Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly... more Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly after extubation in patients receiving general anesthesia. It may also occur due to the bite of the endotracheal tube prior extubation.Case presentation: A 52-year-old male patient was scheduled for ventriculoperitoneal shunt operation. General anesthesia was applied. Respiratory and hemodynamic variables were stable during surgery. At the end of the surgery, anesthetic drugs were discontinued, the lumen of the endotracheal tube and oropharynx were aspirated. When oropharyngeal airway was placed the patient bit and occluded his endotracheal tube, and began exerting breathing effort. Rapid desaturation was observed and pink foamy secretion came through the endotracheal tube. Bilateral diffuse crackles were present. A chest X-ray revealed bilateral pulmonary edema. The patient was transferred to the intensive care unit, sedation was applied and volume controlled positive pressure mechanic...
Background/aim: Different techniques exist for the preoxygenation of patients that will be operat... more Background/aim: Different techniques exist for the preoxygenation of patients that will be operated on under general anesthesia. Preoxygenation with the deep breath (DB) method may affect cardiovascular stability, which is crucial for coronary artery bypass graft (CABG) patients. In this study, we aimed to compare the effects of the 3 min TVB preoxygenation technique and 1 min 8DBs technique on hemodynamic response and arterial oxygenation in patients with normal ejection fraction that were scheduled for elective CABG surgery. Materials and methods: Forty patients classified as ASA II?III and scheduled for elective CABG surgery were randomly assigned to TVB/3 min or 8DBs/1 min for preoxygenation. Cardiovascular variables, i.e. heart rate, mean arterial pressure, central venous pressure, cardiac index, systemic vascular resistance index, and stroke volume index, and arterial blood gas samples were analyzed before and after preoxygenation and at the end of the apneic period before int...
Journal of clinical monitoring and computing, Jan 13, 2017
Univent tube (UT) and EZ-blocker were used for one-lung ventilation (OLV). UT is a single lumen t... more Univent tube (UT) and EZ-blocker were used for one-lung ventilation (OLV). UT is a single lumen tube with a small separate lumen containing a bronchial blocker. EZ-blocker differs with its unique y-shaped double-cuffed distal end. We aimed to compare these two airway devices effects on airway pressures, oxygenation, ventilation and haemodynamics during OLV. Patients undergoing elective thoracotomy for the first time were included in this prospective randomized study. Patients were divided into two groups as UT and EZ. Bronchial blockers (BB) placement time was recorded. In lateral decubitus position, airway pressures, static compliance, tidal volume (TV), respiratory rate (RR) and haemodynamic findings were recorded before inflating the BB cuff (Pre-OLV) and during OLV every 15 min. Arterial blood gas (ABG) samples were obtained before and during OLV. 70 patients were enrolled in the study. The demographic characteristics and data related to anesthesia and surgery were similar in bo...
Journal of Clinical Monitoring and Computing, 2016
Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraopera... more Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.
Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed... more Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed to compare the efficacy of CTrach™ (CT) and Direct Coupled Interface-Videolaryngoscope (DCI-VL) in patients with normal airways. Sixty ASA I-II (American Society of Anesthesiologists) adult patients admitted for elective surgery were enrolled in this prospective study. The patients were randomly assigned to two groups, where intubation was performed via CT or DCI-VL. Time to obtain a good glottic view, total intubation time, success rates and the number of patients who required maneuvers for a good glottic view were recorded. The mean time to obtaining a good glottic view was significantly longer with CT than with DCI-VL (29.4±20.3 seconds vs. 12.8±1.9 seconds, respectively; p=0.01). Intubation was achieved on the first attempt in 28 patients in the CT group (93.3%) and in 24 in the DCI-VL group (80%) (p=0.77). The total intubation time for CT was significantly longer compared to DCI-VL...
Background: Various types of markers have been used so far in order to reveal myocardial perfusio... more Background: Various types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA) is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops. Methods and Results: 30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia) of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD) of IMA (0.67677 ± 0.09985) were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894) and postoperative (0.70477 ± 0.07523) measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA. Conclusions: IMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.
Background and objective: The LMA-Supremet (S-LMAt) is a new supraglottic airway device that pres... more Background and objective: The LMA-Supremet (S-LMAt) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Prosealt (P-LMAt) and S-LMAt. Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMAt (n 5 30) or S-LMAt (n 5 30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H 2 O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMAt, n 5 1; S-LMAt, n 5 1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMAt, n 5 1) due to failed OGT placement. OLPs were similar (P-LMAt; 26.9 AE 6.6 S-LMAt; 26.1 AE 5.2). ICP increased significantly in the P-LMAt at the 30 and 60 min during anesthesia (P-LMAt; 80.1 AE 12.8, 92.9 AE 14.4, S-LMAt; 68.3 AE 10.9, 73.7 AE 15.6). OGT placement was successful in all patients in the S-LMAt, but failed in five patients in the P-LMAt (P 5 0.02). Fiberoptically determined anatomic position was better with the P-LMAt (P 5 0.03). Conclusion: Our findings suggest that S-LMAt had leak pressures similar to the P-LMAt, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation.
Journal of Clinical Monitoring and Computing, 2017
In this study, we aimed to compare the effects of forced-air warming upper body blankets and forc... more In this study, we aimed to compare the effects of forced-air warming upper body blankets and forced-air warming underbody blankets on intraoperative hypothermia in patients who were planned to undergo open abdominal surgical operations in which extensive heat loss occurs. This prospective and randomized study included 92 patients who would undergo lower abdominal surgery under general anesthesia. Patients were randomized by closed envelope method and divided into two groups. Group I (n:46) included the patients who would receive warming with forced-air warming upper body blanket, and Group II (n:46) consisted of the patients who received warming with forced-air warming underbody blanket. Central body temperature was recorded by measuring with a temperature probe placed in distal esophagus. Demographic data, amount of fentanyl, crystalloid and blood products used, duration of operation, type of operation, hemodynamic parameters, shivering and thermal damage information were recorded. There was not any statistically significant difference among the patients in terms of demographic data, amount of fentanyl, crystalloid and blood products used, duration and type of operation and hemodynamic parameters. No difference was found between the groups in terms of body temperatures (Group I:36.1 °C, Group II:36.3 °C, respectively) (P > 0.05). Forced air warming underbody blanket can be as effective as forced-air warming upper body blankets in preventing intraoperative hypothermia. They can be alternative in cases where use of forced-air warming upper body blankets is not feasible.
Foreign body aspiration is a serious condition with risk of mortality. It happens at all ages but... more Foreign body aspiration is a serious condition with risk of mortality. It happens at all ages but mostly at childhood. Chest x-ray can demonstrate the foreign body if it is radioopaque. But laterally and oblique chest graphies must seen for the exact diagnosis with its size and localization. We report two cases admitted with same symptoms indicate to foreign body but different final diagnosis. Case 1: A 1.5-year old child with Down syndrome was admitted to emergency clinic of our hospital with cough, wheezing and stridor. There was a history suitable for a foreign body aspiration and no any other significant history. Chest x-ray demonstrated an opasity similar to a foreign body. We performed a rigid bronchoscopy. There was no foreign body in his tracheobronchial system. Thereby esophagoscopy was performed under scopy. Again there was no foreign body although the image was suitable to a foreign body. In the postoperative period with a more detailed investigation it was understood that the radiological opasity was an endovasculary stent set up with angiography to carry on PDA for another cardiac disease treatment. Case 2: A 7-year old child was admitted to our hospital with persisting cough, wheezing and stridor. Clinical history and chest x-ray demonstrated a foreign body similar to the first case. Rigid bronchoscopy was performed and a metallic foreign body (pencil bow) is extracted from left main bronchus. History takes a great role in diagnosis of foreign body aspiration. Radiological investigation must perform to all suspected cases. Although a chest x-ray demonstrate mostly atelectasis and hyperaeration at the affected side a normal graphy can not eliminate the foreign body. If the suspicion persists we must apply bronchoscopy.
Aǧrı Agrı Dernegi Nin Yayın Organıdır the Journal of the Turkish Society of Algology, 2009
Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is... more Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is not feasible for various reasons. We describe a 28-year-old, ASA physical status I, male patient who was operated for pectoral flap release under lateral sagittal infraclavicular block. Using ultrasound guidance alone, total volume of 30 ml of local anesthetic mixture (15 ml of levobupivacaine 5 mg/ml and 15 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine) was injected dorsal to the axillary artery. There was no vascular puncture or any other complication. The block was successful and the patient was ready for surgery 20 minutes after block performance. This case report is one of the examples that ultrasound guidance may be the only way to perform safe regional anesthesia; ultrasound guidance alone is an effective way of performing infraclavicular block.
Recent advances in surgical techniques for thoracic have led to an increased use of one lung vent... more Recent advances in surgical techniques for thoracic have led to an increased use of one lung ventilation techniques. One lung ventilation is performed by doubled lumen tubes, fogarty catheters, Univent tubes and bronchial blockers. In this paper our bronchial blocker experiences were presented in fifteen thoracic surgery patients. Bronchial blockers were placed in fifteen patients who needed one-lung ventilation during thoracic surgery between January-April in 2007. Type of the bronchial blockers were selected randomly and total eight Cohen and seven Arndt bronchial blocker were placed. Following endotracheal intubation some of the bronchial blockers were performed at supine and the others were in lateral position to patients. Fiberoptic investigation was performed in all of the patients following lateral position. Bronchial blocker were placed in fifteen patients. In one patient who had congenital tracheal bronchus, one lung ventilation could not have been achieved by bronchial blocker. Following lateral positioning bronchial blocker of two patients were malpositioned and they were repositoned. Successfull one lung ventilation was performed by both bronchial blocker type. While the patient's airway position, postoperative period and type of the surgery have been considered, bronchial blockers may be an alternative airway device for one-lung ventilation.
Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Sy... more Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Symptoms are usually due to sudden expansion of the aneurysm, which can cause a vague pain in the back, or sometimes a sharp pain that may denote the presence of impending rupture. Other symptoms are related to pressure on adjacent structures, such as pressure on the bronchus that can cause respiratory distress, or pressure on the laryngeal nerve causing vocal hoarseness. Pressure on the esophagus can cause difficulty in swallowing. <br />Currently, open surgery and thoracic endovascular aneurysm repair (TEVAR) are the choices of treatment for descending thoracic aneurysms (DTA). The decision to intervene on a DTA depends on its size, location, rate of growth and symptoms, and the overall medical condition of the patient. The indications for TEVAR should not differ from those for open surgery and typically include aneurysms larger than 6 cm in diameter. Saccular and symptomatic aneur...
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2015
High implantation technique during CoreValve replacement in a high-risk aortic stenosis patient w... more High implantation technique during CoreValve replacement in a high-risk aortic stenosis patient with a sigmoid left ventricular hypertrophy and a large aortic annulus Sigmoid sol ventrikül hipertrofisi ve geniş aort anülüsü olan yüksek riskli aort darlıklı bir hastada CoreValve yerleştirilmesi sırasında uygulanan yüksek implantasyon tekniği
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society, 2014
Akciger izolasyonu basta torasik cerrahi ameliyatlari olmak uzere pek cok alanda yaygin olarak ku... more Akciger izolasyonu basta torasik cerrahi ameliyatlari olmak uzere pek cok alanda yaygin olarak kullanilmaktadir. Bu amacla cift lumenli tupler ve bronsiyal blokerler kullanilmaktadirlar.Akciger izolasyonu icin ilk kullanilan tup Carlens’tir ve gunumuze degin pek cok cift lumenli tup gelistirilmistir. Modern anlamda bronsiyal blokerlerin ilk ornegi ise Univent tuptur, ilerleyen yillarda bagimsiz bronsiyal blokerler (Arndt, Cohen, Uniblocker, EZ, Coopdech vs.) gelistirilmislerdir. Bronsiyal blokerlerle karsilastirildiklarinda cift lumenli tupler, daha kisa surede yerlestirilirler, daha az malpoze olurlar. Cift lumenli tuplerle aspirasyon daha efektiftir, istenildiginde kolaylikla tek veya cift akciger ventile edilebilir. Cift lumenli tuplerin bu avantajlarinin yaninda bronsiyal blokerler ise zor havayolunda, obez hastalarda, postoperatif donemde mekanik ventilasyon gerekecegi ongorulen hastalarda, intraoperatif herhangi bir donemde akciger izolasyonu gereken hastalarda ve cocuk hastalarda ilk secenek olarak onerilmektedirler.Bu derlemede akciger izolasyonu amaciyla kullanilan havayolu gereclerinin gelisiminden, birbirine olan avantaj ve dezavantajlarindan ve kullanim onceliklerinden bahsedilecektir. Cunku torasik anestezistler gerektiginde her iki akciger izolasyon gereclerini de kullanabilecek bilgi ve deneyime sahip olmalidirlar.
Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly... more Background: Acute negative pressure pulmonary edema is a complication that usually occurs shortly after extubation in patients receiving general anesthesia. It may also occur due to the bite of the endotracheal tube prior extubation.Case presentation: A 52-year-old male patient was scheduled for ventriculoperitoneal shunt operation. General anesthesia was applied. Respiratory and hemodynamic variables were stable during surgery. At the end of the surgery, anesthetic drugs were discontinued, the lumen of the endotracheal tube and oropharynx were aspirated. When oropharyngeal airway was placed the patient bit and occluded his endotracheal tube, and began exerting breathing effort. Rapid desaturation was observed and pink foamy secretion came through the endotracheal tube. Bilateral diffuse crackles were present. A chest X-ray revealed bilateral pulmonary edema. The patient was transferred to the intensive care unit, sedation was applied and volume controlled positive pressure mechanic...
Background/aim: Different techniques exist for the preoxygenation of patients that will be operat... more Background/aim: Different techniques exist for the preoxygenation of patients that will be operated on under general anesthesia. Preoxygenation with the deep breath (DB) method may affect cardiovascular stability, which is crucial for coronary artery bypass graft (CABG) patients. In this study, we aimed to compare the effects of the 3 min TVB preoxygenation technique and 1 min 8DBs technique on hemodynamic response and arterial oxygenation in patients with normal ejection fraction that were scheduled for elective CABG surgery. Materials and methods: Forty patients classified as ASA II?III and scheduled for elective CABG surgery were randomly assigned to TVB/3 min or 8DBs/1 min for preoxygenation. Cardiovascular variables, i.e. heart rate, mean arterial pressure, central venous pressure, cardiac index, systemic vascular resistance index, and stroke volume index, and arterial blood gas samples were analyzed before and after preoxygenation and at the end of the apneic period before int...
Journal of clinical monitoring and computing, Jan 13, 2017
Univent tube (UT) and EZ-blocker were used for one-lung ventilation (OLV). UT is a single lumen t... more Univent tube (UT) and EZ-blocker were used for one-lung ventilation (OLV). UT is a single lumen tube with a small separate lumen containing a bronchial blocker. EZ-blocker differs with its unique y-shaped double-cuffed distal end. We aimed to compare these two airway devices effects on airway pressures, oxygenation, ventilation and haemodynamics during OLV. Patients undergoing elective thoracotomy for the first time were included in this prospective randomized study. Patients were divided into two groups as UT and EZ. Bronchial blockers (BB) placement time was recorded. In lateral decubitus position, airway pressures, static compliance, tidal volume (TV), respiratory rate (RR) and haemodynamic findings were recorded before inflating the BB cuff (Pre-OLV) and during OLV every 15 min. Arterial blood gas (ABG) samples were obtained before and during OLV. 70 patients were enrolled in the study. The demographic characteristics and data related to anesthesia and surgery were similar in bo...
Journal of Clinical Monitoring and Computing, 2016
Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraopera... more Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.
Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed... more Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed to compare the efficacy of CTrach™ (CT) and Direct Coupled Interface-Videolaryngoscope (DCI-VL) in patients with normal airways. Sixty ASA I-II (American Society of Anesthesiologists) adult patients admitted for elective surgery were enrolled in this prospective study. The patients were randomly assigned to two groups, where intubation was performed via CT or DCI-VL. Time to obtain a good glottic view, total intubation time, success rates and the number of patients who required maneuvers for a good glottic view were recorded. The mean time to obtaining a good glottic view was significantly longer with CT than with DCI-VL (29.4±20.3 seconds vs. 12.8±1.9 seconds, respectively; p=0.01). Intubation was achieved on the first attempt in 28 patients in the CT group (93.3%) and in 24 in the DCI-VL group (80%) (p=0.77). The total intubation time for CT was significantly longer compared to DCI-VL...
Background: Various types of markers have been used so far in order to reveal myocardial perfusio... more Background: Various types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA) is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops. Methods and Results: 30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia) of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD) of IMA (0.67677 ± 0.09985) were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894) and postoperative (0.70477 ± 0.07523) measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA. Conclusions: IMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.
Background and objective: The LMA-Supremet (S-LMAt) is a new supraglottic airway device that pres... more Background and objective: The LMA-Supremet (S-LMAt) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Prosealt (P-LMAt) and S-LMAt. Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMAt (n 5 30) or S-LMAt (n 5 30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H 2 O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMAt, n 5 1; S-LMAt, n 5 1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMAt, n 5 1) due to failed OGT placement. OLPs were similar (P-LMAt; 26.9 AE 6.6 S-LMAt; 26.1 AE 5.2). ICP increased significantly in the P-LMAt at the 30 and 60 min during anesthesia (P-LMAt; 80.1 AE 12.8, 92.9 AE 14.4, S-LMAt; 68.3 AE 10.9, 73.7 AE 15.6). OGT placement was successful in all patients in the S-LMAt, but failed in five patients in the P-LMAt (P 5 0.02). Fiberoptically determined anatomic position was better with the P-LMAt (P 5 0.03). Conclusion: Our findings suggest that S-LMAt had leak pressures similar to the P-LMAt, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation.
Journal of Clinical Monitoring and Computing, 2017
In this study, we aimed to compare the effects of forced-air warming upper body blankets and forc... more In this study, we aimed to compare the effects of forced-air warming upper body blankets and forced-air warming underbody blankets on intraoperative hypothermia in patients who were planned to undergo open abdominal surgical operations in which extensive heat loss occurs. This prospective and randomized study included 92 patients who would undergo lower abdominal surgery under general anesthesia. Patients were randomized by closed envelope method and divided into two groups. Group I (n:46) included the patients who would receive warming with forced-air warming upper body blanket, and Group II (n:46) consisted of the patients who received warming with forced-air warming underbody blanket. Central body temperature was recorded by measuring with a temperature probe placed in distal esophagus. Demographic data, amount of fentanyl, crystalloid and blood products used, duration of operation, type of operation, hemodynamic parameters, shivering and thermal damage information were recorded. There was not any statistically significant difference among the patients in terms of demographic data, amount of fentanyl, crystalloid and blood products used, duration and type of operation and hemodynamic parameters. No difference was found between the groups in terms of body temperatures (Group I:36.1 °C, Group II:36.3 °C, respectively) (P &gt; 0.05). Forced air warming underbody blanket can be as effective as forced-air warming upper body blankets in preventing intraoperative hypothermia. They can be alternative in cases where use of forced-air warming upper body blankets is not feasible.
Foreign body aspiration is a serious condition with risk of mortality. It happens at all ages but... more Foreign body aspiration is a serious condition with risk of mortality. It happens at all ages but mostly at childhood. Chest x-ray can demonstrate the foreign body if it is radioopaque. But laterally and oblique chest graphies must seen for the exact diagnosis with its size and localization. We report two cases admitted with same symptoms indicate to foreign body but different final diagnosis. Case 1: A 1.5-year old child with Down syndrome was admitted to emergency clinic of our hospital with cough, wheezing and stridor. There was a history suitable for a foreign body aspiration and no any other significant history. Chest x-ray demonstrated an opasity similar to a foreign body. We performed a rigid bronchoscopy. There was no foreign body in his tracheobronchial system. Thereby esophagoscopy was performed under scopy. Again there was no foreign body although the image was suitable to a foreign body. In the postoperative period with a more detailed investigation it was understood that the radiological opasity was an endovasculary stent set up with angiography to carry on PDA for another cardiac disease treatment. Case 2: A 7-year old child was admitted to our hospital with persisting cough, wheezing and stridor. Clinical history and chest x-ray demonstrated a foreign body similar to the first case. Rigid bronchoscopy was performed and a metallic foreign body (pencil bow) is extracted from left main bronchus. History takes a great role in diagnosis of foreign body aspiration. Radiological investigation must perform to all suspected cases. Although a chest x-ray demonstrate mostly atelectasis and hyperaeration at the affected side a normal graphy can not eliminate the foreign body. If the suspicion persists we must apply bronchoscopy.
Aǧrı Agrı Dernegi Nin Yayın Organıdır the Journal of the Turkish Society of Algology, 2009
Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is... more Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is not feasible for various reasons. We describe a 28-year-old, ASA physical status I, male patient who was operated for pectoral flap release under lateral sagittal infraclavicular block. Using ultrasound guidance alone, total volume of 30 ml of local anesthetic mixture (15 ml of levobupivacaine 5 mg/ml and 15 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine) was injected dorsal to the axillary artery. There was no vascular puncture or any other complication. The block was successful and the patient was ready for surgery 20 minutes after block performance. This case report is one of the examples that ultrasound guidance may be the only way to perform safe regional anesthesia; ultrasound guidance alone is an effective way of performing infraclavicular block.
Recent advances in surgical techniques for thoracic have led to an increased use of one lung vent... more Recent advances in surgical techniques for thoracic have led to an increased use of one lung ventilation techniques. One lung ventilation is performed by doubled lumen tubes, fogarty catheters, Univent tubes and bronchial blockers. In this paper our bronchial blocker experiences were presented in fifteen thoracic surgery patients. Bronchial blockers were placed in fifteen patients who needed one-lung ventilation during thoracic surgery between January-April in 2007. Type of the bronchial blockers were selected randomly and total eight Cohen and seven Arndt bronchial blocker were placed. Following endotracheal intubation some of the bronchial blockers were performed at supine and the others were in lateral position to patients. Fiberoptic investigation was performed in all of the patients following lateral position. Bronchial blocker were placed in fifteen patients. In one patient who had congenital tracheal bronchus, one lung ventilation could not have been achieved by bronchial blocker. Following lateral positioning bronchial blocker of two patients were malpositioned and they were repositoned. Successfull one lung ventilation was performed by both bronchial blocker type. While the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s airway position, postoperative period and type of the surgery have been considered, bronchial blockers may be an alternative airway device for one-lung ventilation.
Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Sy... more Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Symptoms are usually due to sudden expansion of the aneurysm, which can cause a vague pain in the back, or sometimes a sharp pain that may denote the presence of impending rupture. Other symptoms are related to pressure on adjacent structures, such as pressure on the bronchus that can cause respiratory distress, or pressure on the laryngeal nerve causing vocal hoarseness. Pressure on the esophagus can cause difficulty in swallowing. <br />Currently, open surgery and thoracic endovascular aneurysm repair (TEVAR) are the choices of treatment for descending thoracic aneurysms (DTA). The decision to intervene on a DTA depends on its size, location, rate of growth and symptoms, and the overall medical condition of the patient. The indications for TEVAR should not differ from those for open surgery and typically include aneurysms larger than 6 cm in diameter. Saccular and symptomatic aneur...
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2015
High implantation technique during CoreValve replacement in a high-risk aortic stenosis patient w... more High implantation technique during CoreValve replacement in a high-risk aortic stenosis patient with a sigmoid left ventricular hypertrophy and a large aortic annulus Sigmoid sol ventrikül hipertrofisi ve geniş aort anülüsü olan yüksek riskli aort darlıklı bir hastada CoreValve yerleştirilmesi sırasında uygulanan yüksek implantasyon tekniği
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society, 2014
Akciger izolasyonu basta torasik cerrahi ameliyatlari olmak uzere pek cok alanda yaygin olarak ku... more Akciger izolasyonu basta torasik cerrahi ameliyatlari olmak uzere pek cok alanda yaygin olarak kullanilmaktadir. Bu amacla cift lumenli tupler ve bronsiyal blokerler kullanilmaktadirlar.Akciger izolasyonu icin ilk kullanilan tup Carlens’tir ve gunumuze degin pek cok cift lumenli tup gelistirilmistir. Modern anlamda bronsiyal blokerlerin ilk ornegi ise Univent tuptur, ilerleyen yillarda bagimsiz bronsiyal blokerler (Arndt, Cohen, Uniblocker, EZ, Coopdech vs.) gelistirilmislerdir. Bronsiyal blokerlerle karsilastirildiklarinda cift lumenli tupler, daha kisa surede yerlestirilirler, daha az malpoze olurlar. Cift lumenli tuplerle aspirasyon daha efektiftir, istenildiginde kolaylikla tek veya cift akciger ventile edilebilir. Cift lumenli tuplerin bu avantajlarinin yaninda bronsiyal blokerler ise zor havayolunda, obez hastalarda, postoperatif donemde mekanik ventilasyon gerekecegi ongorulen hastalarda, intraoperatif herhangi bir donemde akciger izolasyonu gereken hastalarda ve cocuk hastalarda ilk secenek olarak onerilmektedirler.Bu derlemede akciger izolasyonu amaciyla kullanilan havayolu gereclerinin gelisiminden, birbirine olan avantaj ve dezavantajlarindan ve kullanim onceliklerinden bahsedilecektir. Cunku torasik anestezistler gerektiginde her iki akciger izolasyon gereclerini de kullanabilecek bilgi ve deneyime sahip olmalidirlar.
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