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Objective: In this study, the demographic data of the patients hospitalized in the Intensive Care Unit (ICU) were evaluated, mortality rates of the older adults (65 years and over) and young adults (below 65 years) were compared. Material and Methods: The files of 2098 patients hospitalized and treated in the Intensive Care Unit between January 1, 2008 and December 2, 2009 were retrospectively reviewed. Results: Of the patients, 51% were above 65 years of age (n=1070), the mean age was 76.27±6.85 years (65-108), 50.47% were males (n=540) and 49.53% were females (n=530). The discharge diagnosis from ICU for patients who were ≥65 years of age included death in 580 (54.20%) patients, total cure in 10 (0.94%) patients, no change in 10 (0.94%) patients, refusal of treatment in 6 (0.56%) patients, referral to other hospitals in 28 (2.62%) patients and transfer to the wards in 436 (40.74%) patients. The mortality rate for patients ≥65 years of age was 54.2% (n=580), while the mortality rate was 37.0% (n=380) in those younger than 65 years of age (p<0.001). Conclusion: The patients hospitalized in the Intensive Care Units need to be evaluated for mortality and morbidity, and a better quality of life can be targeted for the elderly by taking preventive measures. We believe that larger studies are needed to evaluate this issue. © 2013 by Türkiye Klinikleri.

Ozturk S.,Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi | Ozturk I.,Anesteziyoloji ve Reanimasyon Klinigi | Ilhan S.,Uludag University | Ozgur A.,Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi
Turkish Journal of Thoracic and Cardiovascular Surgery | Year: 2015

Background: In this review, we aimed to analyze the efficacy of C-reactive protein levels measured in preoperative period on detection of postoperative atrial fibrillation developing after cardiac surgery. Methods: Literature screening was performed at Pubmed database without date limitation. The results of trials were evaluated with random or fixed effect model according to the heterogenity. The statistical evaluation was performed by using Comprehensive Meta Analysis version 2 software. Results: Twenty-five articles containing the inclusion criteria and a total of 4,058 patients were included to the meta-analysis. Effect sizes were heterogeneous (Q=135.80, df(Q)=24, p=0.00, I2=82.32%). Results of analysis according to random effect model were OR=1.52, 95% CI 1.11-2.06, Z=4.48 and p<0.05. Conclusion: The analysis results showed that levels of preoperative standard serum C-reactive protein, not high sensitivity C-reactive protein, were associated with postoperative atrial fibrillation developing after cardiac surgery.

Bayram I.,Anesteziyoloji ve Reanimasyon Klinigi | Beyaz S.G.,Anesteziyoloji ve Reanimasyon Klinigi | Senturk Y.,Eskiehir Osmangazi University
Turkiye Klinikleri Journal of Medical Sciences | Year: 2010

Objective: Postoperative shivering is a common problem observed in 5-70 % of patients and it decreases patient comfort and causes postoperative complications. This study is planned in order to investigate the effects of cyproheptadine hydrochloride in prevention of postoperative shivering. Material and Methods: The study included 44 patients undergoing nasal surgery. While 21 patients were administered 10 mg of cyproheptadine, remaining 23 patients were administered placebo 45 minutes before surgery. Neuromusculer blockade was achieved using 0.5 mg/kg of atracurium in all of the patients following an anesthesia induction with 2-3 mg/kg of propofol followed by 0.5 μg/kg of remifentanil. Ambient temperature of 22-24 °C was provided in the operating room during surgery. Systolic and diastolic blood pressures, heart rates and body temperatures of the patients were measured pre, post and perioperatively. Postoperative shivering in extubated patients was determined using a five-graded scale at the end of the surgery. Results: Although postanesthetic shivering was found lower in cyproheptadine group (29 %) compared to placebo group (52%), the difference was not statistically significant (p>0.05). Intensity of shivering was found similar in both groups (p>0.05). Intraoperative and postoperative mean body temperatures did not show a statistically significant difference between groups (p>0.05). Conclusion: Ten mg of cyproheptadine administered as a single dose 45 minutes before surgery did not reduce postanesthetic shivering. Further studies with different dose combinations and larger series are needed for a stronger conclusion. © 2010 by Türkiye Klinikleri.

Objective: Chronic atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing open-heart surgery. In this study, we compared the results of irrigated monopolar and bipolar radiofrequency (RF) ablation in the surgical treatment of AF. Methods: Sixty-three patients with chronic AF, who underwent open cardiac surgery and concomitant irrigated RF ablation between October 2004 and January 2006, were retrospectively studied in two groups. Group 1 included 31 patients (22 female, 9 male), who underwent monopolar RF ablation, and Group 2 included 32 patients (18 female, 14 male), who underwent bipolar RF ablation. All patients received amiodarone during the first 6 months after surgery. Rhythm status of patients after RF ablation was followed-up postoperatively in the intensive care unit, on the day of discharge, and at their follow-ups with electrocardiography. In patients with a documented sinus rhythm (SR) at follow-up, the presence of atrial transport function was assessed with transthoracic echocardiography. Statistical analyses were performed by using t-test for independent samples, Chi-square test and McNemar's test. Complication-free survival during follow-up was evaluated using Kaplan-Meier analysis. Results: There was no hospital mortality in both groups. One patient from Group 1 had non-cardiac mortality (colon carcinoma). While in monopolar ablation group SR was documented in 83.3% of patients at a mean follow-up period of 11.5±4.0 months (between 4-18 months), 68.8% of patients from bipolar ablation group was in SR at a mean follow-up period of 9.3±3.0 months (between 4-15 months). In patients with docu kullamented SR during follow-up visits, atrial transport function was 76.6% in cases undergoing monopolar ablation, whereas it was 72.7% in cases undergoing bipolar ablation (p=0.797). Pacemaker implantation was performed in one (3.4%) patient from Group 1 after hospital discharge and in one (3.1%) patient from Group 2 during hospital stay. Conclusion: Irrigated monopolar and bipolar RF ablation are both safe and effective in terms of restoring SR and atrial transport function in patients with chronic AF, who underwent open cardiac surgery. © 2011 by AVES Yayincilik Ltd.

Dogru S.,Anesteziyoloji ve Reanimasyon Klinigi | Dogru H.Y.,Kadin Hastaliklari ve Dogum Klinigi
Goztepe Tip Dergisi | Year: 2012

Aim: The aim of this study is to determine the complications of spinal, epidural and combined spinal-epidural anaesthesia in patients who received elective surgery. Materials and Methods: In this study, 113 patients, 18-60 years of age and ASA 1-11, were randomized into 3 groups. Before regional anaesthesia, crystalloid solutions (10 ml/kg IV) were administered to patients for hydration and midazolam (0.03 mg/kg IV) for sedation. For spinal anaesthesia (Group S) hyperbaric bupivacaine (%0.5 15 mg) H'ai used. For epidural anaesthesia (Group E), 70 mg levobupivacaine and 100 mcg fentanyl were used. In combined spinal-epidural anaesthesia, 10 mg levobupivacaine and 50 mcg fentanyl for spinal anaesthesia. 35 mg levobupivacaine and 50 mcg fentanyl for epidural anaesthesia were used. Sensory block and motor block levels were evaluated by "Pin-Prick" test and "Bromage" scale respectively. Before regional anaesthesia, after regional anaesthesia and end of the surgery, the parameters SAP, DAP, MAP, HR were recorded at every 5 minutes. Peroperative and postoperative neurological complications (paraplegia, caiida equina syndrome, radiculopathy), hemodynamic complications (hypotension, syncope, bradycardia, cardiac arrest), back pain, headache, findings of infection (local, meningitis), tinnitus, metallic taste, itching were recorded. At the end of surgery, the duration of surgery was recorded. Results: While comparisons between age, ASA and operation times of groups revealed significant differences, distribution of demographic values were similar. Comparison between SAP before regional anaesthesia, and 30., 40., 50. and 60. min -DAP, MAP before regional anaesthesia, and 70., 60., and 70. min- HR values of groups were found significant (p<0.05). Rates of complications in the spinal anaesthesia group were headache (11.6%), back pain (2.3%), nausea-vomiting (9.3%), bradycardia (4.7%), itching (2.3%), while in the epidural anaesthesia group back pain (5.3%), bradycardia (2.6%), and itching (34.2%) were detected in indicated frequencies. The corresponding frequencies of these latter complications in the combined spinal-epidural anaesthesia group.were 6.3, 6.3, and 14.2%, respectively. Conclusion: In this study several complications of central blocks such as headache (4.4%), back pain (4.4%), nausea and vomiting (3.5%), bradycardia (4.4%) and itching (14.2%) were observed.

Isil C.T.,Sisli Etfal Egitim ve Arastirma Hastanesi | Ulufer Sivrikaya G.,Anesteziyoloji ve Reanimasyon KlinigI | Erol M.K.,Anesteziyoloji ve Reanimasyon KlinigI | Eksioglu B.,Anesteziyoloji ve Reanimasyon KlinigI | Hanci A.,Anesteziyoloji ve Reanimasyon KlinigI
Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi | Year: 2011

Objective: In our study we aimed to compare the occurrence of residual curarization after extubation based on clinical observation with antagonization using neostigmine in patients randomized into rocuronium or atracurium groups. Material and Method: Sixty fve patients in physical status ASA I-II group undergoing abdominal hysterectomy were randomly assigned to two groups as rocuronium 0.6 mg kg-1 (Group R) or atracurium 0.5 mg kg-1 (Group A). At the end of the operation all patients were antagonized with neostigmine, and extubated according to clinical extuba-tion criteria. TOF values at the time of extubation and at 1., 3., 5., 10. minutes after extubation, duration of operation and anaesthesia, total fentanyl, neuromuscular blocker agent, and neostigmine doses were recorded. Results: Demographic characteristics of the patients, duration of operation and anaesthesia, total fentanyl, neuro-muscular blocker, and neostigmine doses were similar in two groups. TOF ratio at the time extubation was <0.7 in all patients extubated according to clinical observation criteria. Although TOF ratio was signifcantly lower in Group R compared to Group A at the time of extubation and 1., 3. min after extubation (p<0.05), there were no signifcant differences at the other time intervals. In all patients time to a TOF ratio of ≥0.7 and ≥0.9 were 5. min and 10. min respectively in patients extubated based on clinical observation. Conclusion: In our study, we concluded that TOF monitorization is a useful method in determination the presence, and also prevention of residual curarization and the incidence of residual blockade was found to be similar after administration of either rocuronium or atracurium following reversal with neostigmine.

Aim: In this study,we aimed to evaluate the agents and their antibiotic sensitivity which is isolated from intensive care unit. Material and Method: Microorganisms were identified by conventional methods, antibiotic susceptibilities were determined by using Kirby-Bauer disk diffusion method and evaluated according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Results: Gram-negative isolates accounted for 57.9% of all isolates. The most ferquently isolated bacteria was coagulasae negative Staphylococcus (23.9%), followed by Esherichia coli (18.1%) and Pseudomonas spp. (15.9%) respectively. Methicillin resistance rate of S. aureus was 63%.The most active antibiotics against the majority of gram-negative isolates were carbapenems and amikacin. Discussion:These data can be used to help improve selection of empiric antibiotics for the intensive care unit infections.

Krbas A.,Kalp Damar Cerrahisi Klinig | Tanrikulu N.,Anesteziyoloji ve Reanimasyon Klinigi | Us M.,Kalp Damar Cerrahisi Klinig | Isk O.,Kalp Damar Cerrahisi Klinig
Journal of Clinical and Analytical Medicine | Year: 2015

Aortopulmonary fistula associated with endocarditis complicating mechanical aortic valve replacement has been reported but very limited reports of aortopul-monary fistula following native aortic valve endocarditis in the literature. A 60 year old female presented to our hospital with high fever, dyspnea symptoms over two days. We suspect the endocarditis that Staphylococcus aureus was isolated from blood cultures. Echocardiogram and cathaterization showed that severe aortic regurgitation, aortopulmonary fistula.We urgently performed the aortic valve replacement and closure of both side of fistula with the Contegra® patch.The patient developed multiorgan failure as a cause of death at postoperative 63.day. © 2015, Journal of Clinical and Analytical Medicine. All rights reserved.

Objective: This study aimed to compare the effects of dexmedetomidine and propofol infusion on block and postoperative analgesic characteristics of peripheral nerve block in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach. Material and Methods: After local ethics committee approval and patients' written informed consents were obtained, 40 patients between the ages of 18-65 years, with an American Society of Anesthesiologists (ASA) classification I-II, and underwent surgical procedures due to fractures below the knee, were included in the study. The patients were randomly divided into dexmedetomidine (Group D, n=20, 0.5 μg/kg/min) and propofol (Group P, n=20, 3 mg/kg/h) infusion groups. The patients' demographic data, sciatic-femoral block start and end times, intraoperative visual analog scores (VAS) and duration of postoperative analgesia were recorded. Results: Demographic data were similar in two groups. The amount of intraoperative fentanyl need was lower in Group D than that in Group P (42.50±73.04 μg vs 125.00±83.50 μg; p=0.002). Times to start of sciatic and femoral blocks of Group D were significantly shorter than Group P (p<0.001 for each). Duration of termination of the sciatic-femoral block and postoperative analgesia were similar in two groups. Patients with inadequate block the formation, in the event of sedation or deep sedation were excluded. Conclusion: Substitution of dexmedetomidine with propofol prolongs the time to sedation and sedation duration, shortens the time to beginning of sciatic femoral nerve block, decreases the intraoperative VAS score and the need for intraoperative fentanyl. © 2014 by Türkiye Klinikleri.

Corman Dincer P.,Marmara University | Unsel M.,Anesteziyoloji ve Reanimasyon Klinigi | Yumru C.,Anesteziyoloji ve Reanimasyon Klinigi
Marmara Medical Journal | Year: 2013

Objectives: To evaluate the changes in arterial oxygenation and vital parameters by applying 10cm H2O positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%N2O-40%O2, 4L.min-1 flow and 0.7-1.0 minumum alveolar concentration (MAC) sevofurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm H2O in PEEP 0 group and at 10 cm H2O in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kg-1 were kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p<0.05). Pulse rate in both groups was significantly low during the prone period compared to other periods (p<0.05). PaO2 and compliance were statistically high in PEEP10 group at the prone position as compared to the PEEP 0 group (p<0.05). Conclusion: In our opinion, applying 10 cm H2O PEEP to patients undergoing spine surgery in the prone position is a beneficial implementation.

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