Browsing by Author "Gulhas, Nurcin"

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Comparison of Ketamine, Fentanyl and Remifentanyl in Terms of Sedoanalgesia for Colonoscopy: a Randomized Prospective Double-Blind Study
(Galenos Yayincilik, 2019) Simsek, Lokman; Yuzkat, Nureddin; Soyalp, Celaleddin; Gulhas, Nurcin
Aim: The aim of this study was to compare the effects of fentanyl, remifentanyl and ketamine applied for analgesia during colonoscopy on hemodynamics and sedo-analgesia quality. Methods: A total of 81 patients, who were scheduled for elective colonoscopy, were included in the study. Groups were randomized according to closed envelope method. Group K received 0.5 mg/kg ketamine, group F, 1 mu g/kg fentanyl, and group R received 1 mu g/kg remifentanil. Anaesthetist administered the analgesic agents at a dose of 1 mL/10 kg body weight without knowing the ingredient. Hemodynamic variables, total amount of propofol consumed, time of the endoscope to reach the cecum, and duration of colonoscopy were recorded. After the procedure, Modified Aldrete Score, patient, colonoscopist and anesthesiologist satisfaction were evaluated. Statistical analysis of the data was performed. Results: The demographic characteristics of the patients included in the study and the distribution of the patients between the groups were similar. There were no significant differences in duration of colonoscopy, hemodynamic changes, oxygen saturation, satisfaction scores, quality of analgesia, recovery and recovery after the procedure between the groups. Conclusion: As a result, ketamine, fentanyl, and remifentanyl applied for analgesia during colonoscopy have similar hemodynamic alterations and analgesic quality, therefore these agents may be substituted for one another for colonoscopy procedures.
Comparison of the Effects of Desflurane and Sevoflurane on Cerebral Oxygen Saturation in Patients Undergoing Thyroidectomy: a Randomised Controlled Clinical Study
(Aves, 2019) Akcay, Lerzan; Soyalp, Celaleddin; Yuzkat, Nureddin; Gulhas, Nurcin
Objective: The commonly performed sitting position with head extended during thyroidectomy has been shown to cause adverse effects on cerebral regional oxygen saturation (CrSO2). Therefore, the present study aimed to investigate the effects of two well-known anaesthetic agents, desflurane and sevoflurane, on CrSO2 in patients undergoing thyroidectomy in the semi-sitting position by near-infra-red spectroscopy monitoring. Methods: The study included 60 patients aged 18-65 years, with an American Society of Anesthesiologists (ASA) physical status classification score I-III, who underwent elective thyroidectomy in the semi-sitting position. The patients were randomly divided into two groups, depending on the anaesthetic agent administered: (1) sevoflurane group (Group S; n=30) and (2) desflurane group (Group D; n=30). After intubation, the patients were placed in a 45-degree semi-sitting position. Vital signs and the CrSO2 levels in both hemispheres were recorded both pre-induction and at the induction minute 1, post-intubation, post-positioning, every 5 minutes intraoperatively and in the case of sudden changes. Results: No significant difference was found between the groups in terms of age, height, body weight, the ASA score, operative time and left- and right-hemisphere CrSO2 (p>0.05). Moreover, the two groups were statistically similar to each other with regard to peripheral capillary oxygen saturation, heart rate, systolic and diastolic blood pressure, mean artery pressure and end-tidal CO2 (ETCO2) levels. Conclusion: Desflurane and sevoflurane had similar effects in the preservation of CrSO2 in patients undergoing thyroidectomy in the semi-sitting position.
Cost Analysis on Intensive Care Unit Costs Based on the Length of Stay
(Aves, 2019) Kilic, Mehmet; Yuzkat, Nureddin; Soyalp, Celaleddin; Gulhas, Nurcin
Objective: The present study aimed to determine the profit/loss ratio and the service casts in intensive care unit (ICU) based on the length of ICU stay. Methods: This retrospective study reviewed the medical records of 458 patients who were admitted to ICU between August 2016 and August 2017. Depending on the length of their ICU stay, the patients were divided into six groups: (I) 1 day, (II) 2 days, (III)3 days, (IV) 4 days, (V) 5 days and (VI) more than 5 days. These charges were evaluated under six categories: surgery, laboratory tests, drugs, tools and equipment, radiographic workup and others. Results: This study reviewed the medical records of patients including 273 (59.6%) men and 185 (40.4%) women. The mean age of the patients was 53.87 +/- 22.6 years. The profit/loss ratio was in favour of loss in group I (12,870.82 TL), group II (9,384.61 TL) and group III (371.18 TL). The ration was in favour of profit in group IV (16,505.4 TL). Total service costs comprised 38.31% drug costs, 24.45% tools/equipment, 13.14%, laboratory tests, 10% other costs, 4.92% surgical costs and 3.1% radiographic tests. Conclusion: The cost analysis based on the service costs in ICU with regards to the length of ICU stay revealed that due to the greater use of diagnostic, surgical and medical tools and equipment and laboratory and radiographic tests, the profit/loss ratio was in favour of loss within the first three days in ICU. This ratio turned to profit beginning from day 4 in ICU due to the decrease in the use of these equipment and tests. Moreover total ICU costs comprised 38.51% drug costs and 24.45% medical tools and equipment.
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.
Effects of Menstrual Cycle Phases on Preoperative Anxiety: a Randomized Prospective Observational Trial
(Bayrakol Medical Publisher, 2020) Yuzkat, Nureddin; Soyalp, Celaleddin; Demir, Canser Yilmaz; Kilic, Mehmetlig; Gulhas, Nurcin
Aim: Women experience physical and psychological changes as a result of their menstrual cycle. This study aimed to investigate whether the menstrual cycle had any effect on the preoperative anxiety experienced by women who were scheduled to have an operation. Material and Method: One hundred female patients who were scheduled to undergo a septorhinoplasty, and who met the inclusion criteria, were enrolled in the present study. The patients were divided into two groups according to the phase of their menstrual cycle: Group F (follicular phase) and Group L (luteal phase). The patients' anxiety level was measured preoperatively using the State-Trait Anxiety Inventory Scale. The patients' heart rate and blood pressure measurements were performed preoperatively as well as at 1 min, 5 min, and 10 min after intubation. Results: The preoperative anxiety scores of the patients in the luteal phase (41.14) were statistically significantly higher than those of the patients in the follicular phase (36.04). The blood pressure, heart rate, and peripheral oxygen saturation values were found to be similar between the two groups. Discussion: We believe that preoperative anxiety is higher during the luteal phase of the menstrual cycle than during the follicular phase, but the hemodynamic data were similar in both phases.
Effects of Showing the Operating Room on Preoperative Anxiety and Hemodynamics Among Patients With Hypertension: a Randomized Controlled Trial
(Taylor & Francis inc, 2020) Yuzkat, Nureddin; Soyalp, Celaleddin; Turk, Omer; Keskin, Siddik; Gulhas, Nurcin
Purpose: Anxiety is one of the most important causes of hypertension, increasing direct blood pressure and affecting postoperative morbidity and mortality. The aim of this study was to investigate the effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension. Methods: We enrolled 90 patients with hypertension undergoing cholecystectomy in this trial. Patients were randomly divided into two groups using a sealed-envelope system. Group STOR was shown the operating room the day before surgery, while Group No STOR was not shown the operating room. Results: State-Trait Anxiety Inventory scores measured on the day of surgery were lower for Group STOR (43.2 +/- 6.0) than Group No STOR (49.8 +/- 7.9) (p = .001). Systolic (p = .001, p = .006, respectively), diastolic (p = .001, p = .004, respectively), and heart rate (p = .018, p = .031, respectively) values in the operation room and preoperative unit were lower in Group STOR than in Group No STOR. The number of postponed operations in Group STOR was lower than in Group No STOR (p = .043), and the patient satisfaction score in Group STOR was higher than in Group No STOR (p = .031). Conclusion: In patients with hypertension, preoperative anxiety, blood pressure, heart rate, and respiratory rate all increase in the preoperative unit and operation room. Our findings indicate that showing the operating room to patients with hypertension decreases preoperative anxiety, as well as blood pressure and heart rate inside the operating room and preoperative unit. It also reduces the number of postponed operations and increases patient satisfaction.
Operative and Prognostic Parameters Associated With Elective Versus Emergency Surgery in a Retrospective Cohort of Elderly Patients
(Springer, 2019) Soyalp, Celaleddin; Yuzkat, Nureddin; Kilic, Mehmet; Akyol, Mehmet Edip; Demir, Canser Yilmaz; Gulhas, Nurcin
AimTo evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients.MethodsA total of 533 geriatric patients (aged65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n=285) or emergency surgery (n=248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records.ResultsEmergency surgery group was associated with higher prevalence of ASA-PS III (48.8 vs. 25.6%, p<0.001) and ASA-PS IV (19.0 vs. 0.4%, p<0.001) categories and higher mortality rates (20.6 vs. 4.9% vs. p<0.001) when compared to the elective surgery group. ASA-PS IV category was associated with oldest patient age (median 82.0 vs. 71.0years for ASA-PS I and II, p<0.001 for each and versus 75.0years for ASA-PS III, p<0.05) and highest mortality rate (35.4 vs. 3.4% for ASA-PS I, 6.0% for ASA-PS II and 16.5% for ASA-PS III, p<0.001) as compared with other categories.ConclusionIn conclusion, our findings in a retrospective cohort of elderly surgical patients revealed high prevalence of co-morbidities, predominance of ASA-PS II or ASA-PS III classes and an overall in-hospital mortality rate of 12.2%. Emergency as compared with elective surgery seems to be associated with older age, male gender, ASA-PS III and IV classes, higher likelihood of postoperative ICU transfer and higher mortality rates.
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.