Browsing by Author "Ayhan, Asude"

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Anesthetic and Perioperative Management of Nontransplant Surgery in Patients After Liver Transplant
(2017) Ersoy, Zeynep; Ayhan, Asude; Ozdemirkan, Aycan; Polat, Gulsah Gulsi; Zeyneloglu, Pinar; Arslan, Gulnaz; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0003-2312-9942; 0000-0002-3462-7632; 0000-0003-3299-6706; 0000-0001-8285-0372; 28260430; AAF-3066-2021; AAH-7003-2019; C-3736-2018; AAJ-8097-2021; AAJ-2066-2021
Objectives: We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures. Materials and Methods: We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Baskent University Hospital. Results: The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative blood-product transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%). Conclusions: Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any post operative graft dysfunction.
Anesthetic Management of Renal and Liver Transplantation Recipients During Cesarean Section
(2018) Firat, Aynur Camkiran; Ayhan, Asude; Araz, Coskun; Haberal, Mehmet; Kayhan, Zeynep; 0000-0003-3299-6706; 0000-0002-4927-6660; 0000-0002-3462-7632; 0000-0003-0579-1115; AAJ-2066-2021; AAJ-4576-2021; AAJ-8097-2021; AAJ-4623-2021
Can Hypotension Episodes that were not Identified in the Non-Invasive Blood Pressure be Detected during Cesarean Section? A Randomized Controlled Trial
(2022) Ayhan, Asude; Akovali, Nukhet; Firat, Aynur Camkiran; 35997144
Background: Neuraxial anesthesia is a commonly used technique for cesarean section (C/S) because of its simplicity, rapid onset of action, and the requirement of lower doses of anesthetic agents with the lack of uteroplacental transfer. However, this type of anesthesia often causes sudden onset of hypotension, and its pathogenesis is not yet clearly understood.Aims: To evaluate the efficacy and necessity of continuous non -invasive arterial pressure (CNAP) by comparing it with non-invasive blood pressure (NIBP) in order to understand whether it has advantages over oscillometric technique for detection of hypotensive episodes in healthy pregnant women who underwent C/S under neuraxial anesthesia.Study Design: A randomized controlled study.Methods: This prospective study evaluated healthy pregnant women at term who were scheduled for elective C/S under spinal anesthesia. Subjects were randomly assigned into two groups to receive either CNAP and NIBP, or only NIBP. A 30% decrease in systolic blood pressure from either baseline or the measured values in the first two minutes, or if the systolic blood pressure was less than 90 mmHg, is considered hypotension. Pre-, peri-, and postoperative specifications; newborn characteristics; and complications were recorded and compared.Results: A total of 106 individuals were enrolled in the study, with 53 parturients in each group. They were equally distributed in both groups (P > 0.05). The oscillometric method failed to detect hypotension in 8 out of 29 pregnant women who were noted to be hypotensive with CNAP. The number of hypotension events detected was higher, and the time to detection of the first episode of hypotension was shorter in the CNAP group (P > 0.05). A total of four newborns required intensive care unit treatment, one of whom needed mechanical ventilator support, all born to mothers in the CNAP group (P > 0.05).Conclusion: Continuous non-invasive arterial pressure in detecting hypotensive episodes does not provide an additional advantage to healthy pregnant women undergoing elective cesarean section.
Early Postoperative Acute Kidney Injury Among Heart Transplant Recipients: Incidence, Risk Factors and Impact on Clinical Consequences
(2018) Aliyev, Ali; Ayhan, Asude; Zeyneloglu, Pinar; Pirat, Arash; Sezgin, Atilla; Kayhan, Zeynep; 000-0003-3299-6706; 0000-0003-0579-1115; AAE-8052-2019; AAJ-2066-2021; AAJ-4623-2021
EVALUATION AND MANAGEMENT OF DIFFICULT AIRWAY IN OBESITY: A SINGLE CENTER RETROSPECTIVE STUDY
(2016) Ayhan, Asude; Kaplan, Serife; Kayhan, Zeynep; Arslan, Gulnaz; 27276769
The primary aim of this single center retrospective study was to evaluate difficult mask ventilation (DMV) and difficult laryngoscopy (DL) in a unique group of obese patients. A total of 427 adult patients with body mass index (BMI) >= 25 and surgically treated for endometrial cancer from 2011 to 2014 were assessed. Additional increase in BMI, comorbidities, bedside screening tests for risk factors, and the tools used to manage the patients were noted and their effects on DMV and/or DL investigated. Every escalation in the number of risk factors increased the probability of DMV 2.2-fold, DL 1.8-fold and DMV+DL 3.0-fold. Among bedside tests, limited neck movement (LNM), short neck (SN) and absence of teeth were significant for DMV (p<0.05), LNM, SN and obstructive sleep apnea for DL (p<0.05), and LNM and SN for DMV+DL (p<0.05). However, a 10-point increase of BMI was not an independent risk factor when patients with BMI >25% were considered. In conclusion, LNM and SN are independent risk factors for developing DMV and/or DL in obese endometrial cancer patients, while BMI increase over 30 was not additionally affecting difficult airway.
Incidence and Patient Outcomes in Renal Replacement Therapy After Orthotopic Liver Transplant
(2017) Ayhan, Asude; Ersoy, Zeynep; Ulas, Aydin; Zeyneloglu, Pinar; Pirat, Arash; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0003-3299-6706; 0000-0002-3462-7632; 0000-0003-2312-9942; 0000-0002-8130-9901; 28260481; AAF-3066-2021; AAJ-2066-2021; AAJ-8097-2021; AAJ-2057-2021; C-3736-2018
Objectives: Our objective was to evaluate the incidence of renal replacement therapy after orthotopic liver transplant and to evaluate and analyze patient outcomes. Materials and Methods: We performed a retrospective analysis of 177 consecutive patients at a tertiary care unit who underwent orthotopic liver transplant between January 2010 and June 2016. Patients who were admitted to the intensive care unit after orthotopic liver transplant and who required renal replacement therapy were included. Results: A total of 177 (79 adult, 98 pediatric) orthotopic liver transplants were performed during the study period. Of these, 35 patients (19%) required renal replacement therapy during the early posttrans plantation period. After excluding 5 patients with previous chronic renal failure, 30 patients (17%; 20 adult [25%], 10 pediatric [10%]) with acute kidney injury required renal replacement therapy. The mean patient age was 31.1 +/- 20.0 years, with a mean Model for End-stage Liver Disease score of 16.7 +/- 12.3. Of the patients with acute kidney injury who underwent renal replacement therapy, in-hospital mortality was 23.3% (7 of 30 patients), and 40% remained on dialysis. No significant difference was seen in mortality between early versus delayed initiation of renal replacement therapy in patients with stage 3 acute kidney injury (P = .17). Conclusions: Of liver transplant recipients who present with acute kidney injury, 19% require renal replacement therapy, and in-hospital mortality is 20% in the early postoperative period.
The Influence of Different Sugammadex Doses on Neural Tube Development in Early-Stage Chick Embryos
(2023) Ayhan, Asude; Efe, Ekin; Fidan, Pinar A.; Efe, Oguzhan E.; Ates, Eylem Gul; Sahinturk, Fikret; Ayhan, Selim; 0000-0002-6166-2601; 0000-0001-6955-9839; 0000-0002-3243-7843; 0000-0003-3047-0305; 0000-0002-0471-3177; 37565787; HGE-9282-2022; AAJ-2057-2021; AAJ-4728-2021; W-7908-2019; ABG-5365-2020; AAI-7972-2021
Background: Sugammadex is a modified gamma-cyclodextrin that has been developed with the goal of reversing the steroidal neuromuscular blocking agents. The aim of the present study is to investigate the effects of different sugammadex doses on embryologic and neural tube development in an early-stage chick embryo model. Methods: A total of 100 specific pathogen-free, fertilized domestic chicken eggs were randomly divided into five groups (n = 20, each), and placed in an automatic cycle incubator. The eggs in the "control (C)" group were incubated without administration of any drug till the end of the experiment. Subblastodermic administration of 0.9% NaCl as vehicle control (VC) and different doses of sugammadex solutions prepared with the latter [2 mg/mL (LD), 4 mg/mL (MD), 16 mg/mL (HD)] were performed at 30 hr of incubation. All embryos were removed from the eggs at 72 hr when they were expected to reach Hamburger-Hamilton (HH) stages 19-20, then they were fixed, and evaluated histo-morphologically. Results: Embryonic development was not observed in 11 eggs (1 in C, 1 in VC; 3 in LD, 3 in MD, and 3 in HD). All the developed embryos were compatible with the HH stages 19-20. A neural tube closure defect was detected in one embryo in the HD group. No statistically significant difference was found between the groups in terms of embryonic and neural tube developments. Conclusions: No significant association was found between the drug and adverse outcomes; however, a trend with dosing was seen. Further studies are required before conclude on safety and extrapolate these results to human beings.
Retrospective Evaluation of Patients who Underwent Laparoscopic Bariatric Surgery
(2018) Tuncali, Bahattin; Pekcan, Yonca Ozvardar; Ayhan, Asude; Erol, Varlik; Yilmaz, Tugba Han; Kayhan, Zeynep; 30140537
Objective: In the present study, we aimed to retrospectively evaluate the preoperative characteristics, intraoperative and postoperative results of patients who underwent laparoscopic obesity surgeries. Methods: After obtaining the approval of the Ethics Committee, records of patients who underwent laparoscopic obesity surgery from January 2013 to December 2016 were reviewed. Demographic characteristics, medications used in anaesthesia and analgesia, the duration of recovery unit/hospital stay, intensive care unit/mechanical ventilation requirements and complications were recorded. Results: A total of 329 ASA II-III patients over a 3-year period were operated. Thiopental and propofol were administered at induction, sevoflurane, isoflurane and desflurane were administered for the maintenance, and vecuronium and rocuronium were administered to aid in neuromuscular blockage. The mean durations of recovery unit and hospital stays were 30.80 +/- 6.01 minutes and 4.27 +/- 1.68 days, respectively. The hypnotic agent, muscle relaxant or inhalation anaesthetics used did not have a significant effect on the duration of recovery unit and hospital stay. Mask ventilation and intubation were noted to be difficult in 5.5% and 8.5% of the cases, respectively. The presence of obstructive sleep apnoea syndrome and high body mass index and Mallampati scores significantly increased difficult mask ventilation and difficult intubation rates. Four patients were transferred to intensive care unit for close monitoring. Two patients were re-operated on, two patients had rhabdomyolysis, one patient had Wernicke's encephalopathy and two patients had peripheral neuropathy. Perioperative mortality did not occur in any patient. Conclusion: We believe that appropriate patient selection, the use of well-designed anaesthesia and surgical protocols play important roles in increasing the success rate of patient outcomes and early and late complications in laparoscopic obesity 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.