groups (Non-diabetic control: NDC, Non-diabetic esmolol: NDE, Diabetic control: DC, Diabetic esmolol: DE). Blood glucose analyses were measured in the preoperative period and at the 10th min of the study. Prior to anesthetic induction, 1 mg/kg esmolol to Groups NDE and DE and saline to Groups NDC and DC were administered in 1 min by slow infusion. After 2 mins, systolic and diastolic arterial blood pressures (SBP, DBP), heart rate (HR), bispectral index (BIS) and peripheral oxygen saturation (SpO2) were recorded in all groups. Laryngoscopy and endotracheal intubation were performed after induction. SBP, DBP, HR, SpO2 and BIS values were recorded every minute during 10 mins after intubation. Results: In Groups NDE and DE, SBP, DBP and HR values were significantly lower after drug administration than the values obtained before drug administration (p<0.05). In Groups NDC, NDE and DC, SBP, DBP and HR values were significantly higher in the first minute of the intubation compared to before drug administration (p<0.05), but were significantly low in subsequent measurements (p<0.05). Blood glucose analyses were found significantly higher in Group NDE than Group NDC (p<0.05). Conclusions: We propose that esmolol might be used effectively to control hemodynamic response to tracheal intubation in diabetic patients. We also determined that esmolol causes no difference in blood glucose levels. © TÜBİTAK.
Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit; [Toraks travmali hastalarda intravenöz hasta kontrollü analjezi ile torakal epidural hasta kontrollü analjezinin klinik etkinliǧinin karşilaştirilmasi]
(2007) Topçu I.; Ekici Z.; Sakarya M.
BACKGROUND: The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma. METHODS: Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. RESULTS: There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1±1.6 and 9.2±1.7) and the number of rib fractures (4±1.1 and 6.8±2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6±5.9 and 12.1±4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications. CONCLUSION: We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.
A summary of cases of central venous catheterization in infants; [Infantlarda santral venöz kateterizasyon deneyimlerimiz]
(2007) Toprak V.; Topçu I.; Tezcan Keleş G.
Objective: The purpose of this study is to analyze the features of central venous catheterization (CVC) procedures, retrospective evaluation of the problems observed during catheter insertion up until its withdrawal of them and discuss the results according to the literature in infant cases. Method: Between March 2004 and May 2005, central venous catheters administered to 27 infants by consultant anesthesiologists for follow-up in non-cardiac surgery and Pediatric Intensive Care Unit were evaluated retrospectively with demographic data, primary disease, the place of catheterization and complications. Results: Thirteen of the cases (48.1 %) were younger than 6 months and the rest (51.9%) were older than 6 Months. Sixteen of the infants (59.3%) were female and 11 (40.7%) were male. Fifteen CVC (55.6%) were administered into the internal jugular vein and 12 (44.4%) into the subclavian vein. The mean catheterization time was 5.9±52 days. Arterial punctures during catheterization were observed in 3 of the cases (11.1 %). There was no relationship between arterial puncture and the place of catheterization or the age of infants. Blood could be aspirated in 15 (55.6%) of the infants. There was no relationship between administration site and blood aspiration (p>0.05). Conclusion: In pediatric patients, the complications of CVCs are closely related to age, body size and the experience of the anesthesiologist. The optimum administration place depends on the experience of the anesthesiologist and the clinical condition of the case.
Anesthetic management in a patient with osteogenesis imperfecta; [Osteogenezis i̇mperfektali bir olguda anestezi uygulamasi]
(2008) Topçu I.; Özer M.; Örgü̧ Ş.; Sakarya M.
Osteogenesis imperfecta (OI) is a rare autosomal inherited connective tissue disease, characterized by abnormal type 1 collagen production. Anatomical abnormalities may affect the choice of anesthesia technique by causing difficulties for regional anesthesia in the management of the patients with OI. The problems relation with airway control and intubation and the risk of anesthetic agents triggering malignant or non-malignant hyperthermia are seen in these cases. The discussion of the anesthesia choice and the evaluation of total intravenous anesthesia and laryngeal mask management in a patient with OI undergoing an operation for urethral stone are aimed in this presentation.
Infant who developed noncardiac pulmonary edema after flexible fiberoptic bronchoscopy; [Fleksibl fiberoptik bronkoskopi sonrasi nonkardiyak pulmoner ödem gelişen i̇nfant]
(2009) Yüksel H.; Topçu I.; Ikizoǧlu H.T.; Yilmaz Ö.; Söǧüt A.; Keleş G.
Pulmonary edema may be secondary to cardiac or noncardiac etiologies. Noncardiac pulmonary edema develops as a result of increased vasopermeability, leading to water and protein leak into the interstitium. Negative pressure at the level of the alveoli during flexible fiberoptic bronchoscopy (FFB) may lead to the development of pulmonary edema. This is a rare complication in infants undergoing FFB. Dignostic FFB was performed on a four month old female patient with hypoxic ischemic encephalopathy due to persistent upper respiratory findings. Additional respiratory tract anomalies were not observed in this case who was diagnosed as having laryngomalacia. She developed bronchospastic findings following FFB which improved with nebulized salbutamol treatment. Although her bronchospasm regressed two hours after the procedure, oxygen requirement continued and fine rales became prominent on pulmonary auscultation. Findings of pulmonary edema were observed in the chest X-ray. Mannitol at a dose of 0.5 mg/kg was administered with the diagnosis of pulmonary edema. Physical findings and vital signs normalized with treatment and oxygen requirement ceased. This case was discussed because pulmonary edema after FFB is a rare complication and this is the first experience with mannitol in the treatment.
Anesthetic management in a case severe thoracolumbar kyphoscoliosis and difficult airway; [Ciddi torakolomber kifoskolyozu ve zor hava yolu olan olguda anestezi yönetimi]
(2009) Topçu I.; Öztürk T.; Bulut S.; Tezcan Keleş G.
Anesthetic management in a case severe thoracolumbar kyphoscoliosis and difficult airway Spinal deformities may cause difficulties with both tracheal intubation and regional anesthesia. This report describes the anesthetic management that was performed in 48 years old patient with extremely severe thoracolumbar kyphoscoliosis and mallampati class IV. After examining the risk factors, spinal block by injecting single dose 12, 5 mg bupivacaine solution to the intratechal space was chosen to provide anaesthesia. Motor and sensory blockade at the level of Thl2 was achieved. Spinal anesthesia can be successfull even in cases of severe thoracolumbar kyphoscoliosis and difficult airway manage-ment.
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.
Underestimated role of alcohol at skin disinfection: Lipid dissolving property when used in association with conventional antiseptic agents; [Alkolün cilt dezenfeksiyonunda önemsenmeyen rolü: Klasik antiseptik ajanlarla birlikte kullanıldıǧında lipit çözücü özelliǧi]
(Turkiye Klinikleri Journal of Medical Sciences, 2010) Yentür A.; Topçu I.; Işik R.; Deǧerli K.; Sürücüoǧlu S.
Aim: After conventional aqueous disinfectant solutions, it was shown that microorganisms were still protected in hair follicles. We hypothesized that those aqueous disinfectant solutions when used in combination with alcohol may be more effective on the inhibition of recolonization of skin and therefore catheter tip colonization. & Materials and methods: Skin surface samples were taken from epidural catheter insertion sites prior to catheterization, and before and after disinfection with different combinations of povidone-iodine, chlorhexidine, and alcohol. Before catheter removal, cultures were taken once more and tips of the catheters were cultured. & Results: Catheter tip colonization and skin culture results of 10% povidone-iodine + 70% alcohol group were significantly lower than those of other groups after disinfection. & Conclusion: Sequential use of alcohol and povidone-iodine is the most effective combination for limiting re-colonization of skin flora. Contamination of catheters appears to take place at removal or via the spread of these re-colonized bacteria along the catheter tract. © TÜBİTAK.

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