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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 Does interscalene block increase intracranial pressure?(Sivas Cumhuriyet Üniversitesi, 2023) Gündoğdu, Oğuz; Avcı, OnurInterscalene brachial plexus (ISB) block is widely used in shoulder and humerus surgeries, especially in patients that have high risk for general anesthesia. Increased intracranial pressure (ICP) is not among the complications of this block because there is no data about this issue in the literature. In this traumatic case report, a patient with headache and with a known meningioma in his right temporo occipital region is gonna have a proximal humerus fracture surgery with ISB block under repetitive optic nerve sheath diameter measurements. The result of this case report can add a unique information to the ISB literature.Öğe Effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain following arthroscopic meniscus surgery: A prospective, double-blind, randomized, placebo-controlled, clinical trial(AVES, 2021) Avcı, Onur; Kol, İclal Özdemir; Gündoğdu, Oğuz; Öztemur, Zekeriya; Erşan, İdrisObjective: The aim of this study was to determine the effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain levels and analgesic requirements following arthroscopic meniscectomy. Methods: A total of 60 American Society of Anesthesiologist physical status I-II patients, aged 20 to 62 years, and scheduled for arthroscopic partial meniscectomy under general anesthesia were included in this study. All the patients were randomly assigned to one of four groups (15 patients in each group): Group 1 (8 male, 7 female; mean age = 46.70 ± 13.13 years; 0.9% isotonic 20 ml), group 2 (7 male, 8 female; mean age = 42.60 ± 12.18 years; levobupivacaine 0.5 mg/kg plus 0.9% isotonic), group 3 (8 male, 7 female; mean age = 43.80 ± 12.63 years; 1?g/kg dexmedetomidine plus 0.9% isotonic), and group 4 (7 female, 8 male; mean age = 40.40 ± 11.79 years; levobupivacaine 0.5 mg/kg plus 1?g/kg dexmedetomidine and 0.9% isotonic). All medications were administered at the end of arthroscopic surgery. Pain levels were measured using a Visual Analogous Scale (VAS) and Verbal Rating Scale (VRS) at postoperative 1, 2, 4, 6, 12, and 24 hours. Results: VAS scores at rest were significantly lower in Group 4 at postoperative 1th,2nd,4th,6th,12th, and 24th hours than in other groups. The time to take the first analgesic was significantly higher in Group4 (964 ± 288 min), and total analgesic consumption was significantly lower in Group 4 compared to those of other groups. Conclusion: Although administration of intra-articular dexmedetomidine alone may have a weaker effect than intra-articular levobupivacaine on postoperative pain relief after arthroscopic partial meniscectomy, adding dexmedetomidine to intra-articular levobupivacaine may increase the durationand quality of postoperative analgesia without any side effect. Level of Evidence: Level I, Therapeutic Study. © 2021, AVES. All rights reserved.Öğe Elektrokonvülsif terapide hiperventilasyonun konvülsiyon süresi ve serebral oksijenizasyon üzerine etkileri(Cumhuriyet Üniversitesi, 2018) Gündoğdu, Oğuz; Gürsoy, SinanÖZET Giriş ve amaç: Elektrokonvülsif terapi bir nöbet başlatmak için, bir veya her iki serebral hemisfere elektrik akımı uygulanarak yapılır. Amaç 25-60 saniye süreli bir terapötik yaygın nöbet oluşturmaktır. Anestezik ilaçların nöbet süresini kısaltmaları nedeniyle de elektriksel stimulusu artırmadan nöbet süresinin uzatılması konusunda özellikle anestezistler tarafından pek çok çalışma yapılmış ve bazılarında hiperventilasyonun nöbet süresini uzattığına dair sonuçlar elde edilmiştir. Bu çalışmanın amacı, hiperventilasyonun konvülsiyon süresine ve serebral oksijenizasyon üzerine etkisini araştırmaktır. Gereç ve Yöntem: Çalışmaya anestezi altında ilk kez elektrokonvülsif terapi uygulanacak, yaşları 18-65 arası ASA I-II bireylerden 40 hasta dahil edildi. Kontrolsüz kardiyovasküler, respiratuar, metabolik hastalığı olan, herhangi bir intrakranial patolojiye ve zor hava yolu kriterlerine sahip hastalar, preop hemoglobin değerleri 10 gr/dl'nin altı ve 17 gr/dl'nin üstünde olan hastalar ile araştırmaya katılmayı reddeden hastalar dahil edilmedi. Çalışmamızda hastalar 2 gruba ayrıldı: GRUP H: Hedef etCO2 25-30 mmHg olacak şekilde laringeal maske (LMA) ile 3 dk hiperventilasyon uygulanan 20 hasta GRUP N: Hedef etCO2 35-40 mmHg olacak şekilde laringeal maske (LMA) ile 3 dk normoventilasyon uygulanan 20 hasta Anestezi indüksiyonu öncesi, LMA ile ventilasyonun 3. dakikasında, postiktal 1., 5. Ve 10. dakikalarda sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama arteryel basınç (OAB), kalp atım hızı (KAH), periferik oksijen saturasyonu (sPO2) ve bölgesel oksijen saturasyonu (rSO2) değerleri kaydedildi. Anestezi indüksiyonu sonrası laringeal maske (LMA) ile hava yolu kontrolü sağlanan hastaların ventilasyonun 3. dakikası ve konvülsiyonun 1. dakikasında end-tidal karbondioksit (etCO2) değerleri kaydedildi. Konvülsiyon süresi, Richmond sedasyon-ajitasyon skoru, Aldrete skoru 9 olana kadar geçen süre kaydedildi. Bulgular: Her iki gruptaki bireyler konvülsiyon süresi ve derlenme süresi yönünden karşılaştırıldığında gruplar arası farklılık önemli bulunmuştur. (p<0.05) Her iki grupta değişik zamanlarda ölçülen serebral oksijenizasyon değerleri karşılaştırıldığında gruplar arası farklılık önemsiz bulunmuştur. (p>0,05) Hiperventilasyon grubundaki bireylerin değişik zamanlarda ölçülen rSO2 değerleri karşılaştırıldığında ölçümler arası farklılık önemli bulunmuştur. (p<0.05) Grup H'de rSO2 değerleri ikişerli karşılaştırıldığında bazal ile LMA 3.dakika, bazal ile postiktal 1.dakika, bazal ile postiktal 5. dakika değerleri arasındaki farklılık önemli bulunurken diğer ölçümler arası farklılık önemsiz bulunmuştur. Normoventilasyon grubundaki bireylerin değişik zamanlarda ölçülen rSO2 değerleri karşılaştırıldığında ölçümler arası farklılık önemsiz bulunmuştur. (p>0.05) Her iki guptaki bireylerin Richmond Ajitasyon skorları karşılaştırıldığında gruplar arası farklılık önemsiz bulundu. (p>0.05) Sonuç: Grup H'de Grup N'ye göre konvülsiyon süresinin daha uzun ve derlenme süresinin daha kısa olduğu (p<0,05) tespit edildi. Elde edilen rSO2 verilerinin analizine göre ise hiperventilasyonun aynı bireyde farklı zamanlarda ölçülen serebral oksijenizasyona anlamlı bir katkısı olduğu ancak normoventilasyon yapılan gruptan istatistiksel olarak anlamlı bir fark olmadığı görüldü. EKT'de hiperventilasyonun hangi kriterlere göre yapılması gerektiği konusunda ortak bir kanıya varmak için daha fazla olgu sayısından oluşan çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Hiperventilasyon, elektrokonvülsif terapi, serebral oksijenizasyon, konvülsiyon süresiÖğe Evaluation of Cerebral Oxygenation and Tissue Perfusion in Patients Ongoing Coronary Artery Surgery with Cardiopulmonary By-pass(2019) Avcı, Onur; Gündoğdu, OğuzObjective: We aimed to determine whether there is a correlation between perfusionparameters [Lactate (lac), venoarterial carbondioxide gradient (?pCO2), central venous oxygen saturation (ScVO2)] and the relationship between these parameters and cerebral oxygenation in normothermia (T2), hypothermia (T3) and re-warming (T4) periods in cardiopulmonary bypassprocedure (CPB). Material and Methods: Forty patients aged 19-78 years who were scheduled forelective coronary artery bypass surgery were included in the study. Mean arterial pressure (MAP),cerebral oxygenation (rSO2), periferic oxygen saturation (SpO2) values were recorded and by taking blood samples from arterial cannula and central venous catheter simultaneously; hematocrit(Htc), ?pCO2, lac, ScVO2, actual base excess (aBE), bicarbonate (HCO3) values were recorded in T1(after anesthesia induction and central venous catheterization), T2 (normothermia, 36oC, at the startof CPB), T3 (hypotermia, 32oC) and in T4 (at the end of CPB, rewarming, 36oC). Results: Between?pCO2-lac values, only positive correlation was found in T4 and there was no correlation betweenthem at other times. There was significant negative correlation between rSO2 and lac in T1, T3 andT4, but no significant correlation was found between rSO2-?pCO2 parameters at any time. The correlations of lac and ?pCO2 with cross-clamp and CPB durations were positive, whereas the correlations between ScVO2 and rSO2 with cross-clamp and CPB durations were negative. Conclusion:?pCO2 is not an early indicator of hypoperfusion in patients undergoing CPB in accordance withthe literature and the lactate level is a guiding parameter in reporting the perfusion status. We recommend the intraoperative use of cerebral oximetry to prevent the brain from being affected by hypoperfusion during CPB and to prevent postoperative neurocognitive disorders in patients.Öğe Evaluation of QT Interval of Patients Using Muscle Relaxants Under General Anesthesia, Randomized Clinical Trial(Sivas Cumhuriyet University, 2022) Kurt, Bekir; Gündoğdu, Oğuz; Avcı, Onur; Gürsoy, Sinan; Kol, İclal Özdemir; Kaygusuz, Kenan; İsbir, CemilObjective: The aim of the study was to investigate the effects of rocuronium, mivacurium, and atracurium on arrhythmia markers, QT interval, and QT dispersion (QTd).Method: Ninety patients scheduled for septorhinoplasty were randomly assigned to one of three groups of 30. During the induction of anesthesia, muscle relaxants of 0.6 mg/kg rocuronium in Group R, 0.2 mg/kg mivacurium in Group M, and 0.5 mg/kg atracurium in Group A were employed. Mean blood pressure (MAP), heart rate (HR), and electrocardiogram (ECG) values were measured before induction of anesthesia (T0), immediately after induction of anesthesia (T1), at 1 minute (T2), 5 minutes (T3), 10 minutes (T4) and 15 minutes (T5) after muscle relaxant administration, and QT, corrected QT (QTc), QTd and corrected QTd (QTcd) intervals were recorded. Results: When the groups were compared in terms of QTcd values, the difference between mivacurium and atracurium was significant in terms of T5 values, and atracurium (T5) QTcd was found to be shorter (p<0.05). Group M had 5 of the 6 measures with pathological QTc prolongation.Conclusions: Because the prevalence of pathological QTc is greater in mivacurium, further clinical trials should be conducted to challenge the use of mivacurium in individuals with a long QT interval.Öğe Evaluation of Ultrasound Guided Supraclavicular Block With Traditional Methods And Perfusion Index On Upper Extremity Surgeries(2020) Avcı, Onur; Gündoğdu, OğuzIntroduction: Ultrasound (USG) guided supraclavicular blockin upper extremity surgery is a popular approach. In recentyears, many studies have been published on the perfusion index(PI) in the evaluation of block success. The main objective ofthis study is to evaluate the success and efficiency of thesupraclavicular block with traditional methods (Pin-prick test,Modified Bromage Scale) and perfusion index.Materials and Methods: After the approval of the ethicscommittee (2018-11/01) was taken for the study; 30 volunteerpatients who were 18-75 years old with American Society ofAnesthesiologists (ASA) I-II scores undergoing a hand,forearm, arm surgery, were included in the study. In thisprospective study; after ultrasound-guided supraclavicular blockhas been applied by injecting local anesthetic that consists ofprilocaine 12.5 ml + bupivacaine 12.5 ml to all patients, sensoryblock was checked with pin-prick test every 3 minutes, motorblock was checked by using modified Bromage scale every 2minutes, hemodynamic parameters and PI values were recordedevery 5 minutes. Times of motor block onset and total motorblock onset, sensory and motor block ending time, the durationof block technique, the time of first postoperative analgesiaconsumption and positivity time for pin-prick test wererecorded.Results: When the measured perfusion index values werecompared, the differences were significant. When we comparedthe PI values in pairs, the differences between basal and 5 thmin, 10th min, 15th min, 20th min, 25th min, and 30th min weresignificant. Positivity time for pin-prick test was 8.83 ± 2.70min (minimum 5 minutes and maximum 15 minutes), motorblock onset time was 6.7 ± 2.89 min (minimum 2 minutes andmaximum 13 minutes), time of total motor block onset was10.83 ± 3.07 min (minimum 6 minutes and maximum 19minutes). In the 5th minute PI values, an average increase of148% was observed compared to basal PI values.Conclusion: As a result; the supraclavicular block providedfaster sensory-motor block than other upper extremity blocks.It was concluded that the perfusion index was faster, moreobjective and simpler method than traditional methods inassessing the block success, due to vasodilatation that occurredbefore sensory and motor block.Öğe Retrospective Evaluation of Optic Nerve Sheath Diameters of Patients Diagnosed with Brain Death(2023) Gündoğdu, Oğuz; Avcı, OnurPurpose: Purpose of this study is to reveal the relationship between optic nerve sheath diameter (ONSD) and the etiology of brain death and to investigate whether there is a correlation between ONSD and blood gas parameters before and after the apnea test in patients diagnosed with brain death. Materıals and Methods: The data of 92 patients with brain death diagnoses were retrospectively analyzed for ONSD measurements for each eye, partial carbon dioxide pressure (pCO2), and blood gas parameters before and after the apnea test. Results: Subarachnoidal and intracerebral hemorrhages were the two most common brain death etiology. The mean ONSD for the right eye was 6.37±1.03 mm. The mean ONSD for the left eye was 6.43±1.02 mm. Only 8 patients had ONSD below 5.00 mm. There was no statistically significant correlation between the percent change of pCO2 and ONSD change (p>0.05). Conclusion: The present study shows that ONSD values are very high regardless of the partial pressure of carbon dioxide in patients with brain death diagnoses. We can suggest that ONSD can find a place for evaluating comatose patients for brain death diagnosis.Öğe Sezaryen Gerekli Post-Covid Sağlıklı Gebelerde İntraoperatif Akciğer Mekanikleri: Randomize Kontrollü Çalışma(Sivas Cumhuriyet Üniversitesi, 2024) Balcı, Fatih; İsbir, Cemil; Gündoğdu, Oğuz; Avcı, Onur; Gürsoy, Sinan; Kol, İclal Özdemir; Kaygusuz, KenanAmaç:Bu çalışmanın amacı aktif enfeksiyon süresi boyunca akciğer görüntüleme yapılmamış ve ARDS olmadan Covid-19’dan iyileşen hastalarda akciğer mekaniklerinin etkilenip etkilenmediğini göstermektir. Yöntem:Hastalardan gebelerden oluşuyordu. Çalışma sezaryen ameliyatı sırasında yapılmıştır. Son 1 yıl içinde Covid-19 enfeksiyonu geçirip iyileşmiş gebeler ile Covid-19 enfeksiyonu geçirmemiş gebeler dahil edildi. Çalışmaya alınan 100 hasta iki gruba ayrıldı: Son 1 yıl içinde Covid-19 enfeksiyonu geçirip iyileşmiş hastalar(grup 1, n:50) ve kontrol grubu olarak hiç Covid-19 enfeksiyonu geçirmemiş hastalar(grup 2 n:50). Genel anestezi altında opere olan hastalarda MAP, HR ve SpO2 değerleri hasta takip formunda belirli zamanlarda ölçüldü ve kaydedildi. Entübasyon sonrası 1.dakikadan itibaren belirtilen zaman aralıklarında anestezi makinesi tarafından ölçülen tepe basıncı (Ppeak), plato basıncı(Pplato), dynamic compliance(Cdyn) ve positive end-expiratory pressure(PEEP) değerleri kaydedildi. Bulgular:Her iki gruptaki bireylerden belirli zamanlarda elde edilen Ppeak, Pplato, ΔP, Cdyn ve R verileri karşılaştırıldığında gruplar arası anlamlı fark bulunmamıştır. Grup 1 ve Grup 2’ye ait farklı zamanlarda elde edilen Pplato, ΔP ve R ölçümleri istatistiksel olarak anlamsız bulunmuştur. Sonuç:Covid-19 enfeksiyonu geçirmiş hasta grubu ile kontrol grubu bireylerinin akciğer mekanikleri arasında anlamlı fark yoktu. Her iki hasta grubunda SpO2, MAP, Cdyn değerlerdeki farklılıklar ; laringoskopi, endotrakeal entübasyon ve PEEP uygulama gibi genel anesteziye ait rutin uygulamalarla birlikte beklenen değişiklikler olarak düşünülmektedir.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.
