Browsing by Author "Firat, Aynur Camkiran"

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Accuracy of Continuous Noninvasive Arterial Pressure Monitoring in Living-Liver Donors During Transplantation
(2015) Araz, Coskun; Zeyneloglu, Pinar; Pirat, Arash; Veziroglu, Nukhet; Firat, Aynur Camkiran; Arslan, Gulnaz; 0000-0003-2312-9942; 0000-0002-4927-6660; 0000-0003-1470-7501; 25894178; C-3736-2018; AAJ-4576-2021
Objectives: Hemodynamic monitoring is vital during liver transplant surgeries because distinct hemodynamic changes are expected. The continuous noninvasive arterial pressure (CNAP) monitor is a noninvasive device for continuous arterial pressure measurement by a tonometric method. This study compared continuous noninvasive arterial pressure monitoring with invasive direct arterial pressure monitoring in living-liver donors during transplant. Materials and Methods: There were 40 patients analyzed while undergoing hepatic lobectomy for liver transplant. Invasive pressure monitoring was established at the radial artery and continuous noninvasive arterial pressure monitoring using a finger sensor was recorded simultaneously from the contralateral arm. Systolic, diastolic, and mean arterial pressures from the 2 methods were compared. Correlation between the 2 methods was calculated. Results: A total of 5433 simultaneous measurements were obtained. For systolic arterial blood pressure, 55% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.479, continuous noninvasive arterial pressure bias was -0.3 mm Hg, and limits of agreement were 32.0 mm Hg. For diastolic arterial blood pressure, 50% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.630, continuous noninvasive arterial pressure bias was -0.4 mm Hg, and limits of agreement were 21.1 mm Hg. For mean arterial blood pressure, 60% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.692, continuous noninvasive arterial pressure bias was +0.4 mm Hg, and limits of agreement were 20.8 mm Hg. Conclusions: The 2 monitoring techniques did not show acceptable agreement. Our results suggest that continuous noninvasive arterial pressure monitoring is not equivalent to invasive arterial pressure monitoring in donors during living-donor liver transplant.
Acute Respiratory Failure in Cardiac Transplant Recipients
(2015) Komurcu, Ozgur; Ozdemirkan, Aycan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; 0000-0003-2312-9942; 0000-0003-1470-7501; 26640904; C-3736-2018; AAH-7003-2019
Objectives: This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients. Materials and Methods: Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included. Results: Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure. Conclusions: A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.
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.
Case Reports: Should We Do Away with Them?
(2017) Firat, Aynur Camkiran; Araz, Coskun; Kayhan, Zeynep; 0000-0002-4927-6660; 0000-0003-0579-1115; 0000-0003-1470-7501; 28235534; AAJ-4576-2021; AAJ-4623-2021
Study objective: There has been a gradual decline in the number of case reports published in leading medical journals in recent years. Since case reports are not highly cited they have an adverse effect on the journal impact factor. On the other hand sharing new experiences, challenges, or discoveries with colleagues is essential for medical community. Should case reports be eliminated from the journals or published only in journals devoted to case reports? Design: Observational study. Setting: Web of Science database was searched, between 2005 and 2009, with terms: "anesthesia", "anesthesiology" and "case report" yielding 25 969, 9532, and 661 publications, respectively. Since some reports contained large number of cases, only those involving up to three cases (n = 425) were evaluated by the authors with respect to their type, contribution to knowledge and/or practice (Likert scale) and times they were cited. Main results: Distribution of answers to the statement "Case has added to my knowledge and/or improved my practice" was; 3% (strongly disagree), 10.5% (disagree), 33.2% (neither agree nor disagree), 39.3% (agree) and 13.7% (strongly agree). Average citations per item was 4.43 (1883/425), 7.32 (4838/661), and 7.82 (74 529/ 9532). As to the types of the reports; 50% unexpected event in the course of anesthesia, 31% unusual and instructive cases, 9.6% novel/unique anesthetic techniques, 6% novel use of equipment, 1.6% new information on diseases of importance to anesthesiology and 1% scientific observations. Conclusion: Case reports have been an important source of clinical guidance and scientific insight, and play an important role in medical education. They can be published quickly, providing publication opportunity for juniors and for clinicians who may not have the time or finance to conduct large-scale research. On the other hand some argue, that case reports are irrelevant in current medical practice and education, being at the bottom of the hierarchical ladder of medical evidence. We conclude that case reports should not be done away with but be published in websites and journals like the venue to be launched in 2013 by the International Anesthesia Research Society, devoted entirely to them to meet the need for the publication of interesting cases. (C) 2016 Elsevier Inc. All rights reserved.
Distal Limb Reperfusion During Percutaneous Femoral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in an Adult Patient
(2019) Firat, Aynur Camkiran; Sezgin, Atilla; Pirat, Arash; 31276115
Ischemia and compartment syndrome may be seen, especially in the distal limb, after femora-femoral cannulation for extracorporeal membrane oxygenation (ECMO). Several techniques have been used to decrease the rate of complications. Arterial hypoxemia may be prevented by reperfusion with distal limb. Prophylactic superficial femoral artery cannulation results in ease in operation and prevents perfusion. In the present case, we present prophylactic superficial femoral artery cannulation for limb reperfusion.
The Effect of Positive End Expiratory Pressure on Right Ventricular Functions in Coronary Artery Bypass Graft Surgery
(2017) Turker, Melis; Firat, Aynur Camkiran; Pirat, Bahar; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0003-4576-8630; AAI-8897-2021
Background: This study aims to investigate the effect of positive end-expiratory pressure on the right ventricular functions by speckle tracking method in patients undergoing coronary artery bypass grafting. Methods: This prospective study included a total of 20 patients (17 males, 3 females; mean age 59.7 +/- 10.5 years; range 42 to 77 years) who underwent coronary artery bypass grafting between May 2013 and September 2013. After initiation of 5 cmH(2)O positive end-expiratory pressure during mechanical ventilation before sternotomy, 10 and 20 cmH(2)O of positive end-expiratory pressure were applied in five-min intervals, respectively. Four-chamber and two-chamber views of the right ventricle were recorded at each pressure level using transesophageal echocardiography. The right ventricle diameter and velocity, longitudinal strain and strain rate, and right ventricle fractional area change were calculated. Results: Intraoperative systolic, diastolic, and mean blood pressures and mean heart rate were similar at the three positive end-expiratory pressure levels. The mean right ventricle strain value was significantly lower at 20 cmH(2)O pressure (p<0.001 for both). The mean strain rate was significantly lower at 20 cmH(2)O pressure, compared to 5 cmH(2)O pressure (p=0.03). The right ventricle velocity was found to significantly decreased with increasing positive end-expiratory pressure (p<0.05). The mean right ventricle fractional area change was similar at 5 and 10 cmH(2)O pressures (p=0.063), while it was significantly lower at 20 cmH(2)O pressure (p=0.001). The mean right ventricle diameter decreased with increasing positive end-expiratory pressure, while this decrease was significant at 20 cmH(2)O pressure (p=0.01). Conclusion: Our study results show that 5, 10, and 20 cmH(2)O positive end-expiratory pressures does not significantly change hemodynamic data in patients undergoing coronary artery bypass grafting with normal right ventricular functions; however, 20 cmH(2)O positive end-expiratory pressure leads to decreased right ventricular functions, as assessed by transesophageal echocardiography.
Left Ventricular Assist Device As The Bridge to Heart Transplantation: Five-Case Series
(2016) Firat, Aynur Camkiran; Akovali, Nukhet; Gedik, Ender; Zeyneloglu, Pinar; Ozkan, Murat; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0002-7175-207X; ABI-2971-2020
Perioperative Venoarterial Extracorporeal Membrane Oxygenation Support During Heart Transplant
(2017) Gedik, Ender; Atar, Funda; Ozdemirkan, Aycan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; 0000-0002-7175-207X; 0000-0003-2312-9942; 0000-0003-1470-7501; 28260473; AAH-7003-2019; ABI-2971-2020; C-3736-2018
Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods: We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required peri operative extracorporeal support. Preoperative sup port was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.
Post-operative Respiratory Distress Due to Laryngeal Granuloma and Subglottic Stenosis in a Patient Undergoing Open Heart Surgery
(2021) Yazar, Cagla; Aitakhanova, Manat; Gulleroglu, Aykan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; 0000-0002-3887-0314; 0000-0002-6091-9065; AAJ-4188-2021
The cause of impairment in respiratory functions after open heart surgery is multifactorial. A 67-year-old female patient admitted to the intensive care unit (ICU) was intubated after mitral valve replacement and tricuspid annuloplasty. She was extubated on the first post-operative (post-op) day. On post-op day 5, the patient was re-admitted to the ICU due to respiratory distress and tachypnea. Non-invasive mechanical ventilation (NIMV) support and dobutamine 5 mcg/kg/min were started. Prior to diagnosis of septic shock, tazocin 3x4.5 grams was administered. The patient was intubated on the post-op day 6 because of the increase in respiratory distress. She was extubated on the post-op day 7, and NIMV commenced. On the 8th post-op day, she was consulted to the ear, nose and throat (ENT) department because of sore throat. Widespread mucosal aphthous lesions were observed in the uvula, soft and hard palate, mandible inner mucosa and alveolar process. Galactomannan was detected positive in bronchoalveolar lavage and treatment with fluconozole started. On post-op day 15, the patient was discharged. That same night, she was admitted to the ICU again due to sudden respiratory distress and was placed on NIMV support, but the patient whose respiratory distress increased and was unconscious was intubated. The next day, direct laryngoscopy was performed by the ENT department under operating room conditions, and a 3x4 cm polypoid lesion was removed from the vocal cord level. However, after 2 days, the patient was re-examined by direct laryngoscopy, necrotic crusts were removed under the cricoid cartilage posteriorly in the subglottic region. The patient recovered from post-op respiratory distress, was extubated on the 18th post-op day and his support with NIMV continued. The patient was discharged on the 33rd post-op day. Laryngeal granuloma and subglottic strictures should be considered in patients with post-op respiratory distress, no matter how short the intubation period is.
A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery
(2016) Firat, Aynur Camkiran; Zeyneloglu, Pinar; Ozkan, Murat; Pirat, Arash; 0000-0003-1470-7501; 0000-0003-2312-9942; 27472252; C-3736-2018
Objectives: To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications. Design: A 1:1 randomized controlled trial. Setting: Baskent University Medical Center. Patients: Pediatric patients scheduled for cardiac surgery. Interventions: Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months. Measurements and Main Results: The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all). Conclusions: Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and subclavian vein access. The risk of infectious complications was significantly higher with internal jugular vein access.
Speckle Tracking Imaging For Evaluation of Effects of Peep Level on Right Ventricular Function
(2014) Turker, Melis; Firat, Aynur Camkiran; Pirat, Bahar; Sezgin, Atilla; Arslan, Gulnaz; Pirat, Arash; https://orcid.org/0000-0003-4576-8630; AAI-8897-2021
Terlipressin Increases Blood Pressure and Facilitates Weaning from Cardiopulmonary Bypass in Heart Transplant Recipients with Refractory Hypotension
(2016) Akovali, Nukhet; Firat, Aynur Camkiran; Taskin, Duygu; Zeyneloglu, Pinar; Gultekin, Bahadir; Sezgin, Atilla; Pirat, Arash; ABA-7388-2021
Venoarterial Extracorporeal Membrane Oxygenation Support as a Bridge to Heart Transplant: Report of 3 Cases
(2016) Gedik, Ender; Ulas, Aydin; Ersoy, Ozgur; Atar, Funda; Firat, Aynur Camkiran; Pirat, Arash; 0000-0002-7175-207X; 0000-0002-8130-9901; 0000-0003-1470-7501; 27805530; ABI-2971-2020
Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. Among 31 patients who underwent heart transplant between January 2014 and June 2016, we present our experiences with 3 patients who received venoarterial extracorporeal support as a bridge to heart transplant. The first patient was a 51-year-old male with ischemic dilated cardio myopathy. Transplant was performed after 6 days of extracorporeal support, and the patient was discharged and alive at follow-up. Patient 2 was a 12-year-old girl with dilated cardiomyopathy who presented with cardiac arrest. Extracorporeal support was initiated during cardiopulmonary resuscitation. She had full neurologic recovery and remained on the wait list. She received a transplant 22 days after resuscitation. She survived and was alive at day 220 posttransplant. The third patient was a 50-year-old male with ischemic dilated cardiomyopathy requiring venoarterial extracorporeal support. Percutaneous balloon atrial septostomy was performed for left ventricle venting. He underwent transplant on day 28 after intensive care unit admission. He died 29 days after release from the hospital. Regarding patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort.
Venoarterial Extracorporeal Membrane Oxygenation Support As A Bridge To Heart Transplantation: Report of Three Cases
(2016) Gedik, Ender; Ulas, Aydin; Ersoy, Ozgur; Atar, Funda; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0002-7175-207X; ABI-2971-2020