Browsing by Author "Turkoz, Ayda"

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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.
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.
Eighth Istanbul Symposium on Pediatric Extracorporeal Life Support Systems and Pediatric Cardiopulmonary Perfusion
(2015) Alkan-Bozkaya, Tijen; Ozyuksel, Arda; Salihoglu, Ece; Haydin, Sertac; Tanyildiz, Murat; Pekkan, Kerem; Hatemi, Alican; Turkoz, Ayda; Erkan, Halime; Aydin, Sibel; Kahraman, Aydin; Savas, Alper; Ersoy, Cihangir; Turkoglu, Halil; Uendar, Akif; Akcevin, Atif; 25953239
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.
Ultrasound guided continuous paravertebral block in a patient with coronary heart disease and sleep apnea syndrome
(2016) Esen, Bilgiser; Bircan, Huseyin Yuce; Cinar, Ozlem; Turkoz, Ayda; 27225612
The case of a 77-year-old patient with severe coronary heart disease who underwent radical mastectomy with axillary lymph node dissection by ultrasound-guided continuous paravertebral block (CPVB) is described in the present report. Radical mastectomy with axillary dissection is a surgical procedure that necessitates endotracheal intubation and is usually performed under general anesthesia, which carries heightened risk for patients with coronary heart disease (CHD) and sleep apnea syndrome (SAS). Ultrasound-guided CPVB is a simple and safe alternative technique that allows for the use of anesthesia and postoperative analgesia with minimal side effects.