Browsing by Author "Korkutata, Zeki"

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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.
Intraoperative and Postoperative Effects of Dexmedetomidine and Tramadol Added as an Adjuvant To Bupivacaine in Transversus Abdominis Plane Block
(Mdpi, 2023) Korkutata, Zeki; Tekeli, Arzu Esen; Kurt, Nurettin
Background: We aimed to evaluate the intraoperative hemodynamics, opioid consumption, muscle relaxant use, postoperative analgesic effects, and possible adverse effects (such as nausea and vomiting) of dexmedetomidine and tramadol added as adjuvants to bupivacaine in the transversus abdominis plane block (TAP block) to provide postoperative analgesia. Materials and Methods: This was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. After obtaining ethical approval at the Van Yuzuncu Yil University and written informed consent, this investigation was registered with ClinicalTrials.gov (NCT05905757). The study was conducted with 67 patients with ASA I-II physical status, aged 20-60 years, of either sex who were scheduled for an elective laparoscopic cholecystectomy under general anesthesia. Exclusion criteria were the patient's refusal, ASA III and above, a history of allergy to the study drugs, patients with severe systemic diseases, pregnancy, psychiatric illness, seizure disorder, and those who had taken any form of analgesics in the last 24 h. The patients were equally randomized into one of two groups: Group T (TAP Block group) and Group D (Dexmedetomidin group). Standard general anesthesia was administered. After intubation, Group T (Bupivacaine + adjuvant tramadol) = solutions containing 0.250% bupivacaine 15 mL + adjuvant 1.5 mg/kg (100 mg maximum) tramadol 25 mL and Group D (Bupivacaine + adjuvant dexmedetomidine) = solutions containing 0.250% bupivacaine 15 mL + 0.5 mcg/kg and (50 mcg maximum) dexmedetomidine 25 mL; in total, 40 mL and 20 mL was applied to groups T and D, respectively. A bilateral subcostal TAP block was performed by the same anesthesiologist. Intraoperative vital signs, an additional dose of opioid and muscle relaxant requirements, complications, postoperative side effects (nausea, vomiting), postoperative analgesic requirement, mobilization times, and the zero-hour mark (patients with modified Aldrete scores of 9 and above were recorded as 0 h), the third-hour, and sixth-hour visual analog scale (VAS) scores were recorded. The main outcome measurements were the effect on pain scores and analgesic consumption within the first 6 h postoperatively, postoperative nausea and vomiting (PONV), and time to ambulation. The secondary aim was to evaluate intraoperative effects (on hemodynamics and opioid and muscle relaxant consumption). Results: It was observed that dexmedetomidine and tramadol did not have superiority over each other in terms of postoperative analgesia time, analgesic consumption, side effect profile, and mobilization times (p > 0.05). However, more stable hemodynamics were observed with dexmedetomidine as an adjuvant. Conclusions: We think that the use of adjuvant dexmedetomidine in the preoperative TAP block procedure will provide more stable intraoperative hemodynamic results compared with the use of tramadol. We believe that our study will be a guide for new studies conducted with different doses and larger numbers of participants.
Intraoperative and Postoperative Effects of Dexmedetomidine and Tramadol Added To Bupivacaine in Transversus Abdominis Plan Block (tap Bloc) Applied in Laparoscopic Cholecystectomy Operations
(2023) Korkutata, Zeki; Tekeli, Arzu Esen
Amaç: Bu araştırmada cerrahi operasyon sonrasında analjezi sağlanması amacı ile yapılan transversus abdominis plan blokta bupivakain'e adjuvan olarak kullanılabilen dexmedetomidin ile tramadol'ün intraoperatif hemodinami, opioid tüketimi, kas gevşetici kullanımı, analjezik etkiler ve oluşabilecek istenmeyen etkilerin (bulantı-kusma gibi) karşılaştırılması amaçlanmaktadır. Yöntem: Çalışmanın, Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi'nde laparoskopik kolesistektomi operasyonuna alınacak 60 hasta üzerinde yapılması planlandı. Hastalar operasyon öncesinde preoperatif değerlendirme sırasında çalışma hakkında bilgilendirildi. Hastaların preoperatif muayeneleri yapıldı ve rutin tetkikleri (hemogram, açlık kan şekeri, sodyum, potasyum, kalsiyum, üre, kreatinin, AST (aspartat aminotransferaz), ALT (alanin aminotransferaz, koagüasyon) yaptırıldı. Çalışma için ilave tetkik yaptırıldı. Çalışmaya, 20-60 yaş arası, elektif, ASA I-II laparaskopik kolesistektomi cerrahisi geçirecek ve çalışmaya katılım için onam veren hastalar dahil edildi. Operasyon masasına alınan hastalara standart genel anestezi uygulandı, demografik veriler kaydedildi. Hastalar iki gruba randomize edildi. Cerrahi işlem başlamadan önce ; Grup T (Adjuvan olarak tramadol kullanılacak grup) için %0,250'lik 40 mL bupivakaine adjuvan olarak 1.5mg/kg ve maksimum 100 mg tramadol, 2. gruba (Grup D – adjuvan olarak deksmedetomidin kullanılacak grup) %0,250'lik 40 mL bupivakaine adjuvan olarak 0.5 mcg/kg ve maksimum 50 mcg olacak şekilde deksmedetomidin eklenerek hazırlanan solüsyonlar kullanılarak bilateral TAP blok uygulandı. Bütün bloklar aynı anestezist tarafından yapıldı. Hastaların intraoperatif vital bulguları (nabız, tansiyon ve satürasyon), ek doz opioid ve kas gevşetici ihtiyaçları, bloklarla ilgili komplikasyon gelişip gelişmediği kaydedildi. Operasyon bitiminde ise atropin ve neostigmin ile standart dekürarizasyon sonrası ekstübasyon yapıldı. Hastalarda postoperatif meydana gelen yan etkiler ( bulantı, kusma, kaşıntı, titreme), postoperatif ek analjezi ihtiyacı ve 0. dakika (Modifiye aldrete skoru 9 ve üzeri olan hastalar 0. Saat olarak kayıt edilerek), 3. saat ve 6. saat Visual Analog Skala (VAS) skorları değerlendirilip kaydedildi. Bulgular: Deksmedetomidinin tramadole kıyasla postoperatif analjezi süresi, postoperatif analjezik tüketimi, yan etki profili ve post operatif mobilizasyon süresi üzerinde anlamlı farklılık bulunmadığı fakat daha stabil bir hemodinami sağladığı bulunmuştur. Sonuç: Kolesistektomi operasyonlarında daha stabil hemodinamik sonuçlar için TAP blok uygulanırken adjuvan ilaç olarak deksmedetomidinin tramadole kıyasla daha uygun olacağını düşünüyoruz.