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    Comparison Of Percutaneous and Intraabdominal Blockades Of Iliohypogastric and Ilioinguinal Nerves For Postoperative Pain Management Of Total Abdominal Hysterectomy Patients: A Randomized Controlled Clinical Trial
    (Sivas Cumhuriyet University, 2022) Düger, Cevdet; Avcı, Onur; Boztosun, Abdullah; İsbir, Cemil; Kol, İclal Özdemir; Kaygusuz, Kenan; Gürsoy, Sinan
    Objective: In this study we aimed to determine whether iliohypogastric and ilioinguinal nerve blockade from intraabdominal approach for the postoperative pain management of total abdominal hysterectomy patients could be a reliable and effective alternative compared to percutaneous block of IHII nerves. Materials and Methods: This study is a randomised controlled double blind prospective clinical trial. This study was conducted in operating room, and recordings were performed in postoperative recovery unit and gynaecology clinic. Eighty seven women undergoing total abdominal hysterectomy were enrolled in this study but 82 completed the study. Patients were divided into three groups (n=29 in each), as control group (group C), percutaneous IHII block group (group PB) and intraabdominal IHII block group (group IB). Group C patients received no block procedure. The percutaneous bilateral IHII nerves block was performed after abdominal closure to group PB and intraabdominal IHII block was performed before abdominal closure to group IB. Mean arterial pressure, heart rate, pain scores, satisfaction scores, morphine consumptions and side effects were recorded at the 2nd, 6th, 12th and 24th postoperative hours. Results: Postoperative MAP, HR results of control group were found similar in all groups. VAS scores at all postoperative hours were found to be significantly lower in the block groups PB an IB than control group. There were no significant differences in pain scores between group PB and IB at any time point. Morphine consumption data were found to be significantly lower in the PB and IB groups than in the control group. Conclusions: Intraabdominal IHII blockade just before closure of the abdomen for relieving postoperative pain in total abdominal hysterectomy patients is as effective and safe method as conventional percutaneous IHII blockade without adverse effects.
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    Spinal anestezide morfin ilavesinin ve blok seviyesinin QT aralığına etkilerinin araştırılması
    (Cumhuriyet Üniversitesi, 2007) Düger, Cevdet; Mimaroğlu, Caner
    Bu çalısmanın amacı, bupivakain gibi kardiyak aritmojen bir ajana morfin ilave edilerek yapılacak spinal anestezinin ve duyusal blok seviyesinin QT intervaline olan etkilerini arastırmaktır. Hastaların ve etik kurulun izni alındıktan sonra, torakal 10 seviyesinin altında ürolojik cerrahi uygulanan 60 hasta rasgele 2 gruba ayrıldı. Grup I (n=30) hastalarına, 12,5 mg %0,5 hiperbarik bupivakain ile 0,3 ml izotonik NaCl solusyonundan olusan 2,8 ml'lik kombinasyon, Grup II (n=30) hastalarına, 12,5 mg %0,5 hiperbarik bupivakain ve 0,3 mg morfin hidroklorür' den olusan 2,8 ml'lik kombinasyon ile spinal anestezi uygulandı. Ameliyat öncesi ve süresince SKB, DKB, OAB, KAH, SS, EKG, SpO2, duyusal blok seviyeleri, motor blok kaydedildi. EKG cihazıyla, 12 derivasyonlu EKG kayıtları alındı ve QT ve QTc intervali degerleri hesaplanarak kaydedildi. Ayrıca postoperatif yan etkiler, VAS skoru kaydedildi. Gruplar demogarfik veriler yönünden benzerdi (p>0,05). Hemodinamik degerler Grup II de daha düsük bulundu (p<0,05). Ancak efedrin ve atropin ihtiyacı olmadı. Grup II' de blok tepe düzeyleri daha yüksek, blogun T10 dermatomuna ulasma süresi daha kısa, blogun iki seviye gerileme zamanı daha uzun bulunmustur (p<0,05). Yine Grup II' de motor blogun daha hızlı ilerledigi ve daha uzun sürdügü görüldü (p<0,05). Gruplar arasında QT intervali yönünden bir fark yoktu (p>0,05). Ancak her iki grupta da QT degerleri duyusal blok seviyesi yükseldikçe bazalin anlamlı derecede üzerine çıktı (p<0,05). QTc degerleri her iki grupta da bazalin anlamlı derecede üzerine çıkmasına ragmen (p<0,05), Grup II' de spinal sonrası 20, 25 ve 30. dk'larda Grup I' den anlamlı derecede daha düsük bulundu (p<0,05). Bulantı, kusma, kasıntı Grup II' de daha fazla görüldü (p<0,05). Grup I' de postoperatif VAS skorları daha yüksekti (p<0,05). Sonuç olarak kardiyak aritmi potansiyeli olan bir lokal anestezik ajan olan bupivakaine, kardiyoprotektif özellikleri kanıtlanmıs opioid prototipi morfinin eklenmesinin, hemodinamik parametreleri medikasyon gerektirecek derecede bozmaksızın, aritmi insidansını azaltabilecegi kanısına vardık.
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    Successful treatment of intoxication case with rosiglitasone and metformin
    (2013) Düger, Cevdet; Isbir, Ahmet Cemil; Özdemir Kol, Iclal; Kaygusuz, Kenan; Gürsoy, Sinan; Kiliç, Isa; Mimaro?lu, Caner
    Metformin is a biguanide antidiabetic high doses of which may cause lactic acidosis. Rosiglitazone is a member of thiazolidinedione antidiabetics group which increases insulin sensitivity. A 35-year-old female patient was admitted to hospital with the complaints of loss of consciousness, oliguria, nausea and vomiting after a history of 48 g of metformin, 108 mg rosiglitasone uptake for suicide. Hypotension, hypoglycemia and metabolic acidosis were observed in the patient, sos he was supported by mechanical ventilation due to the Glasgow coma scale 5. The patient was discharged liome on the 45th day after continuous venovenous hemodiafdtration, supplamentary treatment and 39 days of mechanical ventilation support. There must be a suspicion for metformin intoxication in the patients with high anionic gap metabolic acidosis, and who take overdose drugs for suicide. Since metformin associated hypoglycemia, lactic acidosis and hypothermia are reversible, early diagnosis of metabolic acidosis and cardiovascular support with hemodialysis and hemofdtraiion protect blood glucose level and body temperature, which allow for possible recovery.
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    The investigation of the effects of morphine on QT interval at spinal anesthesia with Bupivacaine
    (2008) Düger, Cevdet; Mimaro?lu, Caner; Kaygusuz, Kenan; Kol, Iclal Özdemir; Gürsoy, Sinan
    Objective: The aim of this study is to research the effects on QT interval of intrathecal morphine added to bupivacaine which is known as a cardiac arrhythmogenic agent. Method: The study was performed on 60 patients that are scheduled to have lower abdominal surgery. The patients were randomized into two groups 30 of each. Solution of 12,5 mg 0,5 % hyperbaric bupivacaine and 0,3 mL 0,9 % NaCl at the control group, and 0,3 mg morphine hydroclorur at the morphine group that have a volume of 2,8 mL were administered to the intrathecal area for spinal anesthesia. The mean arterial pressure, heart rates, sensorial block levels, QT and QTc intervals recorded during the study. Results: The mean arterial pressures at the postspinal 5th minute and after were found lower at the morphine group (p<0,05). QTc values of the morphine group were found lower than the control group at 20th, 25th and 30th minutes (p<0.05). The peak sensorial block level was higher, time to reach the block to T10 level was shorter, the two segment regressing time of sensorial block was longer at the morphine group (p<0,05). Itching were seen at 20% patients in morphine group, but no patients of control group (p<0,05). Conclusion: Adding a prototype and car cardioprotective opioid agent morphine to cardiotoxic agent bupivacaine for spinal anesthesia may decrease arrythmia incidence.
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    The use of empirical antibiotics in intensive care unit and relationship between nutrition and the incidence of infection
    (2019) Yıldırım, Salih; Orak, Yavuz; Menencioğlu, Rukiye; Altun, Ahmet; Orak, Filiz; Düger, Cevdet; Özpay, Esra
    Objective: Aim of study is to determine which antibiotic is started empirically in the ICU and to investigate whetherthe antibiotic started according to culture result was changed or not and the effect of this change on mortality, and toinvestigate the relationship between mortality and infection by determining whether enteral and parenterally fedpatients have attained sufficient calorie level.Method: After the approval of the local ethics committee, the files of 476 patients hospitalized in our hospital wereretrospectively reviewed. A total of 159 patients over 18 years of age who received mechanical ventilation therapy forat least 3 days were included in the study. Blood, urine and tracheal aspirate culture were determined. It wasrecorded whether antibiotics had changed according to the culture result. Nutritional patterns, number of feedingdays and basal caloric need were determined. It was investigated whether basal calorie need was met on 1, 3 and 5days. Factors affecting mortality were investigated.Results: Antibiotic exchange was significantly higher in the patients who died (P = 0.002). Mortality was higher inpatients who were unable to reach the target calorie (P = 0.01). Empirical changes in antibiotics (r: 0.174, P = 0.028),and culture positivity (r: 0.177, P = 0.026) were associated with mortality (r: 0.195, P = 0.014). In the subgroupanalysis, reproduction in tracheal aspirate culture was an important factor affecting mortality (r: 0.211 P: 0.008).Conclusions: The number of days of hospitalization, antibiotic change, culture positivity and inability to reach thetarget calories in nutrition are associated with mortality in the intensive care unit
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    Total intravenous anesthesia in a case of Duchenne muscular dystrophy -single low dose rocuronium usage
    (2013) Isbir, Ahmet Cemil; Düger, Cevdet; Özdemir Kol, Iclal; Kaygusuz, Kenan; Gürsoy, Sinan; Mimaro?lu, Caner
    Duchenne Muscular Dystrophy is an X-linked progressive neuromuscular hereditary disease which effects men and is seen in 1/3.500 frequency. Although the basic problem in this disease is musclular weakness; anesthetic approach in Duchenne Muscular Dystrophy is important because the disease might cause cardiac and respiratory problems during anesthesia. Moreover, inhalation anesthetics might be the reason for malignant hyperthermia and rhabdomyolysis. This case report aims at discussing the safe anesthetic approach in a 7 year old patient who was operated by orthopedic surgeons with Duchenne Muscular Dystrophy and right supracondylar humerus fracture. In this case ventilator was totally cleaned from anesthetic agents to avoid from malignant hyperthermia and rhabdomyolysis. 50% oxygen-air mixture and low dose propofol with remifentanil were used in total intravenous anesthesia. Because of the non-depolarizing muscle relaxant sensitivity, low-dose rocuronium and sugammadex were used as its reverse agent. No complications were encountered during preoperative and perioperative period. After the case was observed in intensive care unit, he was transferred to the orthopedics clinic. It has been concluded that use of propofol and remifentanil together with total intravenous anesthesia, and low-dose rocuronium bromide will be a safer anesthesia application.
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    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 Cemil
    Amaç: 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.