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Öğe Airway management of a huge thyroid mass: A case report(Fatih BAŞAK, 2020) Gültekin, Ahmet; Yıldırım, İlker; Sahin, Ayhan; Arar, CavidanIn large thyroidal masses with excessive tracheal shift, the laryngeal opening is usually in the normal position and intubation may not be difficult. However, in some cases, such as retrosternal big thyroid glands, airway management can get challenging. Failure to successfully manage difficult airways is responsible for 30% of deaths attributed to anesthesia, with approximately 600 deaths annually. Successful awake intubation can be performed in 88-100% by considering the appropriate position and experience of anesthesiologist with a fiberoptic bronchoscope. However, the path to be followed should be determined according to each patient.Öğe Anket Çalışması: Türkiye'deki Anestezi Uzmanlarının Doğum Analjezisi Deneyimlerine Bakış(2020) Şahin, Ayhan; Gültekin, Ahmet; Yıldırım, İlker; Cebeci, Zübeyir; Çanakçı, EbruAmaç: Doğum sürecindeki ağrı, kadının yaşamı boyunca katlanacağı en acı deneyimlerden biri olup, fetal ve maternal tehlikelere neden olabilmektedir. Sezaryen ile doğumu tercih eden kadınların en büyük nedeni doğumda esnasındaki ağrıdır. Doğum analjezisinde rejyonel tekniklerin geliştirilmesi ile anestezi uzmanları, doğum analjezisi kontrolünün bir parçası haline gelmiştir. Bu çalışmada Anestezi uzmanlarının doğum analjezisi konusunda düşünce ve deneyimlerinin tespit edilmesi amaçlanmıştır.Materyal ve Metot: Çalışmada demografik veriler, doğum analjezisi uygulama yöntemleri, rejyonel analjezi teknikleri, kullanılan ilaçlar, rejyonel analjezi komplikasyonları ve doğum analjezisi konusundaki çekinceler hakkında sorular içeren anket formu anestezi uzmanlarına gönderilerek cevaplamaları istenmiştir.Bulgular: Çalışmaya 182 anestezi uzmanı katılmıştır. Katılımcıların %84.7’si doğum analjezisinin gerekliliğine inanırken, çalışmaya katılan 182 anestezi uzmanından 103'ü (%56.6) doğum analjezisi uyguladığını, 79'u (%43.4) doğum analjezisi uygulamadığını belirtmiştir. Doğum analjezisi için müdahalede bulunmama nedenleri içinde en sık olarak doğumhane ekibinin isteksiz olması, hasta talebinin olmaması ve deneyim yetersizliği bildirilmiştir. Doğum analjezisi için ilk tercih epidural analjezi (%77.4) olarak saptanırken, en çok tercih edilen ilaç bupivakain ve fentanildir.Sonuç: Anestezi uzmanlarının doğum analjezisine gereksinim olduğunu yüksek oranda düşünmekle beraber, doğum analjezisi uygulamalarının yetersiz olduğu saptanmıştır. Sonuç olarak doğum analjezisi kullanımını arttırıcı önlemlerinin alınmasının normal doğum oranının artışına destek olabileceğini düşünmekteyiz.Öğe Can Ultrasound-Guided Regional Anesthesia Techniques For Tracheostomy Be An Alternative To General Anesthesia?(Sage Publications Inc, 2021) Şahin, Ayhan; Baran, Onur; Gültekin, Ahmet; Gücer Şahin, Gülcan; Ersözlü, Tolga; Arar, Makbule CavidanIntroduction The cervical plexus block (CPB) has been used for a long time for both analgesia and anesthesia in carotid endarterectomy and thyroid operations. To be unfamiliar with the technique and its perceived difficulty, potential risks, and possible adverse effects such as intravascular injection has limited broader use before the practical use of ultrasound. We hypothesize that the cervical plexus block can provide adequate anesthesia in tracheostomy cases and provide excellent anesthesia comfort when combined with a translaryngeal block. Methods This double-blinded, randomized 29 patients undergoing primary tracheostomy operation to receive either CPB (Group S) or CPB with translaryngeal block (Group ST). The primary outcome was cumulated analgesic consumption during the first 24 postoperative hours. Secondary outcomes were as follows: pain related to incision, patient tolerance as assessed by tracheostomy cannula comfort score, cough and gag, pain at rest, nausea and vomiting, and time to first analgesic demand. Results The patient tolerance for tracheostomy was higher in Group ST than Group S. The median tracheostomy cannula comfort score was 4.0 in Group S. In contrast, the median score was significantly lower in group ST (P<.001). The cough and gag reflex scores were significantly lower in Group ST than Group S (1.0 vs 4.0, P<.001). Conclusion This trial supported the hypothesis that the CPB combined with the translaryngeal block yields excellent anesthesia for tracheostomies. The technique we briefly described, in a way, is the equivalent of awake fiberoptic intubation to awake tracheostomy with minimal sedation adjusted according to airway patency.Öğe Combined suprascapular nerve block and axillary nerve block approach vs. peri-articular infiltration analgesia for postoperative pain management following arthroscopic shoulder surgery: a randomized clinical trial(Verduci Publisher, 2022) Şahin, Ayhan; Baran, Onur; Çetin, Mehmet Ümit; Gültekin, Ahmet; Arar, Makbule Cavidan- OBJECTIVE: Postoperative pain following shoulder surgery is a devastating sit-uation. Several approaches, including region-al nerve blocks such as combined supras-capular nerve block and axillary nerve block (SSNB+ANB) and peri-articular infiltration (PÖğe Comparison of the effect of erector spinae plane block for postoperative analgesia on neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients operated for breast cancer(2024) Karadil, Kübra Şahin; Gültekin, Ahmet; Şahin, Ayhan; Gürdal, Sibel Özkan; Yıldırım, İlker; Arar, CavidanObjectives: It was seen that recurrence and metastasis after breast cancer surgery are related to the immune response of the host. Anesthetic agents modulate the surgical stress response or directly impair the functions of immune system cells. In our study, we aimed to compare the effects of nonsteroidal anti-inflammatory drugs and erector spinae plane block, which are among the methods we use for postoperative analgesia, on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients undergoing breast cancer surgery. Methods: One hundred female patients aged 18-75 years, scheduled for unilateral breast cancer surgery, and who agreed to participate were included in our study. These cases were divided into two groups of the analgesia method: Those with erector spinae plane block (Group E) and those who were administered nonsteroidal anti-inflammatory drugs (Group N). According to the results, preoperative and postoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values were calculated and recorded. Results: Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were statistically higher in both groups in the postoperative period. No statistically significant difference was found when the preoperative and postoperative measurement changes of the laboratory parameters between the groups were compared. Postoperative VAS scores were statistically significantly lower in Group E. Conclusions: We concluded that when erector spinae plane block and nonsteroidal anti-inflammatory drug use were compared in managing postoperative analgesia in breast cancer surgery, their effects on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not superior to each other. However, the erector spinae plane block was superior for adequate pain control.Öğe COVID-19 Pandemisinin İlk Yılında Ameliyathanemizin Non- COVID-19 Onkolojik - Onkolojik Tanı Alabilecek Ameliyatlarının Anestezi Değerlendirilmesi: Retrospektif Çalışma(2022) Gültekin, AhmetAmaç: Koronavirüs hastalığı-2019 (COVID-19) pandemisi tüm dünyada olduğu gibi ülkemizde de sağlık hizmetlerinde ciddi değişimlere neden olmuştur. En çok etkilenen grup, onkolojik bir tanı ile ameliyat olacak veya onkolojik bir tanı ile teşhis edilebilecek olanlardır. Çalışmanın amacı pandeminin ilk yılında üçüncü basamak üniversite hastanemizin ameliyathanesinde patolojik inceleme gerektirecek veya onkolojik tanılı ameliyatlarda demografik, cerrahi branş, ameliyat süresi ve anestezi tipi açısından değişiklikleri gözlemlemektir. Gereç ve Yöntem: Kriterleri sağlayan hastaların ameliyat hasta dosyaları retrospektif tarama yöntemiyle incelendi (retrospektif kesitsel çalışma). Bulgular: Ameliyathanemizin olgu sayısının en fazla olduğu ilk 3 cerrahi branş değişmezken, Amerikan Anesteziyoloji Derneği (ASA) II-III skorlamasında (p<0,05) anestezi türünde tek başına uygulanan genel anestezi veya genel anestezi eklenen nöroaksiyel ve gövde bloklarında (p<0,05) farklılık mevcuttur. Ayrıca onkolojik tanılı olgularda %13,3 ve patolojik inceleme gerektiren elektif ameliyatlarda %32 oranında değişim gözlenmiştir. Sonuç: COVID-19 pandemisinde “yeni normal”e uyum sağlanarak daha fazla beklenen iptal oranları oluşmamış ancak bu dönemde ASA skorlarında ve anestezi tipinde farklılıklar olmuştur.Öğe Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study(Elsevier Science Inc, 2021) Çanakçı, Ebru; Cihan, Murat; Altinbas, Ali; Cebeci, Zübeyir; Gültekin, Ahmet; Taş, NilayBackground: Tumor Necrosis Factor -a (TNF-a) and Interleukin-113 (IL-113) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines. Methods: TAP (study group; n = 40) or p-TAP (placebo group; n = 40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-a and IL-113 levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0-hours, 30-minutes, 4-hours, and 24-hours. Analgesic use within the first 24-hours following surgery was monitored. Results: The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24 hours), and the differences between groups were statistically significant (p < 0.001 for all comparisons). In the TAP group, the TNF-a and IL-113 levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p < 0.001 for all comparisons). Conclusion: The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflamma-tory cytokines TNF-ec and IL-1 beta in the first postoperative 24 hours, indicating immunomodulatory effect. (c) 2021 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).Öğe Genel Anestezi Altında Prone Pozisyonda Farklı Taze Gaz Akımının; Maliyet, Havayolu ve Endotrakeal Kaf Basınçlarına Etkisinin Karşılaştırılması(Selçuk BAŞAK, 2021) Gültekin, Ahmet; Sahin, Ayhan; Yıldırım, İlker; Arar, CavidanAmaç: Prone pozisyonda genel anestezi alan hastaların, farklı taze akımlarının (düşük, orta, yüksek) maliyet, havayolu ve endotrakeal kaf basınçlarını karşılaştırmayı amaçladık. Yöntemler: Çalışmaya ASA I-II, prone pozisyonda lomber vertebra cerrahisi geçiren, 18 yaş üzeri 150 hasta dahil edildi. Hastalar düşük akım (n=50, taze gaz akımı:1 l/dk), orta akım (n=50, taze gaz akımı: 2 l/dk) ve yüksek akım (n=50, taze gaz akımı: 4 l/dk) olarak üç gruba ayrıldı. Bu gruplardaki hastaların ilk 60 dakika (0, 15, 30, 45, 60.dakika olarak) içinde perop kalp atım hızı, periferik oksijen saturasyonu, ortalama arter basınçları, endotrakeal kaf basınçları, havayolu tepe ve plato basınçları ve maliyet açısından ise vaka sonunda kullanılan cihaz verileri aracılığı ile kullanlan inhale gazların (sevoflurane, oksijen, azot protoksit) miktarları kayıt edildi. Bulgular: Gruplar arasında hemodinami, havayolu basınçları ve endotrakeal kaf basınçları açısından fark yoktu. Maliyet açısından ise inhale anestezik ajan, oksijen ve azot protoksit açısından düşük akım anestezi grubunda anlamlı fark vardır. Sonuç: Modern anestezi cihazları ile düşük akım ile anestezi uygulamasından kaçınmaya gerek yoktur ancak deneyim eksikliği veya düşük akım anestezi tercih etmek istemeyen anestezistler için taze gaz akımının 2 l/dk fazla olmamasını önermekteyiz.Öğe Investigation of Electroconvulsive Therapy Parameters in Propofol and Ketamine–Propofol Combination Anesthesia(Istanbul Universitesi, 2023) Beyazyüz, Elmas; Buse Codal, Elif; Gültekin, Ahmet; Yıldırım, İlker; Beyazyüz, MuratObjective: It is aimed to highlight the concept of electrical stimulus [electroconvulsive therapy (ECT) dose], an aspect that has not received sufficient attention in previous research on ECT. Methods: This study is a retrospective investigation aiming to examine the medical records of patients who received ECT. Patients were assigned to 2 groups. The first group received a dose of 1mg/kg propofol for ECT anesthesia (n = 25), while the second group receives a combination of 0.5 mg/kg propofol and 0.5 mg/kg ketamine (n = 36).The electrical charge required to induce an effective seizure and the parameters determining the electrical charge, such as pulse width, frequency, stimulus duration, and current, were recorded at each session and compared. Results: In propofol group the initial value of frequency was 29.03 ± 7.35 Hz and the last value (frequence at eighth session) was 83.06 ± 24.45 Hz. The difference in frequency was found to be significantly increased in propofol group (F = 151.95; ?p2 = 0.83; P < .0001). In propofol + ketamine group the initial value of frequency was 24.09 ± 7.42 Hz and the last value (frequence at eighth session) was 91.74 ± 22.39 Hz. The difference in frequency was found to be significantly increased in propofol group (F = 237.05; ?p2 = 0.95; P < .0001). The duration of session was significantly decreased in propofol group (F = 10.29; ?p2 = 0.28; P < .0001). The duration of the seizure in first session was 57.17 ± 19.09 seconds and the duration of seizure in eighth session was 50.78 ± 14.21 seconds in propofol + ketamine group. The duration of the session was significantly decreased in propofol + ketamine group. Conclusion: It was observed that the ECT dose remained similar between the 2 groups. Further research is warranted to delve into the cognitive effects of the propofol + ketamine combination in ECT procedures. © @Author(s).Öğe Our New Choice in Labour Analgesia, Combined Spinal-Epidural Analgesia: Our Short Term Results(Ordu Üniversitesi, 2020) Gültekin, Ahmet; Canakci, EbruObjective: Nowadays, the painless childbirth preference of expectant mothers is gradually increasing. The most important and first objective in labor analgesia should be the safety of mother and baby. Our objective in this study is to compare the effects of combined spinal-epidural analgesia (CSE) and epidural analgesia on analgesia quality and labor in labour analgesia.Methods: Our study was performed prospectively on 40 primigravid pregnant women who requested painless childbirth and were included in the ASAI-II group, between September 1, 2018, and November 30, 2018. Pregnant women who had single fetus at 36-42 weeks, have vertex presentation, no contraindications for regional analgesia, have active contractions and with 3-4 cm cervical opening were randomly divided into two groups in the study. Combined Spino Epidural group (= Group CSE, n = 20), Epidural analgesia group (= Group EPI, n = 20) was determined as the groups. To the pregnant women in the Group CSE, Intrathecal dose in a manner that 2.5 mg hyperbaric bupivacaine + 12.5 µg fentanyl total volume of 1 ml was injected. To the pregnant women in the Group EPI, 20 G epidural catheter was placed with the method used in the first group and fixed to the skin. Epidural analgesia solutions (20 mg bupivacaine + 50 µg fentanyl +15 cc saline) were prepared in 20 cc injectors containing 0.1% bupivacaine + 2.5 µg/ml fentanyl for use in both groups. When the VAS values became 4, these prepared solutions were planned to be given as 10 ml intermittent bolus from these epidural catheters.Results: The mean values of maternal age, weight, and height, and infant height have not shown any difference according to the groups (p> 0.05). The first VAS median value was obtained as 5 in both groups. However, the VAS values were accumulated in the higher values in the combined spinal-epidural group (p = 0.031). Although the second VRS and VAS median values were lower in the pure epidural, the outlet VRS and VAS values have been obtained lower in the combined spinal-epidural group. Conclusion: For normal spontaneous vaginal delivery, every mother should be offered labour analgesia options such as CSE analgesia and epidural analgesia. CSE analgesia may be a good alternative to epidural analgesia because of its advantages such as the onset of fast analgesia, shortening the first stage of labour and increasing the comfort of the mother in the outlet.Öğe Parsiyel Tetrazomi 18 (Tetrazomi 18p- İzokromozom 18) Olan Olgunun Anestezi Yönetimi Deneyimimiz(Merthan TUNAY, 2020) Gültekin, Ahmet; Sahin, Ayhan; Yıldırım, İlker; Arar, CavidanTetrazomi 18p (izokromozom 18), 18. kromozom kısa kolunun iki kopyasından oluşan anormal bir ekstra kromozomdan kaynaklanır. Kesin bir prevalans oranı hesaplanamamasına rağmen, 1 / 140.000-180.000 canlı doğum prevalansı ile çok nadir görülen bir kromozomal anormalliktir. Olgumuz bilateral inmemiş testis ve sünnet operasyonu nedeniyle polikliniğimizde değerlendirilen dört yaşında, 11 kilogram ağırlığında bir erkek çocuk hasta olup, anestezi uygulamamızda zor ventilasyon ve zor entübasyon riskine rağmen 2.0 LMA ile başarılı bir şekilde ventilasyon sağlandı.Öğe Perioperative Considerations in Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences(2020) Şahin, Ayhan; Gültekin, Ahmet; Yıldırım, İlker; Mordeniz, Cengiz; Arar, Makbule CavidanAim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Öğe Predictive Values of Inflammation Indexes in Predicting Mortality in Patients with COVID 19 Hospitalized in General Intensive Care Unit(2022) Engin, Mesut; Yıldırım, İlker; Arar, Makbule Cavidan; Amaç, Bişar; Alpsoy, Şeref; Aydın, Cihan; Gültekin, AhmetObjective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values ??can predict the mortality of patients with COVID-19 disease.Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors)during the intensive care follow-ups. Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively.Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.Öğe Serratus anterior plane block for tertiary revision rhinoplasty with rib cartilage harvest(Elsevier Science Inc, 2021) Şahin, Ayhan; Baran, Onur; Gültekin, Ahmet; Yıldırım, İlker; Arar, Makbule Cavidan; Günkaya, Mustafa[No Abstract Available]Öğe Ultrasound-guided erector spinae plane catheter for postoperative continuous analgesia in a patient undergoing pericardial window opening surgery for pericardial tamponade: a case report(Springer, 2020) Şahin, Ayhan; Gültekin, Ahmet; Gürkan, Selami; Baran, Onur; Arar, Makbule CavidanBackground Anesthetic management of pericardial tamponade is requiring full use of abilities for anesthesiologists because of associated cardiovascular problems inherent to this condition, with its associated comorbidities. Case presentation A 55-year-old man diagnosed with severe mitral insufficiency, asthma, diabetes, and pleural effusion in the lungs and pericardial effusion was scheduled for pericardial window opening surgery. Conclusions Due to compromised lung functions and asthma of the patient led to an anesthetic plan of ultrasound-guided erector spinae plane catheter placement for long-term continuous analgesia.
