Browsing by Author "Kayhan, Zeynep"

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Anaesthesia Management of a Patient with Factor XI Deficiency
(2016) Adibelli, Bilgehan; Araz, Coskun; Ersoy, Zeynep; Kayhan, Zeynep; 0000-0002-4927-6660; 0000-0003-0767-1088; 0000-0003-0579-1115; 27366578; AAJ-4576-2021; AAF-3066-2021; AAJ-4623-2021
Factor XI deficiency is an extremely rare disease presenting no clinical symptoms, unless there is an inducing reason such as trauma or surgery. Normally, factor levels are in the range of 70-150 U dL-1 in healthy subjects. Although no clinical symptoms are seen, only high levels of aPTT can be found. Once a prolongation is detected in aPTT, factor XI deficiency should be suspected and factor levels should be analysed. With careful preoperative preparations in factor-deficient people, preoperative and postoperative complications can be decreased. In this case report, management of anaesthesia during total hip arthroplasty of a patient with factor XI deficiency is presented.
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
Application of Ileobladder for Clinical Kidney Transplantation: Two Case Reports
(2018) Haberal, Mehmet; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Moray, Gokhan; Kayhan, Zeynep; Torgay, Adnan; 0000-0002-3462-7632; 0000-0002-8726-3369; 0000-0002-0993-9917; 0000-0002-5735-4315; 0000-0003-2498-7287; 0000-0003-0579-1115; 0000-0002-6829-3300; AAJ-8097-2021; AAH-9198-2019; AAA-3068-2021; AAC-5566-2019; AAF-4610-2019; AAE-1041-2021; AAJ-4623-2021; AAJ-5221-2021
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.
Clinical utilization of arterial occlusion pressure estimation method in lower limb surgery: effectiveness of tourniquet pressures
(2016) Tuncali, Bahattin; Boya, Hakan; Kayhan, Zeynep; Arac, Sukru; Camurdan, Mehmet Ali Koray; 26969952
Objective: The effectiveness of the arterial occlusion pressure (AOP) estimation method to set tourniquet inflation pressures was assessed in patients undergoing lower limb surgery. Methods: One hundred ninety-eight operations were performed in 224 lower extremities of 193 patients. Tourniquet inflation pressures were set using the AOP estimation formula and adding 20 mmHg of safety margin to AOP value. Primary outcome measures were the amount of tourniquet pressure and its effectiveness. The quality of the surgical field and complications were assessed by the surgical team in a blinded fashion. Secondary measures included the time required to set the tourniquet pressure and complications. Results: The initial and maximal tourniquet pressures used were 168.4 +/- 14.5 and 173.3 +/- 15.6 mmHg, respectively. The performance of the tourniquets was assessed as "excellent" and "good" in all stages of the procedure in 97.76% of cases. The time required to measure AOP and set the tourniquet cuff pressure was 19.0 +/- 2.6 sec. No complications occurred during or after surgery until discharge. Conclusion: Clinical utilization of the AOP estimation formula is a practical and effective way of setting tourniquet pressures for lower limb surgery. Its usage allows achievement of a bloodless field with inflation pressures lower than those previously recommended in the literature for lower limb tourniquets.
Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies
(2023) Doganci, Melek; Zeyneloglu, Pinar; Kayhan, Zeynep; Ayhan, Ali; 37575800; IVV-1127-2023; C-3736-2018; AAJ-4623-2021
BackgroundPostoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. MethodologyA total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts.ResultsThe incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. ConclusionsPatients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.
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
Effects of Minimal Flow Sevoflurane or Desflurane Anaesthesia on Hemodynamic Parameters, Body Temperature and Anaesthetic Consumption
(2020) Taskın, Duygu; Gedik, Ender; Kayhan, Zeynep; 0000-0002-7175-207X; 0000-0003-0579-1115; 33103139; ABI-2971-2020; AAJ-4623-2021
Objective: We aimed to compare minimal flow sevoflurane and desflurane anaesthesia in terms of hemodynamic parameters, body temperature, anaesthetic gas consumption and cost. Methods: 120 patients with ASA I-II (>18yo) who underwent elective surgery for longer than 60 min after general anaesthesia were randomized into two groups. The Drager Perseus (R) A500 workstation was used. Pre-oxygenation was performed for 3 min with 6 L min(-1) to 100% oxygen. Fractional inspirium oxygen concentration (FiO(2)) was reduced to 40%, fresh gas flow was 4 L min(-1) after intubation. Sevoflurane or desflurane was started at 1.5 minimal alveolar concentration (MAC). When the MAC value reached 0.9, fresh gas flow was reduced to 0.5 L min(-1), FiO(2) was increased to 68%. At the end of the surgery, the vaporizer was switched off, the fresh gas flow was increased (4 L min(-1), FiO(2) 100%). When the train-of-four (TOF) ratio was 100%, extubation was carried out. Results: There were no differences in patient characteristics and initial hemodynamic parameters of the groups. There were statistically significant differences between the times to reach 0.9 MAC, extubation and eye opening; anaesthetic, O-2 and air consumption in both groups. Conclusion: With minimal flow, the time to reach target MAC, time to extubation and eye opening were significantly faster for desflurane and anaesthetic, oxygen and air consumption in desflurane anaesthesia were less than sevoflurane. Thus, we can say that desflurane has faster anaesthetic induction and recovery time with lower anaesthetic consumption than sevoflurane.
Effects of Music on Sedation Depth and Sedative Use During Pediatric Dental Procedures
(2016) Ozkalayci, Ozlem; Araz, Coskun; Cehreli, Sevi Burcak; Tirali, Resmiye Ebru; Kayhan, Zeynep; 0000-0002-4927-6660; 0000-0001-6487-3984; 0000-0003-0579-1115; 27687464; AAJ-4576-2021; AAD-6138-2021; HZK-4947-2023; AAD-2907-2020; AAJ-4623-2021
Study objective: The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. Design: Prospective, randomized, and controlled study. Setting: Tertiary, university hospital. Patients: In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. Interventions: Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Measurements and main results: Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). Conclusions: Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients. (C) 2016 Elsevier Inc. All rights reserved.
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.
Hastanemizde mavi kod çağrılarının nedenleri ve doğruluğu
(Başkent Üniversitesi Tıp Fakültesi, 2016) Demirci, Mehmet Ali; Kayhan, Zeynep
Mavi Kod tüm dünyada ve Türkiye’de büyük hastanelerin, öngörülebilecek ya da öngörülmesi mümkün olmayan acil kardiyak arrest olayları için dizayn edilmiştir. Doğru zamanda, uygun hastaya, doğru müdahale, iyi bir organizasyon ve eğitim işidir. Son dönemdeki resüsitasyon geliştirme çabaları pre-arrest döneme bu sebeple daha çok ağırlık vermektedir. Bu çalışmanın primer amacı Mavi Kod anonsu verilen hastalarda kod anonsu verme nedenlerini ve doğruluğunu değerlendirmektir. İkincil amacı ise kardiyopulmoner arrestlere Mavi Kod hızlı cevap ekibi ile gerçekleştirilen müdahalelerin mortalitesini değerlendirmek, müdahale sonrası yoğun bakımda kalış, taburculuk ve eksitus oranlarının tespitidir. Başkent Üniversitesi Klinik Araştırma ve Etik Kurulu onayı (KA 14/267 no’lu proje) ile Mavi Kod anonsu verilmiş 761 hasta çalışmaya dahil edildi. Çalışma retrospektif düzende hazırlandı. Hastaların genel demografik verilerine baktığımızda yaş ortalamasının 65,14±20,42 olduğu, yaş dağılımında en küçük hastanın 1, en büyük hastanın 100 yaşında olduğu görüldü. Hastaların 421’i erkek 340’ı kadın olarak kayda alındı. Hastalar KPR formlarındaki doğru ya da yanlış anons bölümündeki kayıtları doğrultusunda doğru Mavi Kod anonsu verilenler (n=691) ve yanlış Mavi Kod anonsu verilenler (n=70) olarak iki gruba ayrıldı. Yanlış kod oranı % 9,2 olarak bulundu. Her iki grubun demografik verilerinde doğru kod anonsu verilen grubun yaş ortalaması 65,8±20,5 bulunurken, yanlış kod anonsu verilen grubun yaş ortalaması 58,6±18,8 bulunmuştur ve bu fark p=0,005 değeri ile istatistiki olarak anlamlıdır. Hastaneye başvurma nedenleri incelendiğinde, çoğunluğunu KBY hastalarının oluşturduğu Genitoüriner sistem hastalıkları sebebiyle yatmakta olan hastalar ve malignite nedeniyle takip edilen hastalarda, yanlış kod, doğru koda oranla yüksek bulundu. Çalışmamızda yanlış kod anonsu oranı %9,2 (n=70) olarak tespit edildi. Acil servise başvuran hastalar arasında, doğru kod anonsu verilme nedeni olarak en yüksek rakam bilinç kaybı ile başvurmuş hastaların kaydında görüldü. Nöbet geçiren hastalar içinde doğru anons kabul edilen hasta sayısı 21 iken, yanlış anons kabul edilen hasta sayısı 11 olarak görüldü. Bu sayı kod anonsu verme nedenleri arasındaki en yüksek yanlış kod anonsu verme oranı olarak kayda alındı. Tüm yanlış kodlara bakıldığında, rakamsal olarak senkop ve bilinç durum değişikliği, ilk iki sırada yer aldı. Müdahale sonunda eksitus olan hasta oranı %27,5 (n=209) olarak kayda alındı. Yoğun bakıma kabul sonrası eksitus olma oranı %69,5 (n=306) olarak kaydedildi. Yoğun bakım sonrası taburculuğu sağlanabilmiş hasta oranı ise %29,3 (n=129) bulundu. Sonuç olarak Mavi Kod verme nedenleri arasında çoklu kronik hastalık grubu, doğru kod anonslarının çoğunluğunu oluşturmaktadır. Üniversite Hastanesi olarak kritik hasta popülasyonumuzun yüksek olması nedeniyle bu sonuç beklenen bir neticedir. Malignite ile izlenen hastalar ve yakınlarının anksiyeteleri nedeniyle olabilecek yüksek yanlış kod oranı gözlemlendi. Nöbet geçiren hastalarda stabil olarak takip edilen hastalara da kod veriliyor olması, yüksek yanlış kod oranına sahip olma nedeni olarak tespit edildi. KPR formu düzenlenmesi ve doldurulması açısından eğitim hemşireliğinin düzenli eğitimler planlaması ve daha ileri çalışmalar için daha doğru dökümantasyon sağlanması gerekliliği vurgulandı. Code Blue is designed for emergency cardiac arrest events of the big hospitals in Turkey and all over the world, which will be predicted or are impossible to predict. It is a combination of a correct intervention to the correct patient at a correct time, a good organization and training. Recent resuscitation development attempts concentrate on pre-arrest period for this reason. The primary object of the study is to evaluate the reasons and the accuracy of the reason of a code announcement for the patients for whom Code Blue is called. The secondary object is to evaluate the mortality of the interventions performed by Code Blue quick response team to cardiopulmonary arrests and to detect the ratio for staying in the intensive care unit after intervention, releasing from the hospital and exitus. 761 patients who were called for Code Blue were enrolled in the study with an approval of Başkent University Clinical Research and Ethics Committee (the project with no. KA 14/267). The study was prepared retrospectively. When general demographic data of the patients were examined it was seen that mean age was 65,14±20,42 and age of the youngest patient was 1 year whereas age of the oldest patient was 100 years in age distribution. It was recorded that 421 of patients were male whereas 340 of patients were female. The patients were divided into two groups as those who were called for the correct Code Blue announcement (n=691) and those who were called for the wrong Code Blue announcement (n=70) according to their records in correct or wrong announcement sections of KPR forms. Wrong code ratio was found to be 9,2%. In the demographic data of both groups, mean age of the group for whom a correct code announcement was made was found to be 65,8±20,5 whereas mean age of the group for whom a wrong code announcement was made was found to be 58,6±18,8, and this difference was statistically significant with a p value of 0,005. When the reason for applying to the hospital was investigated the wrong code was found higher compared to the correct code in the patients hospitalized due to genitourinary system diseases, most of which was CDF patients and in the patients followed-up due to malignancy. Among the patients applied to emergency service, the highest number as a reson for correct code announcement was seen in the records of the patients who presented with loss of consciousness to the emergency department. It was seen that number of patients considered as the correct announcement was 21 whereas number of patients considered as wrong announcement was 11. This number was recorded as the highest wrong announcement ratio among the reasons of code announcements. When all the wrong codes were evaluated, syncope and changes in the state of consciousness was in the first two places numerically. In our study, ratio of wrong code announcement was found to be 9,2% (n=70). Ratio of the patients who died at the end of the intervention was recorded as 27,5% (n=209). Death rate after acceptance in intensive care unit was recorded as 69,5% (n=306). Ratio of the patients who were released from the hospital was found to be 29,3% (n=129). In conclusion, the group of the patients with multiple chronic diseases represent the majority of correct code announcements among the reasons of Code Blue announcements. This result is an expected outcome as our critical patient population is high as a University Hospital. A high rate of wrong code was observed due to anxieties of the patients who were followed-up for malignancy and their relatives. The fact that code was also called for the patients who were stably followed-up in the patients having seizures was detected as the cause of high wrong code ratio. It is emphasized that nurse administration should organize regular training programs for preparing and filling CPR forms and more accurate documentation should be provided for further studies.
Jinekolojik kanser cerrahisi geçiren hastalarda postoperatif akut böbrek hasarı için risk faktörlerinin belirlenmesi
(Başkent Üniversitesi Tıp Fakültesi, 2014) Didik, Melek; Kayhan, Zeynep
Jinekolojik kanser nedeniyle opere olan hastalarda sağ kalım genellikle iyi olmakla birlikte, postoperatif komplikasyonlar gelişebilmektedir. Bu komplikasyonlardan biri olan akut böbrek hasarı (ABH) yaşam kalitesini ve morbidite ile mortaliteyi önemli ölçüde etkilemektedir. Hipervolemi, hiperkalemi ve metabolik asidoz gibi hayatı tehdit edici sonuçlarından dolayı ABH için preoperatif, intraoperatif ve postoperatif risk faktörlerinin belirlenmesi, gerekli önlemlerin alınması ve ABH’ın erken tespit edilerek erken müdahale edilmesi önemlidir. Bu çalışmada, jinekolojik kanser nedeniyle opere olan hastaların böbrek fonksiyonlarının değerlendirilmesi ve ABH için preoperatif, intraoperatif ve postoperatif risk faktörlerinin retrospektif olarak saptanması amaçlandı. Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu onayı alındıktan sonra Ocak 2007 tarihinden itibaren Başkent Üniversitesi Ankara Hastanesi’nde elektif şartlarda jinekolojik kanser nedenli cerrahi geçirmiş 1000 hastanın medikal ve anestezi kayıtları retrospektif olarak incelendi (Mart 2013’e kadar). On sekiz yaş üstü, böbrek hasarı ya da hastalığı olmayan hastalar çalışmaya dahil edildi. Hastaların demografik özellikleri, eşlik eden hastalıkları, kullandıkları ilaçlar, operasyon öncesi verileri (laboratuvar bulguları, metastaz varlığı, kemoterapi/radyoterapi öyküsü, enfeksiyon varlığı, vital bulguları, tekrarlayan cerrahi durumu), operasyon sırasındaki verileri (anestezi şekli, kullanılan anestezik ajanlar, cerrahi girişimin tipi, vital bulgular, kullanılan kristalloid, kolloid miktarları, kan ve kan ürünü replasmanı, kritik olaylar, komplikasyonlar, inotrop desteği ihtiyacı, cerrahi süre) ve operasyon sonrası verileri (ilk 24 saatteki vital bulguları, ilk 48 saatte verilen kristalloid ve kolloid miktarları, enfeksiyon gelişimi, komplikasyonlar, ilk 24 saatteki idrar miktarı, nefrotoksik ilaç kullanımı, ilk 7 günlük laboratuvar sonuçları, hastanede kalış süresi, yoğun bakım ihtiyacı ve kalış süresi, mekanik ventilasyon ihtiyacı, 28 günlük mortalite varlığı, ilk 5 günde renal replasman tedavisi ihtiyacı) kaydedildi. Çalışmaya dahil edilen 1000 hastanın 88 tanesinde (%8,8) ABH saptandı. İleri yaş, preoperatif yüksek C-reaktif protein (CRP), cerrahi öncesi uzak organ metastazı, cerrahi öncesi yüksek nabız sayısı, intraoperatif fazla kolloid, eritrosit süspansiyonu (ES) ve taze donmuş plazma (TDP) kullanımı, kan kaybı, vasküler travma ve/veya geniş diseksiyon yüzeylerinden sızma, postoperatif ilk gün hipertansiyon ve taşikardi, post-operatif kolloid kullanımı, ilk 24 saatlik idrar çıkışında azalma, non-üriner infeksiyonlar, respiratuar iv komplikasyonlar, uzun hastanede kalış süresi, yoğun bakım ihtiyacı, uzun yoğun bakım kalış süresi ve mekanik ventilasyon ihtiyacı bakımından ABH olan ve olmayan hastalarda istatistiksel olarak anlamlı farklılıklar bulundu (hepsi için p<0.05). VKİ (vücut kitle indeksi) yüksekliği (OR: 1,034; %95 CI: 1,000-1,069; p= 0,049) ve geniş cerrahi uygulanımı (OR: 2,320; %95 CI: 1,330-4,048; p=0,003) jinekolojik kanser cerrahisi sonrası postoperatif ABH için bağımsız risk faktörleri olarak bulundu. Sonuç olarak; jinekolojik kanser cerrahisi geçiren hastalarda postoperatif ABH için preoperatif değerlendirmede ileri yaş, kısa boy, CRP yüksekliği, uzak organ metastazı; intraoperatif taşikardi, kullanılan ES, TDP, kolloid fazlalığı, vasküler travma ve geniş diseksiyon yüzeylerinden sızma, kan kaybı; postoperatif hipertansiyon ve taşikardi, kolloid kullanımı ve idrar miktarında azalmanın anlamlı bulgular olduğu, geniş cerrahi ve yüksek VKİ’in ise bağımsız risk faktörleri olduğu, bu faktörlere yönelik önlemlerin alınması ile ABH görülme sıklığının azalacağı kanısına varıldı.
Long-Term Results of Crescentic Incision for Donor Nephrectomy
(2019) Haberal, Mehmet A.; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Moray, Gokhan; Kayhan, Zeynep; Torgay, Adnan; 0000-0002-0993-9917; AAH-9198-2019; AAC-5566-2019; AAF-4610-2019
LONGTERM RESULTS OF CRESCENTIC INCISION FOR DONOR NEPHRECTOMY
(2019) Haberal, Mehmet; Kirnap, Mahir; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Moray, Gokhan; Kayhan, Zeynep; Torgay, Adnan; 0000-0002-0993-9917; AAF-4610-2019; AAC-5566-2019; AAH-9198-2019
THE NEW CRESCENTIC INCISION: A GOOD OPTION FOR DONOR NEPHRECTOMY
(2020) Haberal, Mehmet A.; Kirnap, Mahir; AlShalabi, Omar; Sultanov, Pulat; Akdur, Aydincan; Soy, Ebru H. Ayvazoglu; Yildirim, Sedat; Moray, Gokhan; Kayhan, Zeynep; Torgay, Adnan
Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty
(2018) Tuncali, Bahatin; Boya, Hakan; Kayhan, Zeynep; Arac, Sukru; 0000-0003-0579-1115; 0000-0002-7898-2943; 0000-0001-6110-4004; 29526158; AAJ-4623-2021; AAJ-7840-2021; AAJ-7840-2021
Objectives: This study aims to investigate the effect of obesity on pneumatic tourniquet inflation pressures determined with a novel formula during total knee arthroplasty (TKA). Patients and methods: Data of 208 patients (19 males, 199 females; mean age 69.8 years; range, 53 to 84 years) who were performed TKA between January 2013 and December 2016 were evaluated prospectively. Patients were divided into two groups as non-obese (body mass index [BMI] <= 30.0 kg/m(2)) and obese (BMI > 30.0 kg/m(2)) according to BMI. Tourniquet inflation pressures were set using arterial occlusion pressure (AOP) estimation method and adding 20 mmHg of safety margin to AOP value. All patients were assessed intra-and postoperatively with outcome measures such as systolic blood pressure, AOP, tourniquet pressure and its effectiveness. The quality of the surgical field and complications were assessed by the surgical team in a blinded fashion. Results: The study included 118 and 90 lower extremity operations in obese and non-obese groups, respectively. Compared to non-obese group; extremity circumference, initial and maximal systolic blood pressures, AOP values, initial and maximal tourniquet pressures were higher in obese group. The performance of the tourniquet was assessed as "excellent" and "good" at almost all stages of the surgical procedure in all patients in both groups. No complication occurred intra-or postoperatively. Conclusion: Compared to non-obese patients, higher tourniquet inflation pressure is required in obese patients during TKA due to their wider extremity circumference and higher systolic blood pressure profile.
Orthotopic Renal Transplantation With Spleno-Renal Shunt
(2018) Haberal, Mehmet; Soy, Ebru H. Ayvazoglu; Boyvat, Fatih; Coskun, Mehmet; Sezgin, Atilla; Kayhan, Zeynep; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0001-5630-022X; 0000-0003-0579-1115; AAJ-8097-2021; AAC-5566-2019; F-4230-2011; AAM-4120-2021; AAJ-4623-2021
PiCCO Monitoring During Liver Transplantation for Pediatric Patients
(2018) Ersoy, Zeynep; Ozdemirkan, Aycan; Zeyneloglu, Pinar; Pirat, Arash; Torgay, Adnan; Kayhan, Zeynep; Haberal, Mehmet; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0003-0579-1115; 0000-0002-3462-7632; AAF-3066-2021; AAH-7003-2019; AAJ-5221-2021; AAJ-4623-2021; AAJ-8097-2021
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.
Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial
(2018) Tuncali, Bahattin; Boya, Hakan; Kayhan, Zeynep; Arac, Sukru; 29752149; W-7391-2019
Objective: The aim of this study was to compare the limb occlusion pressure (LOP) determination and arterial occlusion pressure (AOP) estimation methods for tourniquet pressure setting in adult patients undergoing knee arthroplasty under combined spinal-epidural anesthesia. Methods: Ninety-three patients were randomized into two groups. Pneumatic tourniquet inflation pressures were adjusted based either on LOP determination or AOP estimation in Group 1 (46 patients, 38 female and 8 male; mean age: 67.71 +/- 9.17) and Group 2 (47 patients, 40 female and 7 male; mean age: 70.31 +/- 8.27), respectively. Initial and maximal systolic blood pressures, LOP/AOP levels, required time to estimate AOP/determinate LOP and set the cuff pressure, initial and maximal tourniquet pressures and tourniquet time were recorded. The effectiveness of the tourniquet was assessed by the orthopedic surgeons using a Likert scale. Results: Initial and maximal systolic blood pressures, determined LOP, estimated AOP, duration of tourniquet and the performance of the tourniquet were not different between groups. However, the initial (182.44 +/- 14.59 mm Hg vs. 200.69 +/- 15.55 mm Hg) and maximal tourniquet pressures (186.91 +/- 12.91 mm Hg vs. 200.69 +/- 15.55 mm Hg) were significantly lower, the time required to estimate AOP and set the tourniquet cuff pressure was significantly less (23.91 +/- 4.77 s vs. 178.81 +/- 25.46 s) in Group II (p = 0.000). No complications that could be related to the tourniquet were observed during or after surgery. Conclusion: Tourniquet inflation pressure setting based on AOP estimation method provides a bloodless surgical field that is comparable to that of LOP determination method with lower pneumatic inflation pressure and less required time for cuff pressure adjustment in adult patients undergoing total knee arthroplasty under combined spinal epidural anesthesia. (C) 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.