Browsing by Author "Demirkiran, Hilmi"

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Current Status of Nitrous Oxide Use in Operating Rooms of Turkey
(Kuwait Medical Assoc, 2023) Demirkiran, Hilmi; Tekeli, Arzu Esen; Yardimci, Cevdet; Korkutata, Zeki; Keskin, Siddik; Gulhas, Nurcin
Objective: Investigating the justifications of nitrous oxide (N2O) use in Turkey's hospitals and usage trends during the last five years. Design: A cross-sectional study Setting: A total of 170 university hospitals, training and research hospitals, state hospitals and private hospitals in Turkey. Subjects: Clinical chiefs of 170 anesthesia departments Interventions: A survey was conducted. The Kruskal-Wallis, Mann-Whitney U, Kolmogorov-Smirnov, Chi-square and Fisher tests were performed. This trial was registered at Clinical Trials.gov (NCT04124562). Main outcome measure(s): Hospital type, frequency of N2O use, how many times general anesthesia was used in a month, number of cases N2O was used on the day of the study, the status of N2O use by anesthetists in the last five years, and the reasons for its use were questioned. Results: N2O use combined with inhaled anesthetics was reported by 119 (72.1%) clinical chiefs of anesthesia departments. The mean number of general anesthesia cases in one month in 165 (84.1%) clinics included in this study was reported to be 95,044. The number of cases using N2O combined with inhalational anesthetics was 1401 (39.6%) in one day. Regarding N2O usage in the last five years, 68 (41.2%) anesthetists responded that their usage rate had decreased, 48 (29.1%) stated that they had stopped using, and 47 (28.5%) anesthetists responded that their usage rate was unchanged. Stopping or reducing N2O use due to environmental or global climate and pollution concerns were observed more frequently in the operating rooms of the university hospitals (P<0.05). Conclusion: Despite a reduced usage rate of N2O in Turkey, it is still higher than that of European countries.
The Effect of Low-Flow Versus Highflow Anesthesia on Postoperative Cognitive Functions in Geriatric Patients Undergoing Tur-P Surgery
(Turkish Geriatrics Soc, 2024) Unal, Ekin Anil; Comez, Mehmet Selim; Demirkiran, Hilmi; Koyuncu, Onur; Hakimoglu, Sedat; Urfali, Senem
Introduction: This paper investigates the effect of low -flow anesthesia applications on postoperative cognitive function in geriatric age group (>= 65 years old) patients who underwent elective transurethral resection of the prostate surgery. Materials and Method: A total of 98 patients aged 65 and over who underwent elective transurethral resection of the prostate surgery under general anesthesia between December 2021 and November 2022 in Hatay Mustafa Kemal University Research Hospital's Department of Anesthesiology and Reanimation were included in the study. The patients were subjected to a mini mental test the day before the operation and postoperatively at six hours, one day, three days, and seven days. Visual analogue scale scores were evaluated at 3, 6, 12, 24, 48, and 72 hours. The data obtained were compared between the patient groups who underwent low -flow (1 L/min, n: 49) and high flow (4 L/min, n: 49) anesthesia. P< 0.05 was considered statistically significant. Results: A comparison between the postoperative 6thhour, 1st day, 2nd day, 3rd day, and 7th day mini mental testing scores of the low -flow anesthesia and high flow anesthesia groups did not exhibit any notable variations (p: 0.668, 0.785, 0.745, 0.705, respectively). The visual analogue scale scores of the cases at 3, 6, 12, 24, 48, and 72 hours did not differ statistically according to the type of flow applied (p: 0.316, 0.925, 0.651, 0.548, 0.624, 0.466, respectively). Conclusion: It is thought that low -flow anesthesia can be applied safely, but it does not have a significant effect on cognitive functions compared to high flow anesthesia.
Endobronchial Tumors Presenting as Asthma
(Daedalus Enterprises inc, 2014) Arisoy, Ahmet; Ekin, Selami; Gunbatar, Hulya; Sertogullarindan, Bunyamin; Akdeniz, Huseyin; Bulut, Gulay; Demirkiran, Hilmi
Evaluation of Computed Tomography Angiography as an Ancillary Test To Reduce Confusion After Clinical Diagnosis of Brain Death
(Elsevier Science inc, 2021) Tekeli, Arzu Esen; Demirkiran, Hilmi; Arslan, Harun
Background. The diagnosis of brain death (BD) is mainly a clinical diagnosis. Ancillary tests may be used in confusing situations. Although computed tomography angiography (CTA) has high sensitivity and specificity, it can give false-positive results in cases with craniotomy. Objective. The aim of this study is to emphasize the importance of accurate and detailed clinical diagnosis and to reveal that there is organ loss as a result of prolonged supportive tests, especially in developing countries. Material and Methods. This retrospective study included patients who were diagnosed with BD in the intensive care unit of Van Y?z?nc? Y?l University, between September 2014 and August 2017 in Turkey. The study included 14 male and 8 female patients. Patients who did not show any spontaneous respiratory symptoms after the apnea test were diagnosed with clinical BD. Patients on neurodepressant medications who were hypothermic or hypoxic or had a severe endocrine or metabolic disorder were excluded from the study. CTA was used as an ancillary test in compliance with legal requirements. Age, sex, hospitalization days, day of clinical diagnosis of BD, first radiologic evaluation by CTA, clinical diagnosis, and radiologic evaluation were recorded for all patients. Results. Radiologic evaluation was not compatible with the clinical evaluation in 5 patients. Although 2 of these 5 patients had BD diagnosis clinically, blood flow could be expected during CTA because of cranial injury. Unlike in the literature, false positivity was found in 3 patients with hypoxic ischemic encephalopathy in the present study. Conclusions. Proper management of limited resources and the facilitation of cadaver organ donation in developing countries are important and humanitarian global responsibilities. Revision of the country?s legal regulations is important and is warranted in & nbsp;this regard.
Evaluation of Risk Factors in Patients With Ventilator-Associated Pneumonia Caused by Acinetobacter Baumannii
(Univ Udayana, 2020) Baran, Ali Irfan; Celik, Mehmet; Arslan, Yusuf; Demirkiran, Hilmi; Sunnetcioglu, Mahmut; Sunnetcioglu, Aysel
Purpose: Ventilator-associated pneumonia is a significant disease with high mortality rates. Acinetobacter baumannii is one of the most critical pathogens leading to ventilator-associated pneumonia. This study aims to evaluate the underlying risk factors in patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in intensive care units of our hospital. Patients and Methods: The data of 112 patients diagnosed with ventilator-associated pneumonia caused by Acinetobacter baumannii, who were followed in Intensive Care Units other than Pediatric Intensive Care Unit of our hospital from 2013 to 2017, were evaluated retrospectively. Results: Of the cases included in our study, 70.5% were male, and 29.5% were female patients. Of the cases, 875% were followed in Anaesthesiology and Reanimation Intensive Care Unit. The most common modifiable risk factors are mechanical ventilation, antacid use, and the most common non-modifiable risk factors were the presence of trauma and a history of cardiovascular disease. Conclusion: Ventilator-associated pneumonia is a clinical condition with high mortality and morbidity in intensive care units. Incidence and mortality of ventilator-associated pneumonia can be reduced through the implementation of some necessary policies for the prevention of ventilator-associated pneumonia and the practices for the reduction or elimination of modifiable risk factors.
Evaluation of the Incidence, Characteristics, and Outcomes of Pediatric Chronic Critical Illness
(Public Library Science, 2021) Demirkiran, Hilmi; Kilic, Mehmet; Tomak, Yakup; Dalkiran, Tahir; Yurttutan, Sadik; Basaranoglu, Murat; Oksuz, Hafize
Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.
Flow-Safe Disposable Cpap Efficiency in Cardiogenic Pulmonary Oedema
(W B Saunders Co-elsevier inc, 2020) Guia, Miguel; Demirkiran, Hilmi; Esquinas, Antonio
Fournier Gangrene: Association of Mortality With the Complete Blood Count Parameters
(Lippincott Williams & Wilkins, 2018) Demir, Canser Yilmaz; Yuzkat, Nureddin; Ozsular, Yavuz; Kocak, Omer Faruk; Soyalp, Celaleddin; Demirkiran, Hilmi
Background: The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis. Methods: Records of patients diagnosed with Fournier gangrene were analyzed retrospectively. Results: Seventy-four patients (49 men and 25 women) with a mean age of 57.60 +/- 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first debridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first debridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first debridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first debridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/mu l at admission and 196,000/mu l after the first debridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first debridement were defined as the cutoff levels having the best sensitivities and specificities. Conclusions: This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first debridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene.
İntraoperatif Anestezi İlişkili Mortalite: Bir Yükseköğretim Hastanesinde 10 Yıllık Bir Araştırma
(2021) Comez, Mehmet; Demirkiran, Hilmi
Purpose: This study aimed to determine anesthesia-related mortality and intraoperative mortality (IOM) incidences and the associated risk factors. Material and Methods: The operations between the years of 2010-2019 were retrospectively reviewed. It was found that 87 of 351,930 patients who were anesthetized in the last 10 years died. Each patient who died was recruited into one of the patient/condition-related, surgical-related, or anesthesia-related mortality groups. Patient characteristics were determined as age, gender, ASA PS score, and comorbidities. Surgical procedures were classified as minor/intermediate, major, and major complex. Anesthesia type was recorded. Operative time, the requirement for vasopressor and the invasive monitoring were determined. Results: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The IOM group had a higher rate of out-of-hours work, surgical emergency, prolonged operative time, high comorbidity rate, high ASA PS score, major complex surgeries, use of VP, and invasive monitoring. Surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (p: 0.000) were independent determinants of IOM. Major complex surgeries (p: 0.007), surgical emergency (p: 0.000), use of VP (p: 0.002), and invasive monitoring (0.000) were potentially associated factors in anesthesia-related mortality. Conclusion: The incidence of IOM and anesthesia-related mortality were 2.47 and 0.28 per 10,000 patients, respectively. The fact that anesthesia-related mortality was associated with drug administration is important for the development of preventive measures. Primary prevention may play a key role in reducing the high fatality. These results indicate the need for improving medical perioperative practices in high-risk and emergency patients
Kör Teknik ile Supraklavikülar Blok Uygulanan Hastalarda Bupivakain ile Levobupikainin’in Etkilerinin Karşılaştırması
(2018) Karaman, Haktan; Bahar, İlhan; Demirkiran, Hilmi
Amaç: Bu çalışmada kliniğimizde son zamanlarda sık kullanılmaya başlanan supraklavikular bloğun etkiniğilini değerlendirmeyi düşündük. Yöntemler: Çalışmaya alınan hastalarının tamamı kör teknik ile supraklavikülar blok uygulanan hastalardı. Hastalar iki gruba ayrıldı ve Grup levopubivakain (L); 25 hastaya levobupivakain (%0,5; 5 mg/ml) 20 ml üzerine 20 ml SF ile tamamlanarak 40 ml ve Grupbupivakain (B); 25 hastaya bupivakain (%0,5; 5 mg/ml) 20 ml üzerine 20 ml SF tamamlanarak 40 ml uygulanan hastalar dahil edildi. Hastalar; Amerikan anestezistler birliği (ASA) sınıflaması, yaş, cinsiyet, boy, kilo, motor blok başlama süresi, duysal blok başlama süresi, postoperatifaneljezik ihtiyacı ve komplikasyon açısından değerlendirildi. Bulgular: Her iki grup arasında: yaş, kilo, boy, cinsiyet, ASA açısından fark yoktu. Grup B hastalarında motor blok başlama süresi ortalama ± standart sapma (ort±ss) (5,15 ± 3,55) dakika bulunurken, Grup L deki hastaların motor blok başlama süresi ort±ss(9,3 7,1) dakika bulundu (p=0,01). Bupivakain gruptaki hastaların duysal blok başlama süresi ortalama 19,46 ± 11,10 dakika iken, levobupivakain gruptaki hastaların duysal blok başlama süresi ortalama 25,36 ± 11,15 dakika bulundu (p=0,04). Sonuç: Çalışmamızda bupivakain ile levopubikaine göre daha erken duysal ve motor blok sağlandığını ve kör teknik ile yapılan supraklavikuler bloğun deneyimli kişiler tarafından yapıldığında pnömotoraks açısından da güvenli bir uygulama olabileceğini bulduk
Prevalence and Clinical Features of Chronic Critical Illness in the Elderly Population in Turkey
(Gunes Kitabevi Ltd Sti, 2020) Demirkiran, Hilmi; Uzunoglu, Emine; Erdivanli, Basar; Karadamar, Ulas; KOc, Suna; Tomak, Yakup; Oksuz, Hafize
Objectives: The definition of chronic critical illness in the elderly has not yet been determined. The aim of the study is to determine the prevalence and clinical features of chronic critical illness in the elderly population in Turkey. Materials and Methods: Data from 16 intensive care units of public and private hospitals in Turkey were evaluated. Patients staying in the intensive care units for at least eight days between 2015 and 2017 and having at least one of the additional criteria were accepted as chronic critical illness and they were divided into two groups by age, those 65 and older and those under 65. Results: The chronic critical illness patient rate in the intensive care units was 10.7%. Of chronic critical illness patients in the intensive care units, 60.9% were 65 years of age and older, and the mortality rate of patients 65 years and older was 70%. The frequencies of ischemic stroke and sepsis, the number of patients with comorbidities, and the mortality rate were higher in patients over 65 years of age, while the frequency of traumatic brain injury, presence of a major wound, tracheostomy, length of hospital stay and cost of care were higher in patients under 65 years of age. Conclusion: We determined that prolonged mechanical ventilation, traumatic brain injury, tracheostomy and major wound presence in intensive care units patients 65 years and older increased hospital stay and costs. More work is needed to define chronic critical illness more clearly in elderly.
The Relationship Between Preoperative Smoking Cessation, Anxiety, and Postoperative Anxiety and Pain: a Prospective Clinical Trial at a University Hospital in the East of Turkey on 120 Participants
(Pakistan Medical Assoc, 2022) Tekeli, Arzu Esen; Demirkiran, Hilmi; Kacar, Cemal; Duzenli, Ufuk; Gulhas, Nurcin
Objective: To reveal the relationship between smoking cessation before surgery, pre- and post-operative anxiety, and pain among chronic smokers. Method: The cross sectional prospective clinical study was conducted in 2018 on the east of Turkey, in Van Yiiziincii Yil University Dursun Oda ba Medical Center in city of Van. After approval from the ethics committee participants of either gender aged 20-60 years scheduled to undergo rhinoplasty surgery and graded as American Society of Anaesthesiologists I-II were included.The participants were categorised into smokers group S and non-smokers group NS. Spielberger State-Trait Anxiety Inventory values for preoperative period, postoperative 0, which is the moment when the modified Aldrete score is >9, as well as for 2, 4 and 6 hours, and visual analogue scale values for the postoperative 0, 2, 4 and 6 hours were recorded. Data was analysed using SPSS 26. Results: Of the 120 patients, there were 60(50%) in group S; 28(46.7%) females, 32(52.3%) males, overall mean age 33.0 +/- 9.7 years. In group NS, there were 34(56.7%) females and 26(43.3%) males with an overall mean age of 34.7 +/- 10.1 years (p>0.05). Group S had Spielberger State Trait Anxiety Inventory preoperative and postoperative values significantly higher than group NS (p<0.05). While the values for postoperative 4 and 6 hours increased in group S, corresponding values decreased in group NS (p<0.05). Conclusion: High anxiety scores in preoperative period appeared to be associated with stress from surgery and anaesthesia and could have been caused by smoking dependency during the preoperative and postoperative periods.
Response To Letter To the Editor From Author, Brasil (transproc-1588) On: Evaluation of Computed Tomography Angiography as an Ancillary Test To Reduce Confusion After Clinical Diagnosis of Brain Death
(Elsevier Science inc, 2021) Tekeli, Arzu Esen; Demirkiran, Hilmi; Arslan, Harun
Severe Burnout Among Critical Care Workers in Turkey
(Saudi Med J, 2019) Elay, Gulseren; Bahar, Ilhan; Demirkiran, Hilmi; Oksuz, Hafize
Objectives: To determine the prevalence and risk factors for burnout in the intensive care units (ICU) staff in Turkey. Burnout is prevelant in physicians and nurses in the ICU worldwide. Most ICU workers with burnout plan to leave their professions. Frequent replacement of ICU staff increases cost and decreases the quality of care. Prevalence and risk factors of burnout in ICU staff in Turkey are largely unknown. Methods: This is a cross-sectional study. Data were gathered using the Maslach Burnout Inventory (MBI) which was distributed during August 2018, among all 1161 ICU workers in Turkey. Results: Burnout was detected in at least one subscale in 99% of participants and in all 3 subscales in 15% of the participants. Risk factors for emotional exhaustion included female gender (odds ratio [OR]=1.87 [95% CI: 1.26-2.78]; p<0.01), alternate-day shift (OR=3.93 [95% CI: 1.66-9.30]; p<0.01), and incidence of end of life care (OR=1.01 [95% CI: 1.00-1.03]; p<0.01). For depersonalization it included alternate-day shift (OR=2.22 [95% CI: 1.15-4.26]; p<0.05), incidence of end of life care (OR=1.02 [95% CI: 1.01-1.03]; p<0.01), and for reduced personal accomplishment it included incidence of end of life care (OR=0.97 [95% CI: 0.96-0.98]; p<0.01). Conclusion: The results indicated that ICU staff in Turkey had a high rate of burnout.
Türkiye’de Ameliyathane Çalışanlarının Anestezi Tercihleri
(2020) Demirkiran, Hilmi; Eker, Esra; Demir, Canan; Bartın, Mehmet Kadir; Tekeli, Arzu Esen
Amaç: Anestezi uygulamaları ile her gün karşı karşıya olanameliyathane çalışanlarının kendileri ya da yakınları ile ilgili bircerrahi gerektiğinde hangi anestezi yöntemini tercih ettiklerinive nedenlerini ortaya koymak.Gereç ve Yöntem: Yarı yapılandırılmış sorulardan oluşan biranket, teknolojik iletişim yöntemleri ile (internet üzerindenGoogle forms, messenger, whatsapp gibi) Türkiye’nin farklıbölgelerinde ve farklı hastanelerinde görev yapan 1000ameliyathane çalışanına ulaştırıldı. Yaş, cinsiyet, meslek vesüresi, kendilerine anestezi uygulanıp uygulanmadığı,uygulandı ise yöntemi, hangi anestezi yöntemini neden tercihedecekleri ya da etmeyecekleri ve hangi anestezi yönteminineden önereceklerini kapsayan sorular soruldu.Bulgular: Yaşları 20 ila 60 arasında değişen katılımcıların%51.2’sini (n=327) erkekler, %48.8’ni (n=312) kadınlaroluşturuyordu. Katılımcıların % 69’u (n=440) herhangi birnedenle kendilerine anestezi uygulandığını belirtirken %31’i(n=199) anestezi uygulanmadığını ifade etti. Katılımcılar içingenel anestezi, rejyonal anestezi, periferik sinir bloğuyöntemlerinin üçünün de uygun olduğu cerrahi işlemlerdetercihin % 47 ile rejyonal anestezi (spinal, epidural, kombinespinal epidural anestezi) yönünde olduğu anlaşıldı.Yakınlarınıza ve hastalarınıza hangi anestezi yöntemini tavsiyeedersiniz sorusuna ameliyathane çalışanlarının cevabı rejyonalanestezi ağırlıklı olmuştur.Sonuç: Bu çalışmada Türkiye’de ameliyathane çalışanlarınındaha çok rejyonal anestezi tercih ettiğini saptadık. Daha genişkatılımlı çalışmalar ile anestezi tercihlerinin ne yöndeolacağının öğrenilebileceği ve bu durumun iş gücü ve maliyetplanlaması açısından da önemli olabileceği kanısındayız.