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Öğe COMPARISION OF INTRAOPERATIVE AND PREOPERATIVE HEMODYNAMIC PARAMETERS AND QT CHANGES IN ECG IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE PROSTATE UNDER SPINAL ANESTHESIA Onur(Afyonkarahisar Sağlık Bilimleri Üniversitesi, 2019) Sarpdağ, Cafer; Kaygusuz, Kenan; Avcı, Onur; İsbir, Ahmet Cemil; Kol, İclal Özdemir; Gürsoy, SinanOBJECTIVE: In our study we aimed to compare intraoperative hemodynamic changes and changes in QT interval with preoperative values in patients undergoing transurethral resection of the prostate (TUR-P) under spinal anesthesia.MATERIAL AND METHODS: The study comprised of 45 patients, between the ages of 40 to 65 and ASA I-II who were planned to undergo transurethral resection of the prostate. The patients were randomly divided into 3 groups. %0.9 NaCl to group I, gelatin to group II, and to group III hydroxyethyl starch were intravenously injected via using 18 gauge intravenous catheter. Hemodynamic parameters were recorded as 5-minute intervals in preoperative period and also during the operation. QT values were recorded in 5, 15, 30, 60 minutes, before, during and after the operation.RESULTS: There was no significant hemodynamic differences between the groups whereas in Group I, QT interval, between the preoperative and postoperative period were significantly different. Also we compared preoperative values and postoperative values of post-op 5min and 10min and found significant difference and increase. In Group II, preoperative and postoperative QT intervals were significantly different and the measurements are found to be increased. In Group III the difference between preoperative and postoperative 15min and 20min values were significant and the measurements are found to be increased. In Group III, there was significant difference between the values taken in 5 min and other times and the measurements are found to be increased.CONCLUSIONS: In view of prolonging on intraoperative and postoperative QT interval on patients that have TUR-P operation; more care should be taken in patients who are planned TUR-P operation, who have coronary heart disease and have pre-operative acquired or congenital prolonged QT interval.Öğe Comparison of Pleth Variability Index and Inferior Vena Cava Distensibility as a Perfusion Indicator in Sepsis Patients: An Observational Study(Turkiye Klinikleri, 2022) Göktürk, Orhan; Avci, Onur; Gündoğdu, Oğuz; İsbir, Ahmet Cemil; Özdemir Kol, İclal; Gürsoy, Sinan; Kaygusuz, KenanObjective: The aim of this study was to compare the sensitivity and specificity of Pleth Variability Index (PVI) and distensibility of inferior vena cava (dIVC) in fluid responsiveness of patients with sepsis. Material and Methods: Forty patients over 18 years of age who underwent fluid replacement for sepsis in the intensive care unit were included in the study. In our study, the patients were divided into 2 groups as those who had less than 15% increase in cardiac output (CO), and those who had more than 15% increase in CO after fluid replacement (fluid responders and non-responders). Before fluid replacement, demographic data of the patients (age, weight, cause of sepsis, body surface area, SOFA score), vital parameters (systolic arterial pressure, diastolic arterial pressure, mean arterial pressue, heart rate) and measuredd values (maximum diameter of vena cava inferior, minimum diameter of vena cava inferior, central venous pressure, PVI, CO, and stroke volume) were recorded. After applying crystalloid in a dose of 10 mL/kg for 15 minutes, the recorded parameters were repeated at 15th minute. Results: When receiver operating characteristic (ROC) analysis was performed for dIVC, the area under the curve (AUC) was found to be 0.833 (0.739-0.926). The threshold value was found to be 17.52%, sensitivity was 77.5%, and specificity was 72.5%. When ROC analysis was performed for PVI, AUC was found to be 0.889 (0.817-0.962). The threshold value was found as 12.50%, sensitivity was 72.5%, and specificity was 92.5%. Conclusion: PVI was found to be more specific but less sensitive than dIVC. dIVC is less sensitive and less specific than central venous pressure. However, dIVC and PVI can give useful results in patients who have contraindication of an invasive technique. © 2022 by Türkiye Klinikleri.Öğe The Effect of BATHE Method on Preoperative Anxiety, Patient Satisfaction and Individual Anesthesia Concerns: Randomized, Placebo-Controlled, Clinical Trial(2021) Karakoyun, İsmail; İsbir, Ahmet Cemil; Gündoğdu, Oğuz; Avcı, Onur; Kol, İclal Özdemir; Gürsoy, Sinan; Kaygusuz, KenanObjective: The aim of this study is to determine the causes of concern among the patients who will undergo elective surgical operations and receive general anesthesia, to gauge their preoperative anxiety levels and to study the effects of the BATHE method on preoperative anxiety and patient satisfaction. Material and Methods: Five hundred adult patients who were planned to undergo elective surgery with general anesthesia were included in the study. Before the preoperative examination, demographic data of all patients, their three biggest fears about anesthesia and Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores were recorded. Then, the patients were divided into two groups with a closed envelope randomization method with 250 patients in each. The patients underwent BATHE anamnesis or standard anamnesis methods according to their groups, then their APAIS and patient satisfaction scores were recorded. Results: The most feared cause of anesthesia in all patients was “not waking up after surgery”. The APAIS anxiety score was found to be higher in women, young people, married people with children, people with no prior anesthesia experience and people with a higher degree of education. Anxiety values were found to be higher in gynaecology patients and obstetrics. The difference between APAIS scores before and after the examination was higher in the group using the BATHE method during the preoperative visit compared to the standard anamnesis group. The patient satisfaction score of the patients in the BATHE group was higher than the standard anamnesis group. Conclusion: We concluded that the inclusion of BATHE interview technique in preoperative examination may reduce preoperative anxiety.Öğe The Effects of Carotid Endarterectomy Surgery on Cerebral Oxygenation, Randomized Clinical Trial(2022) Mert, Gonca Kaya; Avcı, Onur; Gündoğdu, Oğuz; İsbir, Ahmet Cemil; Kol, İclal Özdemir; Gürsoy, Sinan; Kaygusuz, KenanPurpose: The aim of this study is to assess how NIRS values changed with cross-clamp (CC) duration in carotis endarterectomy (CEA) surgeries.Materials and Methods: The study included 30 patients. Before induction of general anesthesia, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), and regional oxygen saturation(rSO2) values were recorded as right and left sides. The same parameters were recorded before the carotid CC, at the 3rd, 5th, and 10th minutes of the carotid CC, and at the 1st and 5th minutes after the cross-clamp removal postoperatively.Results: When the rSO2 values of the study participants were measured at different times, there was a significant difference (p<0.05) between the right-sided mean rSO2 values of the patients who underwent right-sided surgery (n=11). There was also a significant difference (p<0.05) between the left-sided mean rSO2 values of the patients who underwent left-sided surgery (n=19).Conclusion: We discovered that there was a significant decrease in cerebral oxygen saturation during CC in patients who had CEA surgery under general anesthesia and that cerebral oxygen saturation reached or exceeded the basal value after the CC was opened.Öğe Total Kalça Cerrahisi Operasyonunda Non-invaziv PVI (Pleth Variability İndeks) Monitörizasyonunun Sıvı ve Kan Transfüzyonuna, İntraoperatif Hemodinami Üzerine Etkinliğinin Değerlendirilmesi(2018) Şen, Gülten; Düger, Cevdet; Avcı, Onur; Gürsoy, Sinan; Kaygusuz, Kenan; Kol, İclal Özdemir; İsbir, Ahmet CemilAmaç: Genel anestezi altında yapılan total kalça artroplastisioperasyonlarında, invaziv standart monitörizasyon ile noninvaziv PVI monitörizasyon tekniklerinin hemodinamikparametrelerdeki farklılıklar, sıvı ve kan transfüzyonu üzerineetkilerini kıyaslamayı amaçladık.Gereç ve Yöntem: Etik kurul onayı alındıktan sonra ASA I-IIgrubu, 30-85 yaş arası, 82 hasta üzerinde PVI ölçümleri ilestandart monitörizasyon ölçümlerinin, hastaların hemodinamikparametreleri, sıvı ve kan transfüzyonuna etkinlikleri prospektifolarak karşılaştırıldı. I. grup hastalar, peroperatif dönemde,noninvaziv PVI monitörizasyonu yanında anestezi monitorü ileII. grup hastalar ise; sadece anestezi monitorü ile standartmonitorize edildi. Hastalara mayi replasmanı, standartmonitorizasyon grubundaki hastalara 8ml/kg/saatten kristaloidile, PVI monitorizasyonu yapılan gruba ise PVI değerlerinegöre, hedef PVI<% 13 olacak şekilde kristaloid replasmanıyapıldı. PVI grubuna kan kaybı da gözönünde bulundurularakhedef PVI<% 13 olacak şekilde kristaloid+kolloid+kantransfüzyonu yapıldı. Standart monitorizasyon grubuna da; kantransfüzyonu için kriter olarak %15-30 arası kayıplardakristaloid+kolloid infüzyonu, kan kaybı oranı >%30, >1500 mlüzeri kayıplarda kan transfüzyonu uygulanmıştır.Bulgular: Ölçülen pulse oksimetri değerleri karşılaştırıldığındagruplar arası farklılık önemli bulundu. PVI ölçümleri zamaniçerisinde bir düşüş gösterdi. Her iki gruptaki bireylerin girişHgb değerleri karşılaştırıldığında farklılık önemli bulunurken,çıkış Hgb değerleri karşılaştırıldığında farklılık önemsizbulundu. Verilen toplam mayi açısından karşılaştırıldığındagruplar arası farklılık önemli bulunup, PVI monitörizasyongrubuna daha az mayi replasmanı yapıldı.Sonuç: Non-invaziv PVI monitorizasyonun, standartmonitorizasyonla kıyaslandığında hastanın hemodinamikstabilitesinin sağlanmasında ve mayi rejiminin takibinde dahapratik, komplikasyonsuz ve kullanımının kolay olduğukanaatindeyiz. Ancak PVI monitorizasyonun, daha fazlaaraştırılarak sıvı yönetimi dışındaki parametreler üzerindekietkinliğinin aydınlatılmasına ihtiyaç olduğunu düşünmekteyiz.
