Objectives This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge. Patients and methods This prospective randomized double- blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg -1 ketamine (group K1), 1 mg.kg -1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded. Results Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups. Conclusion Intraarticular injection of 0.5 mg.kg -1 and 1 mg.kg -1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.
Objectives:We aimed to evaluate the anesthetic approaches of patients who underwent surgery in our hospital during the early COVID-19 pandemic period. Methods: All patients admitted to general surgery (GS), orthopedics, neurosurgery (NS), urology, cardiovascular surgery (CVS), thoracic surgery, ear nose throat, and plastic and reconstructive surgery at the operating rooms in our hospital in early pandemic periods were scanned retrospectively. Demographical data, surgical indications, urgency, anesthetic methods, and complications are evaluated. Anesthetic methods used in the operations were examined as general anesthesia, regional anesthesia, and sedoanalgesia. In addition, patients' hospital stay period, intensive care unit admission rate, 30 days mortality, and COVID-19 positivity after surgery were examined. Results: Two hundred and ninety patients were admitted for operation in our hospital during a pandemic. CVS, Orthopedics, and GS were departments that admitted the most number of patients with ratios of 27.2%, 26.2%, and 25.2% respectively. The patients who underwent emergency surgery were seen in the CVS with 79 patients and the orthopedics with 73 patients. In anesthesia management, the application rate of general anesthesia was 44.1%, regional anesthesia 33.1%, and sedoanalgesia 22.8%. Totally 61 patients were admitted to ICU. According to surgical branches, 30-day mortality rates were determined as 8.3% in NS, 6.6% in GS, 3.8% in CVS, and 2.7% in orthopedics respectively. 4 patients were postoperative COVID-19 positive in total. Conclusions: Anesthetic approaches in surgical patients may affect the length of hospital stay, referral to the intensive care unit, and mortality in the early period of the COVID-19 pandemic.
Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic. Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours. Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.
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Serebral palsili çocuklar sıklıkla var olan nörolojik hasar nedeniyle çiğneme ve yutma güçlüğü yaşamaktadır. Bu nedenle malnütrisyon için önemli bir risk grubunu oluştururlar. Fiziksel malformasyonları ve ek hastalıkları nedeniyle anestezi yönetimi diğer çocuk hastalara göre daha zordur. Çalışmamızda serebral palsili çocuklara yapılan perkütan endoskopik gastrostomi işlemleri sırasında ameliyathane dışı prosedüral sedasyon uygulamalarını değerlendirmeyi amaçladık. Mayıs 2017 ile Haziran 2021 tarihleri arasında ameliyathane dışında endoskopi ünitesinde prosedüral sedasyon ile perkütan endoskopik gastrostomi işlemlerinin gerçekleştirildiği 0-18 yaşları arasındaki hastalar retrospektif olarak değerlendirildi. Toplam 21 serebral palsili hasta ve 30 girişim değerlendirildi. Tüm hastalarda perkütan endoskopik gastrostomi uygulamasının temel endikasyonunu yutma güçlüğü ve malnütrisyon oluşturuyordu. Hastaların %26,6’sı (n=8) ASA skoru 2, %73,3’ü ise (n=22) ASA skoru 3 risk grubu olarak değerlendirildi. Hastaların %73,3’ünün (n=22) vücut ağırlığı
Objective: In this study, it was aimed to compare various parameters during surgery and postoperative cognitive functions in patients undergoing coronary artery bypass graft (CABG) surgery using different levels of perioperative oxygen. Methods: One hundred patients scheduled for elective CABG surgery were included in the study. The patients were divided into two groups according to arterial oxygen levels during surgery. In the normoxia group (NG) (n = 50), PaO2 was between ≥100mmHg and <180mmHg with at least 40% FiO2 mechanical ventilation (MV), and in the hyperoxia group (HG) (n = 50), PaO2 was ≥180 mmHg with 100% FiO2 MV. Hemodynamic parameters, peripheral oxygen saturation (SpO2), cerebral oxygen saturation (rSO2) measured from bilateral sensors, and blood gas values were recorded at the planned measurement times. Mini-mental state examination test (MMSE) was applied to the patients before and at the 12th, 24th hours; on the 1st, 3rd, 6th months after surgery. Results: Extubation time was found to be shorter in NG (p <0.05). Between the groups, rSO2 and mean arterial pressure (MAP) were found to be significantly lower in HG at the time of T4 measurement (p = 0.042, p = 0.038, respectively). MMSE values of the groups at the 1st, 3rd and 6th months were found to be significantly higher in NG (respectively p = 0.017, p = 0.014, p = 0.002). Conclusion: Hyperoxemia application during CABG may be associated with worse postoperative late-term cognitive functions. Keywords: cardiopulmonary bypass; hyperoxia; postoperative complications; cognitive function; spectroscopy, near-infrared.
Sezaryen; fetüs, plasenta ve zarlarının batın ve uterustan yapılan insizyonlardan doğurtulmasıdır. Çalışmamızda Ocak 2012 – Aralık 2013 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Hastanesi’nde mesai saatleri içinde ve dışında alınan sezaryen olgularında sezaryen endikasyonlarını, uygulanan anestezi tekniğini ve teknik seçimini etkileyen faktörleri belirlemeyi amaçladık. Etik kurul onayı sonrası sezaryen olan 1025 olgunun ve doğan bebeklerinin demografik verileri, sistemik hastalıkları, sezaryen endikasyonları, anestezi tekniği retrospektif olarak kaydedildi. Mesai içi/dışı saatler tanımlanarak olgular gruplandırıldı. Olguların %51.3’ünün mesai içinde, %48.7’sinin mesai dışında alındığı çalışmamızda genel anestezi %76.4, spinal anestezi %14.4, kombine spinal epidural (KSE) anestezi %6.2, epidural anestezi %3 oranlarında uygulanmıştı. Spinal ve genel anestezi uygulanma oranı mesai içinde ve dışında eşitken, KSE anestezi uygulanma oranının mesai içinde daha fazla olduğu saptandı (p=0,003). Rejyonal anestezilerin %91.3’ü başarılı %8.7’si başarısızdı. Başarısız rejyonal anestezi oranı her iki grupta da benzerdi. Mesai içi sistolik ve diyastolik arter basınçları (SAB/DAB) daha düşük (p=0.001, p
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