Browsing by Author "Tekeli, Arzu Esen"

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Bir Üniversite Yoğun Bakım Ünitesinde Eritrosit Süspansiyonu Transfüzyon Değerlendirmesi: Retrospektif Çalışma
(2021) Tekeli, Arzu Esen; Keskin, Mehmet Emin
Amaç: Yoğun bakım ünitemizde bir yıllık eritrosit süspansiyonu transfüzyonları incelendi. Transfüzyon uygulama kararları ve bu kararların arkasındaki kriterlerin ortaya konulması amaçlandı. Gereç ve Yöntem: Ocak 2017- Ocak 2018 tarihleri arasında Anesteziyoloji ve Reanimasyon kliniği yoğun bakım ünitesinde yatan ve herhangi bir nedenle eritrosit süspansiyonu transfüzyonu uygulanan 188 hasta çalışmaya dahil edildi. Hastalar aktif kanama nedeni ile eritrosit süspansiyonu replasmanı yapılanlar (Grup K) ve aktif kanama olmaksızın resplasman yapılanlar (Grup NK) olarak ayrıldı. Hastaların demografik verileri, yatış tanıları, yoğun bakım kabulünün ilk 24 saatinde APACHE değerleri, eşlik eden hastalıklar, replasman için karar verildiğinde mevcut hemoglobin (Hb) değeri, hastaların yoğun bakımda yatış süreleri not edildi. Bulgular: Grup K’da hastaların yaşlarının Grup NK’dan anlamlı (p < 0.05) olarak daha düşük olduğu görüldü. Grup K’da komorbidite oranının Grup NK’dan anlamlı düşük olduğu izlendi (p < 0.05). Yoğun bakımda ilk 24 saatte bakılan APACHE değerlerinin Grup K’da anlamlı düşük (p < 0.05) olması dikkati çekti. Replasman kararı verildiğinde bakılan Hb değerleri açısından yapılan karşılaştırmada Grup K’da Hb değerlerinin anlamlı yüksek olduğu (p < 0.05) görüldü. Yoğun bakım yatış sürelerinde ise Grup NK’ nın belirgin farkla (p < 0.05) önde olduğu izlendi. Sonuç: Oluşturulmuş bir transfüzyon protokolü olmamakla birlikte esas belirleyicinin Hb değeri olduğunu, bununla birlikte diğer faktörlerin de etkili olduğunu gözlemledik. Aktif kanaması olmayan hastalarda, kanıtlar kan transfüzyonları ile daha konservatif bir yaklaşım önermektedir. Yoğun bakımda yatan hastalarda transfüzyon stratejilerini kişiselleştirmek ve etkenlerin farklı kombinasyonlarının ortak etkilerini ölçmek için daha fazla araştırmaya ihtiyaç olduğu kanaatindeyiz.
Clinical Analysis of Cesarean Section Cases at a Tertiary University Hospital From 2018 To 2023: a Van-Scaled Retrospective Study,
(2024) Taş, Rüstem; Tekeli, Arzu Esen
Üçüncü Basamak Bir Üniversite Hastanesinde 2018-2023 Yılları Arasında Operasyona Alınan Sezaryen Vakalarının Klinik Analizi: Van Ölçekli Retrospektif Çalışma, Dr. Rüstem TAŞ, Uzmanlık Tezi, Van, 2024. Amaç: Bu çalışmada, Türkiye'deki 3. basamak bir hastanede sezaryen operasyonlarında tercih edilen anestezi türlerini, postoperatif dönemde yoğun bakım ihtiyacı olan hasta oranlarını ve intraoperatif ve postoperatif mortalite oranlarını sunmayı ve bu faktörlerle ilişkili etkenleri araştırmayı amaçladık. Yöntem: Bu retrospektif kohort çalışmasında, Van Yüzüncü Yıl Üniversitesi Dursun Odabaşı Tıp Merkezi ameliyathanesinde, 2018-2023 tarihleri arasında spinal veya genel anestezi altında sezaryen doğum uygulanan 2709 hasta dahil edilmiştir. Tüm katılımcıların preoperatif, intraoperatif ve postoperatif bilgileri retrospektif olarak hastanemizin bilgisayarlı veri tabanı kayıtlarından elde edildi. Bulgular: Olguların yaş ortalaması 30,48 ± 6,76 yıldı. Kadınların %66,3'üne genel anestezi, %33,7'sine spinal anestezi ile sezeryen ile doğum uygulanmıştır. Hastaların %0,6'sına yoğun bakım ünitesi yatışı gerekmiştir. Genel anestezi yüzdesi; yüksek komorbidite sayısı, düşük 1. ve 5. dakikalardaki APGAR skorları, yüksek ASA skoru, yüksek HELLP sendromu, preeklampsi ve plasenta invazyon anomalisi yüzdesi, yüksek eritrosit süspansiyonu ve taze donmuş plazma replasmanı ve yüksek intravenöz analjezi yüzdeleri ile ilişkili bulundu. Postoperatif yoğun bakım ünitesi ihtiyacı yüksek komorbidite sayısı, düşük 1. ve 5. dakikalardaki APGAR skorları, yüksek ASA skoru, yüksek eklampsi, preeklampsi ve plasenta invazyon anomalisi yüzdesi, genel anestezi uygulanması, inhaler ajan kullanılması, yüksek eritrosit süspansiyonu ve taze donmuş plazma replasmanı yüzdeleri ile ilişkili bulundu. Sonuç: Bu bulgular, kliniğimizde sezaryen ile doğumlarda ilk tercihin genel anestezi olduğunu ve spinal anestezinin genel anesteziye kıyasla klinik avantajlar sunduğunu göstermektedir. Sezaryen ile doğumlarda genel anestezi endikasyonlarının gözden geçirilmesi gerekmektedir. Anahtar Kelimeler: Sezaryen, Genel anestezi, Spinal anestezi, APGAR, Yoğun Bakım
Comparison of Dexmedetomidine-Propofol and Ketamine-Propofol Administration During Sedation-Guided Upper Gastrointestinal System Endoscopy
(Lippincott Williams & Wilkins, 2020) Tekeli, Arzu Esen; Oguz, Ali Kendal; Tuncdemir, Yunus Emre; Almali, Necat
Background: Dexmedetomidine and ketamine popular sedative agents that result in minimal respiratory depression and the presence of analgesic activity. We aimed to compare the effectiveness and safety of a dexmedetomidine-propofol combination and a ketamine-propofol combination during upper gastrointestinal system endoscopy. Methods: The study commenced after receiving approval from the local ethics committee. Patients between 18 and 60 years in the American Society of Anesthesiologists (ASA) I and II groups were included. Patients who had severe organ disease, who had allergies to the study drugs, and who refused to participate were excluded. Cases were randomized into a dexmedetomidine-propofol group (Group D, n = 30) and a ketamine-propofol group (Group K, n = 30). Cardiac monitoring, peripheral oxygen saturation, and bispectral index (BIS) monitoring were performed. Group D received 1 mg/kg dexmedetomidine + 0.5 mg/kg propofol intravenous (IV) bolus, 0.5 mu g/kg/h dexmedetomidine + 0.5 mg/kg/h propfol infusion. Group K received 1 mg/kg ketamine + 0.125 mL/kg propofol iv bolus, 0.25 mg/kg/h ketamine + 0.125 mL/kg/h propfol infusion. Patients were followed up with a Ramsay Sedation Scale (RSS) of >= 4. Means, standard deviations, lowest and highest frequency values, and ratio values were used for descriptive statistics, and the SPSS 22.0 program was used for statistical analyses. Results: In Group K, recovery time and mean blood pressure (MBP) values were significantly shorter. Furthermore, coughing rate, pulse, and BIS values were higher than in Group D (P < .05). Although there were no significant differences between the groups in terms of endoscopic tolerance and endoscopist satisfaction, we observed that the dexmedetomidine group experienced more comfortable levels of sedation. Conclusion: Dexmedetomidine-propofol and ketamine-propofol combinations may be suitable and safe for endoscopy sedation due to their different properties. It was observed that the dexmedetomidine-propfol combination was superior in terms of sedation depth and that the ketamine-propofol combination was superior in terms of early recovery. As a result, we suggest the dexmedetomidine-propofol combination for upper gastrointestinal system endoscopy sedation due to hemodynamic stability and minimal adverse effects.
Comparison of Milligan Morgan Hemorrhoidectomy and Direct Current Electrotherapy for the Treatment of Hemorrhoidal Disease
(Discovery Publication, 2018) Bartin, Mehmet Kadir; Tekeli, Arzu Esen; Eker, Esra; Oner, Muzaffer Onder
Background: It is aimed to compare Milligan Morgan hemorrhoidectomy and direct current electrotherapy for the treatment of grade 2 and grade 3 internal hemorrhoids. Material and Methods: Patients with symptomatic grade 2 or 3 internal hemorrhoids which is refractory to medical treatment were enrolled in this retrospective study. In the galvanization group, hemorrhoidal columns were coagulated using electrotherapy by a 2mA to 16mA current probe. And the Milligan Morgan hemorrhoidectomy was applied routinely as an open surgical procedure. Operative time, postoperative pain, hospitalization duration, clinical stage was measured. Patients were followed up for 3 months for healing, late complications and the recurrence. Results: The operative time and the hospitalization duration were significantly more in Milligan Morgan group (p<0.05). The relapse occurred in 3 patients in Milligan Morgan group and in 1 patient in galvanization group. The relaps rate was statistically less in galvanization group (p<0.05). Postoperative pain scores were similar in two groups at seventh day of the surgery (p=0.326). But at the first and third day of surgery the VAS values were higher in Milligan Morgan group (p=0.032). Conclusion: Hemorrhoidal coagulation with galvanic electrotherapy reduces the operation time and hospitalization duration. Also the relaps rate and the postoperative pain which is scored by the VAS values are less in this procedure according to the Milligan Morgan open surgery. However the late complications and late postoperative pain violence may be equivalent between these two surgery types.
Comparison of the Effects on Intraoperative and Postoperative Periods of Subcostal Transversus Abdominis Plan Block (subcostal Tab Block), Erector Spina Plan Block (esp Block) and Paravertebral Blocks (pvb) in Laparoscopic Cholecystectomy Operations: Single-Blind, Closed Envelope, Controlled Trial
(2021) Türk, Ömer; Tekeli, Arzu Esen
Bu çalışmada primer olarak genel anestezi altında yapılan elektif laparoskopik kolesistektomi operasyonlarında preoperatif uygulanan TAP blok, ESP blok ve PVB ların intraoperatif ve postoperatif dönemler üzerine etkilerini karşılaştırmak amaçlandı. Yöntem: Van Yüzüncü Yıl Üniversitesi Klinik Araştırmalar Etik Kurulu 20.11.2019 tarih, 01 sayılı etik onay sonrası klinik araştırma projesine başlandı. Hasta onamları alındıktan sonra; elektif laparoskopik kolesistektomi operasyonu planlanan, 20-60 yaş aralığında ve ASA( American Society of Anesthesiologist ) I-II fiziksel statüsüne sahip olan 60 hasta çalışmaya dahil edildi. Operasyon masasına alınan hastalara standart genel anestezi uygulandı, demografik veriler kaydedildi. Hastalar üç gruba randomize edildi. Gruplar, TAP blok uygulanan (Grup T), ESP blok uygulanan (Grup E) ve PVB uygulanan (Grup P) olarak belirlendi. Her üç gruba da bilateral 20cc (her hasta için total 40cc) % 0,25 lik Bupivakain uygulandı. Grup T için hastalar supin pozisyonuna, Grup E ve Grup P için lateral dekübit pozisyona alınarak USG eşliğinde enjeksiyon işlemi yapıldı. Hastaların intraoperatif vital bulguları(nabız, tansiyon ve satürasyon), bispektral indeks değerleri (BİS), Train-of-four (TOF) değerleri, 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, 3. saat ve 6. saat Visual Analog Skala (VAS) skorları değerlendirilip kaydedildi. Bulgular: Tüm gruplar arasında hastaların yaşları, cinsiyet dağılımı anlamlı farklılık göstermedi. Yine tüm gruplar arasında hastaların boyları, ağırlıkları, BMI (Body Mass Index) değerleri anlamlı farklılık göstermedi. Grup P de nabız değerleri grup E ve grup T den anlamlı olarak daha düşüktü. Grup E ve grup T arasında nabız değeri anlamlı farklılık göstermedi. Grup P, grup E, grup T arasında sistolik arter basınçları (SAB), diyastolik arter basınçları (DAB), ortalama arter basınçları (OAB) ve SpO2 değerleri anlamlı farklılık göstermedi. Grup T de TOF ve BİS değerleri grup P ve grup E den anlamlı olarak daha yüksekti. Grup T de postop analjezik ihtiyacı grup P ve grup E den anlamlı olarak daha yüksekti. Grup P, grup E arasında postop analjezik ihtiyacı anlamlı farklılık göstermedi. Grup T de bulantı, kusma, titreme oranı grup P ve grup E den anlamlı olarak daha yüksekti. Grup T de mobilizasyona başlama süresi grup P ve grup E den anlamlı olarak daha yüksekti. Grup E de mobilizasyona başlama süresi grup P den anlamlı olarak daha yüksekti. Grup T de postop 0.dakika, postop 3.saat, postop 6.saat VAS skoru grup P ve grup E den anlamlı olarak daha yüksekti. Grup E de postop 0.dakika, postop 3.saat, postop 6.saat VAS skoru grup P den anlamlı olarak daha yüksekti. Sonuç: Üç periferik sinir bloğunun aynı cerrahi işlemde etkilerini değerlendiren bu çalışma ile PVB'un bakılan hemen tüm parametreler için diğer iki bloktan avantajlı olduğunu (etkinlik fazla, yan etki az) gördük. Mevcut çalışmada istatistiki olarak anlamlı çıkmasa da kendi kliniğimizden de yola çıkarak uygulama zorluğu ve olası komplikasyonları nedeni ile PVB dan kaçınıldığını, yine güçlü etkileri olan ESP blok ve TAP blokların daha çok tercih IX edildiğini düşünmekteyiz. Mevcut verileri destekleyecek ve güçlendirecek, geniş katılımlı, farklı çalışmalara ihtiyaç olduğu kanaatindeyiz.
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.
Doğum Sonrası Erken Dönem Gelişen Aort Diseksiyonu
(2018) Tekeli, Arzu Esen; Eker, Esra; Gür, Ali Kemal
İntima ve media tabakasının ayrılması sonucu gelişenaort diseksiyonu tedavi edilmediği takdirde mortal seyredenbir hastalıktır. Tedavisi acil cerrahi müdahaleolan aort diseksiyonu genellikle hipertansif ve bağ dokuhastalığı olan hastalarda görülmektedir. Gebeliğe bağlıhipervolemi, taşikardi, kardiyak output artışı ve özelliklegebeliğin son dönemlerinde aortaya ve iliac arterlerebası sonrası asendan ve torakal aortada meydanagelen basınç gebelikteki aort diseksiyonları için riskfaktörleridir. Bu makalemizde 29 yaşında herhangi birkardiyak öyküsü olmayan 35 haftalık gebelik sonrasıüçüncü çocuğunu doğuran ve postpartum 1. günde anibaşlayan sırt ağrısı ile yapılan tetkikler sonrasındaaort diseksiyonu tanısı konan bir kadın hastayı sunmakistedik.
Effect of Dexketoprofen Trometamol as Immunohistochemical and Electron Microscopy on Kidney in Rats
(Asian Network Scientific information-ansinet, 2019) Tekeli, Arzu Esen; Yagmurdur, Hatice; Ongen, Ercin; Tekeli, Ahmet; Take, Gulnur; Erdogan, Deniz; Dikmen, Bayezid
Background and Objective: Dexketoprofen trometamol is the dextrorotatory enantiomer of NSAID ketoprofen formulated as a tromethamine salt. This study aimed to perform immunohistochemical and electron microscopic evaluations of the effects of two different doses of dexketoprofen trometamol on kidneys via parenteral administration for 7 days. Materials and Methods: The study was conducted on 30 healthy, male Wistar albino rats, each weighing approximately 220 g. The rats were randomized and distributed across 3 groups, with 10 rats in each group. In the control group, 0.9% NaCl was used in 1 mL volume. In the other groups, and 16 mg kg(-1)/day doses of dexketoprofen trometamol (Arveles 50 mg/2 mL) in 1 mL were used intraperitoneally twice per day for 7 days. Results: In the high-dose group, a statistically significant reduction in live weight was observed, along with apoptosis and increased cell proliferation when compared to the control group. In the low-dose group, statistically significant increased apoptosis and cell proliferation were found. Conclusion: It was found that dexketoprofen trometamol induced apoptosis and caused cell proliferation and the 16 mg kg(-1)/day dose initiated the necrotic process. When an overdose of dexketoprofen trometamol (16 mg kg(-1)) was administered, losses in live weight and diffuse degeneration of the kidney tissue occurred. Administrations of this dosage are not recommended as similar effects on human tissue are predicted.
The Effect of Nitrous Oxide on the Outcomes of Underlay Tympanoplasty: a Prospective Study
(Sage Publications inc, 2019) Duzenli, Ufuk; Bozan, Nazim; Turan, Mahfuz; Agirbas, Semra; Tekeli, Arzu Esen; Kiroglu, Ahmet Faruk
The main aims of tympanoplasty are eradication of chronic middle ear disease, repair of the tympanic membrane, and restoration of hearing. Nitrous oxide (N2O) is not a commonly preferred anesthetic agent for tympanoplasty because this agent may increase middle ear pressure and displace the graft. In this study, we researched the surgical outcomes of the underlay tympanoplasty performed with N2O anesthesia. Patients who underwent tympanoplasty were included in this prospective study. A type 1 tympanoplasty was performed in all patients using the underlay technique. Patients were randomized to groups that did and did not receive N2O. Preoperative and postoperative hearing thresholds were evaluated, postoperative pain scores were recorded, and the differences between the groups were statistically evaluated. There were 44 patients who received N2O and 44 who did not. The graft success rate was 93.2% in the N2O-receiving group and 84.1% in the nonreceiving group (P > .05). Hearing levels improved significantly after surgery in each group (P < .05), but the difference between the groups was not significant (P > .05). The postoperative pain score was 3.72 +/- 1.3 in the N2O-receiving group and 4.45 +/- 2.3 in the nonreceiving group (P > .05). Nitrous oxide is a cheap, safe, and readily available anesthetic agent that provides acceptable success rates in patients undergoing tympanoplasty.
The Effects of Instrumental Music Listening on Intraoperative Parameters and Post Operative Pain and Side Effects (nausea, Vomiting, Shivering) in Thyroidectomy Operations
(2021) Kaya, Murat Bayram; Tekeli, Arzu Esen
Genel anestezide tiroidektomi uygulanan hastalarda müzik dinletisinin intraoperatif hemodinamik değişiklikler, kas gevşemesi, postoperatif ağrı ve analjezik tüketimi üzerine etkilerini araştırmayı amaçladık. Yöntem: Van Yüzüncü Yıl Üniversitesi Klinik Araştırmalar Etik Kurulu etik onayı sonrası klinik araştırmaya başlandı.Hasta onamları alınmış;elektif troidektomi operasyonugeçiren, 20-60 yaş aralığında ve ASA( American Society of Anesthesiologist) I-II fiziksel statüsüne sahip olan 80 hastanın verileriçalışmaya dâhil edildi.Standart genel anestezi uygulanmış olanhastalar iki grupta incelendi. Gruplar, müzik dinletilen (Grup M), müzik dinletilmeyen (Grup K) olarak belirlendi. Hastalarınkayıt altına alınmış olan hemodinamik verileri, intraoperatif vital bulguları(nabız, tansiyon ve satürasyon), bispektral indeks değerleri (BİS), Train-of-four(TOF) değerleri, ek doz opioid ve kas gevşetici ihtiyaçları, yan etki gelişip gelişmediği kayıtlı verilerden derlendi.Operasyon bitiminde atropin ve neostigmin ile standart dekürarizasyon sonrası ekstübe edilen hastaların 0. Dakika (Modifiye Alderete skoru>9 ), 3. saat ve 6. saat Visual Analog Skala (VAS) skorları değerlendirmeleri kayıtlardan not edildi. Bulgular: Müzik dinletisi uygulanan grupta(GRUP M), kontrol grubuna göre intraoperatif kullanılan fentanil ve rokuronyum miktarları daha düşük bulundu. Benzer şekilde müzik grubundaki hastaların BIS değerlerinin konrol grubuna göre benzer olduğu izlendi. Ayrıca müzik grubundaki hastalarda postoperatif dönemde ağrı düzeyinin daha düşük olduğu izlendi. Müzik terapisinin derlenme sırasında kan basıncı, kalp hızıve SpO2 düzeyleri açısından farklılık olmadığı saptandı. vii Sonuç:Nonfarmakolojik bir girişim olan müzik dinletisi, intraoperatif dönemde kas gevşetici ve analjezik ihtiyacını azaltmasının yanısıra postoperatif dönemde, vas skorları açısından olumlu etkilere yol açan, yan etkisi olmayan etkili bir yöntemdir.
The Effects of the Usage of Blood and Blood Products in Open Heart Surgery Patients and the Risk of Postoperative Atrial Fibrillation Development
(Discovery Publication, 2018) Gur, Ali Kemal; Tekeli, Arzu Esen; Eker, Esra; Aykac, Mehmet Coskun
Background: The current study explains the relationship between blood and blood-products that are used during surgery and AF. Material and Methods: A total of 260 patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2015 and March 2017 were included in the study, retrospectively. The study subjects were divided into two groups; patients whom we used blood products during surgery (Group I) and patients whom we didn't use blood products during surgery (Group II). In Group I there were 140 patients (54 female, 86 male), in Group 2 there were 120 patients (45 female, 75 male). AF rates, perioperative and postoperative blood usage rates and preoperative demographic characteristics were recorded and studied in both groups. Results: AF developed in 95 (36%) of 260 patients who underwent isolated coronary bypass surgery. AF developed in 64 (45%) patients in group I and 31 (25%) in group II. The incidence of AF was found to be statistically significantly lower in the group which we the blood products weren't used (p> 0,05). There was no significant difference between the groups in terms of smoking habits, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and hypertension (HT). The mean age was 63.2 +/- 9.2 years in Group I and 60.5 +/- 8.3 years in Group II. Aortic cross clamping (ACK) duration in patients with cardiopulmonary bypass was 65.2 +/- 33.1 minutes in Group I, In the Group 2 mean duration was 59.7 +/- 25.4 minutes (p < 0,05). The mean number of distal anastomoses was 3.1 +/- 2.3 in Group I and 3.5 +/- 2.7 in Group II (p < 0,05). 1 bag of blood and blood products were given to 75 patients (53.5%), 2 bags to 38 patients (27.1%) and 3 bags were given to 27 patients (19.2%). The mean duration of hospitalization in intensive care unit was 3.2 +/- 1.6 days in Group I and 2.1 +/- 1.1 days in Group II. No mortal cases within the first month were included in the study. Conclusion: The incidence of AF was significantly lower in coronary bypass operations without the usage of blood and blood products during and after the operation. We conclude that limiting the usage of blood and blood products will result in a significant reduction in the incidence of AF.
The Effects of Thyroid Gland Volume and Weight on Surgical Approach Selection and Anesthesia Management in Retrosternal Goiter
(Zamensalamati Publ Co, 2022) Bartm, Mehmet Kadir; Tekeli, Arzu Esen; Okut, Gokalp; Eker, Esra; Oner, Muzaffer Onder
Background: Retrosternal goiter surgery is a technically challenging procedure. Selecting the appropriate surgical approach is critical in preventing surgical and anesthesia complications. Objectives: This retrospective clinical study aimed to investigate the role of thyroid volume and weight in the development of retrosternal goiter and the importance of special anesthesia management in patients with retrosternal goiter, which is a potentially difficult airway candidate. Methods: Retrosternal goiter was detected in 125 patients through ultrasonography. Patients were divided into cervical surgery (CA) and sternotomy (ECA) groups. Volumetric measurements were performed ultrasonographically. Patients' demographics, preoperative thyroid ultrasonography features, American Society of Anesthesiologists (ASA) classifications, Mallampati classifications, intubation characteristics, perioperative and postoperative patient data, and postoperative thyroid specimen weights were recorded. Results: A total of 106 patients (32 male and 74 female) were operated on for bilateral total thyroidectomy. Total thyroidectomy was performed with CA in 98 (92.5%) patients and with ECA in 8 (7.5%) patients. Malignancy was detected in 4 (3%) of 106 operated cases. All of the malignant cases were seen in patients with a cervical approach. When the volumetric measurements of both groups were compared, the volume values were significantly higher in the ECA group (P=0.032). 67 patients were ASA I and 39 patients were ASA II. 64 patients were defined as Mallampati Class I, 36 patients as Mallampati Class II, and 6 patients as Mallampati Class III. Intubation was performed on the third attempt for 5 patients and 8 patients with Mallampati I and Mallampati II, respectively. The rate of difficult intubation was statistically significant in the ECA group (P=0.019). Conclusion: Predicting ECA requirement in the preoperative period is closely related to the preoperative volumetric analysis of the thyroid gland with three-dimensional ultrasonography. In addition, since anesthesia management is difficult in patients who need ECA, volumetric analysis has become even more critical.
The Efficacy of Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy Cases: a Retrospective Evaluation of 515 Patients
(Sage Publications Ltd, 2020) Tekeli, Arzu Esen; Eker, Esra; Bartin, Mehmet Kadir; Oner, Muzaffer Onder
Objective To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy. Methods This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting. Results A total of 515 patients were included (group A,n = 247; group T,n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A. Conclusions Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.
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.
Histological and Electron Microscopic Examination of the Effect of Dexketoprofen Trometamol on Liver in Rats
(Discovery Publication, 2017) Tekeli, Arzu Esen; Yagmurdur, Hatice; Ongen, Ercin; Tekeli, Ahmet; Take, Gulnur; Erdogan, Deniz; Dikmen, Beyazit
Background: The current study was performed for histological and electron microscopic examination of the effects of different doses of dexketoprofen trometamol on liver in rats. Material and Methods: Shame group consisted of rats administered 1 ml of 0.9% NaCl twice a day via intraperitoneal route, 8 mg/kg/day was used in Dexketoprofen Trometamol low-dose group, and 16 mg/kg/day was used in Dexketoprofen Trometamol high-dose group. 30 healthy Wistar albino type male rats were used in the study as animal materials. Results: The presence of TUNEL positive cells was increased with the increasing dose level of Dexketoprofen Trometamol and TUNEL positive hepatocytes distributed all over the tissue. Diffuse degeneration was determined in the liver sections of the group administered high-dose. Necrotic areas became more apparent particularly in regions close to the central vein. PCNA involvement was detected to be considerably increased compared to the shame and low-dose groups. Electron microscopic image of liver in the group administered high-dose drug showed that all hepatocytes present with highly active cell structure. Hepatocyte mitochondria were observed to be highly developed and to grow large and fuse from place to place. Granulated and smooth endoplasmic reticulum tubulus and cisternae displayed a highly-dilated appearance. Bile canaliculi were distinguished as dilated and its lumen was covered with microvilli. There were many vacuolar formation in addition to lipid droplets in the cytoplasms of ito cells. Conclusion: Dexketroprofen Trometamol drug administration was determined to increase activation particularly in parenchymal cells depending on dose and cause degeneration in liver tissue with heavy activity.
Intensive Care Residents? Views Regarding Ethical Issues and Practices
(int Scientific information, inc, 2022) Sevimli, Sukran; Tekeli, Arzu Esen
Background: This study sought to understand the ethical issues encountered by medical residents during their residencies, evaluate the solutions proffered by them, and present their suggestions. Material/Methods: A survey consisting of 32 questions, including demographic information, was developed and distributed to Intensive Care Unit (ICU) residents from December 2020 to January 2021. A total of 53 completed question-naires were submitted to the researchers. The data were analyzed using SPSS software version 26.0.Results: Of the participating residents who returned completed forms, 50.9% were male and 49.1% were female, with an overall mean age of 30.5 +/- 4.4 years. Most residents' views on ethical issues concerned themselves, the clin-ic, and patients/patient relatives. Responses showed a number of commonalities with the views of ICU physi-cians in other countries. Suggestions for resolving ethical issues solutions included instruction in medical eth-ics for all staff, increasing and strengthening pathways of communication both inside and outside of the clinics, regular inventory of medical supplies and assessment of equipment to prevent a shortage of resources, and the establishment of a hospital ethics committee. Conclusions: As numerous and varied ethical issues were encountered in the participating ICUs, we propose the following: preparation of an ICU-specific guide for resolving ethical problems, clarification of rules based on legal regula-tions, determining a hierarchy of responsibilities, and ethics courses for all ICU staff. In addition, hospital man-agers should support ICU services from both a legal and ethical standpoint.
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.
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