Browsing by Author "Altun, Dilek"

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Anesthesia Management with Ultrasound Guided Thoracic Paravertebral Block for Donor Nephrectomy: A Prospective Randomized Study
(2017) Yenidunya, Ozlem; Bircan, Huseyin Yuce; Altun, Dilek; Caymaz, Ismail; Demirag, Alp; Turkoz, Ayda; 28235492; AAR-7467-2020; R-6394-2019
Study objective: To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy. Design: Prospective randomized controlled study. Setting: Private foundation university hospital; November 2014 to June 2015. Patients: Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n = 14) or Group M (morphine, n = 16). Interventions: In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively. Measurements: Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Homer's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression. Results: Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P <.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P. Conclusions: Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications. (C) 2016 Elsevier Inc. All rights reserved.
Comparison of the Efficacy of Intrathecal Bupivacaine and Levobupivacaine in Artroscopic Knee Surgery
(2014) Altun, Dilek; Demir, Guray; Cetingok, Halil; Tilluba, Evrim Kucur; Cukurova, Zafer; AAR-7467-2020
Objective: In our study, we aimed to compare the degree of sensorial and motor block efficiency of intratechal bupivacaine and levobupivacaine in artroscopic knee surgery. Materials and methods: ASA I-III 100 patients, were divided in two groups. Spinal anesthesia was achieved with 10 mg of bupivacaine 0.5% in Group BPV and 10 mg of levobupivacaine 0.5% in Group LVB. Sensorial block increment time of T10, maximum level of sensorial block, maximum level of motor block and its formation time, total motor and sensorial block time, pain degree with VAS, complications and side effects were recorded. Results: The sensorial block incerement time of T10 was shorter in group BPV, the time of sensorial block was longer. Group LVB increment time of T10, increment time of maximum upper dermatome and the increment time of maximum motor block levels were higher in Group BPV than the Group LVB (p<0.01). Sensorial increment time, level of motor block was longer in group BPV then group LVB (p<0.01). Motor block time of Group BPV was longer then group LVB (p<0.01). Group LVB's VAS score during the initial operation was higher than Group BPV (p<0.01). Hypotension probability was higher in Group LVB than Group BPV (p<0.05). Conclusion: Sensorial and motor block existence was happened in a short time with a longer continuation by bupivakanin instead of levobupivacaine. Because of the longer motor block existence of bupivacaine, levobupivacaine might be preferred in case of the motor block demands during the operation but in case of short-time operations like artroscopic knee surgery, levobupivacain should be more suitable because of the early cover of motor block.
The Effect of Modified Ultrafiltration Duration on Pulmonary Functions and Hemodynamics in Newborns and Infants Following Arterial Switch Operation
(2014) Turkoz, Ayda; Tuncay, Ezgi; Balci, Sule Turgut; Can, Meltem Guner; Altun, Dilek; Turkoz, Riza; Undar, Akif; 24977688; AAR-7467-2020
Objectives: Modified ultrafiltration is used to ameliorate the deleterious effects of cardiopulmonary bypass in pediatric cardiac surgery patients. The ideal duration of modified ultrafiltration has not been established yet. We investigated the effects of extended duration of modified ultrafiltration on pulmonary functions and hemodynamics in the early postoperative period in newborns and infants who had transposition of great arteries operations. Design: Single-center prospective randomized study. Setting: Pediatric cardiac surgery operating room and ICU. Patients: Sixty newborns and infants who had been scheduled to undergo transposition of great arteries operation. Interventions: None. Measurements and Main Results: Modified ultrafiltration was applied to all patients following the termination of cardiopulmonary bypass (for 10, 15, and 20 min in groups 1, 2, and 3, respectively). Pulmonary compliance, gas exchange capacity, hemodynamic measurements, inotropic support, blood loss, transfusion requirements, hematocrit level, and duration of ventilatory support were measured after intubation, at termination of cardiopulmonary bypass, at the end of modified ultrafiltration, and in the 1st, 6th, 12th, and 24th hours after admission to ICU. The amount of fluid removed by modified ultrafiltration in groups 2 and 3 was larger than that of group 1 (p < 0.01). Systolic blood pressure was significantly increased at the end of modified ultrafiltration in group 3 compared to groups 1 and 2 (p < 0.05). Hematocrit levels were significantly increased at the end of modified ultrafiltration in groups 2 and 3 compared to group 1 (p < 0.01). Therefore, RBCs were transfused less after modified ultrafiltration in groups 2 and 3 compared to group 1 (p < 0.05). Static and dynamic compliance, oxygen index, and ventilation index had improved similarly in all three groups at the end of modified ultrafiltration (p > 0.05) Conclusions: Modified ultrafiltration acutely improved pulmonary compliance and gas exchange in all groups. Increased hematocrit and blood pressure levels were also observed in the longer modified ultrafiltration group. However, extended duration of modified ultrafiltration did not have a significant impact on duration of intubation or the stay in ICU.
The Effect of Tramadol Plus Paracetamol on Consumption of Morphine After Coronary Artery Bypass Grafting
(2017) Altun, Dilek; Cinar, Ozlem; Ozker, Emre; Turkoz, Ayda; 0000-0003-2279-3083; 28183564; AAR-7467-2020
Study of objective: To compare the effects of oral tramadol + paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol. Design: A prospective, double-blind, randomized, clinical study. Setting: Single-institution, tertiary hospital. Patients: Fifty cardiac surgical patients undergoing primary CABG surgery. Interventions: After surgery, the patients were allocated to 1 of 2 groups. Both groups received morphine according to the PCA protocol after arrival to the coronary intensive care unit (bolus 1 mg, lockout time 15 minutes). In addition to morphine administration 2 hours before operation and postoperative 2nd, 6th, 12th, 18th, 24th, 30th, 36th, 42th, and 48th hours, group T received tramadol + paracetamol (Zaldiar; 325 mg paracetamol, 37.5 mg tramadol) and group P received placebo. Sedation levels were measured with the Ramsay Sedation Scale, whereas pain was assessed with the Pain Intensity Score during mechanical ventilation and with the Numeric Rating Scale after extubation. If the Numeric Rating Scale score was.>_.3 and Pain Intensity Score was >= 3, 0.05 mg/kg morphine was administered additionally. Measurements: Preoperative patient characteristics, risk assessment, and intraoperative data were similar between the groups. Main results: Cumulative morphine consumption, number of PCA demand, and boluses were higher in group P (P < .01). The amount of total morphine (in mg) used as a rescue analgesia was also higher in group P (5.06 +/- 1.0), compared with group T (2.37 +/- 0.52; P < .001). The patients who received rescue doses of morphine were 8 (32%) in group T and 18 (72%) in group P (P < .001). Duration of mechanical ventilation in group P was longer than group T (P < .01). Conclusion: Tramadol + paracetamol combination along with PCA morphine improves analgesia and reduces morphine requirement up to 50% after CABG, compared with morphine PCA alone. (C) 2016 Elsevier Inc. All rights reserved.
A Paratyhroid Adenoma Case in Intensive Care Unit: Prognosis and Treatment Approach
(2015) Altun, Dilek; Demir, Guray; Tulubas, Evrim; Cukurova, Zafer; Turhan, Ahmet; AAR-7467-2020
Parathyroid adenoma is the most common cause of primary hyperparathyroidism. More than 80% of the patients are asymptomatic and are usually diagnosed with incidentally detected high serum calcium levels. Concominant elevated levels of serum calcium (Ca++) and parathyroid hormone (PTH) is important in definitive diagnosis. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Here, we report a patient with high serum calcium levels related to parathyroid adenoma and treated in intensive care unit (ICU). 54 years old female patient who is under treatment of osteoporosis had the symptoms of muscle weakness, fatigue, dizziness, vomiting, dehydration, polyuria and depression. High serum Ca+ and PTH levels were returned to normal after surgical excision.
The success rate and safety of internal jugular vein catheterization under ultrasound guidance in infants undergoing congenital heart surgery
(2019) Altun, Dilek; Nurac, Salih Hakan; Toprak, Verda; Eti, Emine Zeynep; 32082823
Background: In this study, we aimed to investigate the effect of central venous catheterization under ultrasound guidance on the success and complication rates in low-weight infants (under 5 kg) undergoing surgery due to congenital heart disease. Methods: A total of 70 infants (38 boys, 32 girls; mean age of patients <1 month was 16.4 +/- 9.5 days [n=20; 28.6%]; 1-7.5 months was 126.3 +/- 47.8 [n=50; 71.4%]) who underwent ultrasound-guided internal jugular venous catheterization between October 2014 and October 2015 were retrospectively analyzed. All catheterizations were done under the guidance of ultrasound by two skilled anesthesiologists. Data including demographic characteristics of the patients, procedural success rate, catheter access time, number of attempts, and complications were recorded. Results: The overall success rate of the procedure was 92.8% (n=65). In 82% of the patients (n=53), the insertion was successful at the first attempt. The mean catheter access time (time from the first puncture to the catheter insertion) was 214 +/- 0.48 sec. Complications were seen in five patients (7.14%), and the body weight of these patients was less than 2,500 g There was no arterial puncture in any patients. One patient (1.42%) developed pneumothorax and four patients (5.7%) developed hematoma due to repeated attempts. Conclusion: Our study results suggest that ultrasound-guided central venous cannulation is a safe and effective technique in pediatric population weighing less than 5 kg undergoing congenital heart surgery.
Successful anesthetic and airway management in Coffin-Siris syndrome with congenital heart disease: Case report
(2016) Altun, Dilek; Demir, Guray; Ayhan, Asude; Turkoz, Ayda; 0000-0003-3299-6706; AAR-7467-2020; AAJ-2066-2021; AAJ-2057-2021
Introduction: Coffin-Siris Syndrome (CSS) is a rare congenital malformation syndrome characterized with mild to severe developmental and cognitive delay, coarse facial features, fifth digit aplasia or hypoplasia associated with ectodermal, constitutional and organ-related (cardiac/neurolo gical/gastrointestinal/genitourinary...) anomalies. Here, we have reported a successful anesthetic and airway management in a case of 5-year old boy with CSS who underwent congenital heart surgery. Case report: A 5-year old male child weighing 14 kg, who was diagnosed as CSS underwent operation for the repair of partial atrioventricular septal defect and secundum atrial septal defect. This case report pertains to the successful anesthetic and airway management in the background of difficult airway and presence of various cardiac abnormalities. Although patient was anticipated to be difficult for intubation due to laryngomalacia, micrognathia, macroglossia, tracheal intubation was performed without any difficulty using fiber-optic laryngoscopy. At the end of the operation, the patient was transferred to the cardiovascular intensive care unit and was extubated when his spontaneous breathing was satisfactory 4 h later after the operation without any complication. Results and discussion: CSS often requires surgery and anesthetic intervention. The abnormal facial and airway as well as mental related features may lead intubation difficult, potentially due to short neck, large tongue and lips, poor dentition and poor communication. Thinking that the practicing anesthetist needs to have appropriate knowledge for this entity and the equipment for managing difficult airway should readily be available. One of these patients which successfully managed without any complication was described in this brief report. (C) 2016 Publishing services by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.