Browsing by Author "Tomak, Yakup"

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Analysis of the Effect of Perioperative Magnesium Sulphate on Minimal Alveolar Concentration of Desflurane Using Bispectral Index Monitoring
(John Libbey Eurotext Ltd, 2011) Tomak, Yakup; Tekin, Murat; Kati, Ismail; Belenli, Ceyda; Aydogmus, Meltem
Background. In this study we aimed to analyze the effect of perioperative magnesium sulphate (MgSO4) on minimal alveolar concentration (MAC) of desflurane using bispectral index (BIS) monitoring. Patients and methods. Sixty patients undergoing abdominal surgery under general anesthesia were randomized into two groups: Mg - receiving perioperative MgSO4 supplementation and C - control. Anesthesia was titrated to maintain the BIS value between 45-55. Results. MAC values, tachycardia and hypertension during intubation was found to be lower in group Mg compared to group C (p<0.001). Time to extubation, verbal cooperation and eye opening was longer in patients receiving infusion of MgSO4 (p<0.001). Conclusion. We concluded that perioperative MgSO4 infusion may be used as an adjunct as it decreases MAC of desflurane and suppresses the hemodynamic response to intubation.
Anestezi Teknikerlerinin Shmyo Eğitimiyle İlgili Görüşleri ve Mesleki Beklentileri: Anket Çalışması
(2016) Hüseyinoğlu, Ürfettin; Köksal, Ersin; Şen, Ahmet; Erdivanlı, Başar; Tomak, Yakup; Silay, Emin; Çeğin, Muhammet Bilal
AMAÇ: Sağlık Hizmetleri Meslek Yüksekokulları (SHMYO) nitelikli yardımcı sağlık personeli yetiştirmek ve eğitimdeki eksiklikleri gidermek için kurulmuştur. Çalışmamızda, SHMYO Anestezi Teknikerliği Bölümü'nde eğitim gören öğrencilerin mesleki beklentileri, yaklaşımları, ve verimlilikleri değerlendirildi.YÖNTEM: SHMYO Anestezi Teknikerliği Bölümü'ne yeni başlayan öğrencilere, isimleri kaydedilmeksizin, yazılı olarak, 23 soruluk anket doldurtuldu. Cevap dağılımları incelenerek, öğrencilerin sosyokültürel özellikleri ile eğitim ve mesleki beklentileri arasındaki ilişkiler incelendi.BULGULAR: Eksiksiz doldurulan 286 anket değerlendirildi. Okulu kendi istekleriyle tercih edenler ve ebeveyn tavsiyesini dikkate alanların yaşları daha ileri (sırasıyla p=0,012 ve 0,045), arkadaş tavsiyesi ile yönelenler daha genç (p=0,02) bulundu. Öğrencilerin 96'sı (%33) anestezi teknisyenliğini sevebileceği düşüncesiyle tercih ettiğini, 154'ü (%54) ekonomik kaygılarla tercih ettiğini belirtti. Sağlık meslek lisesi mezunlarının hasta başında kendine daha çok güvendiği (p<0,01), takım çalışmasını önemsedikleri (p<0,03) saptandı. Sağlık meslek lisesi mezunlarının 90'ı (%90), diğer öğrencilerin 138'i (%75), sağlık meslek lisesi mezunu olmayı mesleki bir avantaj olarak gördüğünü belirtti.SONUÇ: Sağlık sektörü ekonomik beklentiler ve işsizlik korkusuyla tercih edilecek kadar hafife alınmamalıdır. SHMYO'ların, sağlık alanında temel eğitim almış, ve eğitimini ilerletmeyi hedefleyen öğrencilerin girebildiği eğitim kurumları olması gerektiği kanaatindeyiz.
Bebekte İlginç Bir Santral Venöz Kateter Yanlış Yerleşimi: (Olgu Sunumu)
(2006) Tekin, Murat; Tomak, Yakup; Katı, İsmail
Pediyatrik hastalarda santral venöz girişime, gerek cerrahi gerekse tıbbi amaçla ihtiyaç olabilmektedir. Ayrıca bu kateterler kısa veya uzun süreli beslenme tedavilerinde de kullanılmaktadır. Birbuçuk yaşında erkek bebek status epileptikus nedeniyle Anesteziyoloji Yoğun Bakım Ünitesine alındı. Sıvı tedavisi ve beslenme amacıyla sağ subklaviyen vene santral venöz kateter yerleştirildi. Kateterin yerini doğrulamak için çekilen radyografide kateterin ucunun sol internal juguler vene yerleştiği görüldüğü için kateter geri çekildi ve J teli üzerinden yenisi ile değiştirildi. Bu olgu ile özellikle bebeklerde kateterin yerinin radyografi ile doğrulanması gerekliliğine dikkat çekmek istedik.
Comparison of the Effects of Room Air and N2o + O2 Used for Proseal Lma Cuff Inflation on Cuff Pressure and Oropharyngeal Structure
(Springer Tokyo, 2008) Tekin, Murat; Kati, Ismail; Tomak, Yakup; Yuca, Koksal
This study aimed to evaluate the effects of different inflating gases used for ProSeal LMA (PLMA) cuff inflation on cuff pressure, oropharyngeal structure, and the incidence of sore throat. Eighty patients (American Society of Anesthesiologists; ASA I-II) were randomly divided into two groups. PLMA cuff inflation was achieved with appropriate volumes of 50% N(2)O + 50% O(2) in group I and room air in group II, respectively. When the PLMA was removed, oropharyngeal examination was carried out immediately, using a rigid optical telescope. Patients were asked about sore throat symptoms postoperatively. Cuff pressures were significantly lower in group I, except at the initial pressure measurement. Cuff pressure was positively correlated with the length of the operation in group II, and negatively correlated in group I. PLMA cuff inflation with room air led to increased cuff pressure during the operation, possibly due to the diffusion of N(2)O into the cuff. We consider that a PLMA cuff inflated with an N(2)O-O(2) mixture is convenient, especially in operations in which N(2)O has been used.
Effect of Dexmedetomidine Iv on the Duration of Spinal Anesthesia With Prilocaine: a Double-Blind, Prospective Study in Adult Surgical Patients
(Elsevier Science inc, 2007) Tekin, Murat; Kati, Ismail; Tomak, Yakup; Kisli, Erol
Background: The duration of spinal anesthesia with prilocaine has been poorly documented and no English-language study has been published regarding the effects of dexmedetomidine on the duration of anesthesia with spinal prilocaine. Objective: The aim of this study was to assess the effects of dexmedetomidine IV on the duration of action of prilocaine and its associated adverse events (AEs) in spinal anesthesia. Methods: In this double-blind, prospective study, patients classified as American Society of Anesthesiologists grade I to 11 who were to undergo lower abdominal, anorectal, or extremity surgery with a spinal anesthetic were assigned to I of 2 groups. All patients were administered prilocaine 2% for spinal anesthesia. Within 10 minutes after spinal anesthesia was initiated, group I received a loading dose of dexmedetomidine 1 mu g/kg IV, followed by a maintenance dose of 0.4 mu g/kg - h for 50 minutes; group 2 (control) received the same amount of physiologic saline in the same time frame. Mean arterial pressure (MAP), heart rate (HR), duration of sensory and motor blockade, and sedation scores were tracked. Patients were observed for 4.5 hours after surgery, with follow-ups occurring up to 96 hours after surgery. Results: Eighty-three patients were assessed for study inclusion, 23 of whom were excluded. Sixty patients (42 men, 18 women; mean [SD] age, 40.56 [16.861 years) were included in the study. MAP was similar in the 2 groups throughout the study. Mean (SD) HR was significantly lower in group I compared with group 2 at 20 minutes (70.43 [19.28] vs 77.63 [18.14] beats per minute, respectively; P = 0.02). The mean (SD) duration of the persistence of sensory anesthesia (ie, the time required for the maximal level of anesthesia to regress 2 dermatomes) was significantly longer in group I compared with group 2 (148.33 [21.18] vs 122.83 [18.73] minutes; P < 0.001). The mean (SD) time to complete abolishment of motor blockade was also significantly longer in group I than in group 2 (215.16 [25.10] vs; 190.83 [18.57] minutes; P < 0.001). The average sedation score in group I was significantly higher than in group 2 (P < 0.001) during anesthesia. Significantly more patients in group I required atropine than those in group 2 (9 vs 2 patients; P < 0.001) to treat bradycardia. There was no significant between-group difference in the number of patients who received ephedrine to treat hypotension. One patient in each group reported waist and back pain; 2 patients in each group reported nausea. Shivering occurred in 0 and 5 patients in groups I and 2, respectively; the between-group difference in AEs was not statistically significant. Paresthesia, postdural puncture headache, allergic reactions, total spinal anesthesia, urinary retention, or vomiting-AEs commonly associated with spinal anesthesia-were not observed or reported by either group. Conclusions: The results of this study suggest that dexmedetomidine IV significantly prolonged the duration of spinal anesthesia and provided a significantly higher level of sedation compared to placebo in this group of adult surgical patients. The treatment was generally well tolerated in all patients.
Effects of Dexmedetomidine on New Oxidative Stress Markers on Renal Ischaemia-Reperfusion Injury in Rats: Thiol/Disulphide Homeostasis and the Ischaemia-Modified Albumin
(Taylor & Francis Ltd, 2022) Acar, Muberra; Kaplan, Havva Sayhan; Erdem, Ali F.; Tomak, Yakup; Turan, Gupse; Ozdin, Mehmet
Objectives: This study investigated the effect of dexmedetomidine on the oxidant-antioxidant (thiol/disulphide) balance. Methods: A total of 24 rats were divided into four groups. The renal arteries in groups IR (ischaemia/reperfusion) and IR + D (ischaemia/reperfusion + dexmedetomidine) were clamped for 45 min and reperfused for 180 min. Groups D (Dexmedetomidine) and IR + D were administered 100 mu g/kg dexmedetomidine. Oxidant-antioxidant (thiol/disulphide) levels were measured. Kidney tissue was examined histopathologically. Results: No statistically difference was found between the groups in terms of thiol-disulphide averages, while IMA, TOS and thiol-disulphide results showed a minimal decrease in Group IR + D compared to Group IR (p > 0.05). Tubular lesions and necrosis were found in 26-50% of tubules in Group IR. Tubular damage and necrosis in Group IR + D declined to 5-25% . Conclusions: No statistically difference was found in the study where OSI index, thiol/disulphide balance and IMA were measured together as biochemical values.
Evaluate of the Effects of Peroperative Intravenous Magnesium Sulphate Use on Minimal Alveolar Concentration Level of Desflurane by Bispectral Index Monitorization
(2006) Tomak, Yakup; Tekın, Y. Murat
1. ÖZETBu çalismada; Perioperatif intravenöz magnezyum sülfat'in (MgSO4 ), Bispektral indeks(BIS) monitorizasyonu ile desfluranin minimal alveolar konsantrasyon (MAC) degeri üzerineetkilerini arastirmayi amaçladik.Yüzüncü Yil Üniversitesi Tip Fakültesi Etik Kurul Onayi alindiktan sonra genel anesteziile operasyonu planlanan ASA I-II grubundan, 60 hasta çalismaya alindi. Hastalar rastgele30'arli iki gruba ayrildi. Hastalara premedikasyon uygulanmadi. Anestezi derinligi BIS ilemonitorize edildi. Anestezi indüksiyonu 2 Âµg/kg fentanil 2,5 mg/kg propofol ve 0.1mg/kg veküronyum ile gerçeklestirildi. Birinci gruba 10 dakikada 30 mg/kg yükleme ve10 mg/kg/saat idame intravenöz (iv) MgSO4 , ikinci gruba ise ayni süre ve miktarda ivserum fizyolojik verildi. Anestezi idamesi BIS degeri 45-55 arasinda olacak sekilde, %40O 2 + %60 N2 O, desfluran, remifentanil ve vekuronyum ile saglandi. MAC degerleriistatistiksel olarak I. grupta II. gruptan çok ileri derecede anlamli düsük bulundu (p<0.001).Entübasyonda olusan tasikardi ve hipertansiyon, I. grupta II. gruba göre çok ileri derecedeanlamli düsük bulundu (p<0.001). Operasyon sonrasi I. grupta II. gruba göre ekstübasyon,kooperasyon ve göz açma zamanlarinda çok ileri derecede anlamli uzama bulundu (p<0.001).Sonuç olarak, perioperatif dönemde i.v verilen MgSO4 'in desfluranin MAC degeriniazaltmasi nedeniyle, genel anestezi sirasinda kullaniminin uygun olacagi kanisina varildi.3
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.
Fiberoptik Bronkoskopi Girişimlerinde Propofol ve Alfentanilin Kombinasyonunun Diazepam ile Karşılaştırılması
(2006) Özbay, Bülent; Uzun, Kürşat; Tekin, Murat; Tomak, Yakup; Katı, İsmail
Amaç: Fleksibl fiberoptik bronkpskopi (FOB) uygulamalarında propofolalfentanil kombinasyonu ile diazepamın sedatif ve olası yan etkilerinin karşılaştırılması amaçlandı. Yöntem: ASA I-II grubundan 30 olgu çalışmaya alındı. Tüm olgulara atropin, topikal lidokain ve lidokain gargara ile premedikasyon uygulandı. I. gruba intranenöz 1 mg.kg{-1} propofol ve 10 ug.kg{-1} alfentanil, II. gruba 10 mg İM diazepam verildi.Birinci grupta ilaç uygulamasını takiben, ikinci grupta uygulamadan yarım saat sonra işleme başlandı. Bulgular: Demografik veriler açısından gruplar arasında anlamlı fark yoktu. İşlem öncesi kalp atım hızı, kan basıncı,SpO2 değerleri arasında da anlamlı fark tespit edilmedi. Kari basıncı işleme başlandıktan sonra 2.ve 5. dakikalarda,kalp atım hızı ise 5. dakikada birinci grupta anlamlı olarak düşük bulundu. SpO2 değerleri ikinci grupta 2. dakikada,sedasyon skoru ise birinci grupta anlamlı derecede yüksek saptandı. Birinci grupta öksürük ikinci gruba göre anlamlı olarak daha azdı. Hasta memnuniyeti değerlendirildiğinde birinci gruptakilerin tamamı aynı yöntemi tercih edebileceklerini söylerken, ikinci gruptakilerin %80'i tercih etmeyeceklerini belirtmişlerdir. Sonuç olarak propofol ve alfentanil kombinasyonunun hemodinamik parametreleri daha az etkilemesi, hasta memnuniyetinin daha fazla olması, daha az öksürüğe yol açması nedeniyle fiberoptik bronkoskopi girişimlerinde diazepam gibi klasik yöntemlere alternatif bir yöntem olabileceği kanısına varıldı.
Fibre-Optic Bronchoscopy-Assisted Percutaneous Dilatational Tracheostomy by Guidewire Dilating Forceps in Intensive Care Unit Patients
(B C decker inc, 2008) Yuca, Koeksal; Kati, Ismail; Tekin, Murat; Yilmaz, Nebi; Tomak, Yakup; Cankaya, Hakan
Objective: The purpose of this study was to prospectively analyze intensive care unit patients with fibre-optic bronchoscopy assisted percutaneous dilatational tracheostomy by guidewire dilating forceps (GWDF; Griggs percutaneous tracheostomy). Design: Prospective study. Setting: A tertiary care centre. Materials and Methods: Fifty-two critically ill patients (32 men and 20 women), aged 16 to 84 years (mean +/- 6 SD 42 +/- 1.6 years) who required endotracheal intubation for longer than 15 days were consecutively selected to undergo tracheostomy by the GWDF technique. The diagnoses of the patients and intraoperative and postoperative complications were recorded. Results: The patients were mechanically ventilated for an average of 14.8 +/- 1.2 days. The duration of the GWDF technique was 4.9 +/- 1.7/min. Intraoperative complications occurred in 10 (19.2%) patients: hemorrhage in 3 cases, puncture of the tracheal tube in 2 cases, difficult cannulation in 2 cases, difficult dilatation in 1 case, false passage in 1 case, and inadvertent extubation in 1 case. Postoperative complications occurred in three (5.7%) patients, stomal cellulitis in one case, subcutaneous emphysema in one case, and difficult recannulation in the remaining case. Conclusions: Fibre-optic bronchoscopy-assisted percutaneous dilatational tracheostomy by GWDF is a simple and fast technique for inserting a tracheal cannula.
Glutamine Supplemented Parenteral Nutrition To Preventventilator-Associated Pneumonia in the Intensive Care Unit
(Galenos Publ House, 2012) Aydogmus, Meltem Turkay; Tomak, Yakup; Tekin, Murat; Kati, Ismail; Huseyinoglu, Urfettin
Objective: Ventilator-associated pneumonia (VAP) is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of-hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN). We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU). Material and Methods: With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20), and the second was prescribed TPN (n=20) while the third group was given glutamine-supplemented TPN (n=20). C-reactive protein (CRP), sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs. Results: No statistically significant difference was found among groups in terms of development of VAP (p=0.622). Conclusion: Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP.
Landau-kleffner Sendromu'nda Anestezik Yaklaşım
(2004) Tomak, Yakup; Yıldız, Hüseyin; Tekin, Murat; Silay, Emin; Katı, İsmail
Parafimozis nedeniyle operasyona alınan Landau Kleffner Sendrom'lu 7 yaşında erkek olgunun anestezi yönetimi irdelendi. Anestezi indüksiyonu ve idamesi, intranazal midazolam premedikasyonu sonrası sevofluran ile sağlandı. Ameliyat sırasında ve sonrasında herhangi bir komplikasyon gelişmedi.
Magnesium of Use in Anaesthesia Practice
(Aves, 2006) Yildiz, Huseyin; Tomak, Yakup
Magnesium is the confactor of lots of enzims. The application of peroperative magnesium both reduce the stress effect to inbtubation and surgery, and make the reducement of used anesthetectic and analgezic medicines' dosage. Also bronchodilator shows an antiaritmic and antiagregation effect. This work aim to examine the usage of magnesium in anesthesia.
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.
Reanimasyon Ünitemizdeki Erişkin Zehirlenme Olgularının İncelenmesi
(2004) Dilek, İmdat; Tekin, Murat; Silay, Emin; Tomak, Yakup; Katı, İsmail
Zehirlenmeler, sık karşılaşılan ve ölümcül olabilen önemli bir sağlık sorunudur. Akut zehirlenmeler, potansiyel olarak ciddi sonuçlara yol açabilmekte ve olguların %3-5'i yoğun bakım ünitesinde izlenmeye gereksinim duyarlar. Bu çalışmada, 4 yıl içinde Reanimasyon Ünitesine zehirlenme tanısı ile kabul edilen olgular, retrospektif olarak incelenmiştir. Toplam 73 zehirlenme olgusunun 4O'ı kadın, 33'ü ise erkekti. Kadınların yaş ortalaması 26, erkek olguların yaş ortalaması ise 28 olarak saptanmıştır. Olgularının 3'ü (%4.1) karbonmonoksit, 3'ü (%4.1) besin ve/veya mantar, 6'sı (%8.2) metil alkol, 24'ü (%32.9) organofosfat zehirlenmesi, 34'ü (%46.6) ilaçlara, ve 3'ü (%4.1) de bilinmeyen maddelere bağlı zehirlenme idi. Karbonmonoksit ve tek çeşit ilaç nedeni ile zehirlenenlerden ölen olmazken, metil alkol ile zehirlenenlerden 3'ü (%50), besin ve/veya mantar ile 2'si (%66.6), organofosfat ile 4'ü (%16.6), kombine ilaç ile l'i (%16.6) ve bilinmeyen maddeler ile de 2'si (%66.6) eks olmuştur. Sonuç olarak, akut zehirlenme ile Reanimasyon ünitesine kabul edilen olguların çoğunluğunu genç kadınların oluşturduğu, ve ilaç ile zehirlenme de en yaygın zehirlenme türü idi. Besin ve/veya mantar, bilinmeyen maddeler ve metil alkol alan olgularda, mortalitenin daha yüksek oranda görüldüğü tesbit edildi.