Browsing by Author "Demirkiran, H."

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Discharge From Hospital To Home Care
(Springer International Publishing, 2021) Demirkiran, H.; Oksuz, H.
The care levels, locations, and transfers of patients during discharge are critical processes. Out-of-hospital discharge with ventilation support is associated with high mortality. Among the factors determining the success of HMV, the indication for HMV, current stage of disorder, comorbid conditions, likely progression of the disorder, and the level of dependency on ventilator support can be counted. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.
The Effects of Different Doses of Ketamine on Renal Ischemia/Reperfusion Injury in Rats
(Yuzuncu Yil Universitesi Tip Fakultesi, 2019) Demirkiran, H.; Senoglu, N.; Oksuz, H.; Dogan, Z.; Yuzbasiogu, F.; Bulbuloglu, E.; Yardimci, C.
In the patients who have perioperative renal failure risk, anesthetical substances should be choosen with caution to protect the function of kidneys. Ketamine, an anesthetic induction agent, is generally used in patients with severe hypotension or respiratory depression. We aimed to evaluate the different doses of ketamine’s effects on ischemia/reperfusion (I/R) damage mediated by free radicals in rats. Materials and methods: In this study, 42 Wistar albino male rats were splitted randomly into 7 different groups. In the ketamine group, ketamine was applied intraperitoneally (IP) in different doses (3 mg kg־1, 10 mg kg־1, 30 mg kg־1, 60 mg kg־1, 80 mg kg־1) on the 45 th minutes. Clamps were opened at the end of 60 minutes ischemia period. At the end of the reperfusion period, renal tissue and blood samples were taken from the rats. In the plasma samples, pro-inflammatory biomarkers [Interleukin (IL)-1β, IL-6, tumour necrosis factor alpha (TNF-α)] were analysed. In renal tissue samples, antioxidating activities [Superoxide dismutase (SOD), glutathione perox idase (GPx) and nitric oxide (NO)] and lipid peroxidation product “Malondialdehyde (MDA)” levels were studied biochemically. Renal tissue damage was evaluated histopathologically. There were no differences among the beneficial effects of ketamine given gro ups (10-30-60-80 mg kg־1 doses) before reperfusion in the way of antioxidant activities, pro-inflammatory markers and lipid peroxidation product. When ketamin was applied in 3 mg kg־1 there were beneficial effects on tissues in the way of SOD, GPx, NO, MDA values and histopathologically (p<0.05). Some studies have shown that ketamine has little anti-inflammatory properties. This animal study has shown that ketamine in low doses significantly reduces the I/R injury in rats (p<0.05). © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Our Five Years’ Experience on the Patients With Brain Death Diagnosis: Two Centered Retrospective Study
(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Andic, O.; Demirkiran, H.; Bahar, I.; Tekeli, A.E.; Gulhas, N.
Brain death (BD) diagnosis is a clinical diagnosis, but in many countries, other confirmatory tests are obligatory. The study was aimed to investigate the clinical effects of the current process of BD in Turkey. This study was performed retrospectively by evaluating BD-diagnosed patients’ files and computer records in the Van Yuzuncu Yil University Hospital’s Anesthesiology Intensive Care Unit (ICU) and in a Private Istanbul Hospital’s general ICU. This study was conducted between 2012 and 2017 in Turkey. Of the 57 patients included in the study, 63.2% were male (n = 36), and 36.8% were female (n = 21). The most common causes of hospital admissions were cerebral hemorrhage (38.6%; n = 22) and trauma (36.8%; n = 21). Of the patients who accepted organ transplantation, 80% (n = 4) were diagnosed at an average of 60 hours (min 24, max 120). The rates of using imaging methods in the clinical diagnosis of BD were as follows: 75.4% (n = 43) for Computerized Tomography Angiography (CTA), 17.6% (n = 10) for Magnetic Resonance Angiography (MRA), and 7% (n = 4) for Transcranial Doppler (TD) Ultrasonography. Of the patients, 8.78% (n = 5) were used as donors. Studies in the literature have indicated that the short duration of BD diagnosis will lead to an increase in organ donation acceptance rates. This study found that the diagnosis time was longer than presented in the literature and that CTA was the most commonly used imaging modality in addition to the apnea test. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Predictive Risk Factors for Intensive Care Unit Mortality in Acute Exacerbations of Copd Requiring Invasive Mechanical Ventilation
(Yuzuncu Yil Universitesi Tip Fakultesi, 2022) Sunnetcioglu, A.; Çilingir, B.M.; Çelikel, M.; Bedirhanoğlu, S.; Demirkiran, H.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently necessitate intensive care unit (ICU) admissions. The purpose of this study is to determine risk factors for ICU mortality in AECOPD who required invasive mechanical ventilation (IMV). Patients requiring IMV for AECOPD between January 2013 and March 2019 were retros pectively reviewed. Patients’ characteristics, comorbidities, and laboratory results were reviewed from the medical charts. Subjects’ acute physiology and chronic health evaluation (APACHE) II score, Glasgow Coma Scale (GCS), IMV (days), and mortality were recorded. As an output or dependent variable, ICU mortality was considered. Other variables were considered to independent factors or risk factors. Then, Logistic regression analysis was performed to determine risk factors for ICU mortality in AECOPD. The study, 134 patients were included. The mean duration of IMV were 11.6 ± 12.2 days. The ICU mortality were 51.4 %. On admission to ICU, patients had APACHE-II scores of 23.0 ± 6.2. Nonsurvivors had lower blood Mg levels ( 1.8 ± 0.2 mmol/L, p = 0.002), lower blood Ca levels (8.0 ± 0.7 mg/dL, p = 0.005), higher Uric Acid, (8.5±3.8 mg/dl, p = 004), higher CRP levels (87.2 ± 71.8 mg/dl, p = 0.048), higher leukocyte count (14.7 ± 10.2 103L, p= 0.040), higher serum lactate (2.3 ± 1.7 mmol, p = 0.003) compared to survivors. APACHI score and uric acid level were found statististically significant risk factors for ICU mortality. © 2022, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Thiopenthal for Propofol Related Extrapyramidal Movements: Case Report
(Yuzuncu Yil Universitesi Tip Fakultesi, 2018) Demirkiran, H.; Dalkilinç, B.; Yardimci, C.; Soyalp, C.; Yuzkat, N.; Kiliç, M.
Many drugs are used in outpatient anesthesia procedures. One of them, propofol, is used frequently because of its advantages like fast effect and short duration. Involuntary tonic-clonic movements similar to epilepsy are rarely seen when using propofol. A 41-year old male patient weighing 80 kg and admitted with acute appendicitis presented hemiballismus like severe extrapyramidal movements in all his extremities when propofol was administered. In this article, we discuss how we treated these undesired propofol side effects. © 2018, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Using Propofol for Flexible Bronchoscopy
(Yuzuncu Yil Universitesi Tip Fakultesi, 2015) Arısoy, A.; Demirkiran, H.; Ekin, S.; Gunbatar, H.; Asker, S.; Sertogullarindan, B.
Propofol is a sedative-hypnotic drug with rapid onset and recovery time. There are limited number of studies in which propofol was used for bronchoscopy. In this current study, we evaluated our patients who received propofol sedation for bronchoscopy in our clinic and investigated the usefulness of the procedure for both patients and physicians We prospectively evaluated patients who had bronchoscopy in our clinic between 2012 January and 2013 January. We recorded demographic features, indications for bronchoscopy, procedures of bronchoscopy, duration of the procedures, minor and major adverse events and hemodynamic parameters of the patients. All patients were monitored until they were discharged from the bronchoscopy unit. In total, 97 patients were included in the study. The mean age of the participants was 65 years, 60 of them were male (61%) and 37 were women (39%). Major indications were lung lesions that were suspected to be central or peripheral lung cancer. Other indications were mediastinal-hilar lymph nodes, hemoptysis, tuberculosis, atelectasis, chronic cough and tracheomalacia. Mean propofol dose was 90 mg in patients who had biopsy and 70 mg for those who did not have biopsy. Mean duration of the procedure was 14 minutes in those who had biopsy and 10 minutes in those who did not have biopsy. One patient had epistaxis after receiving topical lidocaine and two patients had respiratory arrest that required ambulation with a mask. Thirty-five patients (36%) had desaturation, which was reversed by providing adequate oxygenation. Propofol is a useful and applicable sedative-hypnotic for patients and physicians for fiberoptic bronchoscopy. © 2015, Yuzuncu Yil Universitesi Tip Fakultesi, Universitas Indonesia. All rights reserved.